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: cephalexin / penicillins attending: chief complaint: transferred to for catheterization after stemi at the outside hospital major surgical or invasive procedure: left heart catheterization with hepacoat stent placement in lad history of present illness: 68 yr old female w/ dmii, htn, hyperlipidemia, cri( baseline cr-1.3) transferred to for cath after acute stemi at the outside hospital. the patient was initially admitted to the outside hospital geriatric/psychiatric unit with generalized weakness and acute mental status changes after withdrawal from darvocet/zoloft x 1 week. on she developed sudden sob, chest tightness, tachycardia, vomiting, anxiety, desatted to 55% on ra and was placed on 100% nrb. cxr showed bilateral pulmonary edema and pleural effusions. abg 7.45 29 50 88% on 3l. ecg with anteroseptal st elevations. trop=14.95. mbi=5.5 (ck168,ckmb9.3). the patient was treated with lasix - 20mg iv and zaroxylyn 2.5 mg po, morphine, integrilin, nitro gtt, plavix, asa. she was then transferred on to for emergent catheterization. past medical history: 1. dmii with peripheral neuropathy 2. htn 3. hyperlipidemia 4. cri (cr 1.3) 5. hysterectomy s/p cancer 6. bladder surgery 7. osteonecrosis bilat feel/severe pedal edema 8. anemia 9. gout 10. lumbar disc disease 11. chronic venous stasis 12. recurrent cellulitis social history: widowed, lives alone, 6 children, no etoh abuse, no recent tobacco physical exam: at the time of admission to ccu: 98.3 bp 117/56 hr 88 rr18 general: drowsy, arousable, answers questions appropriately heent: nc, at, eom intact, sclera white, conjunctiva pink, perrla, mm moist neck: jvd at about 12 cm cv: rrr, nl s1, s2, no m/g/r pulm: cta bilaterally abd: + bs, soft, nt, nd, no hsm extr: 1+ ankle edema, venous stasis changes bilaterally, dp pulses dopplerable bilaterally, feet with changes c/w h/o osteonectosis r groin: no ecchymosis, no hematoma, no bruit pertinent results: 09:23pm wbc-8.5 rbc-3.35* hgb-9.0* hct-26.6* mcv-79* mch-26.8* mchc-33.8 rdw-17.9* 09:23pm plt count-164 04:50pm iron-17* cholest-145 04:50pm caltibc-200* vit b12-312 folate-greater th ferritin-367* trf-154* 04:50pm triglycer-227* hdl chol-35 chol/hdl-4.1 ldl(calc)-65 04:50pm tsh-3.1 09:23pm ck(cpk)-232* 09:23pm ck-mb-12* mb indx-5.2 09:23pm glucose-203* urea n-39* creat-1.3* sodium-137 potassium-3.6 chloride-102 total co2-23 anion gap-16 09:29pm %hba1c-6.1* 10:09pm wbc-8.0 rbc-3.35* hgb-8.7* hct-27.3* mcv-81* mch-26.0* mchc-32.0 rdw-17.9* 07:20am blood glucose-143* urean-57* creat-1.3* na-140 k-4.1 cl-101 hco3-27 angap-16 cardiac catheterization : ra 40/21/23 rv 59/18 pa 59/34/46 pcw 112/66/55 co/ci 4.2/2.1 svr 648 pvr 286 successful pci of mid lad with a two overlapping hepacoat stents 3.0x23mm proximal and 3.0x33mm distal. final angiography revealed no residual stenosis, no dissection and timi-3 flow (see ptca comments). final diagnosis: 1. acute anterior st segment elevation myocardial infarction. 2. one vessel coronary artery disease of the mid-lad. 3. severe biventricular diastolic dysfunction with elevated right and left sided filling pressures. 4. moderate pulmonary hypertention (59/34 mmhg). tricuspid regurgitation. 5. depressed cardiac output & index (4.2 l/min, 2.1 l/min/m2). 6. successful pci of proximal and mid lad. echo : dilated. lv mod dilated. lv syst function is severely depressed (ef 30%). anterior, septal and apical akinesis and lateral and inferior hypokinesis with preservation of basal wall motion. the aortic valve leaflets (3) are mildly thickened. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. 04:06am blood wbc-8.0 rbc-3.19* hgb-8.7* hct-25.9* mcv-81* mch-27.2 mchc-33.4 rdw-18.1* plt ct-163 05:20am blood wbc-7.4 rbc-3.96* hgb-10.6* hct-32.3* mcv-81* mch-26.8* mchc-32.9 rdw-17.5* plt ct-208 07:20am blood wbc-8.4 rbc-4.67 hgb-12.3 hct-37.4 mcv-80* mch-26.3* mchc-32.7 rdw-16.9* plt ct-234 06:40am blood wbc-7.0 rbc-4.33 hgb-11.5* hct-34.3* mcv-79* mch-26.4* mchc-33.4 rdw-16.9* plt ct-270 03:14am blood wbc-7.7 rbc-3.95* hgb-10.7* hct-31.0* mcv-79* mch-27.1 mchc-34.5 rdw-16.8* plt ct-250 01:16pm blood hct-35.3* 07:00pm blood hct-32.3* 01:25am blood hct-31.6* 07:05am blood wbc-8.5 rbc-4.08* hgb-10.9* hct-33.1* mcv-81* mch-26.7* mchc-32.9 rdw-17.1* plt ct-279 02:50pm blood wbc-7.9 rbc-4.04* hgb-10.5* hct-32.9* mcv-81* mch-26.1* mchc-32.1 