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: history of present illness: this is a 72 year old gentleman who has a history of known coronary artery disease status post myocardial infarction in and , who underwent a pci stent to the circumflex and right coronary artery in . the patient underwent an exercise treadmill test in which showed an ejection fraction of 27% and was positive for evidence of ischemia. the patient presented to his primary care physician with increasing shortness of breath and dyspnea on exertion times six months. the patient was referred to for cardiac catheterization. cardiac catheterization showed an left ventricular end diastolic pressure of 30, pa pressures of 69/20, 100% proximal left anterior descending lesion and 100% first diagonal lesion, 100% mid circumflex lesion, 100% obtuse marginal one, 100% right pda and 100% rpl. the patient had an echocardiogram done at that time which showed left atrial enlargement and global left ventricular hypokinesis. no aortic insufficiency, two plus mitral regurgitation, one to two plus tricuspid regurgitation, pulmonary artery hypertension and an ejection fraction of 20%. the patient was evaluated by dr. and scheduled electively for a coronary artery bypass grafting. past medical history: 1. hypertension. 2. hypercholesterolemia. 3. type 2 diabetes mellitus, diet controlled. 4. status post renal cell carcinoma in ; status post nephrectomy with a baseline creatinine of 2.0 to 2.1. 5. status post perforated diverticulum in , well healed by colonoscopy. preoperative medications: 1. cozaar 50 mg p.o. twice a day. 2. lopressor 50 mg p.o. twice a day. 3. crestor 10 mg p.o. q. day. 4. imdur 60 mg p.o. q. day. 5. aspirin 81 mg p.o. q. day. 6. plavix 75 mg p.o. q. day. allergies: no known drug allergies. social history: the patient is a physician in addiction . he lives at home with his wife. denies tobacco, occasional etoh. review of systems: significant for peripheral neuropathy and mild anemia as well as the previously mentioned diverticular disease and diabetes mellitus. laboratory: preoperatively showed a hematocrit of 34.7 and creatinine of 2.7. hospital course: the patient was admitted to on . he was taken to the operating room with dr. for a coronary artery bypass graft times three with left internal mammary artery to the first diagonal, saphenous vein graft to the left anterior descending and saphenous vein graft to the obtuse marginal 1. intraoperative tee revealed and ef of 15% and 2+ mr. improved to 30% postoperatively and the mr decreased to 1+. the patient was transported to the intensive care unit on milrinone, epinephrine and levophed. please see operative note for further details. on the first postoperative evening, the patient had a large volume requirement with a progressive acidosis and a worsening lactate. on the morning of postoperative day number one, the patient had liver function tests done which were significant for an amylase of 1700 which, on repeat, was found to be 2700. the patient's lactate at that time was holding steady at 4.0. a general surgery consultation was obtained and a ct scan was obtained which showed an unremarkable gallbladder, two small granulomas in the right lobe of the liver, some fatty infiltration of the pancreas without enlargement or fat stranding around the pancreas, grossly patent celiac and superior mesentery artery. hyper enhancement of the mucosa of the large bowel with generalized edema of the entire colonic wall and a question of pneumatosis in the descending colon, moderate stranding around the cecum and a small amount of free intraperitoneal fluid in the upper pelvis. with these findings, the general surgery team of dr. was significantly concerned for mesenteric ischemia and the decision was made to take the patient to the operating room for an exploratory laparotomy. the patient was taken on postoperative day number one and intraoperatively there were no findings of ischemic bowel. the bowel wall was moderately thickened but no evidence of vascular insufficiency was identified. with these findings, the patient was returned to the intensive care unit in stable condition with continued aggressive fluid resuscitation. the patient's vasopressors were weaned off. the patient had good hemodynamic numbers. the patient had a low level acidosis which resolved with administration of bicarbonate. the patient's creatinine which had been 1.8 on postoperative day number one began to rise to 2.3 on postoperative day number two and continued to rise and peaked at 3.0. the patient also developed some hyperkalemia on postoperative day number two. renal consultation was obtained and felt that this was dye induced acute tubular necrosis in spite of the patient receiving peri-procedure mucomyst. on postoperative day number two, the patient was weaned and extubated from mechanical ventilation without any difficulty. the patient's hemodynamics remained good off all drips. the patient's amylase was trending down. by postoperative day number three, the patient's potassium was stable and no longer remained elevated. the renal team felt that the patient needed more fluid resuscitation and with which his urine output increased. the patient's chest tubes which had been placed during the initial operation continued to have significant amount of serous output. the patient's albumin had been checked and was found to be 1.7. it was recommended that the patient receive 25 grams of albumin as well as taking chest