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: lipitor / lisinopril attending: chief complaint: shortness of breath/chest pain x 3.5 weeks major surgical or invasive procedure: coronary artery bypass grafting x4: left internal mammary artery to the left anterior descending, saphenous vein graft to the obtuse marginal, saphenous vein graft to the posterior descending artery and saphenous vein graft to the diagonal . exploratory laparotomy and liver biopsy history of present illness: 75m with a history of atrial fibrillation, htn, diastolic heart failure, esrd s/p renal transplant in , cad s/p 2-vessel pci/desx2 in , possible new inferolateral reversible defect on p-mibi in , worsening exertional cp/sob over the last month. he also complains of significant claudication symptoms. he describes the chest pain as sub-sternal, squeezing/sharp with radiation to his arms. he has been pre-medicating himself with nitroglycerin prior to exertion. he also complains of orthopnea, pnd and cough productive of whitish sputum. he has been experiencing abdominal pain for the past month (ruq) a/w mild nausea, no vomiting/diarrhea/constipation. history of mild dilation of distal aorta. no recent long travel, no recent surgeries. came to ed today because granddaughter called his cardiologist who recommended evaluation. he denies fevers, chills, and diaphoresis. in the ed, initial vitals were 99 75 155/70 18 95% ra. no new ekg changes. labs significant for tnt 0.05, ck:mb 135:3, bun/cr 35/2.2, probnp 3083 and inr 1.1. the patient was totally chest pain-free in the emergency department. patient given aspirin 81mg x 4. vitals on transfer were 58 110/85 24 96%. on arrival to the floor, the patient is borderline tachypnic and in mild respiratory distress. he is actively wheezing, complaining of orthopnea and pnd. review of systems 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, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence syncope or presyncope. past medical history: coronary artery disease acute systolic heart failure atrial fibrillation pmh: coronary artery disease s/p stents to om and lcx myocardial infarction and hypertension hyperlipidemia atrial fibrillation diastolic heart failure esrd, s/p renal transplant peripheral vascular disease h/o cmv infection c/b pancytopenia dry eye syndrome gerd h/o gastrointestinal bleed past surgical history s/p left brachiocephalic av fistula s/p l3-l4 spinal fusion social history: patient lives alone and is divorced. he has 2 children and 5 grandchildren. his granddaughter is frequently with him and helps with his meds. he has a distant smoking history, quit 20yrs ago. denies etoh and illicits. family history: brother worked with tiles and passed from lung disease at age 59. father died at age 79 of cancer. mother died at 82 of old age. other siblings alive in their 80s and otherwise healthy. no family history of early mi, arrhythmia, cardiomyopathy, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical examination: vs- t= 97.4 bp= 161/77 hr= 62 rr= 20 o2 sat=96% general- mild respiratory distress. 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 with jvp of 14 cm. cardiac- pmi located in 5th intercostal space, midclavicular line. irregular rhythm, normal s1, variably split s2. systolic murmur at rusb. no thrills, lifts. no s3 or s4. lungs- no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. diffuse wheezes. fine crackles 1/4 up lung fields. abdomen- soft, ntnd. no hsm. ruq tenderness worse with inspiration. abd aorta not enlarged by palpation. no abdominial bruits. extremities- no c/c/e. no femoral bruits. skin- no stasis dermatitis, ulcers, scars, or xanthomas. pulses- right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: echocardiogram the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the inferior and inferolateral walls. the remaining segments contract normally (lvef = 45-50 %). overall left ventricular systolic function is mildly depressed. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction c/w cad. moderate pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , regional wall motion abnormalities are new and systolic function is not as vigorous. . cardiac cath: 1. lmca and three vessel heavily calcified coronary artery disease, progressed from , with moderate in-stent restenosis of the om1 stent, mild in-stent restenosis of the av groove cx, and stable collateralized chronic totally occlusive in-stent restenosis of the rca. 2. systemic systolic arterial hypertension. 