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: iodine; iodine containing / lipitor / codeine attending: chief complaint: transfer from an outside hospital for non st elevation myocardial infarction, congestive heart failure exacerbation major surgical or invasive procedure: cardiac catheterization without pci coronary artery bypass grafts x 4 (lima-lad,svg-dg1,svg-om,svg-rca)& mitral valve repair (28mm annuloplasty ring)- left heart catheterization, coronary angiography- history of present illness: this is a 72-year-old female with a past medical history significant for hypertension, diabetes, smoking, cad s/p mi x3 most recently in complicated by cardiogenic shock, s/p rca stenting x2 and lcx stenting x2, chf with ef of 40%, mr, pulmonary hypertension, and pvd s/p lower extremity stenting transfered from an osh for nstemi and chf exacerbation. in brief, she was discharged from on after a prolonged hospitalization notable for a nstemi with stenting of the lcx and hemodynamic compromise requiring a iabp. she did well after discharge with improvement of her sob and mobility. she and her husband went on vacation during which time she developed doe, the cp mostly a night with no correlation to activity. her cp responded consistently to 1 to 2 ntg. she began to notice orthopnea and pnd as well as ankle edema. she had nausea and sob associated with her cp but not sweats or dizziness. on she had a bacon and cheese omelet for breakfast and clam chowder and steak with french fries for lunch. that afternoon she began to have persistent cp and sob with associated nausea not relieved by ntg x3q5 minutes. ems was called and she was admitted to medical center in , n.h. where she was found to be atrial fibrillation and pulmonary edema with and an admission probnp of 5814.4. a central line was placed and emergent cardioversion was performed. she initially was hypotensive but stablized post cardioversion. ekg revealed st depression in the lateral leads. her tni trended 1.17, 3.03, 8.9 consistent with an nstemi. she was maintained on a heparin drip with aggressive diuresis. proir to transfer she had been on and off nitroglycerin drip. she has chest pressure whenever it was shut off but she was hypertensive when the nitro is increased. by report from the osh she was wheezing on admission. her blood sugar on admission to the osh was 515 and she was briefly on an insulin drip with improvement of her sugars. there is also a question of whether she missed a dose of her beta-block dose prior to her admission. she was transferred to for further management. . she developed 7/10 chest pain with no ecg changes. she was continued on heparin drip and ntg drip was restarted with resolution of her cp. she had recurrent chest pain w/ ekg chnages and was taken for an emergent coronary srtery bypass graft and mv repair om . past medical history: coronary artery disease with unstable angina chronic systolic heart failure mitral regurgitatiuon obesity insulin dependent diabetes mellitus s/p coronary angioplasty pulmonary hypertension hypertension peripheral vascular disease-s/p stenting lower extremities s/p cholecystectomy s/p appendectomy s/p psoas abcess gastritis social history: heavy smoker up to 2 ppd for 50 years, quit in . denies etoh or ivdu. pt is a retired x-ray technician. she lives with her husband and two grandchildren in , she is the caregiver for her sister with body dementia and her husband as well as her two grandchildren. family history: no family history of cad or premature death, dm, htn, hld. mother with pd. sister with body dementia. sister with lung ca. physical exam: admission: gen: obese elderly lady in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. dry mm. no pallor or cyanosis of the oral mucosa. no xanthalesma. no cervical or axillary lad. neck supple with jvp of 10 cm. no carotid bruits cv: pmi difficult to assess. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. pulm: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. poor air movement. diffuse mile crackles greater in the bases with scattered wheezes. abd: bs+, soft, ntnd. no hsm or tenderness. gas on percussion. limbs: no c/c/e. no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ radial 2+ dp 1+ left: carotid 2+ radial 2+ dp 2+ pertinent results: 03:52am blood wbc-17.3* rbc-3.53* hgb-10.8*# hct-30.9* mcv-87 mch-30.6 mchc-35.0 rdw-14.3 plt ct-191 04:28am blood wbc-14.4* 04:28am blood glucose-57* urean-28* creat-1.2* k-3.8 echocardiography report , (complete) done at 10:54:24 am final referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 72 f hgt (in): 65 bp (mm hg): 123/67 wgt (lb): 230 hr (bpm): 