rdw-17.0* plt ct-250 07:20am blood wbc-8.4 rbc-3.88* hgb-10.2* hct-30.9* mcv-80* mch-26.3* mchc-33.0 rdw-16.7* plt ct-258 07:10am blood wbc-6.4 rbc-3.79* hgb-10.1* hct-30.7* mcv-81* mch-26.6* mchc-32.8 rdw-16.7* plt ct-233 04:50pm blood plt ct-205 05:49pm blood pt-14.0* ptt-24.8 inr(pt)-1.2 08:02am blood pt-13.6 ptt-28.1 inr(pt)-1.2 03:15pm blood pt-13.5 ptt-33.0 inr(pt)-1.1 07:20am blood pt-13.6 ptt-40.3* inr(pt)-1.2 11:30am blood ptt-67.4* 05:30pm blood pt-13.5 ptt-52.6* inr(pt)-1.1 10:50am blood pt-14.6* ptt-100.7* inr(pt)-1.3 07:00pm blood ptt-40.0* 07:05am blood ptt-150* 07:05am blood plt ct-279 02:50pm blood plt ct-250 07:20am blood pt-17.6* ptt-41.3* inr(pt)-2.0 07:10am blood pt-17.0* ptt-45.2* inr(pt)-1.8 04:50pm blood ck(cpk)-264* 09:23pm blood ck(cpk)-232* 04:06am blood ck(cpk)-153* 04:06am blood ck-mb-9 09:23pm blood ck-mb-12* mb indx-5.2 04:50pm blood iron-17* cholest-145 09:23pm blood calcium-8.8 phos-3.9 mg-1.8 04:06am blood calcium-8.7 phos-3.9 mg-2.0 iron-18* cholest-144 07:05am blood calcium-9.1 phos-5.1*# mg-1.8 iron-52 07:10am blood calcium-9.6 phos-3.3 mg-2.1 04:50pm blood caltibc-200* vitb12-312 folate-greater th ferritn-367* trf-154* 04:06am blood caltibc-191* vitb12-321 folate->20 ferritn-484* trf-147* 07:05am blood caltibc-234* ferritn-639* trf-180* 09:29pm blood %hba1c-6.1* 04:50pm blood triglyc-227* hdl-35 chol/hd-4.1 ldlcalc-65 04:06am blood triglyc-273* hdl-29 chol/hd-5.0 ldlcalc-60 04:50pm blood tsh-3.1 04:06am blood tsh-2.5 03:51pm blood type-art o2 flow-6 po2-80* pco2-39 ph-7.37 calhco3-23 base xs--2 intubat-not intuba 03:51pm blood o2 sat-95 brief hospital course: the patient was admitted to the ccu after her catheterization. 1. cad - 1 vessel s/p lad hepacoat stent. ck peaked at 264. the patient was started on integrilin for 18 hours and then was started on heparin drip for anterior mi. the patient was started on asa, plavix, lipitor. beta-blocker was added after the patient's heart failure was better compensated. the patient had no events on telemetry. she has remained in nsr. course c/b hct drop with guaiac+ stool while supratherapeutic on heparin (ptt 150); also, had prerenal azotemia during this episode. coumadin and heparin were d/c'd, to be held until patient is seen by a cardiologist as an outpatient and gi bleed has resolved with stable hct. 2. pump - ef 30% with apikal akinesis/wall motion abnormalities. patient had elevated r and l pressures likely due to ischemia. she was diuresed with iv lasix to goal 1-2l negative a day. acei was started, then held for arf, then restarted after creatinine returned to . she was started on heparin drip for thromboembolism prevention due to apical akinesis and then was bridged to coumadin, however this was discontinued after the patient had evidence of a gi bleed. anticoagulated will need to be readdressed by her outpatient cardiologist, who will be determined by referral from her pcp . (. restarting outpatient lasix regimen of 20mg po qd upon discharge. 3. dm - hgb a1c 6.1%. the patient was started on diabetic diet and iss for tight control. diabetes center was consulted. she received nutrition education while in the hospital. she was instructed not to eat sugary food and drinks. she was offered further education at after discharge but turned this option down. 4. anemia - anemia of chronic disease, plus gi bleed loss later in hospital course. fe studies were most consistent with anemia of chronic disease. b12, folate levels were wnl. tsh was also normal. the patient was transfused 2 units prbcs . her hct rose appropriately. this was prior to her gi bleed while supratherapeutic on heparin bridge to coumadin. she has remained stable since anticoagulation was stopped. 5. darvocet/zoloft withdrawal - social work/substance abuse consult was obtained. will defer to pcp regarding indications for these meds. pt has not been on these meds while in house. 