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: the patient was initially seen by dr. in his office on . the patient is a 78 year old insulin dependent diabetic who underwent emergency renal artery bypass graft secondary to acute renal failure and left carotid endarterectomy was done at that time. at the time that her initial surgery was done she had carotid disease on the right of 80 to 99%. she denies any symptoms. she is now admitted for elective carotid endarterectomy. past medical history: significant for acute renal failure requiring hemodialysis in and bilateral renal artery stenosis, coronary artery disease with a positive p-mibi with apical posterolateral wall changes, carotid disease with bilateral carotid stenosis of 90%, hypertension, congestive heart failure, chronic obstructive pulmonary disease, fvc with 52% of predicted value, fev 1 58% predicted value and fev 1/fvc ratio was 111% of predicted value. past surgical history: right aortorenal bypass graft with endarterectomy, right hickman catheter placement for dialysis, right renal biopsy, aortic valve replacement in , bilateral cataract surgery and left carotid endarterectomy. medications: humalog 75/25 38 units q. am and 20 units q. pm, aspirin 325 mg one q.d., combivent puffs 2 b.i.d., vasotec 20 mg q.d., lopressor 100 mg b.i.d., cardura 8 mg q.d., lasix 40 mg q.d., lipitor 20 mg q.d. and multivitamin tablet. allergies: percocet and cardizem, actual reaction unknown. physical examination: vital signs, blood pressure is 130/60, heartrate 80 and regular, respirations 18. head, eyes, ears, nose and throat examination shows pupils are equal, round, and reactive to light and accommodation. extraocular movements intact. fundi were not visualized. neck is supple. carotid bruits are noted with endarterectomy scar on the left. lungs are clear to auscultation without rales, rhonchi or wheezes. heartsounds are distant. there is no significant murmurs or gallops. abdominal examination is obese without guarding, rebound or rigidity. there are no abdominal bruits or abdominal pulsations appreciated. extremities reveal no cyanosis, clubbing or edema. neurological is unremarkable. hospital course: the patient was admitted to the preoperative holding area on . she underwent a right carotid endarterectomy. she was transferred to the post anesthesia care unit in stable condition. she required intravenous nitroglycerin for systolic blood pressure control. she was begun on beta blockers and she was transferred to the vascular intensive care unit for continued monitoring and care. postoperative day #1 there were no overnight events. ambulation was begun and diet was progressed as tolerated. on the evening of postoperative day #1 she had an onset of respiratory distress. cardiology was consulted regarding management of the patient. their recommendations were that the patient may have mild congestive heart failure, secondary to intraoperative intravenous fluids. no evidence for pulmonary embolus or acute bowel dysfunction. the patient should be ruled out for myocardial infarction. an echocardiogram should be done to rule out for any new systolic dysfunction or valvular dysfunction. monitor oxygen saturations. discontinue sedatives. continue with intubation. review chest x-ray. postoperative hematocrit was 31.6 with a white count of 11.5, bun 29, creatinine 1.9, potassium 5.1. initial cpk 77 seconds was 963 with an mb of 15, ratio 1.6. third set of cpks were 13,037 with mb of 16, ratio of 1.2, troponin less than 0.3. arterial blood gases were 7.18, 79, 148, 31. chest x-ray was unremarkable. the patient was transferred to the critical care unit intubated. transesophageal echocardiogram was done which showed normal functioning of the aortic valve and the stress test was negative for ischemia. the patient was begun on nitroglycerin for systolic blood pressure rate of 160. oxygen saturation remained 98% intubated. electrocardiogram showed sinus rhythm with st depressions in v3 and 6. the patient remained intubated over night. on postoperative day #2 the patient was diagnosed with a non-q wave myocardial infarction. considerations for cardiac catheterization were being made. she remained in the surgery intensive care unit. she remained on ventilator support. she remained npo, discontinued on intravenous heparin. she remained in the