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: metoprolol attending: chief complaint: right carotid stent placement major surgical or invasive procedure: - right sided carotid stent placement history of present illness: 84 y/o m with a history of bioprosthetic avr and cabg x 1 with lima to lad in , htn, hld, h/o skin ca, with known carotid stenosis and has been followed annually by dr. . recent testing has shown a progression in the carotid disease on his right and he was scheduled for right carotid angiography with stenting. of note, he was enrolled in the flow reversal system vs embolic filter trial. prior to procedure, he felt well and denies any neurological symptoms such as unilateral weakness/numbness, aphasia or amaurosis fugax. he states that he exercises at the gym on a daily basis. he has a prior history of slips/falls; however, his last 5 months ago. patient tolerated the procedure; however, filter could not be deployed. right carotid was very calcified at the ostium, 8.0 wall stent was placed. patient required atropine intraoperatively, given tenous blood pressure. right radial arterial line placed. he was transferred to ccu for close monitoring. after arrival to ccu, patient appears to be in no acute distress. he reports chronic back pain as well as neck pain, which he attributes to having to lay flat for an extended period of time. he denies any other complaints. in particular, he denies any numbness / tingling / weakness, visual changes, chest pain, shortness of breath. on review of systems, he 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. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. he does report long-standing stable ankle edema. past medical history: 1. cardiac risk factors: + dyslipidemia, + hypertension 2. cardiac history: - cabg: st. medical biocor aortic tissue valve with cabg x 1 with lima to lad - percutaneous coronary interventions: - pacing/icd: none 3. other past medical history: s/p tonsillectomy moderate mitral regurgitation paroxysmal atrial fibrillation bilateral carotid stenosis barrett's esophagus benign prostatic hyperterophy spinal stenosis multiple skin cancers h/o ? rheumatic fever hyponatremia - siadh though to be r/t ssri use mild depression dementia; pt reports memory has improved greatly since his surgery visual disturbance 15 years ago unclear etiology described as seeing through a milk bottle. social history: lives alone at an -newbridge on the . has an aide who helps with daily meds and showering. meds kept in a lock box. has a son, a daughter, and 2 granddaughters. formerly smoked ~5 cigars per week but quit approx 20 years ago. "moderate" etoh use (less than one drink in a week on average). family history: father had an mi at 55 but lived until age and died following an infection in his leg. no other family history of cardiac disease, sudden cardiac death, or arrhythmias. no family history of carotid disease. physical exam: admission exam: vs: t=96.6 bp=145/68 hr=68 rr=22 o2 sat=99% on ra general: 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, jvd difficult to assess. cardiac: rr, faint s1, normal s2. no m/r/g. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: cn ii-xii grossly intact aside from mild left-sided facial droop (reported to be baseline), 5/5 strength in all 4 extremities pulses: right: dp 2+ left: dp 2+ discharge exqam: unchanged from above pertinent results: admission labs: 02:48pm blood wbc-8.6 rbc-3.93* hgb-11.7* hct-31.8* mcv-81* mch-29.7 mchc-36.7* rdw-13.8 plt ct-178 02:48pm blood neuts-69.5 lymphs-20.9 monos-6.1 eos-3.1 baso-0.4 02:48pm blood pt-13.7* ptt-34.7 inr(pt)-1.3* 02:48pm blood glucose-90 urean-22* creat-1.1 na-131* k-4.0 cl-102 hco3-21* angap-12 02:48pm blood calcium-8.7 phos-3.7 mg-2.2 . imaging studies: - right carotid stent placement () 1. severe right internal carotid artery stenosis. 2. successful stenting of with 8.0x36mm wallstent with spider filter distal protection. 3. transient hypotension treated with ivf and neosynephrine 4. successful closure of right femoral arteritomy with 6f angioseal. 5. successful placement of right radial arterial line for bp monitoring. . discharge labs: 06:15am blood wbc-5.6 rbc-3.58* hgb-10.4* hct-30.4* mcv-85 mch-28.9 mchc-34.1 rdw-13.8 plt ct-132* 04:20am blood pt-13.5* ptt-26.6 inr(pt)-1.3* 06:15am blood glucose-99 urean-23* creat-1.2 na-132* k-5.0 cl-103 hco3-23 angap-11 04:20am blood ck-mb-8 06:15am blood calcium-8.8 phos-3.4 mg-2.2 brief hospital course: 84 y/o m with a history of bioprosthetic avr and cabg x 1 with lima to lad in , htn, hld, h/o skin ca, with known r carotid stenosis s/p carotid stent placement, admitted to the ccu overnight for close monitoring. . # carotid stenosis - patient was noted to have >70% proximal internal carotid artery stenosis on recent cta neck and had elective carotid stent placed on the right side. he was admitted to the the ccu after the procedure for close monitoring and bp control. arterial line was placed during the procedure and systolic bp was maintained at 120-140 for 24 hours after the stent was placed. he required phenylepherine at 0.1-0.4 mcg/kg/min to maintain these pressures. this was weaned on hd2 and he was