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: chest pain, shortness of breath major surgical or invasive procedure: cardiac cath s/p stent to left main, lad iabp placement history of present illness: 62 yr old male with 3vd, chf 20-25% with 3-4+ mr, bilateral carotid stenoses s/p l ica stent now awaiting cabg/mvr who presented with chest pain and shortness of breath. pt states that the chest pain came on while at rest, located on the right side radiating down his right arm, described as sharp, associated with shortness of breath, diaphoresis, nausea, no vomiting. multiple episodes of chest pain over the day, lasting one minute at a time. on further questioning, pt states that he has had these episodes of chest pain x 2 weeks. he has also noted that his lower ext swelling has gotten worse over the past few days as well. +2-pillow orthopnea, no pnd. two days prior to admission, pt presented to complaining of lower abd pain, described as a sharp pain across his lower abdomen, associated with nausea, vomiting and dry heaves. lfts, amylase and lipase were found to be elevated. ruq ultrasound, abd ct were both negative for gallstones, liver pathology. pt has no hx of gallstones, no hx of alcohol use; he has been taking tylenol (6 extra strength tabs/day). pt states that his abd pain went away after some fluids. past medical history: 1. cad (3vd) s/p mi x 2 -cath in : 100% prca, 80% p-mlad, 70% diag, 100% plcx 2. + mr 3. bilateral carotid stenoses s/p l ica stent (r ica not ammenable to stent) 4. dm, dx in 5. chf, ef 20-25% 6. copd 7. shoulder surgery social history: married with 3 children, lives with wife smoking 2 ppd for 30yrs, no down to 6 cigarettes per day no etoh family history: dad has htn, chf, grandparents have dm. physical exam: temp 97.3, bp 86-99/49-72, hr 87, rr 18, o2 98% ra gen: nad, appears comfortable heent: perrl, eomi, mmm, anicteric sclera neck: no bruits heard, jvp 7cm at 80 degrees cv: distant heart sounds, 3/6 systolic murmur at apex, no radiation to axilla; pmi not palpable chest: crackles at base bilaterally, no wheezes abd: +bs, +midly distended, nontender to deep palpation, liver edge non-palpable, guaic negative in ed ext: 3+ pitting edema to mid-thigh, 2+ dp neuro: cn 2-12 intact pertinent results: ** cbc ** 09:25pm wbc-9.0 rbc-4.05* hgb-12.7* hct-39.3* mcv-97 mch-31.4 mchc-32.3 rdw-16.7* 09:25pm plt count-280 09:25pm neuts-80.1* lymphs-12.1* monos-5.7 eos-1.4 basos-0.6 09:25pm pt-14.3* ptt-29.6 inr(pt)-1.3 . 09:25pm d-dimer-763* . ** chem ** 09:25pm glucose-312* urea n-43* creat-1.3* sodium-125* potassium-5.5* chloride-88* total co2-23 anion gap-20 09:25pm alt(sgpt)-346* ast(sgot)-114* ld(ldh)-272* alk phos-590* amylase-141* tot bili-1.5 09:25pm lipase-137* . ** ce ** 09:30pm ck(cpk)-156 ctropnt-0.03* . ** cta: no pulmonary embolism. mediastinal lymphadenopathy. . ** chest x-ray: cardiomegaly without overt failure. . ** ruq u/s: 1. no evidence of cholelithiasis or cholecystitis. 2. simple right renal cyst. . ** cardiac cath: 1. resting hemodynamics on iabp revealed significantly elevated right (ra mean 19 mm hg, rvedp 21 mm hg) and left (pcwp mean 22 mm hg) sided filing pressures. the c.i was significantly reduced (1.2 l/imn/m2). 2. iabp was placed: augmented dp 140, unloaded systolic 90, unassisted systolic 100, mean bp 90. 3. selective coronary angiography of only the left system revealed a 80% ostial lm, 100% proximally occluded lcx, 90% mid lad stenosis, 80% distal lad stenosis. the rca was known to be t.o and was not engaged (rca was filling viw left to right collaterals). 4. successful stenting of the lm with two overlapping cypher des (3.5x13 and 3.5x8mm, postdilated to 3.75) (see ptca comments). 5. successful stenting of the mid lad with a 3.5x18mm cypher des postdilated to 3.75 (see ptca comments). 6. successful stenting of the distal lad with a 2.5x8mm cypher des (see ptca comments). 7. abdominal aortography revealed mild distal disease with no critical lesions in the iliacs and common femorals. . ** chest ct: 1) bronchiectasis and peribronchial opacity that is most prominent within the posterior right lower lobe with associated small effusions. this finding is suggestive of pneumonia. atelectasis is a less likely consideration. a similar lesser amount of opacity is seen within the posterior left upper lobe. 2) an intraaortic balloon is in place with its distal tip below the carina. the inflated balloon in place at the origin of the celiac axis. 3) unchanged enlarged mediastinal lymph nodes. 4) emphysema. 5) cardiomegaly and pericardial effusion. . ** echo: the left ventricular cavity is severely dilated. resting regional wall motion abnormalities include diffuse hypokinesis with anteroseptal and apical akinesis, basal to mid inferior akinesis and basal inferolateral akinesis. no apical thrombus seen (cannot definitively exclude). right ventricular chamber size is normal. right ventricular systolic function is borderline preserved. the aortic valve leaflets are mildly thickened. