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 / xylocaine / nitroglycerin attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterizations: & history of present illness: 85f with hypertrophic cardiomyopathy, paroxysmal atrial fibrillation on amiodarone, reported ef of 32% who reports with increasing substernal chest pressure lasting 15 minutes to hours with radiation to her neck, associated with palpitations, exacerbated with movement, alleviated with rest. patient reports that she's had increasing chest pain over the past few months who presents with increasing chest pain pver 5 days refusing to go to the ed but came to dr. ??????s office on . he did blood tests and told her to go to the ed. she did not and instead went home. the labs came back with a troponin of 2.28 so he called her and had her come to ed for transport to our cath lab. of note she had a nuclear stress test in that was reported as completely normal. her ef was 32%. . labs at : wbc 8.3 hgb 14.9 hct 42.5 plt 180 inr 1.0 calcium 8.9 na 131 k 3.9 cl 86 co2 29 crt cpk 173 mb 19.8 index 11.2 troponin 2.28 past medical history: cad hypertrophic cardiomyopathy paroxysmal atrial fibrillation dermatomyositis social history: etoh neg tob neg illicits neg family history: nc physical exam: vs: t:95.3 bp:68/41 hr:65 rr:18 o2:99% 2lnc gen: wdwn middle aged female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 2 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. ii/vi sem along precordium. no rubs or gallops. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. bibasilar crackles. no wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: bilateral lower extremity ecchymosis. no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: imaging: c.cath study date of comments: 1. coronary angiography of this left dominant system revealed severe single vessel coronary artery disease. the left main coronary artery had no angiographically apparent flow limiting stenoses. the lad had a 90% stenosis in the mid segment involving the bifurcation of the first major diagonal branch. the lcx was a large caliber dominant artery and had no angiographically apparent flow limiting stenoses. the rca was a small caliber nondominant vessel with no angiographically apparent flow limiting stenoses. 2. resting hemodynamics revealed low right sided filling pressures (mean ra pressure was 3 mm hg and rvedp was 4 mm hg). pulmonary artery pressures were normal (pa pressure was 30/11 mm hg). left sided filling pressures were normal (mean pcw pressure was 13 mm hg). systemic arterial pressure ranged from low to normal (aortic pressure averaged 90/47 mm hg). cardiac output was low (ci was 2.1 l/min/m2). post intervention and bolus administration normal saline, left sided filling pressures were slightly higher (mean pcw pressure was 14 mm hg). 3. successful pci/stent to mid lad/diagonal bifurcation with a 3.0x23mm cypher stent deployed at 14atms. excellent result with normal flow and no residual stenosis in both vessels. patient left cathlab painfree. final diagnosis: 1. severe single vessel coronary artery disease. 2. low right sided filling pressures and relatively low left sided filling pressures. 3. successful rotation atherectomy, angioplasty, and stenting with des of the mid lad with rescue of the first diagonal branch. . ct pelvis w/o contrast 9:32 am impression: 1. no evidence of retroperitoneal bleed but hematoma in right groin in soft tissues at site of recent cath. 2. heavy coronary artery and aortic calcifications. 3. low-attenuation lesion in segment 3 of the liver which is too small to characterize but may represent a cyst. 4. minimal free fluid in the pelvis. 5. catheter in situ in right common femoral artery and vein . chest (portable ap) 7:05 am impression: interval resolution of pulmonary edema and effusions. . echo study date of conclusions: the left atrium is mildly dilated. the estimated right atrial pressure is 11-15mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (ejection fraction 40-50 percent) secondary to hypokinesis of the interventricular septum and apex. there is a mild resting left ventricular outflow tract obstruction. the gradient increased with the valsalva manuever. right ventricular chamber size and free wall motion are normal. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis (preacceleration of flow in the left ventricular outflow tract may also be contributing to the elevated flow velocity across the aortic valve). no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. there is a minimally increased gradient consistent with trivial mitral stenosis. moderate to severe (3+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: 1. septal and apical hypokinesis 2. left ventricular hypertrophy 3. mild-to-moderate left ventricular outflow tract obstruction 4. minimal mitral stenosis (from severe annular calcification) 5. at least moderate-to-severe mitral regurgitation 6. possible minimal aortic stenosis . c.cath study date of comments: 1. patent mid lad stent. 2. diagonal branch has no significant stenosis 3. normal dominant lcx and rca final diagnosis: 1. one vessel coronary artery disease. 