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: no known allergies / adverse drug reactions attending: chief complaint: hypotension major surgical or invasive procedure: cardiac catheterization with placement of bare metal stent in om1 repeat cardiac catheterization cardiopulmonary resuscitation and defibrillation history of present illness: in brief this is a 63yo m pmhx hd dependent esrd s/p failed allograft, cad s/p cabg ( - lima to lad, svg to rpda, svg to om1, svg to ramus), pvd, htn, hld, schf (ef 20-30%) who was admitted for elective cardiac catheterization , notable for occluded om graft, patent lima, svg-pda and svg-ramus grafts, om1/circ w flow-limiting disease, circ not able to be wired, bmsx2 to om1 takeoff, complicated by circ jailing, course further c/b femoral pseudoaneurysm at and hypotension during post-cath hd. night prior to transfer, patient with continued slow bleeding from cath site (changing dressing q30-60minutes), abciximad held (given psuedoaneurysm). next am patient developed hypotension to 60s/30s while at hd, as well as dizziness and mental status changes that did not initially resolve with fluid bolus; hd stopped, patient given 2 units of prbcs w resolution of pressures to 100s . at time of initial exam in hd, patient w hr 60s, sbp 108, mentating well and without complaint of chest pain, shortness of breath, dizziness, ekg with st depressions in ii,iii,avf similar to prior ekg. patient transferred to ccu for further management. past medical history: 1. cardiac risk factors: +dyslipidemia, +hypertension 2. cardiac history: schf (ef 20-30%), cad -cabg - () lima to lad, svg to rpda, svg to om1, svg to ramus. -pci - () bms to om1 x2 c/b jailed circ -pacing/icd: none 3. other past medical history: - esrd interstitial nephritis versus post-infectious glomerulonephritis s/p allograft (), c/b failure (), hd dependent - secondary hyperparathyroidism with hypercalcemia. - gerd w barrett's esophagus () - peripheral vascular disease - colonic polyps - prostate adenocarcinoma () s/p cyberknife therapy - s/p appendectomy. - s/p hernia repair. social history: former engineering consultant, now on disability; married with two children, rare alcohol use, former smoker quit in . family history: mother with cabg at 60. father with cabg at 70. brother with cad status post pci in 62. physical exam: admission physical examination: vs: 98.4 132/82 91 21 100% on ra general: pleasant gentleman, laying comfortably in bed, nad, alert and appropriate heent: ncat. eomi. mmm. neck: supple, jvp not appreciated cardiac: rr, normal s1, s2, no s3, s4. i/vi systolic murmur heard throughout the precordium. lungs: ctab, no increased wob, no wheezes, rales, rhonchi. abdomen: soft, ntnd. nabs, kidney transplant palpable in rlq groin: r groin cath site; slight tenderness to palpation, soft extremities: no c/c/e. lue fistula with thrill pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: a/ox3, cn ii-xii intact. non focal. . discharge physical exam: vs 97, 74, 128/63, 21, 94ra at rest, desats as low as mid 70's when ambulating on ra which resolves with 2-4l o2 by nc general: pleasant gentleman, laying comfortably in bed, nad, alert and appropriate heent: ncat. eomi. mmm. neck: supple, jvp not appreciated cardiac: rr, normal s1, s2, no s3, s4. i/vi systolic murmur heard throughout the precordium. lungs: slight bibasilar crackles, but otherwise lung fields clear to auscultation b/l abdomen: soft, ntnd. nabs, kidney transplant palpable in rlq extremities: no c/c/e. lue fistula with thrill pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: a/ox3, cn ii-xii intact. non focal. pertinent results: admission labs: . 07:12am blood wbc-9.4 rbc-3.50* hgb-11.0* hct-33.0* mcv-94 mch-31.4 mchc-33.3 rdw-17.9* plt ct-216 01:10pm blood glucose-107* urean-53* creat-9.7*# na-130* k-5.9* cl-92* hco3-19* angap-25* 06:45pm blood ck-mb-38* 06:45pm blood ck-mb-38* 01:10pm blood calcium-9.7 phos-4.3 mg-2.6 . pertinent labs: . 10:04am blood ck-mb-319* mb indx-24.0* ctropnt-2.47* 10:11am blood ck-mb-324* mb indx-24.1* ctropnt-2.30* 02:32am blood ck-mb-204* mb indx-19.1* ctropnt-6.21* 06:49am blood ck-mb-10 mb indx-5.1 ctropnt-12.17* 04:55pm blood ck-mb-9 ctropnt-13.07* 01:30am blood cortsol-14.0 04:40pm blood lactate-0.7 . discharge labs: . 04:37am blood wbc-8.0 rbc-2.67* hgb-8.4* hct-24.7* mcv-93 mch-31.3 mchc-33.9 rdw-16.0* plt ct-284 04:37am blood glucose-80 urean-61* creat-7.9*# na-137 k-4.4 cl-93* hco3-28 angap-20 04:37am blood calcium-9.3 phos-6.2*# mg-2.3 . micro/path: . mrsa screen : negative mrsa screen : negative . imaging/studies: . c.cath : final diagnosis: 1. severe native three vessel coronary artery disease. 2. patent lima-lad, svg-ri. 3. occluded svg-om. 4. normal systemic arterial blood pressure. 5. successful pci of om1 with two overlapping bms. 6. unsuccessful attempt to revascularize av groove lcx. 7. hemodialysis post-procedure. 