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: substernal chest pressure and shortness of breath major surgical or invasive procedure: cardiac catheterization percutaneous cholecystostomy history of present illness: mr. is a 70 yo patient of dr. with cad and h/o anteroseptal qwmi, s/p cabg (left-dominant system; lima-lad, svg-pda, svg-om2. known ocluded svg to pda and om2 with backfilling) with nstemi treated with stents to lcx and l-pda, chf with ef 35-40%, htn, and hyperlipidemia. he had been feeling fatigued/lethargic as per his wife but with was in his usual state of cardiac health (able to walk -mile without chest pain or shortness of breath; no orthopnea, no pnd, no peripheral edema) until sunday evening around 3am when he awoke with dyspnea and substernal chest pressure that felt like an " stuck in his chest." he thinks the pain may have radiated to the shoulder, he did have diaphoresis (which he attributed to symptomatic hypoglycemia), shortness of breath, and feeling "off balance." he ignored his chest discomfort for several hours and decided the next morning to visit his pcp who sent him via ambulance to at 1:30pm. en-route to the hospital he was given 1 spray of sl nitroglycerine which relieved his chest pain permenantly. at nwh his ekg revealed lateral st depressions and his ck was positive at 660, trop 8.8. he was started on heparin drip; had already taken aspirin. his initial vital signs were p 74, bp 123/60, rr 28, t 100.2 axillary, 95% on ra. cxr showed mild chf and later he was placed on 100%nrb for hypoxia and given 40mg iv lasix without response. he was transferred to for cardiac catheterization. . also significant to his history is an axillary temperature of 100.2 at the osh with several days of feeling fatigued, lethargic, with poor appetite. he denies any abdominal pain, nausea, or vomiting. his platelets were noted to be 100 down from a baseline of 250 and hct of 25 down from a baseline of 30. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he does report recent t to 100.2 axillary but denies chills or rigors. he denies exertional buttock or calf pain. he denies abdominal pain, nausea or vomiting although he did notice abdominal pain when his pcp pressed on his ruq and again when this maneuver was done here. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . cardiac history: cabg, in anatomy as follows: lima-lad, svg-pda, svg-om2. known ocluded svg to pda and om2. percutaneous coronary intervention, in anatomy as follows: known patent lima-lad, known occluded svg-pda and svg-om. diffuse lcx disease treated overlapping cypher stents; bms to pda past medical history: -cad : cabg x 3 (lima to lad, svg to pda, svg to cx); catheterization in revealed occluded svgx2 and lima patent) -hypertension -type ii diabetes x 20 years, with peripheral neuropathy -chronic renal insufficiency with baseline cr 1.1 -anemia -pvd -benign ??????lump?????? removed from right foot -osteoporosis -questionable gerd -hypothyroidism social history: patient is married with four children. he previously worked at polaroid, in electronics division. currently retired. denies alcohol and tobacco use. wife , can be reached at . family history: mother with angina in her 50??????s, died of mi at age 57. father had a stroke in his 50s. sister with cad and dm. physical exam: vs: t 98.6, bp 107/53, hr 60, rr 24, o2 100% on 100% nrb gen: wdwn middle aged male in mild respiratory distress. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva pale, skin and oral pallor neck: supple with jvp to level of earlobe. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. difficult to auscultate over nrb mask chest: no chest wall deformities, scoliosis or kyphosis. crackles up chest bilaterally, no wheezes, no ronchi. abd: notable for + ruq ttp and sign. + voluntary guarding, no rebound. + bs ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; dp/pt dopplerable left: carotid 2+ without bruit; femoral 2+ without bruit; dp/pt dopplerable rectal: guiac negative, no mass pertinent results: 10:46pm wbc-10.9 rbc-2.63* hgb-8.8* hct-24.5* mcv-93 mch-33.4* mchc-35.8* rdw-14.4 10:46pm neuts-71.0* lymphs-17.0* monos-11.4* eos-0.7 basos-0.1 10:46pm plt count-101* 10:46pm pt-15.3* ptt-90.9* inr(pt)-1.4* 10:46pm fibrinoge-532* 10:46pm ret aut-2.3 10:25pm glucose-83 urea n-39* creat-1.6* sodium-132* potassium-3.1* chloride-94* total co2-27 anion gap-14 10:25pm alt(sgpt)-27 ast(sgot)-53* ld(ldh)-475* ck(cpk)-596* alk phos-68 amylase-56 tot bili-0.8 10:25pm lipase-17 10:25pm ck-mb-10 mb indx-1.7 ctropnt-1.58* 10:25pm calcium-8.8 phosphate-3.5 magnesium-1.9 iron-13* 10:25pm caltibc-278 haptoglob-191 ferritin-186 trf-214 ekg initially demonstrated nsr with normal axis, borderline prolonged qrs at 110, decreased axial