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: patient recorded as having no known allergies to drugs attending: chief complaint: stemi, vfib arrest major surgical or invasive procedure: cardiac catheterization history of present illness: 61 y/o m who while working at started complaining of substernal chest pain. ekg at the park showed stemi, he received aspirin 325 mg, and he was transported to the . initial systolic bp at was in the 90s. while enroute, he lost his pulse and arrested. he underwent cpr for approximately one to two minutes prior to arriving in the ed. he was intubated. in the ed, he was in vfib. at that time he received 2 shocks. he also received epinephrine and atropine x1 dose each. he also received one dose of amiodarone. a pulse was obtained and a systolic blood pressure in the 90s. he was started on levophed and dopamine prior to cath. he went into afib and then sinus tachycardia. . in the ed, initial vitals were unobtained as patient in wide complex rhythm without a pulse. see above for code sequence. . he was taken directly to the cath lab. in the cath lab, he had proximal lad occlusion with residual mid and distal disease, had placement of 2 promus stents in proximal lad, 2 cipher stents distally. placed on integrillin and heparin. stopped integrillin and heparin b/c had petechiae on legs b/l. he did have hypoxia, which was due to ventilator malfunction and cuff , he was reintubated in the cath lab. by the end of the procedure, he was weaned off the dopamine and levophed. during cath co=9, ci=4.5. required a large amount of sedation for the cath. had arterial sheath in, large bore so pulled in lab. a femoral swan catheter remained in place. . in the lab, he received an amiodarone gtt, dopamine gtt, levophed gtt, propofol gtt, bolus of succinylcholine and vecuronium, bolus of versed, bolus of heparin and integrilin and plavix 600 mg. the dopamine and levophed were weaned prior to transfer. . ros and specifically, cardiac review of systems could not be obtained as patient intubated and sedated. while in the ccu, patient dropped bp's to 70's systolic (also in the setting of sedation), and required levophed briefly. an arterial line was placed. was weaned overnight. past medical history: none/unknown social history: formerly homeless, now living in an apartment. works at park in food service. smoker, tox screen on admission negative. family history: unknown physical exam: general: wdwn male who is sedated and intubated. heent: ncat. sclera anicteric. perrl. neck: unable to assess jvp due to body habitus. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab in anterior fields. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. +petechiae on le b/l. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ neuro: posturing, perrla access: right femoral cvl/swan, left radial aline pertinent results: labs on admission: 11:20pm wbc-21.2* rbc-5.25 hgb-14.6 hct-44.0 mcv-84 mch-27.9 mchc-33.3 rdw-13.6 11:20pm neuts-92.0* lymphs-4.9* monos-2.6 eos-0.1 basos-0.3 11:20pm plt count-285 10:54pm glucose-271* lactate-3.2* 08:30pm alt(sgpt)-28 ast(sgot)-39 ck(cpk)-91 alk phos-88 tot bili-0.7 08:30pm lipase-31 08:30pm pt-13.4 ptt-19.5* inr(pt)-1.1 08:30pm blood ck-mb-notdone ctropnt-<0.01 01:13am blood ck-mb-198* mb indx-12.7* ctropnt-5.59* 05:38am blood ck-mb-239* mb indx-13.5* ctropnt-4.76* 11:00am blood ck-mb-279* mb indx-16.1* ctropnt-4.62* 04:31am blood ck-mb-251* mb indx-22.7* micro: blood culture blood culture, routine-pending inpatient urine urine culture-pending inpatient blood culture blood culture, routine-pending inpatient sputum gram stain-final; respiratory culture-preliminary inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient urine urine culture-final inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-preliminary {bacillus species; not anthracis}; aerobic bottle gram stain-final inpatient (thought to be contaminant) sputum gram stain-final; respiratory culture-final inpatient urine urine culture-final inpatient mrsa screen mrsa screen-final inpatient imaging: c cath () comments: 1- coronary angiography in this right dominant system demonstrated one vessel disease. the lmca ahd rca had no angiographically apparent disease. the lad was proximally occluded. the lcx had mild diffuse disease without angiographically significant stenoses. 