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: keflex / procardia / morphine / iodine; iodine containing attending: chief complaint: shortness of breath, chest pain major surgical or invasive procedure: cardiac catherization history of present illness: patient is a 68 year old female with past medical history of hypertension, hyperlipidemia, congenital right-sided aortic arch staus post aorta-aorta bypass many years ago. she was transferred from an outside hospital after presenting with shortness of breath. she reports that the night prior to presentation she awoke from sleep around 11 pm with severe shortness of breath, which improved with sitting up. of note, patient reports several episodes of orthopnea and pnd over the past 3-4 weeks. she also admits to dietary indescretions with lots of salty foods over the past 4 weeks. she was very anxious and started to experience burning chest pain over her left breast with radiation to the left arm. ems was called. she was given ntg and 325 asa and taken to . there her initial vitals were: 97.7, 115/60, 79, 20, 95% ra. she was given sublingal nitroglycerin, 20 mg of iv lasix (to which she put out 300 cc urine). her labs were significant for a ddimer of 386.2 (0-230 nl), bnp 704, trop 0.02, wbc 11.6. patient was transferred to . . in ed: initial vitals were 97.7, 118, 60, 79, 19, 97% 3l nc. she was given mucomyst 600mg x1, ntg sl. of note, she became transiently hypotensive with nitroglycerin with systolic present to the 50's only briefly. she was also given levaquin 750mg iv x1, dilaudid 0.5mg iv, started on integrillin and heparin gtt. a cta was done which was negative for any pulmonary embolus. a chest x-ray showed a small bilateral effusion but no overt pulmonary edema. patient continue to have intermittent chest pain with question of st changes on ecg but negative enzymes. cardiology was consulted and patient was admitted to the medical intensive care unit. . ros: patient noted increasing ankle edema over the past 3 weeks. patient also reports increased dyspnea on exertion with climbing stairs over the same time period. denies recent fever or chills, chest pain as detailed in hpi. denies abd pain, reports urinary frequency but no dysuria. no weight gain/loss. past medical history: - hypertension - hyperlipidemia - cad (1 vd 60% stenosis of d1) - congenital right-sided aortic arch, status post aorta/aorta bypass surgery at 27 y.o. also status post stenting of the aorta/aorta bypass graft in (3 stents in aorta-aorta bypass), restenosis in req. ptca/stentin, and stenting of coarctation of the aorta in . - laproscopic cholecystecomy - right sided aortic arch, aberrant left subclavian. - seasonal asthma and bronchitis. - tonsillectomy social history: no smoking, occasional alcohol, no drug use. patient is married and lives with her husband and children. family history: the patient's father had a cerebrovascular accident at the age of 60. her mother had lung cancer and cardiac surgery. physical exam: vs: temp: 98.9 bp: 115/57 hr: 77 rr: 21 95% on venti-mask 50% gen: anxious, sitting up in bed, ventimask in place. heent: dry mucous membranes, eomi. neck: jvd elevated at 90 degrees resp: bilateral rales way up, soft expiratory wheezes cv: iii/vi holosystolic murmur throughout precordium abd: nt/nd, normoactive bs, soft ext: 1+ bilateral dp, 1+ bilateral pitting edema at ankles. skin: no rashes/no jaundice pertinent results: : cardiac catherization comments: 1. coronary angiography of this right dominant system revealed mild single vessel coronary artery disease. the lmca, lad, and lcx had no angiographically evident flow limiting stenosis. the rca was a dominant vessel with a distal 40% lesion. 2. supravalvular aortography revealed known right sided aorta. previously placed stent in the native aortic arch coarctation is widely patent. aorta-aorta bypass graft is widely patent except at the origin, which has a 40-50% in stent restenosis. 3. resting hemodynamics revealed mildly elevated right sided filling pressures, with rvedp of 14 mm hg. pa systolic pressure is mildly elevated at 43 mm hg. mean pcwp is 14 mm hg. a modest 20 mm hg gradient is present across the native aortic coarctation. cardiac index is preserved at 3.32 l/min/m2. 4. nipride infusion to a maximum dose of 1.0 mcg/kg/min resulted in a decline in gradient between ascending and descending aorta to 10 mm hg and lvsp decline to 110 mm hg. the patient remained asymptomatic for the duration of the study. final diagnosis: 1. mild single vessel coronary artery disease. 2. 40-50% isrs of proximal aorta-aorta graft stent. remaineder of ao-ao graft stents are widely patent. 3. widely patent native aortic arch coarctation stent. 4. recommend aggressive blood pressure control; goal rue bp 100 mmhg or lue bp 90mm hg, which corresponds to lvsp of 120 mm hg. titrate to maximal dose; if rue bp remains over 120 mm hg with exertion begin clonidine 0.1 mg daily as tolerated. . cta : impression: 1. no pulmonary embolism within central through segmental branches. subsegmental evaluation is limited due to motion. there is no acute aortic pathology. 2. status post stent placement through and bypassing right aortic arch coarctation. 3. small bilateral pleural effusions with associated atelectasis. cannot exclude superimposed pneumonia within the left lung base. . transthoracic conclusions no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-10mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. increased velocity consistent with a significant gradient/coarctation at the distal aortic arch. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , lvot obstruction is no longer present. coarctation of the aorta is now appreciated. brief hospital course: patient is a pleasant 68 year old female with past medical history of hypertension, hyperlipidemia, and congential right-sided aortic arch s/p bypass and multiple stents who presents with chest pain and shortness of breath. . #. coronary artery disease: patient has no known occlusive coronary artery disease. she was continued on 81 mg of aspirin for prevention. her cardiac enzymes were negative throughout her stay and she was ruled out for a myocardial infarction. it was felt that her chest pain was in large part due anxiety causing much increased left-sided pressures due to her anatomy and hemodynamics. she was given ativan and sublingual nitroglycerin cautiously as tolerated by her blood pressure. she had no pain for several days prior to discharge. . #. congestive heart failure: patient's presentation was consistent with volume overloaded state in the setting of dietary indiscretion and a lot of salt intake. this was supported by an elevated bnp, as well as a history of pnd and dyspnea. she responded well to gentle diuresis. an echo completed today revealed normal lvef with unusually small lv cavity, mild symmetric lvh, and coarctation of the aorta. prior studies have demonstrated diastolic dysfunction. at time of discharge, she appeared euvolemic without any dyspnea, elevated jvp, edema, or rales on exam. she was maintained on a low salt diet. a beta-blocker was continued, and losartan was initiated and titrated upward. she was discharged on 12.5 mg of hctz daily, instead of 25 mg on monday/wednesday/friday. importance of a low salt diet was stressed and dietary education was reviewed. . #. rhythm: she remained in normal sinus rhythm throughout her stay. . #. coarctation, right-sided aorta, prior bypass: patient's stents are patent as noted in catherization report. based on the data and information obtained in the catherization lab, due to her anatomy and hemodynamics, her left arm blood pressures were consistently points lower than her right due to a hypoplastic segment. in the setting of worsening anxiety, her left ventricular pressures rise significantly, which are not reflected in her blood pressure (especially left arm). for this reason, a goal blood pressure of left arm around 100 systolic (110s with exertion) and right arm around 90 systolic would be optimal. - plavix was continued - blood pressure management was stressed as noted below. . #. hyperlipidemia: her home dose of atorvastatin was continued. . #. hypertension: patient was continued on a betablocker, but was switched to toprol xl 100 mg daily due to her renal insufficiency. her home dose of amlodipine was continued. her hctz was increased to daily at a dose of 12.5 mg. she was initated on losartan which was titrated up to the maximum dose. given that her blood pressure was still above goal, clonidine was recommended, but patient stated she had not tolerated this medication well in the past. she was therefore initiated on hydralazine 25 mg every 8 hours, with improvement in her blood pressures to goal, using measurements from her right arm. . #. renal insufficiency: patient was given pre and post cath hydration fluids, and her creatinine remained at 1.3 to 1.5, which appears to be within her baseline. . #. dispo: patient was assessed by physical therapy and felt to be safe for discharge. she will follow up with dr. within a few weeks after discharge. medications on admission: - atenolol 100 qdaily - lipitor 5mg qdaily - plavix 75 mg qdaily - hctz 25mg mwf - norvasc 10mg - asa 81mg daily . allergies: keflex (rash), procardia (pre-syncope), morphine (hallucinations) discharge medications: 1. atorvastatin 10 mg tablet sig: 0.5 tablet po daily (daily). 2. losartan 50 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. amlodipine 5 mg tablet sig: two (2) tablet po bid (2 times a day). 5. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 8. hydralazine 25 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: - dyspnea, hypertension secondary diagnoses: - coarctation of the aorta - congential right-sided aorta s/p bypass - hyperlipidemia discharge condition: stable, ambulating without assistance, without pain. discharge instructions: you were admitted due to shortness of breath and chest pain, and transferred here for further evaluation and work-up. you underwent cardiac catherization and it was found that your stents were all patent. it was felt that elevated blood pressure and anxiety were likely a large part of your symptoms. . please contact your primary care physician, , or go to the emergency room if you experience any chest pain, shortness of breath, palpitations, fever, chills, headache, dizziness, bleeding, leg or groin pain, or other concerning symptoms. . the following changes have been made to your medications: 1. atenolol 100 mg has been changed to toprol xl 100 mg. 2. hydralazine 25 mg three times a day has been added. 3. losartan 100 mg daily has been added. followup instructions: please follow up with dr. at an appointment made for you on at 2:00 pm. the number for the office is . . follow up with your primary care physician as needed. . provider: phone: date/time: 1:00 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of right heart structures diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia unspecified disorder of kidney and ureter 

Answer: The patient is high likely exposed to