2. patent mid lad stent with no major stenosis in diagonal side branch. . echo study date of conclusions: the left atrium is dilated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of basal and mid-anterior septum. right ventricular chamber size and free wall motion are normal. mild (1+) aortic regurgitation is seen. there is severe mitral annular calcification. moderate to severe (3+) mitral regurgitation is seen. there is no pericardial effusion. impression: focused study, showing mild regional left ventricular systolic dysfunction. mild aortic regurgitation. moderate-to-severe mitral regurgitation. . chest (pa & lat) 6:13 pm impression: new small bilateral pleural effusions with adjacent basilar atelectasis. . femoral vascular us right 2:01 pm impression: no evidence of av fistula, pseudoaneurysm, or large hematoma. . micro: sputum cx: no growth urine cx: pending . admission labs: 06:29pm o2 sat-98 06:29pm na+-121* k+-2.8* 06:29pm type-art po2-152* pco2-39 ph-7.43 total co2-27 base xs-2 intubated-not intuba 07:25pm calcium-7.0* phosphate-4.2 magnesium-1.7 07:25pm estgfr-using this 07:25pm glucose-154* urea n-17 creat-0.9 sodium-123* potassium-3.9 chloride-90* total co2-24 anion gap-13 08:31pm pt-12.8 ptt-150* inr(pt)-1.1 08:31pm plt count-159 08:31pm wbc-6.6 rbc-3.83* hgb-13.1 hct-38.1 mcv-99* mch-34.3* mchc-34.5 rdw-16.6* 08:31pm urine osmolal-233 08:31pm urine hours-random creat-6 sodium-47 08:31pm free t4-1.5 08:31pm tsh-0.34 08:31pm osmolal-281 08:31pm albumin-2.9* calcium-6.8* phosphate-4.1 magnesium-1.6 08:31pm ck-mb-22* mb indx-10.0* 08:31pm ck(cpk)-219* 08:31pm glucose-175* urea n-15 creat-0.9 sodium-126* potassium-3.1* chloride-94* total co2-19* anion gap-16 10:07pm urine rbc-* wbc-0 bacteria-none yeast-none epi-0 10:07pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 10:07pm urine color-straw appear-clear sp -1.030 11:30pm urea n-15 creat-0.8 sodium-133 potassium-4.8 brief hospital course: pt is a 85f with nstemi s/p catheterization and des to lad, with subsequent hypotension, transiently on pressors, currently normotensive without support. . #) cad: patient with diagnosed cad, s/p cypher stent to mid-lad. pateint underwent repeat cardiac catheterization on in the setting of chest pain,. probability of instent thrombosis was low and cath revealed patent mid-lad cypher stent. patient never had ekg changes. patient also had us or r groin given a new bruit, although, as reported above, there was no evidence of fistula or aneurysm. the patient was continued on asa & plavix, and had daily ekg without changes. she had episodic bouts of chest pain without ekg changes and it was thought that these this pain was no ischemic. she was not given nitrates in the setting of mild hcm, and this pain responded well to low dose opiates. . #). chest pain: patient with transient chest pain, nonpositional, nonpleuritic, not associated with sob, and temporally associated with food intake. probability of ischemia is low, recent re-cath negative, ekgs without significant changes. patient may have an esophageal component of chest pain. ddx includes des, zenker's diverticulum, gerd. other less likely etiologies include boerhaave's/mwt, schatzki's ring. patient has been cp free for over 24 hours and may benefit from an outpatient workup for possible gi relates issues. . #) pump: given right heart catheterization, patient presented hypovolemic and is also hypotensive. patient with known hcm and the best bp support for her was fluids. she was also transiently on neosynephrine to which she responded well. she received aggressive volume support and had mild pulmonary edema, that of which she autodiuresed well. her diuretics were held and these were not restarted upon discharge. she was hoever, started on toprol xl. . .#) rhythm: hx of paf, although not on coumadin given prior hx of bleeding risk. patient has hx of cardioversion in 2/. patient was continue on amiodarone 200 qd and monitored on telemetry without event. . #)uti- patient with urinary symptoms, and was started empirically on bactrim for a 3 day course. . #) dermatomysositis: - continue prednisone 2.5 mg po qd medications on admission: prednisone 2.5 mg daily ld this am methotrexate weekly ld amiodarone 200 mg daily ld this am fosamax weekly ld was sunday aldactazide 2.5/25 mg daily ld this am asa 325 mg @ 12:40pm today benadryl 50 mg po @ 12:40 pm today zantac 150 mg po @ 12:40 pm today solumedrol 60 mg iv @ 12:40 am today 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. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. prednisone 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 days. disp:*4 tablet(s)* refills:*0* 8. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 9. simvastatin 40 mg tablet sig: one (1) tablet po once a day for 10 days. disp:*10 tablet(s)* refills:*0* 10. simvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*3* 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day for 10 days. disp:*10 capsule, delayed release(e.c.)(s)* refills:*0* 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 13. toprol xl 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po once a day for 10 days. disp:*5 tablet sustained release 24 hr(s)* refills:*0* 14. clopidogrel 75 mg tablet sig: one (1) tablet po once a day for 10 days. disp:*10 tablet(s)* refills:*0* discharge disposition: home with service facility: nursing services discharge diagnosis: primary diagnosis: myocardial infarction . secondary diagnoses: hypertrophic cardiomyopathy paroxysmal atrial fibrillation s/p dccv in chf dermatomyosistis diagnosed - on mtx/prednisone osteoporosis cataracts discharge condition: afebrile, stable vital signs, tolerating pos, ambulating without assistance. discharge instructions: you were admitted for treatment of a heart attack. you had a stent placed into one of the main arteries of your heart. you also had low blood pressure that was treated with fluid hydration. . 1. please take all medication as prescribed. 2. please attempt to make all medical appointments. 3. please return to the emergency room if you have any concerning symptoms. followup instructions: please call your pcp: , m. . please call for a follow-up appointment . provider: , m.d. phone: date/time: 3:40 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on vessel bifurcation diagnoses: other primary cardiomyopathies subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation osteoporosis, unspecified volume depletion, unspecified unspecified cataract dermatomyositis 

Answer: The patient is high likely exposed to