2- resting hemodynamics demonstrated elevated right sided filling pressures with rvedp 18mmhg. the pcwp was elevated at 21mmhg. there was mild pulmonary arterial systemic hypertension with pasp 39mmhg. the cardiac index was preserved at 4.2 l/min/m2. the systemic arterial blood pressure was normal with sbp 119mmhg and dbp 72mmhg. 3- successful primary angioplasty of the lad with placement of 4 dess: two overlapping promus dess to the culprit lesion at proximal lad (3.0x18 and 3.0x8 mm) and two overlapping cypher dess to the mid lad (3.0x13 and 3.0x8 mm) with excellent results (see ptca comments) 4- successful closure of the rcfa (arteriotomy) with a 6f angioseal. final diagnosis: 1- one vessel coronary artery disease. 2- elevated right sided filling pressures and pcwp. 3- preserved cardiac index. 4- successful primary angioplasty to the lad with two promus des to mid vessel (culprit lesion) 5- successful ptca and stenting of the mid lad with two cypher dess 6- successful closure of the rcfa (arteriotomy) with a 6f angioseal echo (): the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. a left ventricular mass/thrombus cannot be excluded. right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is severe mitral annular calcification. mild (1+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cxr: no evidence of acute focal pneumonia, though there may be mild retrocardiac atelectatic changes. ct head: 1. left parietal hypodensity with loss of -white matter differentiation concerning for acute or early subacute infarct. 2. no intracranial hemorrhage. brief hospital course: 61 y/o m who presented with substernal chest pain, stemi and vfib arrest. . # cardiogenic shock: on admission, patient in cardiogenic shock from stemi with vfib arrest. had elevated filling pressures in the lab, co 9 and ci 4.5. intially had required levophed and dopamine to maintain bp's, weaned off within hours of leaving the lab. found to have multiple tight lesions in lad. bp improved after ptca and stents. . # coronary artery disease: patient with stemi, proximal lad occlusion with residual mid and distal disease, had placement of 2 promus stents in proximal lad, 2 cipher stents distally. started on atorvastatin 80mg daily, plavix 75mg x 1 week then 75mg daily, asa 325mg daily. metoprolol succinate uptitrated to 200 mg daily to maintain lower resting hr. . # acute systolic dysfunction, ef 40%: echo following cath showed low ef to 20% and wall motion abnormalities as above. patient started on heparin gtt, added on bb and acei as well. did not require diuresis as euvolemic on exam. ef improved to 35-40% by discharge. coumadin started for near akinetic apex, goal inr with inr 2.8 at discharge on . pt will get inr checked on at dr. office and further instructions on daily coumadin dose. . # rhythm: patient s/p vfib arrest, now in nsr. continued on amiodarone drip initially, then easily weaned off. uptitrated metoprolol succinate to goal hr of 60's-70's. . # hypoxic respiratory failure: patient noted to desat in the cath lab, thought to be in the setting of cuff and ventilator malfunction. difficulty in weaning off the vent given mental status, and required presidex to be started before this could be successfully done. two days after intubation, patient w/ copious sputum, fever to 101.8, and ?infiltrate on cxr, prompting treatment for ventilator associated pneumonia with vancomycin and zosyn. completed 5 day course iv with no further fevers or leukocytosis. dry cough thought secondary to acei use, changed to with improvement of cough. ******ct chest: there was a 1cm pulmonary nodule found in the right upper lobe. rec repeat ct chest done in 3 months as an outpatient to follow-up on this lesion. . # acute mental status changes: patient underwent cooling protocol s/p vfib arrest. also noted to be quite agitated before being weaned off ventilator, possibly from alcohol withdrawal. neuro consulted, felt this to be most c/w encephalopathy. mental status cleared completely before discharge and pt was evaluated and cleared by ot/pt. . # left parietal stroke: patient noted to have left parietal stroke on head ct following catheterization. thought to be cardioembolic in nature. maintained on heparin gtt, asa, plavix. no residual defecits noted at discharge. . # social status: pt lives alone in small room above the veterans homeless shelter in government center. he pays rent and works during the baseball season selling hot dogs. his job requires lifting and standing so pt was told not to return to work until after he sees dr. on . he has no family contact but reports many friends. smokes approx 16 cigs/day and drinks 5-6 beers/day. he was told that quitting tobacco and etoh will be crucial to his continued recovery. he has had no primary care and never took any prescriptions. doesn't cook, heats up frozen and packaged food in the microwave. extensive teaching was done about heart disease, medications, low salt diet and importance of follow-up, especially for coumadin. pt exibited limited understanding and will need continued teaching. homecare will see pt at home and close f/u was made prior to discharge. medications on admission: none discharge medications: 1. simvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 4. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily) for 6 weeks. disp:*45 patch 24 hr(s)* refills:*1* 5. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day for 2 weeks. disp:*14 patches* refills:*0* 6. metoprolol succinate 200 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* 7. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*90 capsule(s)* refills:*0* 11. outpatient lab work please check your warfarin (coumadin) level on friday during your appt with dr. . results to dr. at . discharge disposition: home with service facility: homecare discharge diagnosis: primary: st-elevation myocardial infarction secondary: hypertension tobacco abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure being involved in your care, mr. . you came to the hospital after suffering a massive heart attack and a cardiac arrest while you were working at . you had 4 drug eluting stents placed in the coronary arteries that were blocked. you also had a stroke around the same time. you received antibiotics for pneumonia and finished the 5 day course before leaving. your heart is wek after the heart attack and we have started new medicines to prevent another heart attack and help your heart recover. it is extremely important to take these medicines every day, even if you feel ok. . new medicines: 1. aspirin and plavix: blood thinners to take every day, no matter what. these medicines keep the stents from clotting off and prevent another heart attack. do not stop taking plavix or aspirin unless dr. tells you to. 2. simvastatin: medicine to lower your cholesterol levels. take every day at night. you will need to get blood tests in 6 weeks to check your liver function. 3. metoprolol: a medicine to lower your heart rate and help your heart recover from the heart attack. 4. warfarin (coumadin): a medicine to thin your blood and prevent blood clots that can lead to another stroke. you will need to get your blood checked frequently to make sure the level is not too high or too low. dr. will tell you how much coumadin to take every day. do not take your warfarin on . 5. ranitidine (zantac): a medicine to protect your stomach from the blood thinners 6. nicotine patch: to use to decrease cravings for cigarettes. use the 14 mg patch for 6 weeks, then the 7 mg patch daily for 2 weeks, then discontinue. 7. losartan to lower your blood pressure and help your heart recover from the heart attack. . ** on your ct chest, there was a 1cm pulmonary nodule found in the right upper lobe. you should have a ct chest done in 3 months as an outpatient to follow-up on this lesion. . please weigh yourself every day and call dr. if you gain more than 3 pounds in 1 day or 6 pounds in 3 days. followup instructions: primary care: , md , center, , phone: date/time: friday at 12:30pm. . cardiology: dr. phone: date/time: tuesday at 10:20pm. . ** on your ct chest, there was a 1cm pulmonary nodule found in the right upper lobe. you should have a ct chest done in 3 months as an outpatient to follow-up on this lesion. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of endotracheal tube pulmonary artery wedge monitoring right heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of four or more vascular stents diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation acute respiratory failure other specified cardiac dysrhythmias cardiogenic shock cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure ventricular fibrillation other encephalopathy cerebral embolism with cerebral infarction acute systolic heart failure acute myocardial infarction of unspecified site, initial episode of care ventilator associated pneumonia other abnormal glucose iatrogenic cerebrovascular infarction or hemorrhage chronic total occlusion of coronary artery contact dermatitis and other eczema, unspecified cause spontaneous ecchymoses 

Answer: The patient is high likely exposed to