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: claritin / nsaids attending: chief complaint: syncope major surgical or invasive procedure: stent to r common carotid artery history of present illness: ms. is an 81 y/of with h/o cerebrovascular disease/carotid stenosis including occlusion of left ica and h/o cea on right ica, copd, chf, af, cad s/p pci with h/o cypher stent in , ra/sjogren's who is transferred from hospital with evaluation of syncope. . she was admitted there on after syncopizing at home and brought to the hospital by emts. she was talking with cardiology transfer rn at when she suddenly stopped talking, and rn called ems. vna came at around the same time and found the patient unconscious on the couch, and was present when ems arrived. she was noted to spontanesouly regain consciousness. hr in the field was 68 and bp was 110/p, fsg of 150. . at , the patient was ruled out for mi. she was reversed with vitamin k 5mg x1. ct head there demonstrated mild generalized atrophy with small vessel ischemic changes, no e/o acute ich. the patient had tiny calcification sseen in the brain. . she was transferred for further management. . further history: in talking with the patient's family via telephone, son reports that she has had several episodes lately where she stops talking and slumps in her chair, but quickly comes to without post-ictal-like period; these have been attributed to percocet in the past because of close temporal relationship. she has restless leg syndrome and has had shaking legs for many years. . family and patient also report that her handwriting became more coarse and almost illegible on tuesday (). she also reports symptoms within the last 3 weeks that sounded like tia, with pt reporting "left arm was wood and my face was twisted." . cta on for work-up for these previous episode prior to this admision showed densely calcified plaque involving origin of with complete occlusion beyond the point of extracranial ica with reconstitution via circle. she has h/o right cea in the past. . she was admitted to the on and transferred to the cardiac care unit after going for vascular catheterization and getting a stent of her right common carotid artery. . on admission, (+) visual changes; needs glasses (over weeks) (+) headaches (+) constipation *** cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope. pt reports sleeping up on 2 pillows; pt reports 3 days of calf edema. past medical history: -cad s/p nstemi in after ercp s/p bx velocity hepacoat stent to mid-lad, s/p cypher des to mid-rca and pixel bare-metal stent to om1 in -hypertension -hyperlipidemia -atrial fibrillation -rheumatic heart diseaes -former tobacco use -atrial fibrillation -history of lower extremity (femoral) thromboembolism s/p surgical embolectomy at hospital in -s/p gib in setting of systemic anticoagulation -history of dilated extrahepatic and intrahepatic biliary ducts s/p ercp -cri -copd -rheumatoid arthritis -sjogren's disease -restless leg syndrome -cholelithiasis -diverticulosis and diverticulitis social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: non-contributory physical exam: physical examination: vs - 97.9 bp 125/74 hr 48 rr 20 sat 97% ra gen: elderly frail appearing woman oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 11 cm. b/l bruit then l cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. low pitched ii/vi sm at rusb. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: + le pitting edema skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: femoral 2+ popliteal 2+ dp 2+ pt 2+ left: femoral 2+ popliteal 2+ dp 2+ pt 2+ neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date except 1 day. cranial nerves: pupils equally round and reactive to light, 4 to 2 mm bilaterally. no vf defects grossly. extraocular movements intact bilaterally, no nystagmus. sensation intact v1- v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact. motor: ue/le . reflexes symmetric. no pronator drift. moves all extremities; legs difficult to control because of tremor/restless leg reflexes: +2 and symmetric throughout. toes difficult to test. pertinent results: hematology 03:23pm wbc-5.3 rbc-3.84* hgb-10.5* hct-33.3* mcv-87 mch-27.3 mchc-31.4 rdw-15.7* plt ct-277 06:20am wbc-5.6 rbc-3.68* hgb-10.4* hct-31.2* mcv-85 mch-28.3 mchc-33.4 rdw-16.3* plt ct-252 07:15am wbc-6.0 rbc-3.52* hgb-9.9* hct-30.3* mcv-86 mch-28.2 mchc-32.8 rdw-16.9* plt ct-297 08:02am wbc-5.7 rbc-3.36* hgb-9.2* hct-29.6* mcv-88 mch-27.3 mchc-31.0 rdw-16.5* plt ct-248 03:23pm neuts-74.8* lymphs-15.8* monos-5.5 eos-3.2 baso-0.8 07:15am pt-15.9* ptt-70.1* inr(pt)-1.4* 08:02am pt-25.5* ptt-79.9* inr(pt)-2.5* chemistry 03:23pm glu-134* urean-17 creat-1.4* na-136 