Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: penicillins attending: chief complaint: hypoxia major surgical or invasive procedure: left heart catheterization: performed by dr. on history of present illness: this is an 88yof with h/o dementia who intially presented to bidn with chest pain after a mechanical fall and c/f stemi, now transferred for acute hypoxia requiring intubation. accepted in transfer from . patient is currently unable to provide a history, but per bidn records on the doa she had an unwitnessed mechanical fall at home (her 2nd in 2 days), and while being transported to bidn by granddaughter c/o chest pain. in the ed she was noted to have a positive troponins (.36) with an ekg showing concerning changes (c/w inferior stemi) compared to 3 days prior to her admission. in the ed she received a plavix load, full dose asa, heparin and beta blockers and she was noted to be slightly bradycardic thereafter. she continues on heparin. dr was consulted, and initally offered the family cardiac catheterization which they refused. her troponins peaked at her admission value as did her cks at 310. on the morning of the patient beame agitated and hypertensive (sbp 180's), shortly thereafter she became hypoxemic (o2 sats as low as 68%) she failed 100% non-rebreather and bipap, and was intubated work of breathing and failure to protect her airway. she was given iv nitro, iv lasix, etomidate, versed and fentanyl and her blood pressure dropped to 70. she was given 300cc ivf and her sbp increased to 90's. per family's request, she was transferred to for further evaluation and care. . on transfer, she was intubated and sedated, with stable vs (t 98.2 hr 88 bp 131/57 o2 99% on 70% fio2). . ros: unable to obtain past medical history: 1. gerd. 2. anxiety. 3. depression. 4. dementia, not well characterized . no known cardiac history. no h/o htn, hld, or dm. social history: she lives with her family and has a home health aid for all adls and iadls. she is a nonsmoker, no etoh or ivdu. family history: no known h/o cardiac disease. physical exam: admission exam: general: intubated, sedated. heent: ncat. sclera anicteric. perrl. et tube and og tube in place. neck: supple with jvp of 3cm above clavicle at 30 degrees. cardiac: rrr, iii/vi crescendo systolic murmur that radiates to the carotids. lungs: faint rales heard in r lung anteriorly, l lung clear anteriorly. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. no femoral bruits. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ . . discharge: general: sitting in bed, asleep but arousable heent: ncat. sclera anicteric. perrl neck: supple with no jvd cardiac: rrr, iii/vi crescendo systolic murmur that radiates to the carotids. lungs: faint rales b/l abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. no femoral bruits. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: admission labs : wbc-13.7* rbc-3.91* hgb-11.0* hct-32.4* mcv-83 mch-28.1 mchc-33.9 rdw-14.8 plt ct-103* pt-14.3* ptt-25.7 inr(pt)-1.2* glucose-177* urean-17 creat-0.7 na-139 k-3.9 cl-104 hco3-26 angap-13 calcium-8.6 phos-2.7 mg-1.7 ck(cpk)-63 ck-mb-4 ctropnt-0.23* ekg : normal sinus rhythm is present. the qtc interval is prolonged. there are also widely splayed symmetric t wave changes consistent with a cerebral event or consistent with drug effect or ischemia. these changes are global. nko previous tracing for comparison. clinical correlation is suggested for ischemia and/or cerebral event is required. cxr : ap chest compared to through at 11:39 a.m. at hospital. previous left pic line is no longer visible, and presumably has been withdrawn either completely at least outside the field of view at the left shoulder. et tube is in standard placement and nasogastric tube passes below the diaphragm and out of view. large scale pulmonary consolidation which developed between and and worsened appreciably over the course of the day continues to improve, but the focal nature of the consolidation suggests that what remains could be pneumonia, particularly in the right lower lobe. the rest was edema. heart size is normal. pleural effusion is small if any. no pneumothorax. cxr : in the interim from the previous examination, an endotracheal tube and esophageal catheter have been removed. multifocal opacities, greatest at the right base, continue to improve. no pneumothorax or pleural effusion is seen. the heart size is normal. tte : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is probably mild regional left ventricular systolic dysfunction with probable mid inferoseptal/apical septal hypokinesis and distal inferior hypokinesis although views are technically suboptimal. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cardiac cath : 1) selective coronary angiography of this right-dominant system demonstrated severe 2 vessel cad. the lmca had no angiographically-apparent flow-limiting lesions. the lad was totally occluded after a high diagonal. there were significant left-left and right-left collaterals supplying the lad territory. the lcx was a moderate caliber vessel with a 50% stenosis in om1. the dominant rca had a 90% calcified ostial lesion. 2) resting hemodynamics showed severe left-sided filling pressures with an lvedp of 50 mmhg. 3) left ventriculography was deferred. 4) successful primary angioplasty of the ostial rca lesion with a 3.0 15mm vision bms. final angiography revealed timi 3 flow with no residual stenosis or angiographically-apparent dissection. final diagnosis: 1. severe two vessel cad with probable chronic lad disease. 