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: ace inhibitors / neosporin attending: chief complaint: substernal chest pain major surgical or invasive procedure: five vessel coronary artery bypass grafting utilizing left internal mammary artery to left anterior descending artery with vein grafts to diagonal, obtuse marginal, pda and plv. history of present illness: ms. is a 67 year old obese female with history of dm2 and htn (with no medical care) who presented to an osh with substernal chest pain. she has had substernal chest pain increasing in frequency and intensity since early . this is typically a crushing substernal pain in severity, but 2 days prior to this admission it reached in severity while at rest, prompting her to call her son and go into the at . this pain radiated as it usually does to her neck and shoulders but not her arms. this time as every time she experienced no shortness of breath, diaphoresis, or nausea. as noted above, this has increased in frequency; initially, it occurred 2-3 times per week, but recently (in the last week) has occurred 2-3 times per day. she is unable to describe typical conditions that provoke it, saying it may occur with exertion or at rest. notably, she has not seen a doctor in years and self-discontinued her medications, including levoxyl and diuril and her diabetes medications. she stopped taking zestril due to a cough. she has not been checking her fs glucose recently and had not had her cholesterol checked. after admission to , troponin i came back positive on the 2nd set: 0.17 -> 0.80 -> 0.67. her ck remained flat (58 -> 74 -> 68). ekg there showed nsr at 68 with twi in i, avl, and v2-v6 with 1 mm std in v4-v6. she was chest pain free at that time, so elective cath was planned. however, on the morning of transfer to , she developed crushing sscp, again like her previous episodes but more severe. this was unrelieved with 3 sl ntg and nitropaste 2 inches. she was given lopressor 5 mg iv x3 and 25 mg po, 2 mg iv morphine, 0.5 mg iv digoxin, asa 325, lovenox 80 mg sq, and plavix 300 mg po. she was also noted to have developed atrial fibrillation which converted with the lopressor. transfer was urgently transferred to the . cardiac review of systems is notable for absence of chest pain (currently), dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. on admission, she was chest-pain free without dyspnea, nausea, or diphoresis. she 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. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems are negative. past medical history: acute mi(nstemi), type ii diabetes mellitus, hypertension, hypothyroidism, paroxysmal atrial fibrillation, obesity, s/p gastroplasty , ?hypothyroid-was on levoxyl in past, stopped taking it prior to this admission social history: retired from an administrative desk job. she lives with her grandson. social history is significant for remote tobacco use - smoked 2 packs per week but quit 25 years ago. there is no history of alcohol abuse. family history: father had first mi in early 60s and died at age 83 after a bypass surgery. physical exam: admission: bp 143/74 hr 60 (reg) rr 18 temp 99f o2sat 99%2l fs 233 wt 185# gen: well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. heen: no xanthalesma, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, jvp of 6 cm. chest: no chest wall deformities, scoliosis or kyphosis. pulm: respirations were not labored and there were no use of accessory muscles. ctab, normal bs and no adventitial sounds or rubs. cor: 2/6 sem at lusb. pmi located in the 5th intercostal space, mid clavicular line. no thrills, lifts or palpable s3 or s4. normal s1s2, no rubs, clicks or gallops. abd: no hepatosplenomegaly, nt, soft, nd ext: no pallor, cyanosis, clubbing or edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: no abdominal, femoral or carotid bruits. right: carotid 2+ femoral 2+ dp 3+ pt 2+ left: carotid 2+ femoral 2+ dp 3+ pt 2+ discharge vs: t98 hr80sr bp 147/80 rr18 o2sat 94%ra gen: nad neuro: a&ox3,mae,nonfocal exam pulm: cta bilat-anterior exam cv: rrr, s1-s2, sternum stable incision with steri strips cdi abdm: soft, nt/nd/nabs ext: warm well perfused. trace pedal edema-bilat. bilat evh harvest sites cdi thigh eccymotic pertinent results: 03:10pm blood wbc-9.9 rbc-4.21 hgb-12.9 hct-37.1 mcv-88 mch-30.5 mchc-34.7 rdw-14.1 plt ct-321 03:10pm blood pt-11.7 ptt-32.6 inr(pt)-1.0 03:10pm blood glucose-161* urean-22* creat-1.0 na-140 k-4.1 cl-104 hco3-25 angap-15 03:10pm blood ck(cpk)-77 03:10pm blood ck-mb-notdone ctropnt-0.18* 06:30am blood ck-mb-notdone ctropnt-0.14* 05:26pm blood %hba1c-8.4* -done -done 06:30am blood triglyc-158* hdl-48 chol/hd-4.3 ldlcalc-127 03:10pm blood tsh-11* 06:10am blood free t4-0.81* 06:30am blood free t4-0.89* cardiac catheterization: 1. selective coronary angiography showed a right dominant system with 30% distal lmca stenosis. the lad had long diffuse mid vessel lesion btween d1 and d2 which were small caliber vessels. lcx had a 40% ostial stenosis and 70% om1 stenosis. rca had a proximal 30% lesiona nd a 70% pda and 60% pl branch lesions. 2. left ventriculography showed preserved ejection fraction without mitral regurgitation and with mild anterolateral hypokinesis. 3. limited hemodynamic assessment showed elevated systemic aortic pressures and elevated left sided filling pressures. 