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: patient recorded as having no known allergies to drugs attending: chief complaint: transfer from osh for cath major surgical or invasive procedure: coronary catheterization with balloon angioplasty of right pda. intra-aortic balloon pump placement history of present illness: pt is a 75 yof with pmh of dm2, htn, hypothyroid who experienced acute sob while cooking dinner. went to hospital where she was noted to have mild htn (sbp 140) and evidence desaturation (spo2 90%) ecg with std in inferior pattern. . exam consistent with acute l heart failure (rales, but no peripheral edema), patient required intubation secondary to hypotension and desaturation. once intubated stabilized given dobutamine for hypotension and bradycardia. transferred to for urgent cath. . at cath with spb 96/66, pa 35/15 stat echo in lab without evidence of tamponade or severe valve disease (1+mr) rpda to, crossed and ballon dilated with good improvement in flow and hemodynamics. iabp placed for hemodynamic support and transferred to ccu. of note cath lab produced >2l urine. past medical history: diabetes hypothyroid htn social history: per family, pt high functioning lives alone in a senior center. family history: nc physical exam: afebrile, 87/41, 100% on 60%fio2. vent settings: cmv, fio2 60%, r 16 gen: pt intubated. heent: mmm, perrl, swan in place. chest: ctab, no crackles cvr: rrr, nl s1, s2, no r/m/g. abdomen: soft, nt, nd ext: no edeam bilaterally, no dopplerable pulses. groin: no hematoma, no bruit. neuro: intubated and sedated. pertinent results: 11.9\27.9\175 139 \ 3.5\ 112\ 18 \ 23 \ 0.7 \ 184. ca 7.5, mg. 1.7, phos2.9 osh: 3mm std ii, iii, f, 1mm ste avr post cat: nsr at 66. twi v1-v6, axis nl. . cath : . lcx - to prox occlusion with rca collaterals lmca - no disease lad - 60% prox 80%d1, diffuse 80% before d2 then to. rca - diffuse disease. 40% ostial, 99% at crux with to of pda. residual <30%. . hemo pcw 15, ra 10, ao 78, pa 35/15, rv 35/7 co/ci - 4.8/2.0 . abg. 2am 7.38/34/125/21 on 60%fio2. . echo (ef 25%): conclusions: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. there is severe regional left ventricular systolic dysfunction. overall left ventricular systolic function is severely depressed. tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). resting regional wall motion abnormalities include severe hypokinesis to akinesis of the distal of the left ventricle. no definite left ventricular thrombus seen but cannot exclude. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures. there is a restrictive left ventricular filling pattern consistent with severe diastolic dysfunction. . ct chest: impression: 1. bilateral multifocal pulmonary opacities, more consistent with pneumonia or aspiration than with pulmonary edema. 2. large bilateral pleural effusions. 3. three-vessel coronary artery disease as stated in the provided history. extensive atherosclerotic disease in other visualized vessels. brief hospital course: brief overview: the patient is an 86 yo female with a history of diabetes who presented with acute shortness of breath to an osh where she was intubated and transferred to for emergent catheterization. catheterization revealed diffuse disease including an obstructed pca (rca) that was ballooned open. because the cath was considered high risk and she was thought to be a potential cabg candidate, no stenting was performed. it appeared that hemodynamics improved s/p ballooning, though the patient had been in what appeared to be cardiogenic shock. as a result, iabp was placed. the patient did well and was diuresed aggressively. she was extubated the following day after having the balloon pump removed. she required a short course of bipap just after extubation and improved consistently from there. she was seen by pt/ot and recommended for a short stay at a rehab facility. uti and possible pneumonia (found on ct chest 2 days after extubation - pt afebrile without leukocytosis) were treated with a 10 day course of abx. . ## cad - #ischemia: the patient was noted to have 3 vd on cath. pda was totally occluded and was thought to be the culprit vessel. it was ballooned open with some improvement in hemodynamics, but with residual 30% stenosis post-balloon. the patient was started on asa, plavix and lipitor 80. bb and acei were initially held as a balloon pump was placed to assist with afterload reduction. the patient was started on acei, nitro, and bb over the next 24 hours. she did well and the balloon pump was removed within 24 hours after her cath. following balloon pump removal, the pt was extubated. she did well initially but shortly thereafter her o2 saturations decreased and she was started on bipap, which she tolerated well. the bipap was weaned off after some hours and she did well on nrb face mask. over the next 24 hours she moved from mask to nc. during this time she did not appear to have any specific st changes. for this reason, it was not clear that the patient had a new ischemic event leading to the pulmonary edema or ongoing. she was evaluated by the ct surgeons for cabg and thought not to be an appropriate candidate. some consideration of lad stenting was given, but the patient improved dramatically over time and it was not clear that the decompensation was due to an acute event. it was felt that the risks of revascularization outweighed the benefits at this hospitalization. she should be continued on a full medical management with asa/plavix/statin/bb/acei. . #pump: echo was done in the cath lab without obvious segmental wma. ef 25%, severe hypokinesis of distal lv. pcwp>18. mild pulm htn, severe diastolic dysfunction with restrictive filling pattern e/a 1.29. ?new secondary to ischema given 3vd vs exacerbation heart failure. throughout the first days of her hospitalization