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: celebrex / adhesive tape attending: chief complaint: dyspnea major surgical or invasive procedure: cardiac cath with 2 bms placed cardiac cath history of present illness: this 64 year old woman with a prior history of breast cancer s/p xrt, hypertension and hyperlipidemia who has been experiencing chest discomfort with exertion for the past three years. she describes chest tightness with exertion while either walking quickly or starting up an incline. over the past three months this exertional angina has wrosened. she has not had angina at rest. she denies shortness of breath, lightheadedness, dizziness, pnd, orthopnea, palpitations, snycope, edema, or claudication. she has been followed by dr. and had a stress mibi done in which was remarkable for moderate, partially reversible septal and apical wall perfusion defect. global hypokinesis with ef of 48%. since then, she has been medically managed, however more recently she was enrolled in a study looking at heart disease and lifestyle modification. as part of the study, she underwent a coronary ct which demonstrated significant calcium in the proximal part of the lad. . she has also recently had an exercise stress test, done on . she exercised for 6 minutes on protocol and was stopped for marked st changes. negative for symptoms. at peak exercise, the patient had 3.5 to 4mm st segment depression in the inferolateral leads as well as 1.5 -2mm st segment elevation in v1-v2. these changes are in the setting of baseline prominent voltage repolarization abnormalities. they resolve with rest by minute 8 of recovery. . prior to admission to the ccu, she underwent an elective catheterization for cad. she was given pre-hydragion and had 320 cc of contrast. during the procedure she had an estimated 100 cc blood loss, with no angiographic evidence of cad in her lmca. her lad had a diffuse proximal 90% and mid vessel calcific disease, origin d1 with 50% stenosis at origin. lcx: mild luminal irregularities into om1 with mild vessel 60% stenosis into om2. rca: proximal 50% stenosis. she had chest pain during the procedure and was transfered to the ccu. . upon arrival to the ccu the patient was chest pain free, although she complained of some nausea. she had been given 8 mg of zofran, and was given a one time dose of 10 mg compazine. her vitals were: 76 123/72 11 and 100 ra. . past medical history: 1. cardiac risk factors: + dyslipidemia +hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: -breast cancer s/p left radical mastectomy, radiation therapy -back surgery 2 yrs ago for spinal stenosis -gerd -osteoporosis -remote gib - social history: -retired dental hygenist, and business manager for family practice -retired -non-smoker -no etoh family history: paternal grandfather with stroke father with mi physical exam: exam on discharge: general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. cardiac: regular rate rhytm with normal s1, s2. no s3 or s4. ii/vi systolic crescendo decrescendo murmur at rsb radiating to carotids. lsb ii/vi murmur radiating to the apex. lungs: scar across r breast. no accessory muscle use, no labored breathing, cta- anteriorly, no crackles, wheezes or rhonchi appreciated. abdomen: soft, ntnd. no hsm or tenderness. extremities: no le edema pertinent results: studies: catherization : (prelim report) comments: 1. selective coronary angiography in this right dominant system demonstrated one vessel coronary artery disease. the lmca was free of angiographically apparent disease. the lad had diffuse, calcific proximal and mid-vessel stenosis of 90%. the origin of the first diagonal branch had a 50% ostial stenosis. the lcx had mild luminal irregularities into om1 with mid vessel 60% stenosis into om2. the rca had a proximal 50% stenosis. 2. limited resting hemodynamics revealed normotension. 3. successful cutting balloon/rotablation/ptca/stenting of the mid lad with a taxus liberte atom 2.25x16 mm drug-eluting stent (des) followed by a more proximal taxus liberte 2.5x12 mm at 12 atm and 15 atm respectively. we then stented the more distal mid lad disease with a taxus liberte 2.5x16 mm des at 10 atm. final angiography revealed normal flow, no angiographically apparent dissection and 0% residual stenosis in the stents with an ostial 60% diag branch vessel stenosis with timi 2 flow. (see ptca comments) 4. r 6fr radial artery sheath removed and terumo tr band placed without complications. final diagnosis: 1. one vessel coronary artery disease. 2. successful cutting balloon/rotablation/ptca/stenting of the mid lad with a taxus liberte atom 2.25x16 mm drug-eluting stent (des) and then a more proximal taxus liberte 2.5x12 mm at 12 and 15 atm respectively. we then stented the more distal mid lad disease with a taxus liberte 2.5x16 mm at 10 atm. (see ptca comments) 3. asa indefinitely 4. plavix (clopidogrel) 75 mg daily for at least 12 months 5. integrilin (eptifibatide) gtt for 18 hours 6. secondary prevention for coronary artery disease 7. r 6fr radial artery terumo tr band placed without complications. catheterization : 1. selective coronary angiography in this right dominant system demonstrated one vessel disease. the lmca had no angiographtically apparent disease. the lad had widely patent stents in the proximal and mid portion of the vessel. there was timi 2 flow in d1 that was of similar appearance/ unchanged from films taken on . the cx had a 50% distal stenosis that was unchanged from films taken on . 2. limited resting hemodynamics revealed a central aortic pressure of 118/66 mmhg. 3. the right femoral arteriotomy site was successfully closed with a 6 french angioseal device. 4. final diagnosis: 1. one vessel coronary artery disease that is unchanged from . 