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: dyspnea major surgical or invasive procedure: cardiac catherization history of present illness: 58 y/o arabic speaking only male with history of cad s/p prior cabg in at clinic (lima to lad, svg to pda, radial to diag), who had a lengthy hospital course from to on the surgery service for right below-knee popliteal artery to dorsalis pedis artery bypass with reversed saphenous vein graft. . above hospital course was complicated by post-operative mi. cardiac cath showed severe native coronary artery disease, lmca with severe diffuse disease, lad was totally occluded proximally, lcx had a total occlusion with long diffusely narrowed om or possibly ramus intermedius branch, rca had total occlusion proximally, patent lima-lad with faint collaterals to the pda, atretic rima, radial to d1 had a 90% proximal stenosis just after the ostium, and occluded svg-pda graft. overall, ekg showed inferior st changes and cath noted an ostial occlusion of the radial-diag graft which, when injected gave him chest pain. stent was placed in radial to diag graft. . stat echo showed new severe mr (likely ischemic from injection). subsequent formal tte showed mild-moderate mitral regurgitation most likely due to papillary muscle dysfunction. he required intubation, pressors, iabp for his cardiogenic shock and pulmonary edema, but was able to be discharged to home on . . history is obtained from patient, translator, and family. per report, he was doing well after discharge and was in his usoh. today, he noted acute sob with diaphoresis at 9 am. he denied dietary indiscretion, high salt diet, increase in weight, missing bp pills, changes in his bp regimen. he denied cp or palpitations. . he presented with rr 50s, o2 sat 70s on nrb mask. his pressures were noted to be high and sbp 190s. ed exam was notable for diffuse rales and wheezing. on ekg, ? upsloping ste v1-v2 with increased lateral twi and depressions. cxr c/w severe chf. . he was placed on bipap, nitro gtt, given iv lasix with o2 sats which rose to the 90s. sbp was 160s when going to cath. he was taken to cardiac cath with heparin gtt. grafts looked patent and no interventions were performed. intra-op echo performed as well. a-line was kept in place. heparin gtt was stopped. . per d/w patient, ros positive for cough since discharge. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is positive for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and ankle edema. notable for absence of chest pain, palpitations, syncope or presyncope. past medical history: - chronic systolic heart failure - cad w/ mi s/p cabg - hyperlipidemia - hypertension - diabetes social history: lives in , speaks english/arabic. independent in adls denies tobacco/ etoh he has a very supportive wife who is here with him. ambulates with walker. family history: reports that father and brother have cardiac disease with stenting. physical exam: admission physical exam: vs: t = afebrile, bp 123-150/59-66, hr 102-105, rr 29, sao2 90% on bipap general: mild distress, accessory muscle use, tachypnea. oriented x3 heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink neck: supple with jvp of cm cardiac: pmi located in 5th intercostal space, midclavicular line. tachycardic, regular rhythm, normal s1, s2. grade ii hsm at lsb. no thrills, lifts. no s3 or s4 appreciated. lungs: labored respirations. crackles and decreased bs half-way up the lung fields bilaterally. expiratory wheezing bilaterally. abdomen: soft, mildly distended, non-tender. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 2+ ble pitting edema. no femoral bruits. right upper extremity a-line/4 french catheter. rle with wound vac over heel and ace wrapping over c/d/i incision to thigh skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: aaox3, cnii-xii intact, strength difficult to assess given fatigue, 2+ reflexes biceps, brachioradialis, patellar, ankle. pulses: right: carotid 2+ femoral 1+ popliteal 1+ dp 1+ pt 1+ left: carotid 2+ femoral 1+ popliteal 1+ dp 1+ pt 1+ . discharge physical exam: vitals - tm/tc: 98.2/98.5 hr:71-83 bp: 114-135/68-70 rr:18 02 sat: 99% ra general: well-appearing male in no acute distress heent: mucous membs moist, jvp non elevated chest: bs right base, faint crackles left base. cv:rrr, nl s1 s2, no murmurs rubs or gallops abd: normoactive bowel sounds, soft, non-tender, non-distended, ext: wwp, no edema on left. right leg wrapped w wound vac. dp/pt 1+ on left. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. pertinent results: labs on admission: 12:43pm blood wbc-13.7*# rbc-4.15* hgb-10.8* hct-35.6* mcv-86 mch-26.1* mchc-30.4* rdw-14.8 plt ct-300 12:43pm blood neuts-64.5 lymphs-30.0 monos-4.2 eos-0.9 baso-0.4 12:43pm blood pt-13.0* ptt-32.1 inr(pt)-1.2* 12:43pm blood glucose-205* urean-27* creat-1.7* na-141 k-5.4* cl-105 hco3-27 angap-14 12:43pm blood ctropnt-0.08* probnp-5643* 07:35pm blood calcium-8.1* phos-5.4* mg-1.9 tte : there is moderate to severe regional left ventricular systolic dysfunction with inferior and inferolateral akinesis. right ventricular chamber size and free wall motion are normal. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: inferior and inferolateral akinesis with mild hypokinesis of the other segments. moderate mitral regurgitation. cxr : impression: 1. findings suggesting moderate pulmonary edema with a pleural effusion suspected on the right. 2. low lung volumes with left basilar opacity including air bronchograms. although pneumonia is not excluded, atelectasis could provide an alternative explanation. clinical correlation is recommended and consideration of followup radiographs, preferably with pa and lateral technique, if needed clinically. leni : impression: no dvt of the bilateral lower extremities tte : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is moderate regional left ventricular systolic dysfunction with infer-spetal, inferior and infero-lateral akinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. renal ultrasound : impression: markedly diminished to no diastolic flow, right worse than left, in the bilateral kidneys suggestive of an extensive diffuse parenchymal process. no evidence of renal vein thrombosis given the normal venous outflow bilaterally. this study is not adequate to exclude renal artery stenosis due to technical limitations. brief hospital course: mr. is a 58 y/o arabic speaking only male with history of cad s/p prior cabg (lima to lad, svg to pda, radial to diag), lengthy hospital course from to for right below-knee popliteal artery to dorsalis pedis artery bypass complicated by post-operative mi, cardiogenic shock, and stenting of the radial to diag graft, who presents with hypoxic respiratory failure likely from htn emergency. . active diagnoses: . # hypoxic respiratory failure: on exam and cxr imaging, presentation c/w acute on chronic systolic congestive heart failure. etiology is most likely the fact that he was not on lasix as outpatient, despite having low ef, causing gradual fluid accumulation until he became hypoxic and then sympathetic activation caused significant hypertension which added to his flash pulmonary edema. blood pressures significantly elevated although unclear if precipitant of or secondary to respiratory distress. he denies medication changes, dietary indiscretion. alternate etiologies initially included ischemia, particularly given his severe native cad and recent ostial occlusion of the radial-diag graft versus ischemic or non-ischemic worsening of her mitral regurgitation, particularly given his known moderate mr ; however, cardiac cath yesterday revealed patent grafts and no new ischemia to explain this decompensation. patient was diuresed a total of 13 liters during his hospital course. he was started on carvedilol and lisinopril. eventually, he was able to breathe comfortably and maintain good oxygen saturation on room air. . # cad: prior cabg in at clinic (lima to lad, svg to pda, radial to diag). prior ef 35% as of . cardiac cath showed severe native coronary artery disease, lmca with severe diffuse disease, lad was totally occluded proximally, lcx had a total occlusion with long diffusely narrowed om or possibly ramus intermedius branch, rca had total occlusion proximally, patent lima-lad with faint collaterals to the pda, atretic rima, radial to d1 had a 90% proximal stenosis just after the ostium, and occluded svg-pda graft. did receive stent in radial to d1 graft during prior admission. during this admission, repeat cardiac cath showed no acute changes and no intervention needed. patient was continued on aspirin, plavix, atorvastatin, carvedilol andl isinopril. his cardiac function was followed by serial ttes. . # rhythm: patient remained in sinus rhythm with intermittent nsvt. he was monitored on telemetry and should consider life vest vs icd due to his risk for arrhythmia from his low ef. he did have several episodes of a flutter noted on telemetry. although his chads2 score is 3, but due to risks associated with triple therapy, we decided to hold off. he should be considered for an ep study and a flutter ablation as an outpatient. . # htn emergency: patient initially presented with hypertensive emergency and was started on nicardepine drip. he was successfully weaned off the nicardepine drip and restarted home isosorbide. when his blood pressure was able to tolerate it, he was also started on lisinopril and carvedilol. . # leg care: patient is s/p right below-knee popliteal artery to dorsalis pedis artery bypass with reversed saphenous vein graft. he will need dressing changes with podiatry. lenis were negative. podiatry recommended multipodus boot while in bed, heel off-loader while with pt, vac change . . chronic diagnoses: . # hld: patient was continued on atorvastatin per home regimen. . # iddm: patient was maintained on an insulin sliding scale. . ======================== transition of care: 1. patient should get an icd eventually. 