8. ongoing optimal medical therapy for cad and chf. 9. repeat echocardiogram to evaluate for improvement in lvef after revascularizing the om1. if not, consider repeat viability study (dobutamine echo) and re-assess the need to open the lcx. . extremity u/s : impression: 1.2 x 1.1 cm right groin pseudoaneurysm. . tte : the left atrium is moderately dilated. the right atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with severe hypokinesis of the inferior and inferolateral walls. the remaining segments contract well (lvef 30-35%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild-moderate pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. impression: normal left ventricular cavity size with regional systolic dysfunction c/w cad. pulmonary artery hypertension. mild mitral regurgitation. compared with the prior study (images reviewed) of , left ventricular systolic dysfunction is now regional and global systolic function is preserved. left ventricular cavity size is now normal. . c.cath : final diagnosis: 1. three vessel coronary artery disease. 2. jailed av groove lcx with delayed flow. 3. patent om bare metal stents. 4. unsuccessful attempt at pci of av groove lcx due to inability to cross lesion with wire. . cxr pa/lat : findings: as compared to the previous radiograph, pre-existing pleural effusions have minimally decreased in extent. however, bilateral, right more than left subtle reticular opacities are seen on both the frontal and the lateral radiograph. given the small overall lung volumes the findings are suggestive of a fibrotic process. ct could be performed to clarify this suspicion. moderate cardiomegaly without evidence of acute pulmonary edema. status post cabg. . cxr portable : impression: 1. worsening congestive heart failure. 2. no residual pneumothorax identified. brief hospital course: 63m with esrd on hd, cad s/p cabg ( - lima to lad, svg to rpda, svg to om1, svg to ramus), schf (ef 20-30%) admitted after elective pci c/b inability to circ, psuedoaneurysm, and hypotension in the setting of hd who experienced in-hospital vfib arrest greater than 48 hours after nstemi. . active diagnoses: . # nstemi/vfib cardiac arrest in-hospital: mr. was admitted for elective cardiac catheterization for optimization of cardiac function in preparation for possible renal transplant. during the procedure he was noted to have severe native vessel disease, 2 patent grafts (lima-lad, svg-ri), and one occluded graft (svg-om). during the procedure om1 was successfully stented with bms x 2, but there was an unsuccessful attempt to revascularize av groove lcx. following the procedure the patient developed chest pain with st depressions in ii/iii/avf and positive ckmb and troponins (ckmb peak of 24.1). on arrival to the ccu he was continued no aspirin, plavix, heparin drip, abciximab, and atorvastatin. echo after the procedures was significant for increase in estimated lvef (30-35% from 20-30% on prior) with preserved global systolic function but severe regional left ventricular systolic dysfunction with severe hypokinesis of the inferior and inferolateral walls. a second cardiac catheterization was conducted which was significant for a jailed av groove lcx with delayed flow and an unsuccessful attempt at pci of av groove lcx due to inability to cross lesion with wire. his condition improved steadily and he was called out of the ccu to the floor. five days following this patient's nstemi, he experienced a vt -> vfib arrest (caught on telemetry) and was rapidly coded receiving chest compressions and defibrillator shocks with rapid rosc. he was transferred back to the ccu for continued evaluation and treatment and was loaded with iv then po amiodarone. he was evaluated by the ep team who offered the possibility of an icd prior to discharge or a lifevest to assess ef in 4 weeks and further discussion regarding need for icd. he was fitted with a lifevest and was discharged home with close follow-up with his pcp, , electrophysiologist, and nephrologist. . # femoral pseudoaneurysm: following initial catheterization the patient was found to have a pseudoaneurysm reported as 1.2x1.1cm by radiology, read as 0.7cm by interventional radiology. per discussion with interventional, thrombin injection of psuedoanuerysm was felt to be of low utility given its small size. on transfer to the ccu, abciximab was initially restarted, then held. the patient would benefit from repeat ultrasound in two weeks to assess the status of this finding. . # symptomatic hypotension: pt was hypotensive in dialysis following his initial catheterization to the 60's systolically with mild light-headedness which resolved quickly with fluids and 2 units of prbcs. there was initial concern for hemorrhage from his cath site but this was felt to be less likely given the reassuring doppler findings and quick resolution. he continued to be mildly hypotensive mostly to the high 80's-low 90's during subsequent dialysis sessions but this continued to improve until he was able to tolerate full dialysis with significant fluid removal. . # acute on chronic anemia of ckd: pt experienced a gradual crit drop from 33 to 25 despite receiving 3 units of blood during his hospitalization. he had no active sources for bleeding (although there was initial concern related to his femoral pseudoaneurysm as mentioned above). perhaps it is multifactorial given his esrd and more frequent but shorter dialysis sessions perhaps leading to sequestration of rbc's within the tubing. this should be followed as an outpatient to ensure his crit does not continue to drop. . #hypoxia: this patient was hypoxic on ra at rest to the high 80's on occasion. he