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: sulfonamides / ciprofloxacin / levofloxacin / percocet attending: chief complaint: chest pain major surgical or invasive procedure: cabg x4 (lima to lad, svg to om, svg to diag, svg to pda)/ mv repair (26 mm ring)/ left carotid endarterectomy sternal wound debridement debridement of bilateral pectoralis musculocutaneous advancement flap. history of present illness: the patient is a 59 year old female with known cad (50% lmca, to mrca, and 90% mlcx), chf (ef 40%,) dm, htn, hl, and tobacco who presents with complaints of chest pain. the patient had two prior admissions for heart failure in the end of . a tte during those hospitalizations showed new inferior wma and a reduced ef. a pmibi confirmed a new severe fixed inferolateral defect with the left ventricle also demonstrating inferolateral akinesis and a reported ejection fraction of 28%. the patient was reffered by her pcp to cardiology for evaluation of cardiac catherization. in , the patient underwent an elective diagnosic cardiac catheterization, which demonstrated a totally occluded mrca, diffusly diseased lad, 90% mlcx, and a 50% discrete lmca lesion. the patient was reffered to ct surgery for possible cabg. in the interim, the plan was to optimize the patients modifiable risk factors. the patient represented in early with complaints of chest pain. she was having frequent chest pain with activity. her cardiac markers were cycled negative, ekg showed non-specific tw changes. ct surgery was consulted. the option of bypass surgery was discussed with patient. the discharge summary from that admission indicated that the patinet opted to continue medical management at this time, however the patient says that the team had decided that surgery wasn't an option. review of scanned records show that decision prefered to medical rx, and if failed, then surgery. the patient was discharged with a new prescription for imdur. since discharge, the patient has responded well to the imdur, and has not had any angina. on the night of presentation, the patient was watching tv, when she began to develop a banding chest pressure. the quality of the pain was similar to prior angina, but more intense, without radiation. she was becoming increasingly more uncomfortable. she took 2 slng, without any relief. ems was activated, who provided an additional 2 slng with complete resolution of pain. she has been chest pain free since. she denies any associated n/v, diaphoresis, lightheadedness, or palpitation. she hasn't had any recent orthopnea, pnd, or le edema. the patient was taken to for further manegement. . on presentation to the ed, initial vitals were 98 95 151/84 100 on ra. her first set of cardiac markers showed a slighly elevated trop at 0.04, flat ck. ekg reportedly unchanged from prior. she was given 25mg of po metoprolol, started on a heparin gtt. she remained cp free. she is now admitted to service for further manegement. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: - cad: 50% lcca and 90% mid lcx - dm type 2 x 20 yrs, most recent hga1c 9.5. reports diabetic neuropathy - hypertension (htn) - systolic (ef 40-45%) and diastolic chf - dyslipidemia - anxiety - depression - hypothyroidism - pvd, per imaging studies in - reports at baseline she walks 50 yds or up 1 step until she gets pain - chronic low back pain - osteoarthritis of left knee - diverticulitis/diverticulosis s/p partial colectomy 20 yrs ago and several hospitalizations for abd abscess since then although last was several yrs ago - obesity - smoking, now ppd, h/o smoking x40 years, as much as 2ppd cardiac risk factors: + diabetes, + dyslipidemia, + hypertension, + family history, +tobacco abuse . cardiac history: -percutaneous coronary interventions: cardiac cath showed 2vd with 50% lcma. no interventions taken, patient declined cabg, and has been managed medically. social history: she has a 40pkyr tobacco history and quit in . however, just two to three weeks ago she restarted 1/2ppd. denies any alcohol use in the last 40 years. denies any illicit drug use. lives alone, no family close by. adult daughter lives in , . not employed x1 yr, former secretary. patient's closest contact is her boyfriend who lives two houses away from her. family history: admits majority of family members have various forms of heart disease including heart attacks, htn, and arrythmias requiring pacemakers. physical exam: vs 880, 12, 130/80 general: comfortable skin: unremarkable heent: unremarkable neck: supple, full rom chest: lungs ctab heart: rrr, +murmur apex abd: soft, nt, nd, +bs ext: warm, well perfused, -edema varicosities: minimal spider veins neuro: grossly intact pertinent results: admission labs: 12:35am blood wbc-11.1* rbc-3.98* hgb-12.2 hct-35.1* mcv-88 mch-30.7 mchc-34.8 rdw-13.9 plt ct-281 12:35am blood neuts-77.8* lymphs-17.4* monos-3.0 eos-1.3 baso-0.5 12:35am blood pt-13.0 ptt-29.4 inr(pt)-1.1 12:35am blood plt ct-281 12:35am blood glucose-323* urean-24* creat-1.1 na-135 k-3.8 cl-99 hco3-25 angap-15 06:20am blood alt-14 ast-25 ld(ldh)-182 ck(cpk)-132 alkphos-111 totbili-0.3 12:35am blood ctropnt-0.04* 12:35am blood calcium-9.7 phos-4.4 mg-2.0 . conclusions prebypass 1. no atrial septal defect is seen by 2d or color doppler. 2. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesia of the apex, apical and mid portions of the inferior wall, inferior septum and inferolateral walls. overall left ventricular systolic function is mildly depressed (lvef= 40% %). 3.right ventricular chamber size and free wall motion are normal. 4.there are simple atheroma in the ascending aorta. there are complex (>4mm) atheroma in the descending thoracic aorta. 5. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. 6. the mitral valve leaflets are moderately thickened. moderate (2+) mitral regurgitation is seen. 7. dr. was notified in person of the results on at 1000am. post bypass 1. patient is in sinus rhythm and receiving an infusion of phenylephrine. 2. biventricular function is unchanged. 3. annuloplasty ring seen in the mitral position. appears well seated and there is no mitral stenosis or regurgitation. there is no . 4. aorta is intact post decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 14:42 ?????? caregroup is. all rights reserved. 11:49am blood wbc-16.6*# rbc-2.88* hgb-8.6* hct-27.0* mcv-94 mch-29.7 mchc-31.7 rdw-14.4 plt ct-584* 11:49am blood glucose-173* urean-20 creat-1.2* na-132* k-4.5 cl-98 hco3-25 angap-14 11:49am blood mg-2.2 brief hospital course: the patient is a 59 year old female with known severe coronary artery disease, systolic congestive heart failure (ejection fraction of 40%,) hypertension, dyslipidemia, and diabetes mellitus who presented with recurrent chest pain. the patient's chest pain had resolved by time of arrival to the emergency department. the patient was admitted to cardiology service and ruled in for non-st elevation myocardial infarction on hospital day 1 with peak troponins of 0.55. she was placed on a heparin gtt to which integrilin gtt was added when she ruled in. she remained on integrilin gtt for approximately 12 hrs until troponins trended down and heparin gtt for 48 hrs. she was continued on her home beta blockade, aspirin, statin, lasix. ct surgery was consulted and pre op workup was performed which included negative urine analysis, liver function tests, chest radiograph. also transthoracic echocardiogram was done with results as above. ultrasound lower extremity veins, pulmonary function tests and arterial blood gases were done. surgery was consulted for possible carotid endarterectomy. combined coronary artery bypass grafting and carotid endarterectomy was planned by and cardiac surgery for . during work-up for coronary artery bypass grafting, carotid ultrasound revealed severe left carotid disease, and left carotid endarterectomy planned with dr. at time of coronary artery bypass grafting. plavix was held. she underwent surgery with drs. / on . she was transferred to the cardiovascular intensive care unit in stable condition on milrinone, phenylephrine, propofol, and nitroglycerin drips. she was extubated on post operative day two and her pressors were weaned. her chest tubes removed per protocol. she was transferred to the surgical step down floor. she underwent a right-sided thoracentesis for 300 ml of serosanguinous fluid. she continued to diurese. a 2cm portion of her inferior mediastinal wound was opened and packed secondary to drainage. she as placed on keflex for the same. she was seen in consultation by the clinic for persistently elevated blood sugars and lantus was incrementally increased. infectious disease was also reconsulted for elevated white blood cell counts. the mediastinal wound was opened along the length of the incision and packed. the patient returned to the or on 4/ 16 for superficial sternal debridement with placement of vac. antibiotics were