2. patient had a few episodes of aflutter during hospitalization. his chads2 score was 3. he is already on asa, plavix so was not started on coumadin due to risks associated with triple anticoagulation. he should be considered for an ep study and aflutter ablation as an outpatient. medications on admission: home medications (confirmed): atorvastatin - (prescribed by other provider) - 40 mg tablet - 2 tablet(s) by mouth once a day benzonatate - (prescribed by other provider) - 100 mg capsule - 1 capsule(s) by mouth three times a day carvedilol - (prescribed by other provider) - 12.5 mg tablet - 2 tablet(s) by mouth twice a day clopidogrel - 75 mg tablet - 1 tablet(s) by mouth daily insulin glargine - (prescribed by other provider) - 100 unit/ml (3 ml) insulin pen - 1 insulin(s) twice a day 30 units insulin lispro - (prescribed by other provider) - 100 unit/ml insulin pen - 1 insulin(s) four times a day isosorbide mononitrate - (prescribed by other provider) - 30 mg tablet extended release 24 hr - 3 tablet(s) by mouth daily (daily) lisinopril - (prescribed by other provider) - 5 mg tablet - 1 tablet(s) by mouth daily (daily) . medications - otc aspirin - (prescribed by other provider) - 325 mg tablet - 1 tablet(s) by mouth daily (daily) ferrous sulfate - (prescribed by other provider) - dosage uncertain multivitamin - (prescribed by other provider) - tablet - 1 tablet(s) by mouth daily (daily) discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. carvedilol 12.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. insulin glargine 100 unit/ml solution sig: fifteen (15) units subcutaneous twice a day. 8. humalog kwikpen 100 unit/ml insulin pen sig: 0-12 units subcutaneous four times a day: as per sliding scale. 9. ferrous sulfate 325 mg (65 mg iron) capsule, extended release sig: one (1) capsule, extended release po once a day. disp:*30 capsule, extended release(s)* refills:*2* 10. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 11. multivitamin capsule sig: one (1) capsule po once a day. discharge disposition: home with service facility: vna discharge diagnosis: acute on chronic systolic congestive heart failure peripheral vascular disease brief atrial flutter coronary artery disease diabetes mellitus hypertension dyslipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure caring for you at . you had trouble breathing at home that was due to fluid overload in your heart and lungs. you needed medicines and a bipap machine to help you breathe. a cardiac catheterization was performed that showed no changes or further blockages from previous. an echocardiogram showed that your heart pumpinig function is weak and you were started on medicines to help your heart pump more effectively and to prevent the fluid from coming back. the podiatry team followed you for your foot issues and you will see them and the vascular surgeons after you leave, along with dr. . weigh yourself every morning before breakfast, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. please also watch for signs the fluid is coming back such as trouble breathing, swelling in the feet or legs, trouble sleeping or a new cough. you also briefly developed a heart rhythm problem called atrial flutter while you were sick. this is now gone and the decision was made not to start any new medicines for this right now. . we made the following changes to your medicines: 1. stop benzozonate and imdur 2. decrease carvedilol to one table twice daily 3. increase lisinopril to 20 mg daily 4. start furosemide 40 mg twice daily, you can take the second dose about 3pm. 5. restart ferrous sulfate (iron) and docusate for your anemia 6. decrease the glargine insulin to 15 units twice daily. please check your fingersticks before meals and at bedtime and use the humalog sliding scale to calculate the humalog dose. you may need to increase your glargine back to 25 units slowly if your fingerstick readings are high. followup instructions: needs vascular department: podiatry when: thursday at 11:20 am with: , dpm building: ba ( complex) campus: west best parking: garage department: cardiac services when: thursday at 10:20 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status atrial flutter other and unspecified hyperlipidemia acute respiratory failure acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities, unspecified 

Answer: The patient is high likely exposed to