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: pneumovax 23 attending: chief complaint: right carotid artery stenosis major surgical or invasive procedure: 1. cardiac cath with stent placement placement to the right carotid artery. history of present illness: ms. is a 78 year-old female with a history of hypertension, hyperlipidemia and diabetes who presents for referred for right carotid artery angiography and possible revascularization. . recently noted to have a right carotid bruit on routine exam in . on , she had a carotid duplex at the - which revealed a critical, 90% stenosis of the right internal carotid artery. no significant abnormalities were noted on the left side. she has had mild intermittent dizziness for the past few years. she also reports some positional lightheadedness in the morning, but otherwise has been asymptomatic from a neurological stanpoint. she has no history of stroke or tia. she specifically denies any motor or sensory changes, or amaurosis fugax. she does report numbness and tingling in her feet for the last several years. . the patient had her pre-carotid neurological assessment on by dr. . of note, her blood pressure during her visit with dr. was over 200 systolic. . from a cardiovascular standpoint, she does report having some exertional dyspnea. this occurs with activity such as walking one block. she denies any chest pain, pnd or orthopnea. she also denies lower extremity edema and claudication. due to her multiple risk factors, she was referred for a persantine mibi. . currently, the patient feels well with no chest pain or shortness of breath. past medical history: 1) carotid bruit--->stenosis 2) htn 3) dmii-hgalc 6.1% on at osh 4) hypercholesterolemia 5) rheumatic fever 6) hypothyroidism 7) peptic ulcer disease 8) recent urinary tract infection-on admission to osh, patient moderate leukocyte esterase and 30-40 wbc. treated with bactrim. 9) s/p thyroidectomy 10) s/p hysterectomy 11) s/p r mastectomy breast ca ) chronic renal insufficency-baseline cr of 2.0. at osh, cr trended upwards from 2.0 on admission to 2.6 at discharge. social history: social history is significant for the absence of current tobacco use; 25 pack-year history, but quit 25+ years ago. there is no history of alcohol abuse. widow. has 4 children. lives with one of her sons. currently retired and has no car. relies on ??????the ride?????? for transportation for medical care. her son can be reached at (cell). family history: there is no family history of premature coronary artery disease or sudden death. mother had a pacemaker, father died of an mi in his early 80??????s. physical exam: ht: 5 feet 3.5 inches wt 138 lbs . blood pressure was 112/71 mm hg while lying flat. pulse was 108 beats/min and regular, respiratory rate was 12 breaths/min and she was satting 99% on room air. weight 138 lbs and 63.5 inches. generally the patient was 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. . there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jvp of 2-3cm. the carotid waveform was normal. there was no thyromegaly. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. . examination of the heart revealed no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. there was a soft ii/vi systolic murmur at the left lower sternal border. . the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing or edema. there were no abdominal, femoral or carotid bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. . neurologic exam showed cn ii-xii to be intact. strength was in the upper and lower extremities bl and sensation was grossly intact in all four extremities. gait was not assessed. . pulses: right: carotid 1+ femoral 2+ dp 2+ pt 2+ left: carotid 1+ femoral 2+ dp 2+ pt 2+ pertinent results: 04:54pm glucose-146* urea n-9 creat-0.5 sodium-140 potassium-3.4 chloride-106 total co2-23 anion gap-14 04:54pm estgfr-using this 04:54pm calcium-8.6 phosphate-4.3 magnesium-1.9 04:54pm wbc-9.3 rbc-3.27* hgb-11.1* hct-30.9* mcv-94 mch-33.9* mchc-35.9* rdw-13.5 04:54pm plt count-185 cath ptca comments: initial angiography revealed a severe 90% stenosis of the right ica. we planned to treat this with pta and stenting. heparin was commenced prophylactically. a 6f shuttle sheath was advanced to the right cca. an accunet filter device failed to deliver due to severe tortuosity. the lesion was therefore crossed with a wizdom supersoft wire and exchanged for a 6.0mm spider filter without difficulty. the lesion was dilated with a 2.5mm balloon to 16atms. stenting was performed with a x40mm acculink stent postdilated with a 4.5mm balloon to 12 atms. excellent result with normal flow down vessel and 10% residual. patient remained hemodynamically stable with no neurologically symptoms. patient discharged from cath lab in stable condition. technical factors: total time (lidocaine to test complete) = minutes. arterial time = contrast injected: non-ionic low osmolar (isovue, optiray...), vol ml anesthesia: 1% lidocaine subq. anticoagulation: heparin 1000 units iv cardiac cath supplies used: - cordis, wizdom ss 300 - , quantum maverick rx 20mm - , quantum maverick rx 20mm - allegiance, custom sterile pack 5 cordis, ber, 100 - cordis, ber, 100 - cook, shuttle sheath - guidant, lo pressure inflation device - , embo shield comments: 1. abdominal aorta - type 1 arch without critical lesions 2. left carotid - the lcca is normal. the ica has mild disease without critical lesions. the ica fills the ipsilateral aca and mca with noted fetal origin pca. there is minimal cross filling of contralateral ica. 3. right carotid - the cca is normal. the ica has a tubular 90% lesion. the ica fills ipsilateral aca and mca. 4. successful stenting of right ica with a x 40mm acculink stent posdilated with a 4.5mm balloon. excellent result with 10% residual. patient left cathlab in stable condition. final diagnosis: 1. right 90% ica stenosis 2. successful stenting of right ica with a bare metal stent. brief hospital course: 1. stenosis: after stenting with no complications (see cath report above), the patient underwent serial neurological assessment that demonstrated normal neurological function. she was put on plavix for 12 months and aspirin. systolic blood pressure was maintained at above> 100 without the need for boluses or pressors. . 2. diabetes: - continued home insulin regimen . 3. hypertension: - continued lisinopril. amlodipine was added for better blood pressure control . ---fen: diabetic diet ---received subcutaneous heparin for dvt prophylaxis. medications on admission: 1. lisinopril 5mg daily 2. synthroid 75mcg daily 3. nph 35 units qam discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 3. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 5. insulin nph human recomb 100 unit/ml cartridge sig: thirty five (35) units subcutaneous once a day. 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary: right internal carotid artery stenosis secondary: hypertension, hyperlipidemia discharge condition: hemodynamically stable. neurologically intact. discharge instructions: you were admitted and had a stent placed in your right carotid artery. it will be extremely important for you to continue takingall your medications, as prescribed. please note the following changes: 1. plavix - in addition to aspirin, this helps to thin the blood and keep your new stent open. this must be taken, every day, without exception. 2. amlodipine - this is an additional blood pressure medication. followup instructions: please be sure to follow-up with dr. in 2 weeks time (). procedure: arteriography of cerebral arteries percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of breast personal history of tobacco use occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia unspecified disorder of kidney and ureter postsurgical hypothyroidism 

Answer: The patient is high likely exposed to