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: ms. is a 68-year-old female with cardiac risk factors including non-insulin-dependent diabetes mellitus, hypertension, hypercholesterolemia, and tobacco use, who was in her usual state of health until , when she noted an acute onset of substernal chest pain while cooking which was associated with shortness of breath. this chest pain and shortness of breath lasted for approximately five to ten minutes and resolved with rest. she did not seek medical attention at that time. on , she again had another episode of chest pain and shortness of breath while at rest, which was relieved with a baby aspirin. on , she again noted acute onset of shortness of breath without chest pain while at rest and, upon informing her family, she was taken by ambulance to an outside hospital. it was noted that her shortness of breath was not positional or related to exertion. on the day of admission to the outside hospital she had sharp upper back pain between her shoulder blades which was relieved with motrin. she at that time denied any other symptoms. she denied nausea, vomiting, chest pain, abdominal pain, lower extremity swelling, palpitations, paroxysmal nocturnal dyspnea, lightheadedness, dizziness, melena, diarrhea or constipation. upon arrival to the outside hospital, she was found to be hypoxic to 92% on oxygen saturation on room air and was started on oxygen by nasal cannula which relieved her shortness of breath. she was also given 10 mg of lasix intravenously as her chest x-ray at the time showed pulmonary edema. an ekg done at the outside hospital showed st depressions in the lateral leads, and her initial cardiac enzymes were found to have a ck of 151 with an mb fraction of 10.5 and a troponin of 3.4. she was started on a nitroglycerin drip and subcutaneous lovenox injections and was transferred to for further management and evaluation. upon arrival at the emergency department at she was given 25 mg of lopressor for hypertension, and admitted to the cardiology service for treatment of acute coronary syndrome. past medical history: 1. non-insulin-dependent diabetes mellitus for approximately two years. 2. borderline hypertension. 3. borderline hypercholesterolemia. 4. melanoma status post resection from the chin times two. medications at the time of admission: 1. metformin 500 mg once per day. 2. she was also on a nitroglycerin drip from the outside hospital. allergies: no known drug allergies. social history: the patient states that she smoked one-half pack per day for 20 years but had quit 15 years previously. she lives with her husband and has three healthy children. family history: there is no family history of coronary artery disease or cerebrovascular disease. there is an extensive history of cancer. father died of prostate cancer at age 79, mother died of multiple myeloma at age 80. physical examination on admission: the patient was found to have a temperature of 97.4, heart rate of 86 in sinus rhythm, blood pressure of 164/90 with an oxygen saturation of 96% on two liters nasal cannula. in general, she was an elderly female in no apparent distress. her pupils were equally reactive to light and accommodation with extraocular muscles intact and anicteric sclerae. her mucus membranes were dry. her neck was supple with jugular venous pressure estimated at 8 cm, 2+ palpable carotid pulses, with a question of carotid bruit versus radiation of cardiac murmur. her lung examination demonstrated rales up to one-third of her lung fields bilaterally with no wheezes. there was some left lung dullness, but no egophony or accessory muscle use. her heart showed a regular rate and rhythm with normal s1, s2, and a grade mid to late peaking crescendo-decrescendo systolic murmur heard best at the left upper sternal border and radiating to the carotids. she was found to have no rubs or gallops. her abdomen was obese, soft, non-tender, non-distended, with no hepatosplenomegaly and no palpable masses. there were no periumbilical or femoral bruits. her extremities showed + edema bilaterally up to the mid shin in the lower extremities. she had 1+ palpable dorsalis pedis and posterior tibial pulses bilaterally. on neurological examination, she was alert and oriented times three, with cranial nerves ii through xii intact and no focal motor or sensory deficits. laboratories on admission: showed a white count of 11.7 with hematocrit of 31.3 and platelet count of 267,000. chem-7 showed a sodium of 135, potassium 4, chloride 102, bicarbonate of 20, bun and creatinine of 15 and 0.5 and a blood glucose of 234. her ck at this hospital was 117 with an mb fraction of 11. electrocardiogram: ekg done at the time showed sinus rhythm at 68 beats per minute with t-wave inversions in leads v5, v6, 1 and avl, as well as in 2, 3 and avf. it was found to have poor r-wave progression. there were no st elevations or depressions noted. in comparison with the ekg from the outside hospital, the st depressions noted in the lateral leads had resolved. radiology: on chest x-ray she was found to have bilateral effusions with interstitial edema and borderline cardiomegaly. there were no infiltrates noted. ct of the chest, abdomen and pelvis was also done which showed no dissection, no pericardial effusion, bilateral mild pleural effusions and bilateral increased septal thickening. the abdomen and pelvis were found to be unremarkable. hospital course: ms. was admitted to the hospital through the emergency department to the cardiology service and was monitored for a period. during the next couple days she continued to have episodes of shortness of breath and chest pain, and a troponin which was continually monitored peaked at 21. due to her continuing instability, she was taken to the cardiac catheterization suite on hospital day three, and was found to have severe left main, left circumflex, and right coronary artery disease. she was also found to have mild left ventricular dysfunction, marked left ventricular diastolic dysfunction, moderate mitral regurgitation, and moderate pulmonary hypertension. due to her catheterization results and continued instability and symptomatology, the patient was taken to the operating room on , where she underwent coronary artery bypass graft times four. please refer to the dictated operative note for full details of this procedure. she tolerated the procedure well and was transferred postoperatively to the cardiac surgical intensive care unit. at the time of transfer, she was on a propofol drip at 10 mcg/kg/min. she was also on neo-synephrine and nitroglycerin drip to maintain her systolic blood pressure in an acceptable range. she was a-paced at 88 beats per minute and no ectopy was noted, with an underlying rhythm of 47 beats per minute. she was weaned from the ventilator and extubated late on the day of surgery which she tolerated well. on