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: s/p pci with balloon pump major surgical or invasive procedure: cardiac catheterization iabp history of present illness: 65 year old male, originally from , with no past medical history presents to osh with cp, found to have stemi. pt says that saturday ~ 3 pm, he had a "sharp" pain in lower chest b/l radiating to the back. +associated diaphoresis and mild sob. pt also states that he had bilateral arm pain, non-radiating. no n/v/lightheadedness/dizziness/headache/jaw pain during this or before. pt says that he did have one episode 2 months prior that was similar and lasted ~10 hrs when he was gardening but he ignored it. pt took a pain pill from (unknown) and pain was slightly better though was back to "severe" and lasted until sunday midnight. mr. went to see his pcp and was sent to hospital. there he was found to have st elevation inferiorly and in v1-v2. troponin i 84.5, ck-mb 65.2. received 4 baby asa. of integrillin 6.8 cc and 12cc gtt on transfer, heparin 5000 unit , gtt 1000u/hour. vs there bp 98/60, hr 97 st. transferred to for catheterization. cath here showed totally occluded rca with evidence of thrombus. he had a transient pacing wire put in, was hypotensive on pressors, and co/ci 3.4/1.8. des to rca and iabp placed; pt was then transferred to ccu. past medical history: none social history: married for 35 years. 3 children. originally from , came to us in . works as a gardener. smokes 2 cigarettes a night. smoked ppd x 25 years, last 20 yrs ago. drinks 6 pack beer per night. no h/o blackouts, seizures, vh. no drugs, specifically marijuana, cocaine, heroine. family history: no history of heart disease, htn, dm in family. physical exam: vs: t: 99.7; hr: 110; bp: 110/85; rr: 21; o2: 100 4 l nc gen: speaking in full sentences in nad heent: perrla 5-->3; op clear without exudate. sclera anicteric. neck: no jvd cv: difficult to auscultate balloon pump. s1s2. lungs: cta b/l anteriorly. abd: slightly hyperactive bs. soft, nt, nd. +hepatomegaly 3-4 cm below costal margin. ext: right groin balloon cath in place. left groin cath in place. neuro: cn ii-xii grossly intact without focal findings. pertinent results: ekg on admission- ste ii,iii,avf. std v2, v3. rbbb qrs ~.12.q waves ii,iii, avf. twi v5,v6. weinkebach on later ekg. _____________________________ labs on admission: 06:19pm glucose-165* urea n-16 creat-0.7 sodium-138 potassium-3.6 chloride-101 total co2-24 anion gap-17 06:19pm ck(cpk)-3145* 06:19pm ck-mb-128* mb indx-4.1 ctropnt-17.30* 06:19pm calcium-8.0* phosphate-1.9* magnesium-2.0 06:19pm wbc-18.9* rbc-4.56* hgb-13.5* hct-39.2* mcv-86 mch-29.6 mchc-34.5 rdw-13.6 06:19pm neuts-85.0* lymphs-9.9* monos-5.0 eos-0 basos-0.1 06:19pm plt count-249 _____________________________ labs on discharge: 07:20am blood wbc-12.1* rbc-4.19* hgb-12.5* hct-36.1* mcv-86 mch-29.9 mchc-34.7 rdw-13.8 plt ct-242 07:20am blood glucose-107* urean-15 creat-0.9 na-137 k-3.5 cl-102 hco3-25 angap-14 07:20am blood calcium-8.3* phos-2.4* mg-2.1 ______________________________ cardiac enzymes: 06:19pm blood ck(cpk)-3145* 12:38am blood ck(cpk)-2769* 09:12pm blood ck(cpk)-1182* 04:56am blood alt-75* ast-136* ck(cpk)-808* 06:19pm blood ck-mb-128* mb indx-4.1 ctropnt-17.30* 12:38am blood ck-mb-79* mb indx-2.9 ctropnt-12.35* 09:12pm blood ck-mb-18* mb indx-1.5 04:56am blood ck-mb-12* mb indx-1.5 ctropnt-5.55* _______________________________ cardiac catheterization : 1. coronary angiography of this right dominant system revealed severe single vessel and branch coronary artery disease. the left main coronary artery had no angiographically apparent flow limiting coronary artery disease. the lad had mild disease with a small d1 demonstrating an 80%stenosis at its origin. the lcx was a non-dominant vessel with no angiographically apparent flow limiting stenoses. the rca was a dominant vessel with a proximal total occlusion and evident thrombus with faint left to right collateral filling. 2. resting hemodynamics revealed moderately elevated right sided filling pressures (mean ra pressure was 16 mm hg and rvedp was 18 mm hg). of note, a narrow rv pulse pressure was notable suggesting rv infarct pathophysiology. pulmonary artery pressures were normal (pa pressure was 30/20 mm hg). left sided filling pressures were moderately elevated (mean pcw pressure was 22 mm hg) and prominent v waves were noted suggestive of mitral regurgitation. central arterial pressures were low (aortic pressure was 85/60 mm hg). cardiac index was moderately depressed (at 1.8 l/min/m2). 3. a iabp was placed prophylactically before intervention. a temporary pacing wire was also placed as a prophylactic measure. 4. successful placement of 3.5 x 23 mm cypher drug-eluting stent in thrombotic, totally occluded proximal rca postdilated with a 4.0 mm balloon. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). final diagnosis: 1. severe single vessel and branch coronary artery disease. 2. moderately elevated right and left sided filling pressures. 3. cardiogenic shock requiring iabp placement. 