voltages, old anteroseptal infarct. cove-shaped st segments in iii and avf with possible 1mm ste in lead iii and v1, 1mm st depression in lead i, st depression in avl, avf, st depressio nand t wave inversion in v4-v6. . ekg on presentation to ccu: nsr with tw flattening in all axial leads, 1- depression and twi in v4-v6. . cxr : mild cardiomegaly with increased moderate congestive heart failure and increased left lower lobe atelectasis. superimposed infection in left lower lobe cannot be excluded. . ruq us : mild gb wall edema, with mild gb wall edema of 3mm, gb distension w/o stones or sludge. concern for acute acalculous cholcystitis. . echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately depressed (lvef= 30 %) with global hypokinesis and regional akinesis of the inferior and infero-lateral walls. right ventricular chamber size is normal. there is moderate global right ventricular free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared to the prior study (images reviewed) dated , the overall lvef has decreased and the severity of mitral regurgitation has increased. . cath comments: successful ptca of the lcx/om and left pda vessels. final angiography revealed 0% residual stenosis, no angiographically apparent dissection and timi 3 flow (see ptca comments). summary: successful ptca of the lcx/om/left pda. final diagnosis: 1. three vessel coronary artery disease. . brief hospital course: 70 yo m with severe cad s/p cabg in and stents to lcx and l-pda in , presenting with nstemi s/p balloon angioplasty of lcx for in stent stenosis. also with ruq pain and distended gall bladder on u/s consistent with acalculous cholecystitis s/p percutaneous cholecystostomy tube placement. . #nstemi patient presented w/ ekg changes concerning for laternal infarct, ck peak of 614, troponins-t peak 2.09, in setting of severe cad history. cardiac cath revealed in-stent stenosis of lcx treated with balloon angioplasty. no new stents were placed given fever, ruq pain and concern for sepsis. transfused 3 units prbc for low hct, with stable hct since. chest pain resolved s/p angioplasty. asa, plavix, lisinopril, atorvastatin were provided. metoprolol 50 mg was added and lisinopril was titrated to 30 mg daily. patient will likely need follow up for repeat angiography / stenting given inability to place coronary stents during catherization on this admission. . #systolic dsyfunction post cath echo w/ 30% (c/w 35-40% in ) also with 3+mr. initially was hypoxemic and hypervolemic, however resolved this chf exacerbation, which was likey precipitated by ischaemia, w/ lasix and afterload reduction w/ hydralazine and isosorbide dinitrate. afterload reduction was converted to metoprolol 50 , lisinopril 20 daily. lasix was continued at 20mg po daily for home dose. patient was also discharged with home physical therapy. . # abdominal pain initial ruq pain and dilated gallbladder on ultrasound were consistent with acute acalculous cholecystitis; given pt was poor operative candidate recommended ir guided percutaneous cholecystostomy tube placement. initial wbc, fever, and abdominal pain resolved w/ perc chole tube and zosyn x 7 days. the perc. chole tube is scheduled to be followed by dr. in general surgery and will probably be removed approximately 6 wks from discharge. visiting nursing assistance was scheduled post discharge. . # hypoxia during initial 2 days of hospitalization patient was hypoxic and requiring oxygenation with 50% face mask. he was at first though to have chf and a superimposed lll pneumonia. after diuresis, ambulation, and repositioning, patient was weaned from o2. patient has no known history of lung disease, however exam was positive for wheezing which responded to albuterol and atrovent nebulization. pulmonary was not consulted during the admission; he was scheduled for outpatient pulmonary follow up following discharge. . # diabetes patient's dm is complicated by nephropathy and neuropathy. he had been prescribed 70/30 sliding scale at home. was consulted for tighter dm management while inpatient and recommended 17 units of lantus qhs w/ humalog sliding scale. patient will follow w/ following discharge. . # anemia/thrombocytopenia unclear etiology. has been anemic for "year" with unclear etiology. no evidence of hit as platelets were low prior to starting heparin. for anemia, iron was found to be low at 13, and iron supplementation was initiated. smear showed 1+ schistocytes. on ddx for thrombocytopenia was drug adverse effect of plavix. patient did not experience bleeding episides during hospitalization. given concern for possible myelophthistic process, patient has been scheduled for outpatient heme-onc appointment. . # renal baseline creatinine 1.1, with peak of 1.9 during admission