2. successful angioplasty of the ostial rca lesion with a 3.0 x 15mm vision bms. 3. severely elevated left-sided filling pressures. 4. asa 81mg daily indefinitely and plavix 75mg daily x 30 days. video swallow : barium passes freely through the oropharynx and esophagus without evidence of obstruction. there was penetration and aspiration with thin liquids. no aspiration or penetration with any other consistency of barium. small posterior wall diverticulum above the upper esophageal sphincter is observed. for details please refer to speech and swallow division note in omr. . impression: 1. penetration and aspiration of thin liquids. 2. small diverticulum of the posterior wall of the upper esophagus. brief hospital course: primary reason for hospitalization: 88yof with no cardiac history presents to bidn with chest pain after recent mechanical fall and e/o stemi on ekg, transferred for hypoxia requiring intubation. . active issues: . # stemi: on transfer, pt's family expressed that they wanted to proceed with cardiac cath. she went to cath lab on which showed severe two-vessel disease, chronic lad disease, and 90% occlusion of rcx. bms x1 was placed in rcx. she was started on asa 325mg daily, plavix 75mg daily, atorvastatin 80mg daily, metoprolol tartrate 12.5mg , and lisinopril 10mg daily. she will need to continue plavix for 6 months and asa indefinitely. she was initially started on heparin gtt, and after 48 hours this was discontinued and she was started on lovanox sc. . # hypoxia: thought likely pulmonary edema in setting of stemi and decreased ef. cxr initially c/f multifocal pna and she was continued on vanc/levofloxacin/flagyl (started at bidn). by hd#3 her cxr showed significant improvement and her antibiotics were discontinued. she was breathing comfortably on room air with o2 sats >95%. . # dementia: per family, patient has dementia at baseline. she often exhibited sundowning behavior but responded well with frequent re-orientation, and standing trazadone 25mg hs to maintain sleep/wake cycle. due to family concerns about her safety at home, she was transitioned to an ecf on discharge. . # aspiration: patient had a witnessed episode of aspiration when taking pill with applesauce. she was evaluated by speech and swallow service, and video swallow showed dysphagia with esophageal diverticulum above ues. she was initially started on a diet of nectar-thick liquids and pureed solids, however she was very frustrated with these limitations. after discussion with family it was decided not to restrict her diet in interest of her quality of life. . stable issues: . # lacerations fall: patient was started on doxycycline on her last ed visit, however this was discontinued as she did not show evidence of cellulitis or wound infection. her sutures were removed on hd#6. . # urinary icontinence - stable. the patient has a pessary in place. . transitional issues: - patient maintained full code status throughout hospitalization. - she should continue asa 325mg daily indefinitely and plavix 75mg daily for at least 6 months. - during hospitalization, family expressed concern about the patient's safety at home. she was screened by pt who felt she would benefit from a skilled nursing facility. she was transitioned to a ltac facility. - will need staples in occiput removed on medications on admission: omeprazole er 20 mg daily. risperidone 1 mg daily. sertraline 25 mg daily. doxycycline 100 mg twice daily for 7 days, started on . discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. risperidone 1 mg/ml solution sig: one (1) po daily (daily). 4. sertraline 25 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 8. risperidone 0.25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for agitation. 9. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 10. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime). discharge disposition: extended care facility: healthcare & rehabilitation center - discharge diagnosis: st segment elevation myocardial infarction dementia esophageal diverticulum urinary incontinence discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mrs. , it was a pleasure participating in your care. as you know you had chest pain when you fell and it was determined that you had a heart attack. you were started on several new medications that you will need to continue to take for your heart. these medications are: 1. aspirin 325 mg once a day 2. atorvastatin 80 mg once a day 3. plavix 75 mg once a day 4. lisinopril 10 mg daily 5. metoprolol 12.5 mg twice a day you were also started on risperidone 1 mg daily and trazodone 25 mg at night to help you sleep. it was felt that the safest place for you would be a long term care center and that is where you will be going on discharge. followup instructions: pcp cardiology name: , specialty: internal medicine address: , , phone: **please discuss with the staff at the facility the need for a follow up appointment with your pcp when you are ready for discharge.** department: cardiac services when: monday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters left heart cardiac catheterization arterial catheterization cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified other persistent mental disorders due to conditions classified elsewhere acute respiratory failure pneumonitis due to inhalation of food or vomitus acute myocardial infarction of other inferior wall, initial episode of care hypoxemia acute systolic heart failure urinary incontinence, unspecified other alteration of consciousness dysphagia, oropharyngeal phase difficulty in walking diverticulum of esophagus, acquired 

Answer: The patient is high likely exposed to