the pt was on propofol while intubated and her hr and bp remained low and she was on dobutamine. when her sedation was lightened, her vitals returned and she was weaned from pressors and she was started on bb and acei for cardioprotection. . #rhythm: the patient remained in sinus rhythm throughout her stay. . ## respiratory - the patient presented from the osh intubated for flash pulmonary edema. she was sedated and remained intubated for the first two days of her hospitalization. at the time of her catheterization, her right sided pressures were normal. thereafter, the right sided pressures were low following rapid diuresis. she received a small amount of fluids and her pap returned to . at that point she was overbreathing the vent, and the settings were pressure support with minimal peep. she was extubated and initially did well. however, after 1-2 hours she became increasingly sob. a cxr showed some pulmonary edema, and abg showed some decreased oxygenation. she was put on bipap for support and weaned to o2 facemask over some hours. the following day she was put on nasal cannula and continued to breathe well. a chest ct showed large effusions bilaterally and infiltrates more c/w pna than with fluid overload. the patient did not have a leukocytosis nor was she febrile, but in light of these imaging findings, she was started on levofloxacin for 10d course. . #diabetes - well controlled on riss at this hospitalization. restarted on home oral anti-hyperglycemics. . #hypothyoroid - levoxyl 75 at this hospitalization. pt to resume home dose when discharged (unclear if home dose is 75 or 88mcg daily. . #heme: the patient developed an acute decrease in her platelets from the mid-100's to 99 after having had the balloon pump in and being on heparin for one day. her anti-pf4 ab came back negative after 2 days. in the meantime all heprin products were held. plts remained stable or increased for the rest of her hospitalization. . #id: the patient was found to have a uti and was started on a course of cipro. however, when ct showed likely pna, she was changed to levofloxacin to address both infections. 250mg q day dosing was used due to the patient's advanced age. #fen: throughout the hospital course, the pt's electrolytes were repleted to k>4, mg>2. #code: remained full code throughout this hospitalization. #communication: son is hcp (form was in chart throughout the hospital stay). medications on admission: celebrex, levoxyl, glyburide, atenolol. discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily) for 30 days. disp:*30 tablet(s)* refills:*0* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. levothyroxine sodium 75 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 5. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily): for chf management. disp:*30 tablet(s)* refills:*2* 6. toprol xl 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day: for heart protection and blood pressure control. disp:*30 tablet sustained release 24hr(s)* refills:*2* 7. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily): for heart protection and blood pressure control. disp:*30 tablet(s)* refills:*0* 8. furosemide 20 mg tablet sig: one (1) tablet po daily (daily): take as directed for diuresis and to prevent water retention. disp:*30 tablet(s)* refills:*2* 9. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: take as directed for chest discomfort. repeat if discomfort persists for >5min. call your physician after taking this medication. disp:*30 tablet, sublingual(s)* refills:*0* 10. multivitamin capsule sig: one (1) cap po daily (daily). 11. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 8 days. disp:*8 tablet(s)* refills:*0* 12. glyburide 1.25 mg tablet sig: one (1) tablet po once a day: take as you were prior to this hospitalization. 13. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn: please take one tablet if you experience severe chest pain that is not relieved with rest. if pain does not go away repeat in 5 mins and call your cardiologist or emergency room. disp:*20 * refills:*2* discharge disposition: extended care facility: - discharge diagnosis: flash pulmonary edema coronary artery disease hypotension chf diabetes hypothyroid htn discharge condition: stable, breathing comfortably, free of pain. discharge instructions: you were admitted to the hospital because you had difficulty breathing. for this reason you were intubated. you had a coronary catheterization, which showed that the vessels in your heart are narrow. you have congestive heart failure, which likely led to your difficulty breathing. after diuresis, your symptoms improved and the breathing tube was removed. you appear to be doing well now, but there are some important changes we have made to your medications. you will need to follow up with your primary care physician, . , within the next 2 weeks for further care see appt below. you will need to see a cardiologist, as well. you have started a number of heart medications that will need to be adjusted over time. you will see dr. number appt below. if you develop chest pain, increasing shortness of breath, groin or leg pain or bleeding, lightheadedness or dizziness, or if you lose consciousness or have any other worrisome symptoms, please seek immediate medical attention. followup instructions: please follow up with dr. () in clinic on tuesday at 9:30am. . please also follow up with your pcp . on at 2pm. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters non-invasive mechanical ventilation arterial catheterization implant of pulsation balloon pulmonary artery wedge monitoring nonoperative removal of heart assist system infusion of vasopressor agent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism acute respiratory failure cardiogenic shock acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to