4. successful placement of drug-eluting stent in proximal rca. ________________________________ echocardiogram - the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with near akinesis of the inferior septum, inferior and inferolateral walls. the remaining segments are hypokinetic. no masses or thrombi are seen in the left ventricle. right ventricular cavity size is normal with prominent free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. there is no pericardial effusion. impression: symmetric left ventricular hypertrophy with extensive left ventricular systolic dysfunction and right ventricular free wall hypokinesis c/w multivessel disease (proximal rca). moderate mitral regurgitation most likely due to papillary muscle dysfunction. ef 25%. __________________________________ brief hospital course: impression/plan: 65 yo male, no pmhx, presented with inferior stemi s/p rca des with cardiogenic shock. initially on an intra-aortic balloon pump on dopamine for pressure support. 1. cad- a. ischemia-pt is s/p inferior stemi with des to rca. he was on integrilin for 18 hours post-catheterization. pt was started on asa, plavix, and high dose statin. he was initially put on a beta blocker but this was held given wenckebach on ekg (see below). beta blocker was added back on hd#2. additionally, ace inhibitor was started. cardiac enzymes peaked on hd#1 at ck: 3145 mb: 128 mbi: 4.1 trop-*t*: 17.30 and trended down. lipids were checked and were: tg-170; hdl-66; hdl 52. pt was counselled regarding smoking cessation and re: limitations initially post-mi. he was told that he would benefit from cardiac rehab as an outpt. b. pump-pt with an initially unknown ef however depressed co/ci on catheterization (3.4/1.8) and pcwp of 22. he was put on an intra-aortic balloon pump during catheterization with dopamine gtt for pressure support. dopamine was able to be weaned off over the course of the first night. his iabp was d/cd on hd#3 as his co/ci improved. echo was done and showed an ef of 25%. additionally, echo showed both moderate rv free wall hypokinesis and severe lv systolic dysfxn. ace inhibitor was started for afterload reduction and beta blocker was started as well. pt will need an outpt ep evaluation given his low ef. c. pt was initially on beta blocker but held given wenckebach on ekg that developed and nodal effect of bb. pt then had worsening av conduction delay to pr ~.26. wenckebach went away and was likely in setting of ischemic physiology. additionally pr interval was normal upon d/c. 4. pt with history of drinking 6 pack a night without interruption ever. he was put on a ciwa scale with valium for ciwa >10. he had elevated ast/alt here and hepatomegaly on exam. pt never registered on ciwa and had no hemodynamic changes. he was started on thiamine, folate, and mvi. 5. ppx- initially on heparin gtt while on balloon pump changed to subcutaneous heparin when balloon pump d/cd. pt was taking po, was on a bowel regimen, and received a sleeping aide (ambien) 6. hyperglycemia- glucose initially high in the 160s. we aimed for tight glucose control in this pt post-mi. he was on a riss. however, sugars went to normal <120 and riss was d/cd. 7. f/e/n- low sodium/heart healthy diet. nutrition consult for education. 8. access- piv. left fem a line. 9. code- code status was full code. medications on admission: "sleeping pill"-pt does not know name of medication discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). :*30 tablet, delayed release (e.c.)(s)* refills:*0* 2. plavix 75 mg tablet sig: one (1) tablet po once a day: do not stop taking this medication without speaking to your doctor. :*30 tablet(s)* refills:*8* 3. atorvastatin calcium 80 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*0* 4. multivitamin capsule sig: one (1) cap po daily (daily). :*30 cap(s)* refills:*0* 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*0* 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*0* 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*0* 8. cardiac rehabilitation cardiac rehabilitation. 9. toprol xl 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. :*30 tablet sustained release 24hr(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: inferior myocardial infarction depressed ejection fraction discharge condition: pt is able to ambulate and is chest pain free. he has been educated about his condition, limitations, needs for follow-up, and nutrition. his primary care doctor has been called upon discharge. discharge instructions: -please take all of your medications as indicated. do not stop them without speaking with your primary care doctor. -these medications help keep the stents in your heart open. if you stop taking plavix (clopidogrel) or asa, you may suffer another heart attack, you can not stop taking these medications -please go to all of your appointments. -call your doctor or go to the emergency room immediately if you have chest pain, chest pressure, radiating pain to your arms, shortness of breath, have problems breathing, feel dizzy, or any other health concern. -weigh yourself every day. call your doctor if your weight is increased by 3 pounds. -adhere to a low sodium (3 gram) diet as you spoke about with the nutritionist. -you will need cardiac rehabilitation in 4 weeks time. your primary care doctor can set that up. -you should talk to your doctor about your alcohol use. followup instructions: you have an appointment with a cardiologist at : provider: , m.d. where: cardiac services phone: date/time: 2:30 please see your primary care doctor dr. ( within one week for a follow-up appointment. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of temporary transvenous pacemaker system implant of pulsation balloon nonoperative removal of heart assist system insertion of drug-eluting coronary artery stent(s) diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders cardiogenic shock other and unspecified alcohol dependence, continuous 

Answer: The patient is high likely exposed to