3. moderate-severe left ventricular diastolic heart failure in the setting of known mild regional left ventricular systolic dysfunction. 4. routine post-tr band care. 5. reinforce secondary preventative measures against cad, hypertension, left ventricular systolic dysfunction and diastolic heart failure. 6. suboptimal imaging due to body habitus. 7. cardiac surgery evaluation for suitability for cabg, although distal targets are not ideal. there are no lesions appealing for pci, and presence of heavily calcified lmca stenosis extending past the origin of the lad is strong relative contraindication to pci. 8. heparin infusion without bolus may be resumed in 6 hours as clinically indicated. . carotid doppler: impression: right ica with<40% stenosis. left ica with <40% stenosis. 08:45am blood wbc-7.5 rbc-2.68* hgb-8.2* hct-26.5* mcv-99* mch-30.6 mchc-30.9* rdw-20.1* plt ct-143* 03:40pm blood wbc-6.0 rbc-2.54* hgb-8.0* hct-24.7* mcv-97 mch-31.4 mchc-32.3 rdw-20.1* plt ct-130* 06:31am blood wbc-8.2 rbc-2.68* hgb-8.1* hct-25.8* mcv-96 mch-30.3 mchc-31.5 rdw-19.6* plt ct-140* 05:15am blood wbc-10.5 rbc-2.83* hgb-8.8* hct-27.8* mcv-98 mch-31.0 mchc-31.5 rdw-20.0* plt ct-156 08:45am blood pt-14.1* inr(pt)-1.3* 03:40pm blood pt-14.7* inr(pt)-1.4* 05:15am blood pt-15.2* ptt-35.7 inr(pt)-1.4* 08:45am blood glucose-161* urean-46* creat-5.4*# na-132* k-4.5 cl-94* hco3-24 angap-19 03:40pm blood glucose-131* urean-32* creat-4.2*# na-135 k-3.8 cl-97 hco3-25 angap-17 06:31am blood glucose-160* urean-77* creat-8.6*# na-131* k-4.7 cl-93* hco3-19* angap-24* 05:15am blood glucose-117* urean-62* creat-7.5*# na-135 k-4.6 cl-93* hco3-22 angap-25* 05:20am blood glucose-110* urean-47* creat-6.0*# na-133 k-4.5 cl-96 hco3-24 angap-18 brief hospital course: mr. is a 75 year old male with a history of atrial fibrillation, diastolic heart failure, hypertension, and renal transplant in , cad s/p 2-vessel pci in , possible new inferolateral reversible defect on p-mibi in , and worsening exertional heart failure symptoms over the last month. on catheterization he was found to have progression of three vessel coronary artery disease and was scheduled for bypass grafting. while his work-up was ensuing he was diuresed and his heart failure symptoms began to abate. renal saw him in consult for end stage renal disease secondary to hypertensive nephropathy. his baseline creatinine due to allograft nephropathy was 2.3-2.7. on mr. a coronary artery bypass grafting times four (lima to lad, svg to pda, svg to om, svg to diag). please see the operative note for details. he tolerated the procedure well and was transferred in critical but stable condition to the surgical intensive care unit. on the following day he was extubated and neurologically intact. he hemodialysis for hyperkalemia and fluid overload, and continued to need periodic hemodialysis post-operatively. on post-operative day three a lasix infusion was started for oliguria and fluid overload but he did not respond sufficiently to it, and by the following day he was reintubated with acute acidosis. he a left chest tube placement for 1100ml of serous drainage. he was also started on broad spectrum antibiotics with a white blood cell count of 27 thousand. he went into atrial fibrillation with a controlled ventricular response and was given beta blockers. the transplant staff was asked to consult given concern for mesenteric ischemia and an exploratory laporatomy was performed . please see the operative note for details. this procedure revealed normal intra-abdominal organs, although a liver biopsy was performed intra-operatively later indicated acute hepatic ischemia. his ex-lap wound healed poorly so a wound vac was placed to aid healing. he extubated successfully on post-operative day six. he was thrombocytopenic and was found to be hit positive. hematology was consulted as he was autoanticoagulated with an inr in the mid twos. hemodialysis was aborted after an infiltration of his av fistula. a temporary hd catheter was placed and cvvhd was performed. a serotonin assay was performed to assess for the need for anticoagulation. his sra was negative and subcutaneous heparin was started for dvt prophylaxis. the decision was made to not start coumadin for chronic atrial fibrillation, given that