tubes off suction; the chest tube output decreased and the chest tubes were removed on postoperative day number six. on postoperative day number four, the patient's pulmonary catheter was removed. the femoral arterial line was removed and the patient got out of bed to sit in a chair. at that time, the patient began complaining of symptoms of vertigo where he felt like the room was spinning. the patient denied any previous history of this. the symptoms worsened over the course of the day. a neurology consultation was obtained. the neurology attending felt that perhaps the patient had some subtle neurologic findings and recommended obtaining an mri at a future date as the patient could not have an mri at that time due to the staples on his incisions. a ct scan obtained showed no acute process and no evidence of a stroke. by postoperative day number five, the patient's creatinine had begun to decrease down to 2.1 with good urine output. nephrology team felt that the patient would continue to progress and signed off. during this time, the patient was noted to have intermittently cool and ecchymotic toes and fingers with good pulses. it was continued intermittently throughout his hospital stay. the patient denied having any experience with the same. there was no evidence of vascular compromise and when the cyanosis resolved, the digits became red in color. it was eventually decided that this was possibly a new expression of raynaud's syndrome. by postoperative day number five, the patient was started on clear liquids. the patient was also noted to have a decrease in platelet count and heparin antibody was sent which was subsequently negative. chest tubes continued to have a moderate amount of serous drainage. the patient began working with physical therapy. by postoperative day number ten, the patient was transferred from the intensive care unit to the regular part of the hospital. the patient's diet had been advanced. the patient's p.o. intake gradually increased. the patient was started on lasix with good diuresis. the patient's chest tubes were removed without incident without any evidence of pneumothorax or pleural effusion. on postoperative day number eleven, the patient had been complaining of mild dyspnea on exertion. chest x-ray showed small bilateral pleural effusions and atelectasis. the patient's dyspnea improved with increasing diuresis. the patient was seen by physical therapy on postoperative day number eleven and at that time he was able to ambulate greater than 500 feet and climb one flight of stairs while remaining hemodynamically stable and without requiring oxygen; it was therefore decided that the patient was stable to be discharged to home on postoperative day number twelve. condition at discharge: temperature maximum 98.2 f.; pulse 81 in sinus rhythm; blood pressure 120/64; respiratory rate 18; room air oxygen saturation 93%. laboratory data was white blood cell count of 7.0, hematocrit 28.1, platelets count 206. sodium 138, potassium 4.1, chloride 103, bicarbonate 26, bun 29, creatinine 1.9, glucose 115. the patient's weight on is 88 kilograms; preoperatively the patient was 83 kilograms. neurologically, the patient is alert and oriented times three, grip strength is equal bilaterally and plantar flexion is equal bilaterally. the fingers and toes have good capillary refill without any evidence of cyanosis. heart is regular rate and rhythm without rub or murmur. breath sounds are decreased at the left base; otherwise clear. the abdomen is soft, nontender, nondistended. positive bowel sounds. the patient is tolerating a regular diet and having normal bowel movements. the midline incision is healing well. sternal incision staples are intact. there is minimal erythema at the superior aspect of the incision. there is no drainage from the incision. there is a minimal amount of serous drainage from the left chest tube site. the sternum is stable. the saphenous vein harvest site is clean, dry and intact. lower extremities have two to three plus pitting edema. discharge diagnoses: 1. coronary artery disease. 2. status post coronary artery bypass graft. 3. postoperative hyperamylasemia. 4. status post negative exploratory laparotomy. 5. chronic renal insufficiency and dye induced acute tubular necrosis. 6. postoperative vertigo. 7. raynaud's syndrome. 8. diabetes mellitus. 9. malnutrition and hypoalbuminemia. 10. congestive heart failure and moderate mitral regurgitaion. discharge medications: 1. aspirin 325 mg p.o. q. day. 2. dilaudid 2 to 4 mg p.o. q. four to six hours p.r.n. 3. protonix 40 mg p.o. q. day. 4. lasix 20 mg p.o. twice a day times seven days. 5. lopressor 25 mg p.o. twice a day. 6. amiodarone 200 mg p.o. q. day for 20 days. disposition: the patient is to be discharged to home in stable condition. discharge instructions: 1. the patient is to follow-up with his primary care physician, . , in one week. 2. the patient is to follow-up with dr. in two to three weeks. 3. the patient is to follow-up with dr. in three to four weeks. , m.d. dictated by: medquist36 procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of two coronary arteries diagnostic ultrasound of heart exploratory laparotomy diagnoses: acidosis coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified unspecified protein-calorie malnutrition hyperosmolality and/or hypernatremia urinary complications, not elsewhere classified other drugs and medicinal substances causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to