likely poor cardiac output. creatinine trended down toward baseline upon discharge. lisinopril was initially held but restarted and increased to 30 mg daily. . patient defervesced on and remained hemodynamically stable during admission. patient was started on the following medications: ferrous sulfate / iron supplementation, metoprolol 50 mg , insulin lantus 17 units qhs and sliding scale humalog. lisinopril was increased to 30 mg daily. home toprol xl, nifedical, and diovan, and aldactone were discontinued. follow up appointments were made with pulmonary, his pcp, , , , and . medications on admission: 1. aspirin 325 mg po daily 2. diovan-hct 160-12.5mg po daily 3. lipitor 80mg po daily 4. lisinopril 20mg po daily 5. nifedical xl 60mg po once daily 6. plavix 75mg po daily 7. synthroid 50mcg po daily 8. toprol xl 200mg daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily): do not take at the same time as your thyroid medicine because it can decrease the absorption of the thyroid hormone. disp:*30 tablet(s)* refills:*2* 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. prilosec oral 8. lantus 100 unit/ml solution sig: seventeen (17) units subcutaneous at bedtime. disp:*qs qs* refills:*2* 9. humalog 100 unit/ml solution sig: as directed per sliding scale units subcutaneous four times a day: see sliding scale. disp:*qs qs* refills:*2* 10. lisinopril 20 mg tablet sig: 1.5 tablets po once a day. disp:*45 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: non-st segment elevation myocardial infarction acalculous cholecystitis congestive heart failure discharge condition: good discharge instructions: you were admitted to the hospital because you had a heart attack. in addition, you also went into heart failure causing fluid to accumulate in your lungs making it hard for you to breathe. you had a cardiac catheterization and balloon angioplasty to open up the stent in your artery which was blocked. in addition, you had enlargement of the gallbladder, called acalculous cholecystitis, which was causing your belly pain. a tube was inserted into your gallbladder to drain the bile fluid and relieve the pressure. you were given an antibiotic for 7 days to treat this. you will need to follow-up with surgery in weeks at which time the drain may be pulled. please take all medications as directed. several changes were made to your medications. we stopped the following medications: diovan-hctz, nifedical, toprol xl and aldactone. we changed your insulin from 70/30 to lantus 17 units which you should take at bedtime. we increased your lisinopril from 20 mg daily to 30 mg daily. we added metoprolol 50 mg twice daily. please follow-up with all outpatient appointments. please call your doctor or return to the ed if you experience chest pain, dizziness, shortness of breath, abdominal pain or any other concerning symptoms. in addition, please weigh yourself each morning. if you notice a 3 pound weight gain for two consecutive days, please call your cardiologist and increase your lasix dose from 20 to 40 mg daily. followup instructions: follow up with dr. (general surgeon) on at 1:30 pm. her office is located on of in . call her office at ( if you need to reschedule this appointment. she will assess the cholecystostomy tube at that time. you should follow-up with your cardiologist, dr. . his office number is . you have an appointment with dr. on at 4:20. you should follow up with your primary care doctor, dr. on at 2:15 pm. you should have repeat thyroid function tests in approximately one month. please follow-up with hematology-oncology to follow-up on low blood count and low platelets. the number for the office is . we tried to make you an appointment, but the office would prefer to call you with a date and time. if you do not hear from them within a week, please call the above number. please follow-up in the pulmonary clinic. we made an appointment for you on monday at 2 pm with drs. and . the office is located on the of the building at . the phone number is if you need to reschedule this appointment. please follow-up at the clinic with dr. . you have an appointment on monday at 2 pm. please ask your pcp for referral before going to the appointment or a $200 dollar deposit will be requested at the time of the visit. procedure: injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures trocar cholecystostomy excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] destruction of cranial and peripheral nerves procedure on three vessels diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia osteoporosis, unspecified other complications due to other cardiac device, implant, and graft hypoxemia acute systolic heart failure acute cholecystitis diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to