was never free of rales or pulmonary edema but also desaturated on room air to the mid-70's when walking even after he was dialyzed to his estimated goal dry weight. it was thought that given his prior smoking history, he likely had a component of chronic lung disease. it did not become apparent until just prior to discharge that this patient was previously on home oxygen for the same reason. he was discharged with home oxygen. . #chronic systolic chf: echo during this admission demonstrated an lvef of 30-35% up from 20-30% on prior. he did not have clinical evidence of chf exacerbation on admission and was dialyzed to his dry weight. his home metoprolol and lisinopril were held for a period following his nstemi due to hypotension as above. he was re-started on lower doses of both medications prior to discharge. he will likely benefit from spironolactone in the future when his blood pressures are more robust. . chronic diagnoses: . #atrial fibrillation: stable. he was intermittently in sinus rhythm and afib during this admission. his warfarin was held for a period of time given elevated levels and possibility of placing an icd. he was continued on his home warfarin dose at the time of discharge and instructed to follow-up as usual with coumadin clinic. . # esrd s/p kidney transplant: stable. he was dialyzed frequently during this admission due to his borderline blood pressures and inability to tolerate longer sessions. by the end of his hospitalization he was back to his baseline of tolerating dialysis. we increased his sevelamer per renal recs given chronically elevated phosphate. he will need continue dialysis and prednisone qod as an outpatient. . # gerd: stable. continued on home omeprazole. . transitional issues: # groin u/s in 2 weeks: to assess for pseudoaneurysm . #need for icd?: he will be following up with dr. for discussion of his treatment options. he currently has a lifevest and is being loaded on amiodarone. . #blood pressure: his blood pressures have been a little soft, especially following dialysis which has caused us to lower his home bp regimen (metoprolol succinate 75mg po daily -> metoprolol succinate 25mg po daily, and lisinopril 20mg po daily -> lisinopril 10mg po daily). we will leave it to you to uptitrate these as tolerated as an outpatient. . #atorvasatin: we have lowered his lipitor dose from 80mg po daily -> 40mg po daily due to the addition of amiodarone . #coumadin: this is followed by his pcp/outside coumadin clinic. we anticipate he will have lower coumadin requirements going forward given the amiodarone. . #renal transplant: he is naturally quite concerned that having an icd/arrest may affect his chances for a renal transplant. he will surely have questions regarding this during his renal follow-up. medications on admission: - atorvastatin 80mg daily - nephrocaps 1mg daily - lisinopril 20mg daily - metoprolol succinate 75mg daily - omeprazole 20mg daily - prednisone 5mg qod - sevelamer hcl 1600mg tid - warfarin 4mg daily - aspirin 81mg daily - magnesium oxide 400mg discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. prednisone 5 mg tablet sig: one (1) tablet po every other day (every other day). 5. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 6. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 7. magnesium oxide 400 mg tablet sig: one (1) tablet po twice a day. 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 10. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 11. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day: as needed for constipation. disp:*60 capsule(s)* refills:*0* 12. senna 8.6 mg tablet sig: one (1) tablet po twice a day: as needed for constipation. disp:*60 tablet(s)* refills:*0* 13. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 14. home oxygen order home oxygen for exertion when oxygen saturations fall below 88%. we have found that you desaturate to below 88% on room air when walking short distances. titrate up to 4l's for oxygen saturations less than 88%. 15. triamcinolone acetonide 0.1 % cream sig: one (1) application topical twice a day as needed for itching: apply to affected areas on chest. please do not apply for more than 2 consecutive weeks. disp:*1 pound jar or large trade* refills:*0* 16. atorvastatin 80 mg tablet sig: 0.5 tablet po once a day. 17. amiodarone 200 mg tablet sig: as directed tablet po as directed: please take two tablets twice a day until , then you should take one tablet three times a day until , then you should take one tablet twice daily until , then you should take 200mg daily disp:*90 tablet(s)* refills:*0* discharge disposition: home with service facility: allcare vna discharge diagnosis: primary diagnosis: coronary artery disease s/p cardiac cath with bms to om1 non st elevation myocardial infarction monomorphic vt with vf arrest hypotension end stage renal disease . secondary diagnoses: hypertension hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. chest pain free. discharge instructions: dear mr. , . it was a pleasure taking care of you while you were hospitalized at . you had a cardiac catheterization with a placement of a bare metal stent. after the procedure, you started having some chest pain that we believe was from a heart attack. we did another heart catheterization, but