67 bsa (m2): 2.10 m2 indication: intraoperative tee for cabg procedure and mitral valve repair. chest pain. congestive heart failure. left ventricular function. mitral valve disease. myocardial infarction. preoperative assessment. right ventricular function. icd-9 codes: 428.0, 786.05, 786.51, 440.0, 424.0 test information date/time: at 10:54 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 #: 2009aw2-: machine: 3d echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.0 cm <= 4.0 cm left ventricle - septal wall thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.0 cm <= 5.6 cm left ventricle - ejection fraction: 35% >= 55% aorta - annulus: 2.0 cm <= 3.0 cm aorta - sinus level: 2.7 cm <= 3.6 cm aorta - sinotubular ridge: 2.5 cm <= 3.0 cm aorta - ascending: 3.3 cm <= 3.4 cm aorta - arch: 2.3 cm <= 3.0 cm aorta - descending thoracic: 2.4 cm <= 2.5 cm aortic valve - peak velocity: 0.8 m/sec <= 2.0 m/sec mitral valve - peak velocity: 1.2 m/sec mitral valve - mean gradient: 1 mm hg mitral valve - pressure half time: 53 ms mitral valve - mva (p t): 4.2 cm2 mitral valve - e wave: 0.9 m/sec mitral valve - a wave: 0.5 m/sec mitral valve - e/a ratio: 1.80 mitral valve - e wave deceleration time: *127 ms 140-250 ms findings left atrium: moderate la enlargement. no mass/thrombus in the laa. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness. moderately dilated lv cavity. moderate-severe regional left ventricular systolic dysfunction. moderately depressed lvef. right ventricle: normal rv systolic function. aorta: normal diameter of aorta at the sinus, ascending and arch levels. simple atheroma in aortic arch. normal descending aorta diameter. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. no ms. moderate to severe (3+) mr. to the eccentric mr jet, its severity may be underestimated (coanda effect). tricuspid valve: physiologic tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. 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. frequent ventricular premature beats. patient. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-bypass: the left atrium is moderately dilated. no mass/thrombus is seen in the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate to severe regional left ventricular systolic dysfunction with hypokinesis of the apex, apical portions of the inferior and lateral walls as well as the mid portions of the inferior, inferolateral and inferoseptal walls. overall left ventricular systolic function is moderately depressed (lvef= 35 %). the diameters of aorta at the sinus, ascending and arch levels are normal. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). there is no pericardial effusion. dr. was notified in person of the results in the operating room. post bypass patient is av paced and receiving an infusion of epinephrine, milrinone and phenylephrine. lvef is 40%. rv function is unchanged. annuloplasty ring seen in the mitral position. mild mitral regurgitation seen between the p2 and p3 scallops. dr aware. mean gradient across the mitral valve is 2 mm hg. aorta intact post decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 16:03 , m f 72 cardiology report c.cath study date of brief history: 72 year old female with coronary artery disease and prior mi, status post pci of her lcx and rca, peripheral vascular disease, and mitral regurgitation who was recently admitted to an outside hospital with congestive heart failure and a non-st elevation mi. she is now transferred for cardiac catheterization. indications for catheterization: coronary artery disease procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through an 8 french introducing sheath. cardiac output was measured by the fick method. left heart catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 french angled pigtail catheter, advanced to the left ventricle through a 5 french introducing sheath. coronary angiography: was performed in multiple projections using a 5 french jl4 and a 5 french jr4 catheter, with manual contrast injections. left ventriculography: was performed in the 30 degrees projection, using 39 ml of contrast injected at 13 ml/sec, through the angled pigtail catheter. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 2.13 m2 hemoglobin: 10.3 gms % fick **pressures right atrium {a/v/m} 15/14/9 right ventricle {s/ed} 54/15 pulmonary artery {s/d/m} 54/28/45 pulmonary wedge {a/v/m} 36/41/33 left ventricle {s/ed} 135/36 aorta {s/d/m} 135/54/84 **cardiac output heart rate {beats/min} 80 rhythm n o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 46 card. op/ind fick {l/mn/m2} 5.8/2.7 **resistances systemic vasc. resistance 1035 pulmonary vasc. resistance 166 **% saturation data (nl) pa main 94 ao 61 other hemodynamic data: the oxygen consumption was assumed. left ventriculography: volumetric data: lv ejection fraction (nl 50%-80%). 