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: aspirin / penicillins attending: chief complaint: cardiogenic shock (transfer from hospital) major surgical or invasive procedure: operative iabp placement () cardiac catheterization, tracheostomy tube placement, peg tube placement. history of present illness: 73 yof with pmh htn, hypothyroid who has been complaining of "indigestion" since and has been treated with a ppi without relief. she reports this as a 15-30 min non-radiating burning sensation, unrelated to exertion. she reportedly had a "normal" stress test at on . on the night prior to admission, she had complained of intermittent epigastric pain which became persistent around 6 pm. . around 5 am on , she reported to an osh ed c/o 11 hrs of epigastric pain. she had a bp of 191/120, hr 102, sat 91% on ra (98% on 2l n.c.), and was afebrile. an ecg (performed 90 minutes after arrival to ed) showed q-waves and st elevations in v1-v5, she had elevated cardiac enzymes (troponin peak 135, ck peak 3508) and was taken to an emergent cardiac cath. -cath, she was found to have a r-dominant system, received a bms to her proximally-occluded lad (with resultant timi-3 flow) and also was found to have ostial rca (90% stenosis) and lcx disease (50% stenosis in om1 and om2) which were not intervened upon at the time. . post-cath, had some episodes of hypoxia and hypotension to 70s. a post-cath echo showed an ef of % with anterior/septal/apical akinesis. also of note, she had persistent tachycardia and "did not tolerate" lopressor. she received digoxin for "inotropic support". she was assessed to be "on the cusp of cardiogenic shock" and was transferred to for operative placement of lvad vs iabp placement. . -op, her swan numbers showed a cvp 20, pad 25, 28, co 3.1; she had an iabp placed. an -op tee showed an lvef of 20-25% with 1+ mr. on arrival to the csru, she had map 80, cvp 20, pad 25, 28, co 3.1. past medical history: htn hypothyroid osteoporosis fibromyalgia asthma l total knee replacement r femur fx s/p rod placement social history: no tobacco/alcohol. ambulates with cane at baseline. family history: both parents died of mis in their 50s physical exam: t 98.6 bp 134/67 hr 95 pap 33/21 cvp 14 rr 12 sat 100% on vent gen: sedated, intubated heent: (+) ett, (+)og tube chest: ronchorous breath sounds throughout (ant/lat exam only) cv: regular rate/rhythm, no m/r/g heard abd: soft, ntnd, nl bs, no masses extr: cool, 1+ pt pulses, trace bipedal edema neuro: sedated pertinent results: cxr: cxr tracheostomy tube and left picc line are in standard position. cardiac and mediastinal contours are unchanged. there are worsening bilateral alveolar opacities most prominent in the central portions of the lungs with relative sparing of the apices and extreme periphery. this is most likely due to pulmonary edema particularly given waxing and course over serial prior radiographs. . tee: echo measurements: left ventricle - septal wall thickness: *1.4 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.4 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 3.4 cm (nl <= 5.6 cm) left ventricle - ejection fraction: 40% (nl >=55%) interpretation: findings: this study was compared to the prior study of . left ventricle: mild symmetric lvh with normal cavity size. apical lv aneurysm. no lv mass/thrombus. mildly depressed lvef. right ventricle: normal rv chamber size and free wall motion. pericardium: no pericardial effusion. conclusions: there is mild symmetric left ventricular hypertrophy with normal cavity size. there is an apical left ventricular aneurysm. no masses or thrombi are seen in the left ventricle (echo contrast given to exclude). overall left ventricular systolic function is mildly depressed. right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , no change. impression: no lv thrombus seen. . ecg: sinus tachycardia. prior anteroseptal myocardial infarction. compared to the previous tracing of the rate has slowed and anterolateral st segment elevation persist. otherwise, no diagnostic interim change. . mra head impression: severely limited study demonstrating absence of flow signal in the distal left vertebral artery and small basilar artery which could be secondary to fetal posterior cerebral arteries. no evidence of vascular occlusion seen in the anterior circulation. left posterior cerebral artery is not well visualized. . cardiac cath comments: 1. coronary angiography in this right dominant system demonstrated two vessel disease. the lmca had no angiographically apparent disease. the lad was mildly calcified and had mild luminal irregularities in the proximal section, followed by a widely patent stent; diffuse disease and attenuation of the lad distally. the cx had 40-50% stenosis in om1 and om2.the rca had an ostial 90% lesion and there was diffuse disease in the mid to distal segments of the rca. 2. ptca and stenting of the right coronary artery with aa 2.5 cypher des, post dilated with a 3.0 nc at the ostium; three 2.5 cypher des in the mid vessel and two 2.0 bms in the mid to distal segment. the final angiogram demonstrated no residual stenosis with no angiographic evidence of dissection, embolization or perforation with timi iii flow in the distal vessel. (see ptca comments) final diagnosis: 1. two vessel coronary artery disease. 