6. neuro - held neurontin while in house, as patient's mental status may have been negatively impacted by this medication and she did not complain of neuropathic pain. 7. renal - arf on cri; pt had prerenal azotemia in setting of gi bleed; resolved with adequate po intake, cr returned to baseline of 1.3 from 2.4. fractional excretion of urea c/w prerenal; rare eosinophils, unlikely ain. 8. gi - pt had 6 pt hct drop overnight with 2 x guaiac+ stools; gi consulted, pt was stable, did not require transfusion at that time (though had one earlier in course). pt was found to be supratherapeutic on heparin with ptt 150, this was stopped and hct stabilized around 30. gi recc: outpatient cspy to eval for lgib, to be arranged by pcp. 9. rheum - left knee pain, "10 out of 10" per pt, started on , grew worse, was tapped on by rheum with inflammatory picture, wbc 17k, no organisms, culture pending, no crystals seen but rheum felt to be gout regardless with no crystals because of bloody tap (hct of tap was 28%). suggest regimen of 0.6mg colchicine po qd x 3days, then 0.6mg colchicine po qod x 1week. no steroids injected. will need to restart on allopurinol once through gout attack. medications on admission: seroquel q 4 hours prn, neurontin 300 qhs, lexapro 10 qd, allopurinol 100 qd, pepcid 20qd, lasix 20 qd, insulin. discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po qd (once a day). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 3. atorvastatin calcium 40 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 4. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical qid (4 times a day). disp:*1 tube* refills:*2* 5. metoprolol succinate 25 mg tablet sustained release 24hr sig: 0.5 tablet sustained release 24hr po qd (once a day). disp:*15 tablet sustained release 24hr(s)* refills:*2* 6. 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:*0* 7. acetaminophen 325 mg tablet sig: two (2) tablet po every hours as needed for pain: for left knee pain. disp:*30 tablet(s)* refills:*2* 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: hold for diarrhea. disp:*60 tablet(s)* refills:*2* 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po qd (once a day) as needed for constipation: hold for diarrhea. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation: hold for diarrhea. disp:*30 capsule(s)* refills:*2* 11. insulin 70/30 70-30 unit/ml suspension sig: twenty five (25) units subcutaneous qam. disp:*1 vial* refills:*2* 12. lisinopril 5 mg tablet sig: one (1) tablet po once a day: for high blood pressure. disp:*30 tablet(s)* refills:*2* 13. syringe syringe sig: two (2) syringes miscell. once a day: for insulin injections. disp:*60 syringes* refills:*2* 14. insulin 70/30 70-30 unit/ml suspension sig: twenty three (23) units subcutaneous at bedtime: for diabetes. disp:*1 vial* refills:*2* 15. colchicine 0.6 mg tablet sig: one (1) tablet po once a day for 3 days: for gout. disp:*3 tablet(s)* refills:*0* 16. colchicine 0.6 mg tablet sig: one (1) tablet po every other day for 1 weeks: for gout (start this prescription after three days). disp:*4 tablet(s)* refills:*0* 17. lasix 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: 1. acute myocardial infarction 2. diabetes 3. hyperlipidemia 4. hypertension 5. acute renal failure on chronic renal insufficiency 6. gout flare, l knee discharge condition: stable discharge instructions: please return home and receive physical therapy and visiting nurse services at home. please keep all follow up appointments scheduled for you, including appointments with dr. (primary care doctor) on monday at 3pm at medical facility and with dr. (rhematologist - joint doctor) on at 11:30am at , in the at the . also, dr. will set you up with an appointment to start seeing a cardiologist (heart doctor) for your heart problems. followup instructions: please keep all follow up appointments scheduled for you: 1. dr. (primary care doctor) on monday at 3pm at medical facility 2. dr. (rhematologist - joint doctor, phone:) on at 11:30am at , in the at the . also, dr. will set you up with an appointment to start seeing a cardiologist (heart doctor) for your heart problems. dr. or that cardiologist may want to start you on coumadin (a blood thinning medicine) because of your heart problems. in addition, dr. should set you up for an appointment with a gastroenterologist to have a colonoscopy to evaluate your recent bleeding from your rectum and low red blood cell count. md procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters right heart cardiac catheterization diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified acute myocardial infarction of other anterior wall, initial episode of care other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes diastolic heart failure, unspecified diseases of tricuspid valve 

Answer: The patient is high likely exposed to