40 qualitative wall motion: : 1. antero basal - normal 2. antero lateral - normal 3. apical - normal 4. inferior - hypokinetic 5. postero basal - normal other findings: mitral valve showed the following abnormalities. 1. regurgitation +. aortic valve was normal. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca discrete 70 2) mid rca normal 2a) acute marginal normal 3) distal rca normal 4) r-pda normal 4a) r-post-lat normal 4b) r-lv normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main discrete 30 6) proximal lad normal 6a) septal-1 normal 7) mid-lad discrete 60 8) distal lad normal 9) diagonal-1 discrete 60 10) diagonal-2 normal 12) proximal cx discrete 90 13) mid cx discrete 99 technical factors: total time (lidocaine to test complete) = 34 minutes. arterial time = 18 minutes. fluoro time = 6.0 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 94 ml premedications: 325 mg p.o. anesthesia: 1% lidocaine subq. anticoagulation: other medication: fentanyl 25mcg furosemide 60mg iv nahc03 75ml/hr midazolam 0.5mg cardiac cath supplies used: - allegiance, custom sterile pack - , left heart kit - , right heart kit 5fr , multipack 7fr , pulmonary wedge pressure catheter comments: 1. selective coronary angiography of this right dominant system revealed three vessel disease. the lmca had a 30% ostial stenosis. the lad had a 60% mid-vessel lesion involving a major diagonal branch. the lcx had a 95% proximal isr and a long 99% isr in the mid and distal vessel. the rca had a 70% proximal isr. 2. resting hemodynamics revealed a severely elevated left heart filling pressure with a mean pcwp of 33mmhg. there was moderate pulmonary artery hypertension with a mean pa of 45mmhg. the cardiac index was preserved at 2.7l/min/m2. 3. left venticulography revealed an estimated lvef of 40% with severe inferior hypokinesis. there was severe + mitral regurgitation. final diagnosis: 1. three vessel coronary artery disease. 2. severe mitral regurgitation. 3. moderate systolic and severe diastolic ventricular dysfunction. 4. moderate pulmonary hypertension. attending physician: , . referring physician: , cardiology fellow: , m. attending staff: , e. carotid ultra sound impression: right ica 60-69% stenosis. left ica 40-59% stenosis. both have bulky plaque. antegrade vertebral flow bilaterally. the right has been stable since . the left has evidence of mild progression on today's study. brief hospital course: cardiology service brief hospital course: this is a 72-year-old female with a past medical history significant for hypertension, diabetes, smoking, cad s/p mi x3 most recently in complicated by cardiogenic shock, s/p rca stending x2 and lcx stenting x2, systolic chf with ef of 40%, pulmonary hypertension, and pvd s/p lower extremity stenting transfered from an osh for nstemi and chf exacerbation. on her second day of hospitalization she developed flash pulmonary edema. given she was in sinus when she flashed there was concern for ischemic mr. cath on and was found to have 3vd (lad and isr of lcx and rca) and servere mr. s were taken and cardiac referral was made. pt agreed to cabg. she had egd-colonoscopy to rule out possible sources of gib which was negative. also developed worsening of cri, but improved with holding lasix and . developed recurrent cp with ecg changes and was ultimately sent to ct surgery for emergent cabg the day following her egd-. . #. cad: pt s/p mix4 (the latest nstemi this admission) and found to have 3vd at cath + mr. 325mg po daily. held plavix 75mg po daily for cabg washout but had recent bms to the lcx in . continued metoprolol 37.5mg po bid in place of toprolxl 75mg daily. holding statins for now given history of adverse events to these and excellent cholesterol panel. lipid panel: cholest 147, triglyc 134, hdl 60, ldlcalc 60. cath on showed severe mr with angio showing that lad with 60% mid-vessel lesion involving a major diagonal branch, lcx with 95% proximal isr and a long 99% isr in the mid and distal vessel, and rca with 70% proximal isr. last dose of plavix was on . had cp with ecg changes on the am of during bowel prep. resolved completely with ntgx1. again had cp overnight 1/27-28/09 resolved after ntg x2. triggered for cp x2 in <24hrs with 3vd. sent emergently to cabg on the morning of for recurrent cp. . #. pump: pt with chf with known ef of 40%. pt continues to be in sinus (chf preivously exacerbated by afib s/p cardioversion). however, on pt