postoperative day one she continued to be a-paced at 88 beats per minute as her underlying rhythm was sinus bradycardia in the 40's. she was also continuing to require neo-synephrine drip to maintain her systolic blood pressure in the 130 to 140 range which was necessary due to her carotid artery disease. on postoperative day two, the patient was transfused one unit of packed red blood cells due to a hematocrit of 24.9 with a repeat hematocrit of 28.1. her neo-synephrine drip was also weaned to off, as her systolic blood pressure remained in the 120 to 140 range without need for the drip. she did, however, remained a-paced, as her underlying rhythm ranged between 40 and 60 beats per minute. on postoperative day three, she was noted to have some low urine output for approximately two to three hours, at which time lasix was started. she also demonstrated some lability of blood pressure, requiring neo-synephrine drip from time to time to maintain her systolic blood pressure greater than 110. she did also remain a-paced at this time. though early in the day she was tolerating fluids by mouth, later in the day she began to have episodes of nausea and vomiting, which were treated using reglan and zofran as well as phenergan. she continued to have a poor appetite and was unable to eat without vomiting. on postoperative day four she was actually found to be hypertensive with elevation as high as the 180 to 200 range of systolic blood pressure when in episodes of pain or retching associated with her nausea and vomiting. she was no longer needing to be a-paced, as her underlying rhythm was now in the 70's with normal sinus rhythm and no ectopy. her foley catheter was discontinued on postoperative day four as well. the patient continued to have active bowel sounds and was passing flatus on postoperative day five, however, she did continue to have severe episodes of vomiting and nausea. these episodes were associated with hypertension with systolic blood pressure as high as 200, and were very difficult to control. she was given intravenous labetalol and intravenous haldol to help with her increasing agitation, which helped to improve her blood pressure. she at this time refused nasogastric tube placement despite continued vomiting. the nasogastric tube was finally placed on postoperative day five, and a gastroenterology consult was obtained. possibilities for her etiology of nausea and vomiting were thought to be gastritis with gastric outlet obstruction as opposed to gastroparesis or medication effect. it was recommended by the gastroenterology service that she undergo examination by esophagogastroduodenoscopy. on postoperative day eight, the patient underwent egd, which showed a normal esophagus and duodenum, with two benign-appearing linear ulcers without visible vessels, approximately 4 and 3 cm long respectively and 8 mm wide in the body of the stomach. it was felt by the gastroenterology service that these ulcers likely represented the etiology of the patient's nausea and vomiting. the patient was continually treated on an oral proton pump inhibitor and on postoperative day eight, her nasogastric tube was clamped. she subsequently tolerated this well, and on postoperative day nine, the nasogastric tube was discontinued. in addition, on postoperative day nine, the patient on respiratory examination demonstrated decreased breath sounds at both bases, left greater than right. chest x-ray done at the time showed a large sized pleural effusion on the left, and the patient underwent sterile insertion of a left-sided chest tube with 400 cc of serous drainage. the patient's nausea slowly began to improve on postoperative day ten, and she began to tolerate solid food for the first time. at this time, there was also some question of suicidal ideation on the part of the patient and a psychiatry consult was obtained. at the time of the psychiatric consultation, the patient denied any suicidal ideation, and it was felt by the psychiatric service that she was not a risk for self harm. late on postoperative day ten, the patient was finally deemed ready and stable for transfer from the intensive care unit to the regular patient floor. the patient had progressive improvement in her ability to tolerate oral foods, and decreases in her nausea and vomiting. she also showed improvement in her level of anxiety and expressed no further suicidal ideation. by postoperative day 13, she was tolerating p.o.'s easily, and showed a much improved mental state. at this time it was deemed that she was stable and ready for discharge home with visiting nurses to continue to do wound checks, blood pressure checks and to ensure that she was tolerating a regular diet. her chest tube had been discontinued the day before without incident, and she reported no shortness of breath. at the time of discharge, the patient was afebrile with heart rate of 56 in sinus rhythm, and a blood pressure of 130/80. she did have a slightly unsteady gait, but she was cleared by the physical therapy service for discharge home with use of a cane. physical examination at the time of discharge: showed a regular rate and rhythm with a normal s1, s2 and 2/6 systolic murmur. her lungs were clear to auscultation bilaterally. her abdomen was soft, non-tender, non-distended with no hepatosplenomegaly. her sternal incision was healing nicely. she had minimal lower extremity edema. discharge medications: 1. lasix 20 mg twice per day times seven days. 2. potassium chloride 20 meq twice per day times seven days. 3. enteric coated aspirin 325 mg once per day. 4. percocet one to two tablets every four to six hours as needed for pain. 5. lopressor 50 mg twice per day. 6. captopril 75 mg three times per day. 7. protonix 40 mg by mouth twice per day. 8. metformin 500 mg once per day. 9. ascorbic acid 500 mg twice per day. 10. iron sulfate 325 mg once per day. 11. colace 100 mg twice per day. condition at discharge: stable. discharge diagnoses: 1. coronary artery disease status post myocardial infarction. 2. status post coronary artery bypass graft times four. 3. gastric ulcers times two. 4. gastroesophageal reflux disease. 5. non-insulin-dependent diabetes mellitus. 6. hypertension. 7. hypercholesterolemia. 8. melanoma status post resection times two. follow up: follow up scheduled in the clinic on _______ in two weeks' time. it was told to the patient that she should follow up with her cardiologist and primary care physician within the next one to two weeks. a follow-up appointment was scheduled with dr. in approximately four weeks' time. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage (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 injection or infusion of platelet inhibitor diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled dyspepsia and other specified disorders of function of stomach 

Answer: The patient is high likely exposed to