2. successful closure with angioseal device. echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the mid to distal anterior wall, anterolateral wall, distal inferior wall and apex. the remaining segments contract normally (lvef = 40-45 %). right ventricular chamber size and free wall motion are normal. the study is inadequate to exclude significant aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. focused views. focal left ventricular regional dysfunction c/w cad. mild aortic regurgitation. probable mild aortic stenosis. brief hospital course: 64 year old woman with a prior history of breast cancer s/p xrt, hypertension and hyperlipidemia who has been experiencing worsening exertional angina who presented for an elective cath procedure and had rotational atherectomy of the lad, des in the lad who required a relook cath for chest pain. this second procedure was complicated by diagonal perforation. there was no clinical evidence of tamponade after this perforation and it was thought to be healed upon discharge. . # decreased ef: last echo in with normal ef of 55% without any changes in wall motion abnormalitiy. echo performed during this hospitalization after known ischemia showed ef 40-45%. afterload reduction with lisinopril was started. of note, patient had known mild as prior to admission, also seen on echo here with mild ar. . # cad: diffuse coronary disease with intervention to proximal lad with 3 des. no interval change upon re-cath. the patient was maintained on medical management with the following agents: prasugrel (out of concern for interaction w/ ppi), asa, metoprolol, simvastatin, lisinopril. asa dose was increased and imdur was held on discharge. . # sinus tachycardia: the patient developed tachycardia after the catheterization procedures that was thought to be likely due to decreased ef. hr was well controlled with increase in metoprolol prior to discharge. resting hr 80s, ambulatory hr 110. . # apical hypokinesis: seen on echo (see echo report.) initiation of anticoagulation necessary to prevent accumulation of thrombus. patient started bridge from heparin to coumadin in patient and was continued on lovenox outpatient. . # anemia: stable throughout hospitalization. medications on admission: atenolol - (prescribed by other provider) - 25 mg tablet - 1 tablet(s) by mouth once a day in the morning butalbital-acetaminophen-caff - 50 mg-325 mg-40 mg tablet - tablet(s) by mouth every 6 hr as needed for ha isosorbide mononitrate - (prescribed by other provider) - 30 mg tablet sustained release 24 hr - 0.5 (one half) tablet(s) by mouth once daily pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth twice a day simvastatin - 20 mg tablet - 1 tablet(s) by mouth at bedtime aspirin - (prescribed by other provider) - 81 mg tablet - tablet(s) by mouth calcium carbonate-vitamin d3 - (prescribed by other provider; otc) - 600 mg-400 unit tablet - 1 tablet(s) by mouth once a day multivitamin-minerals-lutein - (prescribed by other provider) - tablet - 1 tablet(s) by mouth once a day discharge medications: 1. enoxaparin 80 mg/0.8 ml syringe sig: 0.7 ml subcutaneous q12h (every 12 hours): total dose 70mg or 0.7ml. discard the remainder of the syringe. disp:*10 syringes* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. butalbital-acetaminophen-caff 50-325-40 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for headache. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: take 1 every 5 minutes up to 3 tabs, then call your doctor/911. disp:*30 tablet, sublingual(s)* refills:*5* 6. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. calcium 600 + d(3) 600-400 mg-unit tablet sig: one (1) tablet po once a day. 9. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 10. prasugrel 10 mg tablet sig: one (1) tablet po daily (daily): do not miss a dose. disp:*30 tablet(s)* refills:*2* 11. metoprolol tartrate 50 mg tablet sig: two (2) tablet po qid (4 times a day). disp:*240 tablet(s)* refills:*2* 12. warfarin 2.5 mg tablet sig: three (3) tablet po once daily at 4 pm: dosage will change based on blood levels, to be directed by dr. office. disp:*90 tablet(s)* refills:*2* 13. outpatient lab work please draw inr on and fax results to dr. office, attention . office phone:( office fax:( discharge disposition: home with service facility: discharge diagnosis: primary diagnoses: coronary artery disease s/p cath x2 heart failure ef 45% secondary diagnoses: sinus tachycardia apical hypokinesis anemia aortic stenosis hypertension dyslipidemia: as above gerd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you have been admitted to the hospital after an elective catheterization procedure to look at the arteries in your heart. while you were here, you received 2 stents to help keep open your arteries. in addition, we have noted some decrease in your heart function. this puts you at risk for clots that could cause a stroke. as a result, we have started a medicine called warfarin to keep your blood thin, and another called lovenox (the injection) to protect you while warfarin takes effect. there have been several changes to your medication: -start prasugrel 10mg once daily to protect your stents/arteries, it is important that you do not miss a dose of this medicine. -start warfarin 7.5mg (3 pills) once daily to thin your blood. there will be lab monitoring associated with this medicine. -start lovenox (injection) twice daily until told by your doctor to stop. this will thin your blood while the warfarin takes effect. -increase your aspirin to 325mg daily -start lisinopril 2.5mg to help your heart/blood pressure -stop atenolol. instead take metoprolol as directed to control your heart rate. this dose will likely be decreased over time. -stop isosorbide (imdur) and only take nitroglycerin as needed for chest pain and as directed. followup instructions: on tuesday , please have your blood drawn at -. the results should be communication to dr.. this is important as it affects your coumadin(warfarin) dosing. follow up: , md phone: date/time: 10:20 procedure: coronary arteriography using two catheters coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of three vascular stents diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux intermediate coronary syndrome unspecified essential hypertension cardiac complications, not elsewhere classified aortic valve disorders personal history of malignant neoplasm of breast accidental puncture or laceration during a procedure, not elsewhere classified other and unspecified hyperlipidemia other specified cardiac dysrhythmias osteoporosis, unspecified nausea alone other postprocedural status acute myocardial infarction of unspecified site, initial episode of care intravenous anesthetics causing adverse effects in therapeutic use accidental cut, puncture, perforation or hemorrhage during heart catheterization 

Answer: The patient is high likely exposed to