surgery intensive care unit. nutritional service was to follow the patient and added boost to her diabetic diet. on postoperative day #3 she was transfused with 1 unit for a hematocrit of 28, post transfusion hematocrit was 30.1, bun and creatinine remained stable at 29 and 1.7. temperature maximum was 101, defervesced 98.6, she will be recultured as she respiked. aspirin, heparin and beta blockers were continued. her postoperative day #3 troponin level peaked at 7.4. she required 2 units of packed red blood cells for her hematocrit of 30.1. bun and creatinine remained stable. the patient remained on simv. she was difficult to wean. neck incision showed a small hematoma without change and no active bleeding. she remained in the surgery intensive care unit. the patient had a left subclavian line placed on postoperative day #3 for monitoring. on postoperative day #4 there were no acute over night events. post transfusion hematocrit was 34.1, bun 26, creatinine 1.5, potassium 4.4, goal ptt was between 60 and 70. on postoperative day #5 the patient was extubated. her hematocrit remained stable at 35.2. her neck hematoma remained stable. p.o. were instituted. bed to chair was begun. pulmonary consult was placed on because of postoperative respiratory failure. the patient with underlying chronic obstructive pulmonary disease. the patient's respiratory decompensation was related to narcotics and benzodiazepines even though she was a non-carbon dioxide retainer. recommendations were discontinue narcotics and benzodiazepines. haldol prn for agitation, get the patient up in a cardiac chair to promote diaphragmatic movement, monitor intakes and outputs and keep her on the negative side, goal oxygen saturations are 92 to 95%. they recommended starting serevent 2 puffs b.i.d. and combivent multidoser inhaler or nebulizers q. 4 to 6 hours. continue to use the bipap, but would not use if required further sedation. they felt that she would probably require a sleep study on an outpatient basis once she is discharged. the patient continued to progress. she was transferred to the regular nursing floor on postoperative day #6. physical therapy evaluated the patient and felt that the patient would benefit from rehabilitation for increased dependent ambulation, mobility and pulmonary care. post extubation gases were 7.37, 59, 83, hc was 30. i felt that the patient continued to show metabolic alkalosis secondary to sedation diuresis, now markedly improved the hypoxia is likely secondary to resolving atelectasis. this should improve post rehabilitation. if it persists, then she may require home oxygen, this can be determined at the time the patient goes to rehabilitation. case manager was requested to begin rehabilitation screening prior to transfer to rehabilitation. we will rediscuss with cardiology the need to investigate her coronary artery anatomy. at the time of transfer, the patient was in stable condition. the right neck wound was without hematoma, skin edges intact. discharge medications: doxazosin 8 mg q.d., lasix 40 mg q.d., insulin 6 dosing, please see insulin flow sheet, insulin sliding scale, please see insulin flow sheet, cepacol lozenges one p.o. prn, albuterol sulfate/ipratropium puffs 1 to 2 inhaler q. 6 hours prn, acetaminophen 325 mg q. 4-6 hours prn, subcutaneous heparin 5000 units q. 12 hours, aspirin 325 mg q.d., atorvastatin 10 mg q.d., mepropolol 100 mg b.i.d., hold for systolic blood pressure less than 100, heartrate less than 60, protonix 40 mg q.d., enalapril 20 mg q.d. discharge diagnosis: 1. right carotid stenosis, asymptomatic status post right carotid endarterectomy 2. right neck hematoma, stable 3. blood loss anemia, corrected 4. respiratory failure, secondary to underlying chronic obstructive pulmonary disease, narcotics and benzodiazepines, corrected 5. chronic obstructive pulmonary disease 6. type 2 diabetes, insulin-dependent, stable 7. hypertension, stable , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified endarterectomy, other vessels of head and neck diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified hematoma complicating a procedure occlusion and stenosis of carotid artery without mention of cerebral infarction alkalosis acute myocardial infarction of unspecified site, initial episode of care 

Answer: The patient is high likely exposed to