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: nitroglycerin attending: chief complaint: chest pain on exertion major surgical or invasive procedure: cardiac catheterization, access through left brachial artery history of present illness: 63yo male with early onset cad s/p cabg (lima-->lad, svg --> om2 and lplb), htn, hyperlipidemia who presented for elective heart catheterization with a history of stable angina. pt reports chest pain with exertion for last several months, worse recently while mowing his lawn. baseline two flights of stairs and develops cp. he denies any rest pain, pnd or orthopnea. . pt underwent heart catheterization complicated by multiple bilateral femoral sticks and required l brachial artery for access. catheter was unable to advance to lima or svg grafts to deliver stents due to severe vessel tortuosity. no stents were deployed. pt became hypotensive after nitroglycerin gtt was started in the cath lab, required brief period on dopamine. . pt arrived to ccu c/o substernal chest pain consistent with prior anginal pain. sbp 190's on arrival. low dose nitroglycerin gtt was started and patient became hypotensive to sbp 40's and tachycardic to 150's. ivf's, dopamine, atropine was given with return of sbp's 120's. pt had hr 150's, svt, adenosine given without effect. hr gradually returned to 100's. metoprolol 5mg iv given and brought hr to 80's, 90's. the patient was monitored in the ccu overnight. past medical history: cabg- (lima-->lad, svg --> om2 and lplb) htn hyperlipidemia social history: worked as manager of computer company, widowed, wife died of ovarian ca two years ago, now in a long term committed relationship with female sig other. drinks 1-2 drinks once per week. 15py smoking history, quit 15 years ago. no illicits. remains independent of all adl's prior to admission. family history: mother d.57 dm, cad maternal aunts and uncles with multiple heart dx related premature deaths brother cabg @ 51 physical exam: vitals: bp 190/100, hr 70, r 16, sat 94% 4lnc ht: 6'5", wt. 275lbs gen: pleasant, lying flat in bed, c/o ss cp. heent: ncat, perrl, mmm cv: nl s1 and s2, no mrg, jvp 7cm pulm: cta b abd: obese, soft, nt, no masses extrem: no cce, 2+ dp, pt pulses groin- no hematoma, no bruits bilaterally, good pedal pulses as above. pertinent results: 08:30pm wbc-11.7* rbc-4.69 hgb-15.8 hct-44.2 mcv-94 mch-33.8* mchc-35.8* rdw-13.6 08:30pm plt count-184 08:30pm magnesium-2.2 08:30pm ck-mb-notdone ctropnt-0.06* 08:30pm ck(cpk)-73 08:30pm ck(cpk)-73 04:04am blood wbc-10.8 rbc-3.87* hgb-13.0* hct-37.4* mcv-97 mch-33.6* mchc-34.8 rdw-13.4 plt ct-154 04:04am blood glucose-98 urean-11 creat-0.8 na-139 k-3.7 cl-107 hco3-25 angap-11 . cardiac catheterization **preliminary report** 1) coronary angiography revealed a right dominant system status post coronary artery bypass grafting with three vessel disease. the lmca had no stenosis. the lad gave off a single, large patent d1 branch prior to a 100% proximal segment stenosis. the lcx showed a 100% proximal segment stenosis. the rca showed a 100% midsegment stenosis with right to left collaterals to the distal lcx system. graft angiography revealed a stump occlusion of a graft which is likely the svg-lpl branch. no other graft could be engaged or seen, suggesting likely occlusion of the svg-om2 graft. the lima-lad graft revealed a patent lima graft with an 80% stenosis of the lad immediately distal to the anastomosis site. 2) hemodynamic studies demonstrated normal right atrial filling pressures of 3) unsuccessful attempts at pci of the lad distal to the insertion was performed. the attempts were unsuccesful due to the poor guide support from the brachial access and the excessive tortuousity of the . further attempts were aborted due to the concern over radiation and dye exposure. final diagnosis: 1. three vessel coronary artery disease. 2. unsuccessful attempts at pci of the lad after the insertion of the . . echocardiogram - **preliminary only** the left atrium is dilated. the right atrium is moderately dilated. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is severely depressed. resting regional wall motion abnormalities include mid anteroseptal and inferior akinesis with hypokinesis elsewhere. right ventricular chamber size is normal. right ventricular systolic function is borderline normal. the aortic root is moderately dilated. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. 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. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: 63yo m with early onset cad s/p cabg (lima-->lad, svg --> om2 and lplb), htn, hyperlipidemia. s/p heart cath complicated by difficult vascular access, tortuous coronary vascular supply impeding stent delivery, hypotension following administration of nitrates. . 1) cardiac: ischemia- the patient presented with stable angina. no stents were able to be delivered due to severely tortuous coronary vessels. cardiac enzymes were cycled and negative post intervention. the patient was started on metoprolol 12.5mg for rate control given rate related lbbb. he was started on aspirin 325mg daily, clopidogrel 75mg daily, lisinopril 5mg daily. nitrates in any form were avoided due to episodes of hypotension. a strict contraindication to nitrates should be noted in all future patient records. . rhythm- the patient remained in normal sinuse rhythm, he was noted to have a rate related lbbb as noted on prior exercise tolerance tests. low dose metoprolol 12.5mg was started while inpatient. . pump- preliminary read revealed moderate dilation, multi-regional hypokinesis/akinesis, severely depressed lvef ~20%. the patient is well-compensated at present, no pulmonary edema, peripheral edema, orthonea/pnd. however is at high risk of congestive failure. given failure of percutaneous revascularization, strict compliance and optimization of medical therapy should continue as an outpatient. he was started on lisinopril and metoprolol while inpatient. . 2) pulmonary- the patient had multiple apneic episodes overnight with bradycardia to 50's. pt had sleep study 1yr ago but could not tolerate mask. pt was informed of risks to his cardiac fx and is amenable for re-evaluation for trial of /bipap. he should be scheduled for repeat sleep/pulmonary evaluation as an outpatient at the discretion of his primary care provider. will likely improve his severely impaired cardiac parameters and he should be strongly encouraged to re-trial the device. . 3) seizure disorder- no seizure activity was observed while during this hospitalization. we continued his home dosage of phenytoin during his inpatient stay. . 4) renal- creatinine clearance was stable following dye-load associated with catheterization and peri-procedure hypotension. he had excellent urine output without the aide of urinary catheter prior to discharge. . pcp: , md code: full contact: (fiance) medications on admission: atorvastatin 80mg po daily phenytoin 300mg po qam phenytoin 200mg po qpm multivitamin discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. phenytoin sodium extended 100 mg capsule sig: three (3) capsule po qam (once a day (in the morning)). 5. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po qpm (once a day (in the evening)). 6. hexavitamin tablet sig: one (1) cap po daily (daily). 7. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: elective cardiac catheterization coronary artery disease secondary: hypertension hyperlipidemia discharge condition: stable. the patient is currently chest pain free. discharge instructions: you came to the hospital for an elective cardiac catheterization which was complicated by difficulty accessing your arteries. in addition, your blood pressure dropped while on a nitroglycerin drip. no stents were placed. you are taking some new medications: plavix, aspirin, lisinopril, and carvedilol. you will continue to take a multivitamin, atorvastatin, and dilantin as you were before. please keep all outpatient appointments. if you begin to experience shortness of breath, chest pain, dizziness or lightheadedness or any other concerning symptom please call 911 or your physician right away. followup instructions: please schedule the following appointments: 1. , j. appointment should be in days 2. , l. call to schedule appointment procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome unspecified essential hypertension aortocoronary bypass status other convulsions other and unspecified hyperlipidemia other specified cardiac dysrhythmias hypotension, unspecified old myocardial infarction 

Answer: The patient is high likely exposed to