no further interventions were able to be made. . later your heart went into an unstable rhythm called ventricular fibrillation. we performed cpr and shocked your heart three times back into a normal rhythm. we considered implanting a device that could shock you back into a normal rhythm if this was to happen again but decided against it, as this irregular rhythm is likely a result of your heart attack. once you recover from your heart attack, you should not be at risk for this rhythm and you may not need a internal defibrillator. instead you should wear a lifevest which is an external device that will stop a dangerous irregular heart rhythm if it occurs again. you should follow up with dr. as scheduled to arrange to have further studies and potential implantation of a defibrillator device at a later time. we also started a medication called amiodarone which will help prevent this arrhythmia. . you will need to take aspirin 325mg daily indefinitely. you will need to take plavix 75mg daily for minimum of one year. stopping these medications prematurely can put you at risk for in stent clot and subsequent heart attack. you should not stop these medications unless dr. tells you otherwise. . weight goes up more than 3 lbs in one day or more than 5 lbs in one week. . your oxygen levels have been low in the hospital, especially when you move around. as a result, we are sending you home on oxygen for you to use when you walk. this may be temporary and you should follow up with your pcp and your kidney specialist to reevaluate this need in the future. ideally your oxygen saturation levels should be greater than 94%. . your blood levels are also lower than normal. your kidney doctor may want to give you blood transfusions at dialysis. . the following changes have been made to your medication regimen: -start amiodarone 400mg twice a day until , then you should take 200 mg three times a day until , then you should take 200mg twice daily until , then you should take 200mg daily -start oxycodone 5mg every 6 hours as needed for pain. -start docusate 1 pill twice daily as needed for constipation -start senna 1 pill as needed for constipation -start plavix 75mg po daily - do not stop this unless dr. instructs you to! -start triamcinolone 0.1% cream twice daily as needed to affected areas. this medication can thin or discolor your skin so please only use it for two weeks at a time. -increase aspirin 325mg by mouth once daily - do not stop this medication unless dr. instructs you otherwise! -increase sevelamer (phoslo) to 2400mg by mouth three times daily -decrease lisinopril to 10mg once daily (this can be increased to your home dose by your primary care doctor or cardiologist) -decrease atorvastatin to 40 mg daily -decrease metoprolol succinate 25mg po daily -continue your other home medications as previously directed . please follow-up with the appointments below. . it is very important that you wear your life vest at all times and follow the instructions provided by the company. you can take off your life vest when you shower but you have to make sure someone is present with you at all times when you have your lifevest off. you should not drive or operate heavy machinery because if you were to have an abnormal heart rhythm at that time you could serious harm yourself or others. followup instructions: please attend the following appointments: . name: , l. location: the medical group address: , , phone: *we are working on a follow up appointment with your primary care provider 1 week. the office will contact you at home with an appointment. if you have not heard within 2 business days please call the office. . you will need continued follow-up with your coumadin clinic as arranged through your pcp. last inr was 1.6 on . you are being discharged on 4mg warfarin po daily. . department: transplant center when: friday at 8:00 am with: , md building: lm campus: west best parking: garage . department: cardiac services when: wednesday at 10:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage . department: cardiac services when: friday at 1 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters other and unspecified coronary arteriography hemodialysis other electric countershock of heart cardiopulmonary resuscitation, not otherwise specified transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status subendocardial infarction, initial episode of care esophageal reflux mitral valve disorders congestive heart failure, unspecified long-term (current) use of steroids hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified coronary atherosclerosis of autologous vein bypass graft cardiac complications, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of prostate other chronic pulmonary heart diseases peripheral vascular disease, unspecified paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia peripheral vascular complications, not elsewhere classified cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure chronic systolic heart failure long-term (current) use of anticoagulants ventricular fibrillation surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation hypotension of hemodialysis kidney replaced by transplant aneurysm of artery of lower extremity 

Answer: The patient is high likely exposed to