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: simvastatin attending: chief complaint: 3vd with chestpain awaiting cabg major surgical or invasive procedure: iabp cardiac catheterization history of present illness: mr. is 76 year-old man with a history of htn who presents with intermittent, stuttering chest pain for 2 days. he describes this as reflux pain with intermittent chest pressure on top. he increased his cimetidine and tums without improvement. he went to his pcp and was given compazine and prilosec prior to discharge home. review of ekg later was concerning so patient was called to go to the ed. ems gave him asa 325mg en route in addition to nitroglycerin with some improvement. in the ed, initial vitals were: t 100.5, p 68, bp 100/60, rr 14, o2sat 96%. he was still having cp. no n/v but +diaphoresis. he was given one sl ntg with resolution of chest pressure but continuation of heartburn-like pain. exam notable for atrophied lll d/t polio; no concern for dvt. ekg showed sb @ 57. lad, q iii,avf. std v2-v3, twi v4-v6; no prior for comparison. cxr clear. labs notable for trop 2.51. pt stared on heparin gtt. repeat ekg with resolution of std v2-v3 but otherwise unchanged. on transfer to floor, vs: p 57, bp 113/74, rr 13, o2sat 97% ra. he was chest pain free upon transfer to floor, with no shortness of breath, nausea, or diaphoresis. review of systems negative for orthopnea, paroxsymal nocturnal dyspnea, lower extremity edema. no syncope or lightheadedness. review of systems otherwise negative. . on review of systems, 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 denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. past medical history: 1. cardiac risk factors: hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: hypertension hypothyroidism gout depression gerd bph mitral valve prolapse. social history: patient is an artist who recently had his own show . he remains socially active despite having lost his wife recently. - history: none -etoh: rare -illicit drugs: none family history: mother had multivessel coronary disease with first mi at age 63 requiring cabg physical exam: vs: bp 115/70, hr 70, rr 12, 98% ra general: pleasant caucasian male in no apparent distress heent: perrl, eomi neck: supple with jvp < 8 cm cardiac: rrr, nl s1/s2, no s3,s4 noted, no appreciable murmurs lungs: clear bilaterally with no rales or rhonchi abdomen: soft, ntnd. normoactive bowel sounds extremities: no edema noted, pulses 2+ throughout skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 1. admission labs: 04:30pm blood wbc-10.6 rbc-4.44* hgb-13.7* hct-39.1* mcv-88 mch-30.8 mchc-35.0 rdw-13.7 plt ct-179 04:30pm blood pt-14.0* ptt-27.8 inr(pt)-1.2* 05:39am blood ret aut-1.4 04:30pm blood glucose-115* urean-19 creat-1.2 na-131* k-4.0 cl-99 hco3-23 angap-13 11:10pm blood ck(cpk)-1300* 06:35am blood alt-40 ast-178* ld(ldh)-683* ck(cpk)-1006* alkphos-55 totbili-1.2 04:30pm blood ctropnt-2.51* 11:10pm blood ck-mb-66* mb indx-5.1 ctropnt-3.38* 06:35am blood calcium-9.4 phos-3.2 mg-1.8 cholest-227* 05:39am blood caltibc-98* hapto-30 ferritn-277 trf-75* 06:35am blood triglyc-116 hdl-54 chol/hd-4.2 ldlcalc-150* ldlmeas-160* . 2. labs on discharge: <<<<<<<<<<<<<<<<<<<<<<<<< >>>>>>>>>>>>>>>>>>> ------------ microbiology: 11:06 am blood culture side port iabp. blood culture, routine (preliminary): gram positive coccus(cocci). in clusters. aerobic bottle gram stain (final ): reported by phone to 9-0936 1/330/11 12:25pm. gram positive cocci in clusters. ------------ imaging: echo: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately depressed (lvef= 35 %) secondary to akinesis of the posterior wall and severe hypokinesis of the inferior and lateral walls. the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with depressed free wall contractility. 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. there is no mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . 1st cardiac cath: comments: 1. selective coronary angiography of this right-dominant system demonstrated 3 vessel coronary artery disease. the lmca had 20% ostial stenosis. the lad had 90% stenosis proximal to d1. there was 60% stenosis in a ramus. the lcx was totally occluded and a large om1 filled via left-to-left collaterals. the rca was totoally occluded at mid-vessel and filled via left-to-right collaterals. 2. limited resting hemodynamics revealed normal systemic arterial pressures. final diagnosis: 1. three vessel coronary artery disease. 2. normal systemic arterial pressures. 3. ct surgery consulted for cabg. . 2nd cardiac cath: interventional details change for 6 french xb3.5 guide. crossed with choice pt xs wire into the upper pole of the om. then a 2.5 mm balloon was was used to perform inflations. a 2.5 x 24 mm endeavor stent was deployed. attention was then turned to the lad. the choice pt xs was redirected into this vessel without difficulty and placed in the distal lad. a 2.5 x 24 mm endeavor stent was deployed. final angiography of this vessel revealed normal flow, no dissection and 0% residual stenosis. at this point, a small distal edge dissection of the cx was noted as well as occlusion of a lower pole of this vessel which could not be appreciate previously because the vessel was totally occluded proximally. the choice pt xs wire was redirected into the distal om upper pole and a 2.5 x 12 mm endeavor stent was deployed completely covering the dissection. a pilot 50 wire was directed into the lower tiny pole of the om, restoring flow and ptca with a 2.0 mm balloon was performed restoring timi 2 flow in a 2.0 mm vessel. the wire was withdrawn from the lower pole and the stents in the om were postdilated with a 2.5 x 15 mm quantum apex balloon. final angiography revealed normal flow in the lad, cx and upper pole om in the stented portion. the lower pole om had timi 2 flow. complications: none assessment & recommendations 1. plavix 75 mg po qd x 12 months uninterrupted 2. successful ptca and stenting of the om and lad with des 3. successful iabp insertion 4. asa indefinitely 5. secondary prevention cad 6. heparin to maintain ptt 50-70 sec while iabp in place. . - carotid ultrasound (): there is less than 40% stenosis within the internal carotid arteries bilaterally. . - ct abdomen/pelvis (): 1. no evidence of retroperitoneal bleed. 