triggered for sob, hypoxia to high 80s on room air. pt's exam showed acute worsening of fluid status concerning for flash pulmonary edema. also concern for ischemic mr. at 5mg po daily ( home dose). lisopril was held the am of transfer to ct surgery to improve renal function. continued metoprolol as above. will consider spironolactone for naturesis in the future. echo on showed ef of 40%, systolic dysfunction with akinesis of the inferolateral wall and hypokinesis of the inferior and anterolateral walls, and severe unchanged mr. initially on lasix drip, but discontinued lasix iv and started lasix 80mg po bid. was retaining some additional fluid so increased lasix to 100mg po bid. this was held on the day of transfer to ct surgery. . #. rhythm: nsr, s/p afib on admission to osh with cardioversion into sinus. . #. renal insufficiency: pt with mild elevation of cr to 1.8 from lasix, , hypovolemia, and bowel prep. held lasix and lisopril the am of transfer to ct surgery. . admission to cardiac surgery post-op. pt was taken to the or on for cabg x4 - lima-lad; svg to d1, om, rca and mv repair. please see operative note for details. the patient arrived to the cardiac icu on milrinone, epi, neo, propofol and insulin drips. she was readily weaned from milrinone and epi and extubated on pod#1. chest tubes and wires were removed. the patient was begun on betablocker and diuresis and transferred to the floor for ongoing management and rehab. patient's insulin were adjusted to achieve glucose control. rehab screening was recommended by physical therapy. postoperative course was uneventful and the patient was discharged to rehab on pod 6. medications on admission: insulin nph 36u and humalog 4u toprol xl 75mg po daily lisinorpil 10mg po daily prilosec 20mg po bid advil 200mg po daily 325mg po daily plavix 75mg po daily hctz 25mg po daily iron colace discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 3. insulin nph human recomb 300 unit/3 ml insulin pen sig: thirty six (36) units subcutaneous twice a day. 4. insulin lispro 100 unit/ml insulin pen sig: four (4) units subcutaneous twice a day. 5. atrovent hfa 17 mcg/actuation aerosol sig: one (1) puff inhalation four times a day. disp:*2 inhaler* refills:*5* 6. xopenex hfa 45 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation four times a day. disp:*2 inhalers* refills:*5* 7. 10 mg tablet sig: one (1) tablet po once a day. 8. metolazone 5 mg tablet sig: two (2) tablet po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 12. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed. 13. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 14. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 15. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 16. amiodarone 200 mg tablet sig: two (2) tablet po once a day: 2 daily for 7 days then one daily for one month. disp:*45 tablet(s)* refills:*0* 17. metoprolol succinate 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). 18. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po twice a day. disp:*60 tab sust.rel. particle/crystal(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease with unstable angina chronic systolic heart failure mitral regurgitatiuon obesity insulin dependent diabetes mellitus s/p coronary angioplasty pulmonary hypertension hypertension peripheral vascular disease-s/p stenting lower extremities s/p cholecystectomy s/p appendectomy s/p psoas abcess gastritis discharge condition: good discharge instructions: shower daily, no baths or swimming no driving for 4 weeks and off all narcotics no lotions, creams or powders to incisions no lifting more than 10 pounds for 10 weeks report any redness of, or drainage from incisions report any fever greater than 100.5 report any weight gain gretaer than 2 pounds a day or 5 pounds a week take all medications as directed followup instructions: dr. in 2 weeks dr. in weeks () dr. in 4 weeks wound clinic in 2 weeks please call for appointments md procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures other endoscopy of small intestine intraoperative cardiac pacemaker colonoscopy open heart valvuloplasty of mitral valve without replacement diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other specified cardiac dysrhythmias long-term (current) use of insulin other postprocedural status esophagitis, unspecified hypovolemia acute on chronic systolic heart failure occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction examination of participant in clinical trial unspecified gastritis and gastroduodenitis, without mention of hemorrhage barrett's esophagus 

Answer: The patient is high likely exposed to