he was not on coumadin preop and had a history of gi bleed. his leukocytosis resolved and his antibiotics were discontinued. he had a large amount of serous drainage from his abdominal wound and this was opened by the transplant team and vac dressings were applied. by the time of discharge on pod 18, he was tolerating a full oral diet with some loose stools (c diff negative ), ambulating with assistance and his wound was healing well with eschar at the lower pole. his liver functiion tests continued to decrease. pravastatin was stopped due to elevated liver function tests and this should be restarted once lft's have normalized. calcitriol was also stopped due to an elevated phosporus by the renal transplant team. tacrolimus levels were stable and he is to continue at his current dose of 1 mg in the am and 0.5 mg q hs with tacrolimus levels to be followed. vac dressing x 2 were changed to the abdominal wound on and last hd was through left arm fistula. it was felt that the patient was safe for transfer to rehab in at this time. medications on admission: the preadmission medication list is accurate and complete. 1. pravastatin 80 mg po daily 2. allopurinol 100 mg po bid 3. tacrolimus 1 mg po qam 4. tacrolimus 1 mg po qpm 5. metoprolol succinate xl 100 mg po bid 6. arava *nf* (leflunomide) 20 mg oral daily 7. amlodipine 10 mg po daily 8. furosemide 40 mg po daily 9. calcitriol 0.5 mcg po daily 10. aspirin 325 mg po daily 11. isosorbide mononitrate (extended release) 120 mg po daily discharge medications: 1. arava *nf* (leflunomide) 20 mg oral daily reason for ordering: wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. 2. aspirin ec 81 mg po daily 3. tacrolimus 1 mg po qam 4. acetaminophen 650 mg po q4h:prn fever, pain 5. aluminum-magnesium hydrox.-simethicone 15-30 ml po qid:prn indigestion 6. calcium acetate 1334 mg po qidwmhs 7. tacrolimus 0.5 mg po qpm 8. glargine 20 units breakfast insulin sc sliding scale using reg insulin 9. metoprolol tartrate 25 mg po tid 10. neomycin-polymyxin-bacitracin 1 appl tp asdir 11. nephrocaps 1 cap po daily 12. pantoprazole 40 mg po q24h 13. quetiapine fumarate 25 mg po hs:prn sleep 14. heparin 5000 unit sc tid discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease acute systolic heart failure atrial fibrillation pmh: coronary artery disease s/p stents to om and lcx myocardial infarction and hypertension hyperlipidemia atrial fibrillation diastolic heart failure esrd, s/p renal transplant peripheral vascular disease h/o cmv infection c/b pancytopenia dry eye syndrome gerd h/o gastrointestinal bleed past surgical history s/p left brachiocephalic av fistula s/p l3-l4 spinal fusion discharge condition: alert and oriented x3 nonfocal ambulating, deconditioned sternal pain managed with tylenol sternal incision - healing well, no erythema or drainage, eschar at lower pole vac changes q 72 hours to abdominal wound - last changed discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: surgeon dr. , md phone: date/time: 1:30 cardiologist dr. at 3:20pm 7 translant surgeon:provider: md phone: date/time: 9:15 renal: dr @ 8:40 am please call to schedule the following: primary care dr. , in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization insertion of endotracheal tube hemodialysis (aorto)coronary bypass of four or more coronary arteries closed (percutaneous) [needle] biopsy of liver exploratory laparotomy pulmonary artery wedge monitoring diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery esophageal reflux intermediate coronary syndrome acute kidney failure with lesion of tubular necrosis other postoperative infection congestive heart failure, unspecified acute and subacute necrosis of liver unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases personal history of tobacco use percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia septic shock old myocardial infarction other complications due to other cardiac device, implant, and graft obesity, unspecified hypovolemia surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney heparin-induced thrombocytopenia (hit) mixed acid-base balance disorder acute on chronic combined systolic and diastolic heart failure chronic kidney disease, stage ii (mild) other pulmonary insufficiency, not elsewhere classified, following trauma and surgery body mass index 32.0-32.9, adult 

Answer: The patient is high likely exposed to