transferred to the floor. after the procedure, there were no new neurological defecits or changes to his mental status. of note, according to prior records he has a slight facial asymmetry which was unchanged during admission. at discharge, we have held his home blood pressure medications (diltiazem, losartan and amlodipine) because of systolic bps in the 90-100s. . # cad - he did not have any chest pain during this admission and there were no ekg changes to suggest ischemic. . # anemia - hct remained stable in the low 30s during this admission. his baseline hct in our records are very variable, ranging from 28-40 over the past 1-2 years. there was no evidence of bleeding or hematoma at the right femoral access site. . # htn - as mentioned above, he had systolic bps in the 90-100s during this admission. he should restart his diltiazem, amlodipine and losartan as an outpatient if his blood pressure will tolerate these medications. . # hyperlipidemia - continued home pravastatin and niacin. . # bph - continued tamsulosin and finasteride. . # gerd and barrett's esophagus - changed omeprazole to pantoprazole given concern for potential drug interaction with plavix which was started this admission. continued on home ranitidine. . # code status this admission - full code . # transitional issues - will follow-up with interventional cardiology on . - started on plavix given stent placement. - switched omeprazole to pantoprazole because of potential interaction with plavix. - holding home antihypertensives (amlodipine, diltiazem, losartan) at discharge, should discuss with outpatient providers when to restart these medications. medications on admission: amlodipine 5 mg tablet by mouth daliy diltiazem hcl 120 mg er by mouth daily losartan 100 mg tablet by mouth once a day pravastatin 10 mg tablet by mouth daily niacin 500 mg capsule by mouth once daily aspirin 325 mg tablet by mouth once a day cholecalciferol 2,000 unit capsule by mouth daily omeprazole 20 mg capsule by mouth twice a day ranitidine hcl 150 mg tablet by mouth daily sennosides 8.6 mg tablet - 2 tablet(s) by mouth once a day tamsulosin 0.4 mg capsule by mouth once a day finasteride 5 mg tablet by mouth daily discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. senna 8.6 mg tablet sig: two (2) tablet po once a day. 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. niacin 500 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 6. pravastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. cholecalciferol (vitamin d3) 2,000 unit tablet sig: one (1) tablet po once a day. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 10. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). discharge disposition: home with service facility: senior living discharge diagnosis: primary diagnosis: . 1. carotid stenosis with right stent placement . secondary diagnoses: . 1. hypertension 2. coronary artery disease 3. paroxysmal atrial fibrillation discharge condition: level of consciousness: alert and interactive. activity status: ambulatory - independent. mental status: clear and coherent. discharge instructions: dear mr. , . it was a pleasure taking care of you during your admission to for carotid stent placement. you had a stent placed in your right carotid artery without any complications. you were admitted to the cardiac intensive care unit after the procedure for close blood pressure monitoring. you briefly required medications to maintain your blood pressure at a safe level after the stent was placed. at discharge, your blood pressure was still on the low side and some of your blood pressure medications have been stopped, as described below. . the following changes have been made to your medications: . start pantoprazole 40 mg by mouth twice daily instead of omeprazole (prilosec) start clopidogrel (plavix) 75 mg by mouth daily . stop amlodipine until you are instructed to restart it by your pcp or cardiologist stop losartan until you are instructed to restart it by your pcp or cardiologist stop diltiazem until you are instructed to restart it by your pcp or cardiologist followup instructions: in the morning (any time) please report to holding area of 4 (, ) - please tell receptionist you are here for filter follow up. . name: , s. address: , 2 west, , phone: *it is recommended that you see dr. within one week. please call his office to set up an appointment. . name: , /cardiology address: ,ste 7c, , phone: when: wednesday, , 1:00 pm procedure: arteriography of cerebral arteries injection of anticoagulant percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel procedure on vessel bifurcation diagnoses: other chronic pain anemia, unspecified esophageal reflux unspecified essential hypertension hyposmolality and/or hyponatremia atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia heart valve replaced by other means personal history of other malignant neoplasm of skin long-term (current) use of anticoagulants backache, unspecified occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction barrett's esophagus first degree atrioventricular block nonspecific low blood pressure reading cervicalgia dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to