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: no known allergies / adverse drug reactions attending: chief complaint: syncope major surgical or invasive procedure: left carotid stent off pump cabgx4 (lima>lad,svg to diag/om, svg>rca) history of present illness: mr. is an 86 year old male with hypertension, diabetes mellitus, and benign prostatic hypertrophy that presented to on after a pre-syncopal episode in church. per outside hospital records, he "passed out" while trying to stand up from a sitting position, and was noted to have diaphoresis at the time. he had denied recent medication changes, had a good appetite and was otherwise feeling well. however, on further history from him, he actually losing consciousness and states he remembers the entire event. he states he has had several episodes in which he stands up, becomes diaphoretic, and subsequently needs to sit down. he palpatitations, chest pain or sob during these episodes. while admitted, he underwent a stress test that revealed signs of lateral wall ischemia. of note the pt's cr was 1.65 on admission which down trended to 1.37. upon arrival to the floor, and after fluid resusciation he was not noted to be orthostatic. he also underwent a renal ultrasound unrevealing for signs of hydronepthrosis or obstruction but did reveal mild cortical atrophy. he had a cardiac catheterization whcih revealed coronary artery disease and was referred to cardiac surgery for revascularization evaluation. past medical history: coronary artery disease carotid stenosis hyptertension diabetes social history: mr. ever smoking and dose not drink alcohol. family history: he has no family history of early myocardial infarction, arrhythmia, cardiomyopathies, or sudden cardiac death. physical exam: physical examination on admission: vs: 98.0 155/74 81 20 99ra general: alert, interactive, appropriate, no acute distress. heent: sclera anicteric. perrl, eomi. mmm. neck: supple. jvp 7cm cardiac: rrr, no m/r/g. no thrills, lifts. no s3 or s4. lungs: ctab, no crackles, wheezes, rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ 2+ dp 2+ pt 2+ pertinent results: 06:20am blood wbc-4.3 rbc-3.52* hgb-11.1* hct-31.5* mcv-90 mch-31.5 mchc-35.2* rdw-16.3* plt ct-143* 06:25am blood wbc-3.8* rbc-3.56* hgb-10.8* hct-30.9* mcv-87 mch-30.5 mchc-35.1* rdw-16.6* plt ct-114* 04:35am blood urean-52* creat-1.6* na-139 k-4.1 cl-100 06:20am blood glucose-181* urean-47* creat-1.5* na-136 k-3.6 cl-99 hco3-29 angap-12 cardiac cath study date of comments: 1. selective coronary angiography in this right dominant system revealed 3 vessel coronary artery disease. the lm had 80% stenosis. the lad 70% stenosis. the lcx had 80% stenosis. the rca had 70% distal and 60% proximal stenosis. 2. selective renal angiography revealed 80% left and 70% right renal artery stenosis. there is a possible suprarenal mass. 3. limited resting hemodynamic revealed severe systemic arterial hypertension of 214/84mmhg. there was moderately elevated left sided filling pressurs of 29mmhg. final diagnosis: 1. three vessel coronary artery disease. 2. refer for cabg. 3. if not canidate or refuses surgery, left main stenting. 4. get renal ultrasound to evaluate mass. carotid series complete study date of 12:43 pm technique and findings: extracranial evaluation of bilateral carotids was performed with b mode, color and spectral doppler ultrasound. on the right side, peak systolic velocities are 223 cm/sec, 103 cm/sec and 120 cm/sec in the internal, common, and external carotid arteries respectively. the right ica to cca ratio is 2.4. on the left side, peak systolic velocities are 572 cm/sec, 52 cm/sec, and 261 cm/sec in the internal, common and external carotid arteries respectively. the left ica to cca ratio is 11. both vertebral arteries presented antegrade flow. there is significant heterogeneous plaque within the internal carotid arteries bilaterally. most significant area of stenosis on the right side situates approximately 2.8 cm from the carotid bifurcation and the most significant area of stenosis on the left side is situated approximately 2 cm from the carotid bifurcation. comparison: none available. impression: there is 70-79% stenosis within the right internal carotid artery. there is 80-99% stenosis within the left internal carotid artery. . renal u/s : renal u.s. study date of 1:44 pm the right kidney measures 10 cm in length and the left kidney 10.7 cm. there is a simple 1.4 cm cyst at the lower pole of the left kidney and a simple 7 x 9 mm cyst at the lower pole of the right kidney. no solid masses, stones or hydronephrosis can be visualized. color flow and pulse doppler assessment was performed showing relatively normal and symmetrical upstroke of the main renal arteries on the left and right side at the level of the renal hilum with perhaps a slight delay of time to peak on the left side compared to the right. peak velocity on the right at the hilum is 98 cm/sec, as compared to 68 cm/sec on the left. resistive indices from the upper, mid, and lower poles of both kidneys are essentially normal to mildly elevated, ranging from 0.71-0.78 on the left side and 0.76-0.82 on the right side. views of the bladder are normal, but the prostate cannot be accurately measured. conclusion: normal-sized kidneys with two small simple cysts, one on each side and relatively normal doppler studies with slight parvus tardus waveform on the left main renal artery and mildly elevated ris bilaterally. please note no suprarenal mass could be identified on either side, but ultrasound is not the optimal form of imaging for identifying adrenal lesions. ct or mri would be preferable and non-contrast studies could be adequate for this purpose. . cxr : findings: no previous images. heart is normal in size and lungs are clear without evidence of vascular congestion or pleural effusion. of incidental note is elevation of the right hemidiaphragm of uncertain etiology. there is also a suggestion of calcifications in the right upper quadrant, which could conceivably lie within the kidney or gallbladder. . portable tte (complete) done at 11:15:50 am final conclusions the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is isolated apical left ventricular hypertrophy. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal regional and global biventricular systolic function. the lv apex appears mildly hypertrophied. no pathologic valvular abnormalities. cta neck w&w/oc & recons study date of 5:34 pm findings: ct head: the parenchymal -white matter differentiation is maintained. there is vague hypodensity within the left corona radiata, subcortical right frontal white matter, right external capsule and the periventricular white matter about the frontal horns of the lateral ventricles. the ventricles and sulci are mildly prominent commensurate with a generalized pattern of mild atrophy. no large territorial infarction, intracranial hemorrhage, mass, mass effect or shift of midline structures is identified. the carotid siphons demonstrate calcified atheromatous plaque. the paranasal sinuses and mastoid air cells where included on the exam are clear. cta head: calcified atheromatous plaque is identified along the cavernous segments of the internal carotid arteries without flow-limiting stenosis. the intracranial internal carotid arteries are otherwise normal in caliber and post-contrast enhancement. the left a1 segment is hypoplastic with a prominent right a1 segment supplying both a2 segments. the right vertebral artery is dominant. the vertebral arteries and basilar artery are normal in post-contrast enhancement and caliber. the posterior cerebral arteries, superior cerebellar arteries, and posterior communicating arteries are normal in post-contrast enhancement and caliber. no evidence of aneurysm, stenosis or occlusion is identified. cta neck: the aortic arch and three-vessel cervical artery origins demonstrate scattered calcified and non calcified atheromatous plaque without significant flow-limiting stenosis. calcified atheromatous plaque is present along the superior wall of the subclavian artery at the origin of the right vertebral artery, resulting in a moderate stenosis of the right vertebral artery. scattered atheromatous plaque involving the left subclavian artery is also present. a stenosis of the origin of the left vertebral artery may be present although possibly artifactual. the cervical vertebral arteries are normal in post-contrast enhancement and caliber with the exception of the above-mentioned origin stenoses. the bilateral common carotid arteries are normal in post-contrast enhancement and caliber. the proximal bilateral internal carotid arteries demonstrate both calcified and noncalcified plaque with varying degrees of stenosis, most severe involving the left proximal internal carotid artery where there is an interupted string of contrast due to a large calcified atheromatous plaque measuring approximately 8 mm in greatest length. although continuity of this segment of extreme stenosis can not be confirmed antegrade flow is felt likely as the ica immediately distal to this segment shows robust postcontrast opacification suggesting antegrade rather than retrograde flow. the right proximal internal carotid artery also demonstrates a string of contrast passing beyond a calcified atheromatous plaque 4 mm in length. slightly distal to this severe stenosis, there is an additional focal approximate 80% stenosis 6 mm in length due to calcified atheromatous plaque. the internal carotid arteries distal to these proximal severe stenoses demonstrate normal post-contrast enhancement and caliber. the external carotid arteries are unremarkable. impression: 1. no evidence of infarction, hemorrhage or mass is identified on the non-contrast ct portion of the exam. there are scattered foci of white matter hypodensity which may represent chronic small vessel ischemic disease, if there is sufficient clinical concern for infarction, mri is more sensitive in a patient with no contraindications to mri. 2. cta of the head demonstrates scattered calcified atheromatous plaque without flow-limiting stenosis. no aneurysm, occlusion or arteriovenous malformation is identified. 