2. multi-stent pci of the rca. brief hospital course: a/p: 73 yo woman with recent anterior mi transferred for cardiogenic shock, now s/p iabp removal on , s/p stents to rca with vap s/p trach placement , peg and new acute cva x2in the setting of hypotensive episodes and l carotid stenosis. . this 73 year old woman was transferred from after acute mi initially out of concern for lvad placement for cardiogenic shock. on arrival she was found to have intraoperative cvp 20, pad 25, 28, co 3.1 so had iabp placed. lvef 20-25% with 1+ mr. pump was weaned and removed. repeat tte showed improved lvef 40%. she was initially attempted to be extubated however shortly afterwards became stridorous and was reintubated. she was found to have pseudomonas and mrsa in her sputum and treated with vanco, ciprofloxacin, and aztreonam. she did not have rapid improvement and continued to have pseudomonas in her sputum so was desensitized to meropenem (given allergy to penicillin) and treated with that for her vap. given difficulty extubating and high rsbi's, she had trach and peg placed for longterm vent weaning. for her cad she underwent cardiac cath on which showed 90% rca lesion that was stented with 2 drug eluting stents and 4 bare metal stents. given her allergy to aspirin she was maintained on 150mg daily of plavix but was desensitized to aspirin and maintained on 325mg daily with 75mg plavix daily for her stents. . ## pump- cardiogenic shock on admission; lvef 40% on re-evaluation. - iabp d/c'ed on ; weaned off pressors readily though blood pressure quite labile and intermittantly requires pressors for map's 40-50 - tee showed ef 20-25% when rate-controlled; recheck tte much improved with lvef 40%, hypokinesis so heparin d/c'd. repeat tte with echocontrast is negative for mural thrombus however she did have evidence of apical lv aneurysm which would be an indication for anticoagulation for 3-6 months. however, given her bleeding while on heparin (into her eye, her mouth, and requiring blood transfusion, we will hold of on starting anticoagulation until the patient is more stable). - beta blocker for am only given labile bp and propensity for hypotension at night; d/c'ed captopril d/t hypotensive episodes - continue furosemide 40 mg po daily . ## cad- s/p 1 bms to lad for large anterior mi at osh (ck peak 3508 at osh); known severe (90%) ostial rca disease and 50% stenoses of om1, om2 so 2 des/4 bms to rca here - desensitized to aspirin on ; now tolerating aspirin 325mg daily - clopidogrel to 75 mg po qd; cont statin - bb restarted in am . ## rhythm- hr elevated with aggitation, but remains in sinus rhythm, on bb . ## valves- 1+ mr -op tee . ## labile blood pressure: intermittently hypotensive (map's 40's-50's) and hypertensive (sbp 200). initially thought volume depletion from diuresis plus blood loss from trach but swings without clear etiology. also noted to occasionally be brady to 50's with hypertension. ? central etiology given recent cva though time course not likely to be cerebral edema and location of cva not characteristic for autonomic dysregulation though cva may have progressed to involve insula. stim appropriate. infection/sepsis is another possible cause for her hypotension, however s/p abx for known vap. labile bp may also be co2 narcosis, however vbg pco2 during hypotensive episode did was not high enough to be concerning for co2 narcosis, no improvement with forced mv. additionally, decreasing sedation did not prevent the events. intermittent levophed required for hypotension earlier in hospital course. midodrine titrated up to 10mg po qhs. she continues to have occasional episodes of sbp as low as 70s but these are transient and she appears to be asymptomatic. neurology recommends an eeg if this persists. - if sbp < 80, re-check in 15 minutes, will likely resolve. if persists for more than 1/2 hour to one hour, consider other etiologies. . ## l frontal stroke. was initially on heparin gtt but this was stopped as it was thought to be a watershed from low blood pressure - continue asa/plavix - ideally keep sbp 120-170 - pt and rehab . ## respiratory failure- likely vap (pseudamonas, mrsa) and pulmonary eduema but both improved. now s/p trach which will make weaning from ventilator easier for pt to tolerate. failed extubation on . sputum cx with continued pseudomonas. id consulted and patient underwent meropenem desensitization. - may have had flash edema during failed extubation +/- further stress on cardiac function - albuterol and ipratropium mdis for wheezing - wean ventilator as tolerated, appreciate pulm recs who state that vent weaning may take several weeks of pulmonary rehab . ## vap; pseudomonas and s. aureus growing in sputum cx, with pseudomonas cont. despite treatment. s/p meropenem desensitization - tolerated meropenem desensitization; course of meropenem now complete on - pseudomonas coverage, d/c aztreonam and cipro - sputum cx growing pseudomonas but per id likely colonized and will hold on further antibiotics unless spikes or clinical change . ## arf: now resolved. likely etiology is contrast nephropathy given the large dye load she got in cath on - follow cr as outpatient . ## ophtho: improved subconjunctival hemorrhage heparin. no evidence of ulcer or infection. also with increased iop. - cont. cosopt 1gtt ou , lacrilube " ou tid . ## hypothyroidism: repeat tsh, free t4 wnl - cont levoxyl . ## access: picc placed . ## full code . ## contact: hcp (husband; or ); alternative shahnaz imam ( or ) . ## dispo: to trach-rehab. medications on admission: flagyl (15 d course for h. pylori +) clarithromycin (15 d for h. pylori +) toprol xl 100mg daily levoxyl 125mcg daily discharge medications: 1. acetaminophen 325 mg tablet : two (2) tablet po q4h (every 4 hours) as needed for pain. 2. levothyroxine 125 mcg tablet : one (1) tablet po daily (daily). 3. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). 4. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q4-6h (every 4 to 6 hours) as needed. 5. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 6. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours) as needed for wheezing. 7. aspirin 325 mg tablet : one (1) tablet po daily (daily). 8. dorzolamide-timolol 2-0.5 % drops : one (1) drop ophthalmic (2 times a day). 9. artificial tear with lanolin 0.1-0.1 % ointment : one (1) appl ophthalmic tid (3 times a day). 10. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 11. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 12. therapeutic multivitamin liquid : five (5) ml po daily (daily). 13. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 14. heparin lock flush (porcine) 100 unit/ml syringe : one (1) ml intravenous daily (daily) as needed. 15. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 16. metoprolol tartrate 50 mg tablet : one (1) tablet po qam. 17. furosemide 40 mg tablet : one (1) tablet po daily (daily). 18. acetaminophen 160 mg/5 ml solution : two (2) po q4-6h (every 4 to 6 hours) as needed for fever, pain, agitation. 19. ibuprofen 100 mg/5 ml suspension : one (1) po q8h (every 8 hours) as needed for pain. 20. midodrine 5 mg tablet : two (2) tablet po qhs (once a day (at bedtime)). 21. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 22. heparin (porcine) 5,000 unit/ml solution : one (1) injection injection tid (3 times a day). 23. erythromycin 5 mg/g ointment : one (1) cm ophthalmic tid (3 times a day) for 10 days. discharge disposition: extended care facility: northeast - discharge diagnosis: coronary artery disease, hypertension, cerebrovascular accident, ventilator associated pneumonia, respiratory failure requiring tracheostomy placement and peg tube placement, hypothyroidism, osteoporosis, fibromyalgia. discharge condition: stable on vent discharge instructions: please take all medications as prescribed. please keep all follow-up appointments. please notify your primary care doctor, dr. or return to the emergency department if you experience chest pain, chest pressure, shortness of breath, dizziness, nausea, vomitting, weakness, numbness, or any symptoms that concern you. followup instructions: please follow-up with your cardiologist, dr. ( within 2 weeks of discharge. . please follow-up with your pcp . at within 2 weeks of discharge. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters injection or infusion of platelet inhibitor diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy implant of pulsation balloon pulmonary artery wedge monitoring transfusion of packed cells nonoperative removal of heart assist system insertion of drug-eluting coronary artery stent(s) infusion of vasopressor agent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of four or more vascular stents diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism acute myocardial infarction of other anterior wall, initial episode of care infection with microorganisms resistant to penicillins asthma, unspecified type, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction acute respiratory failure pneumonia due to pseudomonas bacteremia cardiogenic shock osteoporosis, unspecified methicillin susceptible pneumonia due to staphylococcus aureus cerebral artery occlusion, unspecified with cerebral infarction knee joint replacement myalgia and myositis, unspecified conjunctival hemorrhage chronic passive congestion of liver 

Answer: The patient is high likely exposed to