changed to vancomycin. plastic surgery was consulted for further wound management. they took the patient to the or on and performed debridement of bilateral pectoralis musculocutaneous advancement flap. overall the patient tolerated the procedure well and post-operatively was transferred back to the floor with 2 jp drains. she continued to make progress and was discharged to rehab on . medications on admission: 1. aspirin 325 mg daily 2. amitriptyline 10 mg po hs 3. citalopram 20 mg tablet daily 4. ezetimibe 10 mg po daily 5. furosemide 40 mg po bid 6. metoprolol succinate 100 mg daily 7. trazodone 150 mg po hs 8. valsartan 320 mg tablet daily 9. isosorbide mononitrate 30 mg daily 10. levothyroxine 50 mcg po daily 11. pravastatin 10 mg tablet po daily 12. insulin please continue prior home insulin regimen with lantus 14 units at night and novolog divided into three dose throughout the day. 13. plavix 75 mg po once a day. 14. nitroglycerin discharge medications: 1. outpatient lab work cbc with differential, bun/cre, vanco trough on tuesday with results sent to dr. of id at ( 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. pravastatin 10 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 6. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 9. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 11. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 12. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 15. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 16. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 17. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 18. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 19. vancomycin 1250 mg iv q 24h start: in am for sternal wound **hold for trough level >20 20. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 21. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 22. ipratropium bromide 17 mcg/actuation aerosol sig: four (4) puff inhalation qid (4 times a day). 23. albuterol 90 mcg/actuation aerosol sig: 4-6 puffs inhalation q6h (every 6 hours). 24. furosemide 10 mg/ml solution sig: two (2) injection once a day. 25. insulin glargine 100 unit/ml solution sig: twenty six (26) units subcutaneous dinner. 26. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous four times a day: per sliding scale. discharge disposition: extended care facility: for the aged - discharge diagnosis: coronary artery disease peripheral disease carotid disease mitral regurgitation insulin-dependent diabetes mellitus diastolic heart failure hypertension hyperlipidemia inferolateral myocardial infarction anxiety/depression hypothyroidism chronic low back pain osteoarthritis of left knee obesity diverticulitis/ diverticulosis s/p prior partial colectomy discharge condition: good discharge instructions: no driving for one month no lifting greater than 10 pounds for 10 weeks no lotions, creams, or powders on any incision shower daily and pat incisions dry call for fever greater than 100.5, redness, drainage, or weight gain of 2 pounds in 2 days or 5 pounds in one week followup instructions: see dr. in weeks see dr. in weeks see dr. in weeks see dr. in 4 weeks please call for appts. outpatient lab work cbc with differential, bun/cre, vanco trough on tuesday with results sent to dr. of id at ( provider: () lmob (nhb) phone: date/time: 1:00 provider: , md phone: date/time: 10:00 md procedure: venous catheterization, not elsewhere classified (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery thoracentesis local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] graft of muscle or fascia excisional debridement of wound, infection, or burn annuloplasty endarterectomy, other vessels of head and neck procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder mitral valve disorders other postoperative infection congestive heart failure, unspecified toxic encephalopathy unspecified essential hypertension unspecified acquired hypothyroidism diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction dysthymic disorder other and unspecified hyperlipidemia surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of insulin obesity, unspecified staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus disruption of external operation (surgical) wound acute on chronic combined systolic and diastolic heart failure osteoarthrosis, localized, not specified whether primary or secondary, lower leg 

Answer: The patient is high likely exposed to