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. mitral regurgitation increases to moderate to severe (3+) with the intra-aortic balloon off. there is a trivial/physiologic pericardial effusion. ef < 15% . brief hospital course: a/p: 62 yr old male with severe 3vd, mr, chf now s/p l ica stent, awaiting cabg admitted for chest pain and shortness of breath . 1. cad, chest pain: given the pt's chest pain and shortness of breath, a cta was done and ruled out pe. pt was initially scheduled for elective cath with stenting of the lad to determine whether this would improve his ef. if his ef improved, then the plan would be to pursue mvr and cabg. given his presentation of recurrent chest pain his elective cath was moved up. on admission, ekg was noted to have old twi in the inferior leads and a troponin of 0.03 so heparin was started given his extensive cardiac hx. pt went to cardiac cath on hospital day #3 which revealed 80% lm, 90% lad, 100% lcx and 100% rca. pt then underwent ptca with cypher stent placed to 80% ostial lm lesion and cypher stent x 2 to lad. due to a severely depressed cardiac index, a balloon was placed and the pt was started on dobutamine. during cath, pt received 60mg of iv lasix and he diuresed 2l. in ccu, pt continued to diurese another 8l with lasix and he was weaned off the dobutamine and iabp. the cardiac surgery team evaluated the pt and determined that he was not a surgical candidate at the time due to his concurrent tobacco abuse. they recommended smoking cessation and medical management. he was continued on asa, plavix, beta-blocker, ace-i, imdur and statin. . 2. , 20-30%: pt's chf is multifactorial including ischemia (3vd) and severe mr. as above, pt was maintained on dobutamine and an iabp in the ccu for aggressive diuresis and diuresed approximately 10l. he was evaluted but ct surgery but was not a surgery candidate at the time. he was loaded on digoxin in the ccu and continued on bb, lasix and spironolactone. a repeat echo after his cath showed a further decreased ef of <15%. . 3. elevated lfts/amylase/lipase: pt admits to a hx of lower abd pain associated with nausea and vomiting however, the location of the pain was not typical for pancreatitis and pt was able to tolerate po's. other etiologies included medication-related, especially lipitor, though would not expect elevated pancreatic enzymes. also possible would be a passed gallstone, ruq u/s negative. pt with neg hepatitis panel, ebv, toxo, cmv igm in when being evaluated for heart transplant and were negative again when rechecked. all enzymes trended down and there was still no clear etiology of his elevated lfts on day of discharge. . 3. arf: urine lytes indicated that the pt was pre-renal secondary to poor forward flow. his creatinine improved over his hospital stay as his cardiac medications were adjusted to increase flow to the kidney. . 4. hyponatremia: likely chf and it resolved over the hospital stay. . 5. dm: pt was on an insulin drip in the ccu and then continued on his home dose of nph while on the floor. medications on admission: asa 325 plavix 75mg qd lipitor 80mg qd lasix 40mg aldactone 12.5mg qod lisinopril 10mg qd nph 20u qam, 15u qpm lopressor 25mg discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin calcium 40 mg tablet sig: two (2) tablet po daily (daily). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 10. insulin nph human recomb 100 unit/ml syringe sig: twenty (20) units units subcutaneous qam. 11. insulin nph human recomb 100 unit/ml syringe sig: eighteen (18) units subcutaneous qpm. 12. nitrotab 0.3 mg tablet, sublingual sig: one (1) tab sublingual q5min as needed for chest pain: use q5 min up to 3 times to relieve chest pain. disp:*30 days* refills:*0* 13. magnesium oxide 400 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: 1. coronary artery disease s/p stent 2. congestive heart disease, ef 20-25% 3. diabetes 4. copd 5. tobacco abuse discharge condition: good, chronic lower ext swelling, breathing well on room air discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5l . 1. please take all medications as prescribed (we have stopped your lopressor and started on you on carvedilol instead). 2. go to all follow-up appointments 3. call your pcp or go to the ed if you experience any of the following: chest pain, shortness of breath, weight gain, lower ext swelling, lightheadedness/dizziness, fevers/chills 4. it is essential that you quit smoking. followup instructions: heart failure: , m.d. where: cardiac services phone: date/time: 3:00 . please follow-up with your pcp within the next 2-4 weeks. . go to your follow-up appointment with dr. next friday. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor implant of pulsation balloon insertion of drug-eluting coronary artery stent(s) diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified 

Answer: The patient is high likely exposed to