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: chest pain major surgical or invasive procedure: 1. intra-aortic balloon pump placement 2. cardiac catheterization with left main coronary artery bare metal stent placement history of present illness: the patient is a 79-year-old male with history of prior cva, hypertension, cirrhosis and prior nstemi which was treated medically in who presents now as a transfer from osh with a new nstemi. he has been complaining of epigastric pain and "heart burn" for 5 days leading up to this admission. he had associated chest pain radiating to his jaw and bilateral arms for several days, almost continuously but waxing and in intensity. he states that he felt better with burping, and his pain worsened after eating food. he denies any shortness of breath, chills, or sweats. the patient presented to osh and was found to have elevated troponins to 2.0 with ck of 103. cxr showing mild pulmonary edema. the patient was treated as an nstemi protocol with heparin, , load and he was then transferred to for further management. aditional review of his ekg at revealed normal sinus rhythm but prominent st segment depressions in i, ii, avl, v5-v6 and st segment elevations in leads avr and v1. after admission, the patient was observed on telemetry in preparation for a cardiac catheterization. he was given ongoing therapy with , , statin, beta-blocker, and iv heparin. overnight, he triggered for hypotension and was given fluid bolus of 500cc x2. he remained chest pain free initially but had recurrent chest pain in the early morning hours requiring iv morphine. in the cardiac cath lab, a right heart catheterization demonstrated ra pressure of 19 mmhg,rvedp 21 mm hg, pasp 51 with a mean of 39 mm hg and pcwp 34 mm hg. fluids were discontinued and mr. was given 40mg iv lasix. on left heart catheterization, the lmca had a distal 90% stenosis at the trifurcation of the ramus intermedius, lad, and lcx. the lad had mild diffuse disease with a large d1. the lcx had an om1 with diffuse 90% proximal stenosis. the rca was totally occluded proximally with faint left-right collaterals. resting hemodynamics revealed elevated right and left-sided filling pressures consistent with cardiogenic shock. the cardiac output was 4.2 l/min with an index of 2.0 l/min/m2 and left ventriculography was deferred with plan to stabilize patient with iabp and consider stent or cabg at later time. ultimately, the patient underwent stent placement on with stent placed across lad to distal left main coronary artery. outcome showed an improvement to 30% obstruction at trifurcation vs. prior 90% blockage, with a timi 3 result. . on arrival to ccu, patient was chest pain free and had no shortness of breath. he was lying flat in bed on 4l nc. he denied any back, groin pain, le pain. on review of systems, he denied any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. he denied exertional buttock or calf pain. all of the other review of systems were negative. past medical history: nstemi () cva gout cirrhosis - alcoholic, no biopsy, no known h/o varices or complications from his liver disease. dementia htn osa macular degeneration . cardiac risk factors: dyslipidemia, hypertension cardiac history: nstemi prior percutaneous coronary intervention: none pacemaker/icd:none social history: the patient lives in and is dependent in adl's and iadl's and is cognitively very intact. he denies any history of smoking, current etoh use or any history of drug use. family history: no premature cardiac disease in family, noncontributory family history. physical exam: vs - afebrile, t 98.4, iabp augmented diastolic bp 105/50, hr 82, sao2 95% 4l nc, rr 20 gen: no acute distress, well-developed and well-appearing middle aged male. alert and oriented to person, place and time. mood, affect appropriate. speech mildly slurred (without dentures) . heent: conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. perrl, eomi. neck: thick neck, supine, 8cm jvd. cv: pmi located in 5th intercostal space, midclavicular line. rrr, balloon pump on 1:1. chest: no chest wall deformities, scoliosis or kyphosis. respirations were unlabored, no accessory muscle use. cta anteriorly, decreased b/s at bases. abd: soft, ntnd. no hsm or tenderness. abdominal aorta not enlarged by palpation. ext: slightly cool lower extemities with 1+ pedal pulses bilaterally, no edema. no femoral bruits, r-groin w/o hematoma or ecchymoses, iabp in place. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: dopplerable dp pulses, faintly dopplerable pt pulses b/l. pertinent results: admission ekg: sinus rhythm with nml axis, nml intervals, st depressions in v4-v6, i, avl and st elevation in avr. borderline st elevation in v1. . cardiac cath report: 1. successful ptca and placement of a 3.0x15mm vision stent in the distal lmca and origin lad were performed. the stent was postdilated proximally using a 4.5x8mm quantum maverick balloon and distally using a 3.5x12mm quantum maverick balloon. final angiography showed normal flow, no apparent dissection, and a 30% residual stenosis at the trifurcation site. (see ptca comments.) 2. left femoral arteriotomy closure was performed using an 8 french angioseal vip. final diagnosis:ptca and placement of a bare-metal stent in the distal lmca to origin lad. . echo : the left atrium is moderately dilated. the right atrium is moderately dilated. the estimated right atrial pressure is 10-15mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is moderate global left ventricular hypokinesis (lvef = 40 %). transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . pmibi at osh : left ventricular dialtion with diffuse hypokinesis and reduced ef to 35%. non-transmural inferior wall perfusion defect on post-stress images. subendocarial ishemia 10:42pm ptt-58.0* labs prior to discharge: 05:55am blood wbc-8.1 rbc-3.14* hgb-9.3* hct-28.2* mcv-90 mch-29.7 mchc-33.1 rdw-14.6 plt ct-252 05:55am blood glucose-113* urean-45* creat-1.7* na-141 k-4.2 cl-108 hco3-24 angap-13 07:00am blood alt-26 ast-25 alkphos-73 totbili-0.4 05:55am blood calcium-8.2* phos-3.6 mg-2.1 01:00am blood ck-mb-48* mb indx-11.4* ctropnt-4.06* probnp-* 04:14pm urine color-yellow appear-hazy sp -1.015 04:14pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 04:14pm urine rbc-10* wbc-9* bacteri-few yeast-none epi-0 brief hospital course: in summary, the patient is a 79-year-old male with history of hypertension, s/p nstemi who was transferred from osh after presenting with 5 days of unstable angina with associated dyspepsia and found to have nstemi with transient st elevations in avr and st depressions inferolaterally concerning for significant left main/proximal lad disease with relative hypotension. : coronary artery disease/nstemi and cardiogenic shock: the patient presented to osh and was found to have elevated troponins to 2.0 with ck of 103. the patient was treated as an nstemi protocol with heparin, , load and he was then transferred to for further management. aditional review of his ekg at revealed normal sinus rhythm but prominent st segment depressions in i, ii, avl, v5-v6 and st segment elevations in leads avr and v1. ck peaked peaked at 400. patient continued , , statin and heparin therapy. patient's beta blocker held in the setting of severe cardiogenic shock on admission to ccu. admission tte/echo showed moderate global left ventricular hypokinesis (lvef = 40 %) and grade iii/iv (severe) lv diastolic dysfunction. the right ventricle was mildly dilated with mild global hypokinesis as well. the patient was stabilized with the assistance of a intra-aortic balloon pump to help augment bp. the patient was initially placed on iabp 1:1 and gentle diuresis was given with lasix. diagnostic coronary angiography showed 2 vessel and left main coronary artery disease as patient was found to have 90% l-main occlusion. due to significant comorbidities, there was reluctance to offer cabg as reasonable option. after discussion with family and patient he elected to undergo an attempt at pci. he underwent ptca and placement of a bare-metal stent in the distal lmca to origin of lad and recovered well with no notable complications post-procedure. . pump function: echo revealed lvef of 35%. the patient had initial elevation in bnp of given his acute nstemi and chf with poor cardiac output. he received post catheterization diuresis with lasix and his cxrs showed improvement in his pulmonary edema throughout his hospital course. the patient's oxygen saturations were improved to 96 % on room air by time of discharge and he had no clinical complaints of shortness of breath and only trace lower extremity edema which had improved from his initial presentation. . rhythm : the patient was monitored throughout his stay and per telemetry he remained predominantly in normal sinus rhythm after his pci procedure with very limited pvcs. . anticoagulation: the patient's most recent echo revealed moderate global left ventricular hypokinesis (lvef =35-40 %)and the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. thus, he was started on iv heparin and bridged while starting coumadin therapy to reduce his risk of thrombus and cvas. the end inr goal being . at time of discharge the patient's inr was slightly supratherapeutic at 3.5 and his evening warfarin dose was held prior to his discharge. . acute on chronic renal failure : the patient's initial crf history was further challenged by his relative hypoperfusion in the