k-4.0 cl-99 hco3-25 06:20am glu-83 urean-18 creat-1.3* na-133 k-4.0 cl-97 hco3-27 05:40am glu-86 urean-15 creat-1.2* na-138 k-3.5 cl-102 hco3-27 07:15am glu-95 urean-10 creat-1.2* na-136 k-4.1 cl-100 hco3-26 08:02am glu-86 urean-13 creat-1.5* na-137 k-4.0 cl-101 hco3-27 03:23pm calcium-9.1 phos-3.6 mg-2.0 06:20am calcium-8.9 phos-3.3 mg-2.1 cholest-78 07:15am calcium-9.4 phos-2.8 mg-2.5 08:02am calcium-9.2 phos-3.1 mg-2.6 06:20am triglyc-62 hdl-37 chol/hd-2.1 ldlcalc-29 05:14pm %hba1c-6.0* 10:39am urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-8.0 leuks-neg 10:39am urine rbc->50 wbc- bacteri-rare yeast-none epi-0-2 transe-0-2 blood culture ngtd x2 urine culture 10:39 am urine urine culture (final ): staph aureus coag +. 10,000-100,000 organisms/ml ** mrsa ** this was negative after 24h and prior to discharge, returning after discharge lenis no evidence of left lower extremity deep vein thrombosis. brain mri?mra 1. absent flow signal in the left internal carotid artery could be due to occlusion in the neck. small right distal vertebral artery could be variation. for evaluation of both these abnormalities mra of the neck or cta can help for further assessment. otherwise, no abnormalities on the mra of the head in the remaining arteries of anterior and posterior circulation. eeg: normal awake and drowsy eeg. no focal lateralizing or epileptiform features were seen. carotid catheterization 1. access via right femoral artery with 6f sheath. 2. peripheral angiography with non-selective pigtail catheter revealed a type 2 aortic arch with moderate calcification and tortuosity. we then enganged the carotid arteries selectively with a 5f berenstein. this revealed the left common carotid artery to be patent with origin calcification. the left internal is occluded with faint reconstitution from the opthalmic artery to the mca. the right common carotid artery has moderate calcification at the brachiocephalic without a pressure gradient noted. the right common carotid has a prior cea with proximal 80% restenosis and 30% stenosis distally. the right ica fills the right aca and mca with noted cross filling from a patent anterior communicating to the contralateral aca. the left mca is not seen to fill but noted competitive filling at the bifurcation with the ipsilateral aca. 3. limited hemodynamics with bp 163/65 with hr 67 in sinus. patient has history of afib/flutter and developed flutter in ccu. there was no pressure gradient from our right femoral sheath to the aortic arch. 4. we elected to proceed with intervention on the right common carotid artery. we exchanged for a 6f shuttle sheath over a supracore wire. heparin was given and a therapeutic act was confirmed. we then crossed the lesion with a .014 spartacore wire and exchanged our wire for a 5mm spider filter. we then predilated the discrete lesion with a quantum maverick 4x20mm balloon at 10atm and deployed a self-expanding protege 9x40mm stent. we post-dilated the stent with a viatrac 6x20mm balloon at 22atm. we then retrieved our filter without incident. final angiography with 10% residual with normal flow. the intracerebral circulation was unchanged with normal flow to the contralateral aca. the patient was transferred to the ccu with no neurological deficits. echocardiography the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with focal mild hypokinesis of the distal septum. the remaining segments contract normally (lvef = 55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. there are three moderately thickened aortic valve leaflets, and the left coronary cusp is essentially immobile. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is no mitral valve prolapse. there is mild functional mitral stenosis (mean gradient 4 mmhg) due to mitral annular calcification. severe (4+) mitral regurgitation is seen ( 0.4 cm2, regurgitant volume 68 cc/beat). the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild biventricular systolic dysfunction. mild aortic stenosis. mild mitral stenosis. severe mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary hypertension. compared with the report of the prior study (images unavailable for review) of , left ventricular systolic function has improved, and aortic stenosis has developed. the other findings are similar. chest xray small bilateral pleural effusions are new, moderate-to-severe cardiomegaly is stable, and pulmonary vascular congestion in the upper lobes has progressed. septal lines in the right lower lung appeared to be chronic rather than the manifestations of acute pulmonary edema, but cardiac decompensation is definite. i see no radiographic indication of pneumonia. brief hospital course: transient ischemic attacks / carotid artery stenting the patient experienced symptoms of tia at home prior to her admission, and she had an episode of syncope prompting emergent admission. she had a negative head ct and mri for any stroke. she had tremors of her legs which she stated she could not control, and underwent eeg which had no focal seizure activity. she was not orthostatic. the mra did show complete obstruction of the left internal carotid artery. she underwent carotid angiography which showed 80% stenosis in right former carotid endarterectomy. she had bare metal stent placed in the right common carotid with good angiographic result. she was monitored in the ccu overnight. she had no neurologic sequalae. the stenting was also part of a protocol ("carotid revascularization with ev3 arterial technology evolution post approval study") for which the patient consented. atrial fibrillation the patient was placed on heparin intravenous infusion while warfarin was being held for carotid stenting. she was restarted on coumadin for discharge with inr to be followed by pcp. fever the patient had a fever two nights prior to discharge; urinalysis was not decisively positive, pt was asymptomatic though had had foley during procedure. cxr and blood cultures were unrevealing. urine cx after discharge grew 10-100k mrsa but blood cultures from same day remained negative. this is likely contamination rather than active infection. rheumatic heart disease echo findings essentially similar, better ejection fraction and interval development of mild aortic stenosis. medications on admission: flovent 2 puffs percocet 1-2 tablets q6h prn zocor 40mg po daily lasix 40mg po daily lopressor 25mg po bid oxazepam 10mg o qhsm prn gabapentin 100mg po tid kdur 40 meq po bid protonix 40mg po daily hydroxychloroquine (plaquenil) 200mg po daily tranadol 50mg po q6h prn asa 81mg po daily ] discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily) for 1 months: for one month after procedure. disp:*30 tablet(s)* refills:*0* 2. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. hydroxychloroquine 200 mg tablet sig: one (1) tablet po daily (daily). 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 11. oxazepam 10 mg capsule sig: one (1) capsule po at bedtime as needed for insomnia. 12. lasix 40 mg tablet sig: one (1) tablet po once a day. 13. k-dur 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day: as directed. 14. coumadin 2 mg tablet sig: two (2) tablet po once a day. 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: home with service facility: discharge diagnosis: primary transient ischemic attacks syncope cerebrovascular disease secondary coronary artery disease, (past revascularization with bms and des) -hypertension -hyperlipidemia -atrial fibrillation -rheumatic heart disease -chronic kidney disease stage iii -chronic obstructive lung disease -sjogren's disease -restless leg syndrome -cholelithiasis -diverticulosis and diverticulitis discharge condition: stable neurologic exam discharge instructions: you were transferred to for narrowing of the arteries in the neck, causing you to faint and have stroke like symptoms. you had an mri that showed that you did not have an actual stroke. you had a procedure on your neck and a stent was placed to open the right carotid artery. your medications were changed: you were started on a medicine called "plavix" which you should take for one month. you must not skip any doses of this medication as it prevents blood clots from forming on your new stent. you should continue on your coumadin. anticoagulation: 1 month of plavix, as prescribed; coumadin (warfarin) as instructed by your physician; if you stop coumadin you should consider restarting plavix. discuss these medicines with your physician or physician's office before making any changes. please return to the hospital if you have stroke symptoms including facial droop, inability to move limbs, slurred speech, visual disturbances, or other concerning symptoms. please also return if you develop any chest pressure or worsening shortness of breath. followup instructions: please follow-up with dr. tomorrow 12:30 office records will be sent to at fax # please follow-up with dr. at 9:40 7 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: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of tobacco use atrial flutter percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) old myocardial infarction long-term (current) use of anticoagulants personal history of venous thrombosis and embolism acute on chronic systolic heart failure occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction rheumatic heart disease, unspecified 

Answer: The patient is high likely exposed to