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: penicillins / inderal / fentanyl / abacavir attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization s/p stent x 2 to lad history of present illness: 49m w/antiphospholipid antibody syndrome, premature cad s/p mi x 6 (1st at age 33), family hx of premature cad, pe in ', copd with 2-4 ppd x 40 year smoking history, and hiv (diagnosed in ', on haart with cd4 133 on who presented to the ed on with 2/10 sscp on exertion associated with left arm heaviness. no n/v/sob/diaphoresis. this was similar in quality to his prior mis but much less in intensity. no cp since . pt took two sublingual nitro without relief before he alerted a passing police officer who brought him to the ed. of note, pt had inr checked on the friday before admission (3 days ago) and had an inr of 6.0. therefore, he held his coumadin and his inr on admission was 2.1 (goal 3.5-4.0). in the ed, the patient was made pain free with 3 sl nitro. ekg showed no new ischemic changes and old q waves in ii,iii and avf. pt admitted to medicine floor. had stress mibi which showed severe myocardial perfusion defect involving the entire inferior wall, partially reversible, moderate, myocardial perfusion defect involving the inferolateral and lateral walls. it was decided to conservatively manage pt given his comorbitidies, and high risk of thrombosis. on the floor , heparin was d/cd in the evening. soon after, pt developed "" sscp, diaphoresis, vomited, and with arm heaviness. ekg showed ste mi, with tombstoning in v2-v4, c/w anterior mi in lad distribution. he was urgently taken for catheterization which showed: lad-90% before d1, 70% after d1; lcx-severe pro dz, mid occlusion, collaterals from left to right; rca: diffuse disease with serial lesions to 70% just before bifurcation. his lad was stented x 2 (hepacoat proximal overlapped with zeta stent). past medical history: cad s/p mi x 6 (1st in ). s/p tpa x 2. never been stented. fhx of premature cad (1 brother with cabg at 43) antiphospholipid antibody syndrome pe in ' on coumadin h/o paroxysmal atrial fibrillation hiv with cd4 126 () on haart, diagnosed in '. vl <50 . copd/asthma hemorrhoids social history: the patient formerly worked in the restaurant, accounting business. he is currently retired. he still smokes 2 ppd but has cut down from 4 ppd for a total of 40 years. he admits to etoh on occasion but denies any iv drug use/cocaine. remote history of marijuana. he denies any occupational exposures to asbestos or other inhaled chemicals/toxins. family history: brother - cabg at age 43 father - deceased from anaphylactic reaction to bee-sting mother - with lung cancer physical exam: on admission to the medicine service: tc=95.2 p=88 bp=127/38 rr=28 94-95% on 2 liters o2 gen- nad, aox3, mildly cachectic caucasian male with temporal wasting heent - perla, eomi, wears glasses, no submandibular/anterior/posterior cervical or supraclavicular - rrr, no m/r/g lungs - ctab abdomen - soft, nt, nd + bs, no hepatosplenomegaly ext - no c/c/e, no calf tenderness/erythema pertinent results: labs on admission: 04:35pm blood wbc-5.4 rbc-3.51* hgb-14.8 hct-42.1 mcv-120* mch-42.3* mchc-35.2* rdw-15.0 plt ct-172 04:35pm blood neuts-57.7 lymphs-26.9 monos-6.5 eos-7.7* baso-1.2 04:35pm blood pt-18.4* ptt-29.4 inr(pt)-2.1 05:12am blood wbc-6.5 lymph-26 abs -1690 cd3%-80 abs cd3-1359 cd4%-7 abs cd4-126* cd8%-71 abs cd8-1199* cd4/cd8-0.1* 06:04pm blood glucose-97 urean-19 creat-1.0 na-138 k-3.8 cl-106 hco3-19* angap-17 05:12am blood albumin-4.6 calcium-9.3 phos-2.8 mg-1.8 ________________________________________ cardiac labs: 04:35pm blood ctropnt-<0.01 06:04pm blood ck(cpk)-229* 06:04pm blood ck-mb-6 06:04pm blood ctropnt-<0.01 12:00am blood ck(cpk)-255* 12:00am blood ck-mb-5 ctropnt-<0.01 12:00pm blood ck-mb-30* mb indx-4.4 ctropnt-0.75* 08:35pm blood ck-mb-19* mb indx-3.0 ctropnt-0.34* 06:25am blood ck-mb-12* mb indx-2.4 ctropnt-0.50* 08:35pm blood ck(cpk)-627* 06:25am blood ck(cpk)-495* 09:24pm blood ck(cpk)-854* ________________________________________ pmibi - 1. unchanged, minimally reversible, severe myocardial perfusion defect involving the entire inferior wall, at the level of exercise achieved. 2. unchanged, partially reversible, moderate, myocardial perfusion defect involving the inferolateral and lateral walls, at the level of exercise achieved. 3. transit ischemic dilatation and hypokinesis of the left ventricle with ef of 27%. cath -lad-90% before d1, 70% after d1; lcx-severe pro dz, mid occlusion, collaterals from left to right; rca: diffuse disease with serial lesions to 70% just before bifurcation. ra 11, rv 44/2, p/a 44/22 29 mean, pcwp 22. co 3.59, ci 1.99. brief hospital course: hospital course from admission to ccu. other per hpi. 1. cardiac a. pt with h/o 6 mis in past s/p tpa but never stented. had cp on admission, ce negative x 3 (ck 229, mb 6 peak initially). mibi showed moderate-severe partially reversible defects in inferolateral and lateral walls, which was unchanged from previous. because of the high risk of thrombosis, the decision was made to manage him conservatively. on hd #3, , he had an anterior stemi, peak ck 680. cath showed 3vd and s/p stents x 2 to lad. rfs for pt include fhx cad, htn, smoking, and antiphospholipid antibody syndrome. likely correlation between d/cing heparin and this event? mibi day prior () showed mod-severe perfusion deficits. heparin was continued after catheterization (goal 60-80) as well as integrilin for 18 hours post-cath. we continues asa, plavix, and statin (changed from pravastatin to 80 atorvastatin). pt with allergy to beta blocker in that they lead to severe pulmonary distress. pt