06:40am blood wbc-10.8 rbc-3.23* hgb-10.3* hct-29.3* mcv-91 mch-31.8 mchc-34.9 rdw-14.5 plt ct-339 04:23am blood pt-12.3 ptt-25.9 inr(pt)-1.1 06:40am blood glucose-128* urean-24* creat-1.0 na-141 k-4.5 cl-104 hco3-28 angap-14 medical condition: 67 year old woman with nstemi, s/p cabg reason for this examination: interval changeplease do at 0730. thank you. pa and lateral chest radiographs. indication: 67-year-old female status post cabg for assessment of interval change. comparison: .cardiology report echo study date of cardiac echo patient/test information: indication: left ventricular function. intra-op tee for cabg height: (in) 60 weight (lb): 185 bsa (m2): 1.81 m2 bp (mm hg): 120/56 hr (bpm): 64 status: inpatient date/time: at 08:33 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw01-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. r. measurements: left atrium - long axis dimension: 4.0 cm (nl <= 4.0 cm) left atrium - four chamber length: 4.6 cm (nl <= 5.2 cm) left ventricle - inferolateral thickness: 1.1 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.5 cm (nl <= 5.6 cm) left ventricle - ejection fraction: 40% to 45% (nl >=55%) aorta - ascending: 2.7 cm (nl <= 3.4 cm) aorta - arch: 2.3 cm (nl <= 3.0 cm) aorta - descending thoracic: 1.9 cm (nl <= 2.5 cm) interpretation: findings: left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. normal lv cavity size. mildly depressed lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. focal calcifications in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. no as. no ar. mitral valve: mildly thickened mitral valve leaflets. no ms. mild (1+) mr. tricuspid valve: mild tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: trivial/physiologic pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. see conclusions for post-bypass data conclusions: pre-bypass: 1. the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed. focal hypokinesis is seen in the anterior and anteroseptal apex and mid walls. 3. right ventricular chamber size and free wall motion are normal. 4. there are focal calcifications in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. there is no aortic valve stenosis. no aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 7. there is a trivial/physiologic pericardial effusion. post-bypass: pt is being a paced and is on an infusion of phenylephrine 1. lv systolic function appears improved. rv function is preserved. 2. aorta is intact post decannulation. 3. other findings are unchanged. findings: the patient is status post median sternotomy and coronary artery bypass grafting. since the previous study, there has been interval removal of a right internal jugular central venous catheter. there is no evidence of pneumothorax. there are small bilateral pleural effusions, not significantly changed from previous study. there continues to be opacity at the left base, most consistent with atelectasis, however, given the slight interval worsening, an infectious process cannot be entirely excluded. pulmonary vascularity is not enlarged. there remains a small focus of plate-like atelectasis in the left upper lung field. impression: 1. small bilateral pleural effusions. 2. left basilar opacity, most consistent with atelectasis, however, given interval increase, an infectious process cannot be entirely excluded. brief hospital course: patient was admitted to cardiology with nstemi. she underwent cardiac catheterization on . coronary angiography revealed severe three vessel coronary artery disease. left ventriculogram showed normal left ventricular function without mitral regurgitation.( see result section for more specific details). based upon the above results, cardiac surgery was consulted and further evaluation was performed. workup was unremarkable and she was cleared for surgery. on , dr. performed five vessel coronary artery bypass grafting. for further details, please see seperate dictated operative note. following the operation, she was brought to the csru for invasive monitoring. within 24 hours, patient awoke neurologically intact and was extubated without incident. she maintained stable hemodynamics as beta blockade was resumed. her csru course was otherwise uneventful and she transferred to the sdu on postoperative day two. once on the step down floor the patients activity level was advanced with the assistance of the nursing and physical therapy staff, on pod 5 it was decided the patient was stable and ready for discharge home with visiting nuses visits. medications on admission: current medications on transfer: aspirin 325mg qday lopressor 25mg lovenox 80mg q12h nitroglycerin paste 1 inch q6h glucophage 500mg discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*100 tablet, delayed release (e.c.)(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 4. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain. disp:*45 tablet(s)* refills:*0* 6. furosemide 20 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 weeks: x 1 week then 20mg qd x 1 week. disp:*21 tablet(s)* refills:*0* 7. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po q12h (every 12 hours) for 2 weeks: x 1 week then 20meq qd x 1 week. disp:*42 capsule, sustained release(s)* refills:*0* 8. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). disp:*1 canister* refills:*2* 9. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 canister* refills:*2* 10. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: s/p cabgx5() pmh: acute mi(nstemi), coronary artery disease(s/p cabg), type ii diabetes mellitus, hypertension, hypothyroidism, paroxysmal atrial fibrillation, obesity, s/p gastroplasty discharge condition: good discharge instructions: patient may shower, no baths. no creams, lotions or ointments to incisions. no driving for at least one month. no lifting more than 10 lbs for at least 10 weeks from the date of surgery. monitor wounds for signs of infection. please call with any concerns or questions. followup instructions: dr. in weeks, pt to call for appt() local cardiologist, dr. in weeks, call for appt local pcp weeks, call for appt clinic , call for appt re: education procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization (aorto)coronary bypass of four or more coronary arteries transfusion of packed cells transfusion of other serum transfusion of platelets continuous intra-arterial blood gas monitoring diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery unspecified essential hypertension intestinal bypass or anastomosis status diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation personal history of tobacco use family history of ischemic heart disease personal history of noncompliance with medical treatment, presenting hazards to health epistaxis 

Answer: The patient is high likely exposed to