3. cta of the neck demonstrates severe (string sign) stenoses of the proximal bilateral internal carotid arteries, left more severe than right, described above with a string of contrast passing beyond calcified atheromatous plaque. there are also moderate stenoses of the origins of the right vertebral artery and right subclavian artery. ct head w/o contrast study date of 9:11 pm findings: there is no evidence of acute intracranial hemorrhage, edema, mass effect or loss of -white matter differentiation. small foci of hypodensity in the left corona radiata (2:20), bilateral subinsular white matter (2:), and bilateral periventricular white matter are unchanged, likely representing chronic microvascular infarcts. the ventricles and sulci are prominent due to mild-to-moderate age-related involutional changes. the imaged paranasal sinuses and mastoid air cells are clear. the imaged bones are unremarkable. impression: no acute intracranial hemorrhage. no ct evidence of an acute major vascular territorial infarction. mri would be more sensitive for an acute infarction, if clinically indicated. echocardiography report , (complete) done at 12:25:38 pm preliminary referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 86 m hgt (in): 66 bp (mm hg): 167/89 wgt (lb): 120 hr (bpm): 67 bsa (m2): 1.61 m2 indication: intraoperative tee for off pump cabg. aortic valve disease. chest pain. coronary artery disease. left ventricular function. preoperative assessment. right ventricular function. icd-9 codes: 786.05, 786.51, 424.1, 424.0, 424.2 test information date/time: at 12:25 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2011aw6-: machine: u/s6 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 55% >= 55% aorta - ascending: *3.5 cm <= 3.4 cm aortic valve - peak velocity: 1.4 m/sec <= 2.0 m/sec aortic valve - peak gradient: 8 mm hg < 20 mm hg aortic valve - mean gradient: 3 mm hg findings right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. aneurysmal interatrial septum. no asd by 2d or color doppler. left ventricle: mild symmetric lvh. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. trivial mr. tricuspid valve: mild tr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. conclusions pre revascularization the interatrial septum is aneurysmal. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is no pericardial effusion. post revascularization biventricular systolic function is unchanged. mild mitral regurgitation present. aorta is intact post decannulation. brief hospital course: mr. was admitted for syncope and was found to have coronary artery disease. his pre-op work-up carotid ultrasound showed 70% stenosis on the l and 80-90% stenosis on the r. a left carotid stent was placed on . post-operatively he had an episode of acute mental status change, dysarthrea and left sided clumsiness which spontaneously resolved. a ct of his head was negative for an acute process.he was also found to have possible suprarenal mass when renal vessels selectively engaged on cath. however, a renal ultrasound was repeated and did not show a mass, although ct and mri were recommended as better studies. on he underwent an off pump coronary artery bypass grafting times four (lima>lad,svg to diag/om, svg>rca). please see the operative note for details. he tolerated the procedure well and was transferred in critical but stable condition to the surgical intensive care unit. by the following day he was extubated and weaned from pressors. he was transferred to the surgical step down floor. epicardial wires were removed. he did develop a small apical pneumothorax and air leak. this was followed on chest x-ray and would resolve. chest tubes were discontinued. amiodarone was started for atrial fibrillation. he returned to sinus rhythm within 24 hours. he was seen in consultation by the physical therapy service. by post-operative day 6 he was ready for discharge to rehab of . all follow-up appointments were advised. medications on admission: home medications: glyburide 5mg po bid amlodipine 5mg po daily glucophage 500mg po bid lisinopril 40mg po daily flomax 0.4mg po daily insulin (long acting but didn't remember name) 15u in am . medications on transfer: asa 81mg daily clonidine 0.1mg dailt colace 100mg glyburide 5mg daily acetominophen insulin - novolog iss metoprolol 50mg po bid morphine iv 2mg prn ntg 0.4mg sl prn zofran 4mg iv prn senna tamsulosin 0.4mg daily amlodipine 5mg daily discharge medications: 1. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 9. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 10. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 11. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 12. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 13. metformin 500 mg tablet sig: one (1) tablet po once a day. 14. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): 400mg x 1 week, then 400mg daily x 1 week, then 200mg daily until further instructed. 15. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 weeks. 16. potassium chloride 20 meq packet sig: one (1) packet po q12h (every 12 hours) for 1 weeks. 17. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed): per sliding scale. discharge disposition: extended care facility: tba discharge diagnosis: primary: coronory artery disease carotid stenosis hyptertension diabetes discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 1+ discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: , md phone: date/time: 1:00 cardiologist: , md phone: date/time: 1:00 please call to schedule appointments with your primary care dr. , l. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass coronary arteriography using two catheters arteriography of renal arteries percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hematoma complicating a procedure hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia personal history of malignant neoplasm of bladder delirium due to conditions classified elsewhere iatrogenic cerebrovascular infarction or hemorrhage chronic total occlusion of coronary artery 

Answer: The patient is high likely exposed to