continues to smoke and is not interested in stopping. counselled regarding this. will d/c with asa/plavix/statin/ace. b. pump- ef 27% on mibi. cath showed elevated pcwp. diuresed well after receiving lasix in lab. was on 100% nrb, successfully titrated down to nc. we continued outpt dose of lasix and prn initially, then not needed. we switched his ace inhibitor from captopril tid to lisinopril qhs. repeat echo showed: ef 25% and global hk. c. rhythm- nsr with many pvcs/ occasional couplets. monitored on telemetry. d. htn- regimen at home includes: ace inhibitor (captopril 25 tid), diltiazem , verapamil, isosorbide mononitrate. there was initially question as to why pt was on two dhp that act in the same manner. however, we discussed with outpt pcp, , and pt followed by dr. . pt has been on this regimen for years. he has been tried to be d/cd off of one leading to svt. we initially held his nitrate and diltiazem because systolic bp was in 80s. these were added back on successfully. 2. antiphospholipid antibody syndrome came in to hospital, subtherapeutic on coumadin. put on heparin gtt, but d/cd night of stemi, with subtherapeutic inr. his goal inr is 3.5-4.0 as with apla syndrome as well as a history of pe in the past ('). pt was started on coumadin 10 mg qhs; was on heparin gtt (goal 60-80) which was d/ced when inr 3.6. additionally, cta was done to look for pe and was negative (). had supratheraputic inr on day of discharge, so will decrease coumadin to 2.5 x 2 days, then restart 5mg daily. 3. copd continued home albuterol/flovent and theophylline. pt is not on home o2. 4. acute renal failure- creatinine 1.0 baseline and on admission. peak of 1.8 hd 6. likely contrast nephropathy secondary to dye from cta and cath. serum cr at time of discharge was at baseline. 5. aids: cd4: 126, hiv vl undetectable. we continue his current anti-retroviral therapy: efavirenz, lamivudine, stavudine, tenofovir was well as ppx: acyclovir, bactrim, clindamycin. 6. pulm nodule: cxr: 1.7 x 2.3 cm nodule in the rml with prior serial cts in the past given history of mac. sig for mild bronchiectasis in the right middle lobe. chest ct () shows right lung opacity with right hilar lymphadenopathy and a new rul 7 mm nodule. being followed by pulmonary as an outpt. infection (history of mac) or malignancy given his significant smoking history. plan is to follow this as an outpt. 7. h/o hemorrhoids hct remained stable without evidence bleeding. 8. psych- continued oxazepam. medications on admission: cardizem 150 mg tid captopril 25 mg tid imdur 120 mg qd verapamil sr 240 mg qd pravachol 10 mg qd furosemide 20 mg ecotrin 325 mg qd coumadin nitrostat protonix 40 mg qd oxazepam 15 mg qhs sustiva 600 gm qhs viread 300 mg qd zerit 40 mg epivir 150 mg acyclovir 400 mg biaxin 500 mg bactrim ds 800/160 mg qd theophylline er 300 mg tid flovent 220 mcg albuterol 17 gr 2 puffs tid alupent 14 gr 2 puffs qid discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. oxazepam 15 mg capsule sig: one (1) capsule po hs (at bedtime). disp:*30 capsule(s)* refills:*2* 3. efavirenz 600 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 4. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. stavudine 40 mg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*60 capsule(s)* refills:*2* 6. lamivudine 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. acyclovir 200 mg capsule sig: two (2) capsule po q12h (every 12 hours). disp:*120 capsule(s)* refills:*2* 8. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*30 * refills:*2* 9. theophylline 100 mg tablet sustained release 12hr sig: three (3) tablet sustained release 12hr po tid (3 times a day). disp:*270 tablet sustained release 12hr(s)* refills:*2* 10. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. verapamil hcl 240 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). disp:*30 tablet sustained release(s)* refills:*2* 13. diltiazem hcl 60 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 14. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 16. lisinopril 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 17. coumadin 2.5 mg tablet sig: one (1) tablet po once a day for 2 days: then take 5mg daily . disp:*69 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: st elevation anterior mi coronary artery disease congestive heart failure secondary diagnosis: hypertension anti-phospholipid antibody syndrome chronic obstructive pulmonary disease aids discharge condition: better. pt is chest pain free. he is therapeutic on his coumadin and able to ambulate well. discharge instructions: -please take your medications as directed. you have a new medicine, plavix. you need to take the plavix and aspirin every day. if you stop, this may lead restenosis of your stent. -do not do heavy lifting for two weeks. -go to your appointments below. -call your doctor and/or go to the emergency room if you have chest pain, problems breathing, shortness of breath, dizziness, arm heaviness or tingling, nauseous/vomiting, have a fever >101, or any other health concern. followup instructions: -you need to call your pcp, . () within 3-5 days of discharge for -you will need to call your pulmonologist, dr. to follow up the nodules seen on ct. provider: , m.d. where: cardiac services phone: date/time: 1:30 provider: scan where: radiology phone: date/time: 3:15 provider: breathing tests where: pulmonary function lab phone: date/time: 4:15 procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization injection or infusion of platelet inhibitor diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified human immunodeficiency virus [hiv] disease 

Answer: The patient is high likely exposed to