setting of his acs/nstemi and during his cardiogenic shock. based on limited osh records it is unclear what the patient's true bun/cr baseline is. his cr peaked at 2.4 and came down to 1.6/1.7 by time of discharge. he was given mucomyst pre and post-procedure and ivfs were given sparingly due to the patient's chf/cardiogenic shock. . cirrhosis : the patient had a gi consult for pre-op risk stratification. unclear if patient has true underlying cirrhosis but ultrasound revealed a nodular liver. the patient was cleared for surgery and he had lfts within normal limits at the time of discharge. per gi records the patient had a classification of child class b w/ 30% cirrhosis secondary to alcohol history. he had no appreciable ruq tenderness, jaundice, hsm on exam and he will plan to follow-up with his usual pcp after discharge regarding his gi management. hepatitis b/c panels were done and were all negative. recent pna : the patient was noted to have had a fever at osh and he had recently completed treatment for pna. he had no dullness to percusssion on exam and he had no significant cough or productive sputum during his ccu course. at time of discharge he had wbc count of 8.1 and was afebrile. mr. did have leukocytosis to 19 at osh but only mildly elevated wbc to 12 here and cxr clear other than mild effusions initially which had improved to near resolution by time of discharge. . dementia : for the patient's mild dementia he was continued on his daily donepezil therapy. . urinary tract infection: on the patient had a routine ua which revealed bacteria and wbcs and labs were consistent with a uti so he was started on doxycycline for a 7 day regimen. follow-up urine cultures were negative. he was through 4/7 days therapy at time of discharge and had no complaints of dysuria or frequency. fluids and electrolytes: the patients magnesium and potassium were repleted on an as needed basis during his hospital stay and daily electrolytes were monitored. he was started on a full cardiac diet once he stabilized and he did very well with his oral input and had a good appetite. ivf were used sparingly in the setting of chf. . sacral decubitus: the patient's sacral stage 1 buttock sore remained in tact and he had protective cream applied to avoid any breakdown. patient stable at time of discharge and will plan to follow-up with his pcp regarding further monitoring. . prophylaxis: the patient was on anticoagulation for nstemi and thrombus coverage in the setting of his hypokinetic heart and was therefore covered for dvt prophylaxis as well. pt also helped the patient to do exercises during his stay to maintain a fair level of mobility. he was also given 40mg po daily protonix for gi prophylaxis. . the patient was maintained as a full code status for the entirety of his hospital stay. he was asked to please return to the emergency room or call his primary cardiologist or pcp as soon as possible if he had any worsening shortness of breath, chest pain, dizziness or lightheadedness after discharge. medications on admission: home medications on arrival: reglaid flonase sudafed celexa colchine lopressor allopurinol aricept recently completed levaquin for pna discharge disposition: extended care facility: house rehab & nursing center - discharge diagnosis: non st elevation myocardial infarction acute systolic congestive heart failure urinary tract infection acute renal failure discharge condition: stable creat: 1.6 bun: 47 k: 4.2 hct: 27.9 stage 1 sacral ulcer discharge instructions: you had a heart attack and required a bare metal stent to open one of your heart arteries. you will need to take every day for the rest of your life. you had some damage to your heart muscle and now your heart is weak. because of this, you will need to follow a low salt diet, weigh your self every day and call the doctor if you gain more than 3 pounds in 1 day or 6 pounds in 3 days. we changed some of your medicines. continue daily to keep the cardiac stent open. continue doxycycline for 3 remaining days of therapy for a urinary tract infection and continue daily warfarin as prescribed to avoid blood clots and to decrease stroke risk. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: cardiology: pt will need follow-up with a cardiologist in weeks as a new pt. procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters implant of pulsation balloon angiocardiography of right heart structures cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified alcoholic cirrhosis of liver acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified cardiogenic shock old myocardial infarction pressure ulcer, buttock acute systolic heart failure pressure ulcer, stage i 

Answer: The patient is high likely exposed to