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 attending: chief complaint: patient being evaluated for renal transplant found to have 3 vessel disease and referred to cardiac surgery for bypass grafting. major surgical or invasive procedure: s/p coronary artery bypass grafting x4(left internal mammary-left anterior descending artery, saphenous vein graft-diagonal, saphenous vein graft-obtuse marginal, saphenous vein graft- posterior descending artery)left ventricular outflow tract mass excision() history of present illness: 69yo man with lithium induced end stage renal disease on hemodialysis, being evaluated for renal transplant. persantine mibi was positive and echocardiogram showed left ventricular outflow tract mass. scheduled for cardiac catheterization which revealed 3 vessel disease. then referred to cardiac surgery for bypass grafting prior to renal transplant. past medical history: - esrd lithium exposure and chronic interstitial nephritis on hd (recently initiated) - left upper extremity av fistula placed - normal pressure hydrocephalus s/p drain at in (no shunt seen on imaging) - hypertension - bipolar illness - anemia - h/o endocarditis with bacteremia - pulmonary lymphadenopathy - di from lithium toxicity - lvot mass social history: used to work at mfa museum in . he has been living at the since his last admission. prior to that, he had been living alone in . patient denies any alcohol use. former cigar smoking (2 per day), quit several years ago. patient is close to his niece and nephew in the area. family history: noncontributory physical exam: admission vs t bp 160/80 hr 67 rr 20 o2sat 96%-ra ht 5'8" wt 60k gen nad- appears chronically ill skin sabaceous cysts of posterior neck neck supple, no la chest cta-bilat cv rrr with 3/6 sem abdm soft, nt/+bs ext warm, well perfused. 2+ edema bilat. no varicosities neuro nonfocal exam discharge vs t 98. hr 66 sr bp 120/73 rr 18 o2sat 94%-ra gen nad neuro nonfocal exam cv rrr, no m/r/g. sternum stable, incision cdi pulm cta-bilat abdm soft, nt/+bs ext warm, 2+ bilat edema. svg site l w/steri strips-cdi skin av fistula site with thrill and bruit pertinent results: 12:53pm urine color-yellow appear-clear sp -1.007 12:53pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 12:53pm urine rbc-0 wbc-0 bacteria-none yeast-none epi-0 10:35am glucose-105 urea n-67* creat-5.7*# sodium-142 potassium-4.4 chloride-99 total co2-33* anion gap-14 10:35am alt(sgpt)-12 ast(sgot)-16 ld(ldh)-191 alk phos-73 tot bili-0.3 10:35am albumin-3.8 magnesium-2.9* 10:35am %hba1c-5.6 10:35am wbc-6.1 rbc-2.87* hgb-10.4* hct-29.4* mcv-102* mch-36.4* mchc-35.5* rdw-15.1 10:35am plt count-254 10:35am pt-15.1* ptt-30.7 inr(pt)-1.3* 05:48am blood wbc-6.4 rbc-2.63* hgb-9.3* hct-26.7* mcv-102* mch-35.5* mchc-35.0 rdw-16.3* plt ct-222 05:48am blood plt ct-222 03:27pm blood pt-16.8* ptt-37.6* inr(pt)-1.5* 05:48am blood glucose-98 urean-51* creat-5.7*# na-134 k-5.4* cl-98 hco3-27 angap-14 03:27pm blood alt-12 ast-21 ld(ldh)-170 alkphos-44 amylase-111* totbili-0.2 03:27pm blood tsh-1.2 03:27pm blood t4-4.9 t3-74* ================================================================ , d. m 69 radiology report chest (portable ap) study date of 4:33 pm reason for this examination: s/p ct removal ?ptx final report history: status post chest tube removal, question pneumothorax. chests, 1 vw compared with , the et tube, ng tube, mediastinal drains. and chest tubes have been removed. the swan-ganz catheter has been converted to a sheath, tip overlying the proximal svc. cardiomediastinal silhouette is stable. there has been partial clearing of increased retrocardiac density, with some residual patchyopacity at the left base. minimal atelectasis at right base. equivocal minimal bilateral pleural fluid. no chf, other focal opacity, or gross effusion. no pneumothorax is detected. epicardial pacing leads noted. dr. approved: sat 6:54 pm echocardiography report , (complete) done at 12:43:21 pm final referring physician information , r. , division of cardiothorac , , division of cardiothoracic , status: inpatient dob: age (years): 69 m hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: abnormal ecg. aortic valve disease. coronary artery disease. hypertension. icd-9 codes: 440.0, 424.1 test information date/time: at 12:43 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2009aw-1: machine: siemens echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: *1.5 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 50% to 55% >= 55% aorta - ascending: *3.6 cm <= 3.4 cm aorta - arch: 2.6 cm <= 3.0 cm findings left atrium: mild la enlargement. good (>20 cm/s) laa ejection velocity. no thrombus in the laa. right atrium/interatrial septum: mildly dilated ra. left ventricle: mild symmetric lvh with normal cavity size. moderate symmetric lvh. normal lv cavity size. mild regional lv systolic dysfunction. lv wall motion: regional left ventricular wall motion findings as shown below; remaining lv segments contract normally. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. simple atheroma in aortic root. mildly dilated ascending aorta. normal aortic arch diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: normal aortic valve leaflets (3). mildly thickened aortic valve leaflets. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. results were personally reviewed with the md caring for the patient. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-cpb: 1. the left atrium is mildly dilated. no thrombus is seen in the left atrial appendage. 2. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with ef 50%. the remaining left ventricular segments contract normally. 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic root. the ascending aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. 5. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. mobile mass in the subaortic region adherent to the anterior wall of the lvot. tissue density consistent with myxoma or fibroelastoma. no gradient seen. 6. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 7. there is no pericardial effusion. dr. was notified in person of the results. post-cpb: preserved -ventricular systolic function. mild mr and trace tr unchanged. no new vsd or asd. mobile mass now no longer seen. ascending and descending aorta unchanged i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 13:58 = = = = = = = = = = = ================================================================ brief hospital course: mr was admitted to on for dialysis prior to scheduled coronary bypass surgery. on he was brought to the operating room where he had coronary bypass grafting x4 with left internal mammary to left anterior descending artery, saphenous vein graft to diagonal, saphenous vein graft to obtuse marginal and saphenous vein graft to posterior descending artery. please see operative report for details. he tolerated the operation well and was transferred from the operating room to the cardiac surgery icu in stable condition. he continued to do well in the immediate post-operative period but remained intubated so that he could be dialyzed prior to extubation. on pod1 he was dialyzed and extubated successfully however he stayed in the icu for pulmonary toilet. on pod2 he was transferred to the stepdown floor for continued post-operative care. his tubes lines and drains were removed according to protocol once he was on the stepdown floor. he made slow progress in his activity tolerance and on pod4 it was decided he was stable and ready for transfer to rehabilitation at rehabilitation center. he will be dialyzed at in every t-th-sat @3:30. medications on admission: darbepoetine 100 q2wks sensipar 30' nephrocaps 1' depakote 500 qhs doxazosin 8' effexor xr 75' imdur 30' metoprolol 50" renegal 2400''' lisinopril 5' simvastatin 20' clonazepam 1 hs discharge medications: 1. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 2. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. divalproex 500 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 8. venlafaxine 75 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po daily (daily). 9. sevelamer hcl 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 10. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 13. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 14. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. discharge disposition: extended care facility: discharge diagnosis: s/p coronary artery bypass grafting x4 (left internal mammary-left anterior descending artery, saphenous vein graft-diagonal, saphenous vein graft-obtuse marginal, saphenous vein graft- posterior descending artery/left ventricular outflow tract mass excision() pmh: htn esrd on hd bipolar disorder psoriasis normal pressure hydrocephalus discharge condition: stable discharge instructions: keep wounds clean and dry. ok to shower, no bathing or swimming. take all medications as prescribed. call for any fever, redness or drainage from wounds. no powder, creqam or lotion to incision. followup instructions: dr in 4 weeks dr 2-3 weeks after discharge from rehab patient to call for all appointments procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery hemodialysis excision or destruction of other lesion or tissue of heart, open approach diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bipolar disorder, unspecified other psychotropic agents causing adverse effects in therapeutic use endocardial fibroelastosis chronic glomerulonephritis with other specified pathological lesion in kidney 

Answer: The patient is high likely exposed to