2. moderate-sized hiatal hernia. 3. multiple large renal cysts with ill defined small region of hyperdensity that could represent calcium within cysts. recommend ultrasound for further characterization. brief hospital course: this is a 76 year old male with a history of intermittent chest pain over the past 2 days associated with epigastric pain and mild nausea, relieved with nitroglycerin, and ekg changes consistent with anterolateral ischemia and elevated troponins suggestive of nstemi who underwent cath and had 3 vessel coronary artery disease. . # non-st elevation myocardial infarction (nstemi): patient was found on cardiac catheterization to have 3 vessel disease (lad, lcx, rca). the original plan was to pursue cabg however patient developed hypotension on the morning after catherterization and was unresponsive to fluids. he had an immediate echo which showed a non-compressable ivc, and a moderately reduced ef with 3+ mr. a ct of the abd/pelvis did not reveal a retroperitoneal bleed. he was transferred to the ccu. repeat catheterization was performed with placement of drug-eluting stents (des) to the obtuse marginal(om) and left anterior descending (lad) arteries, as well as an intra aortic ballon pump (iabp). patient was weaned off the ballon pump prior to discharge. low dose ace inhibitor and beta blocker were re-started. he was discharged on daily high dose aspirin and plavix, low dose lisinopril and metoprolol. . # fever/bacteremia: blood culture was positive for gram positive cocci in clusters, 1 out of 4 bottles from side port of iabp, likely a contaminant. patient was treated with iv vancomycin, which was discontinued when his surveillance cultures were negative for > 48 hours. he was afebrile for 24 hours prior to discharge. two sets of blood culutres were pending at time of discharge, but remained no growth to date. these should be followed up on by his primary care physician. . # respiratory distress: cxr was suggestive of pulmonary congestion and patient had desaturation in oxygen level after small (250cc) boluses. he was gently diuresed with iv lasix with improvement of respiratory function. he was transitioned to oral lasix after balloon pump discontinued, and started on lasix 20 at discharge. he was restarted on home advair. . # acute renal failure: on admission, cr was 1.2, which peaked at 1.6, likely due to dye from cardiac catheterization. patient was able to maintain good urine output throughout. prior to discharge, cr trended down and was 1.2 on discharge. . # hypertension: patient remained hypo- to normotensive throughout the hospital course. lisinopril and metoprolol were initially held, then re-started at lisinopril 5 daily and metoprolol sr 25 daily. . # depression: continued on home lorazapem and trazadone prn . # hypothyroidism : continued on levothyroxine 50 mcg po qd. . # gout: allopurinol was held due to acute renal failure. this was re-started on discharge, as renal function improved to baseline. . # other: the patient was evaluated by physical therapy, and discharged home with a cane for ambulation. medications on admission: medications (on transfer): allopurinol 100 mg po/ng daily aspirin 325 mg po/ng daily citalopram 60 mg po/ng daily fluticasone-salmeterol diskus (250/50) 1 inh ih heparin iv per weight-based dosing guidelines levothyroxine sodium 50 mcg po/ng daily lisinopril 40 mg po/ng daily lorazepam 0.5 mg po/ng q8h:prn anxiety metoprolol tartrate 12.5 mg po/ng mupirocin nasal ointment 2% 1 appl nu omeprazole 20 mg po daily rosuvastatin calcium 10 mg po daily trazodone 50 mg po/ng hs:prn . medications (home): lorazepam 0.5 mg prn anxiety lisinopril 40 mg daily levothyroxine 50 mcg daily ranitidine 150 mg tamsulosin 0.4 mg daily allopurinol 100 mg daily omeprazole 20 mg daily fluticasone 50 mcg nasal spray citalopram 60 mg daily trazadone 50 mg qhs discharge medications: 1. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 3. lorazepam 0.5 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed for anxiety. 4. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po at bedtime. 5. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 6. fluticasone 50 mcg/actuation disk with device sig: one (1) puff inhalation twice a day. 7. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 8. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 9. rosuvastatin 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 12. furosemide 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 13. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes as needed for chest pain. disp:*25 tablets* refills:*0* 14. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 15. lisinopril 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: non st elevation myocardial infarction hypertension acute systolic dysfunction discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had a heart attack and required two drug eluting stents in the your heart arteries to keep them open and restore blood flow to the heart muscle. you developed fevers after the procedure but all of the cultures were negative. the fevers went away on their own and antibiotics were discontinued. you will need to be on some new medicines to help your heart work better as it is somewhat weak after the heart attack. you will need to take aspirin and plavix every day for at last one year to prevent the stents from clotting off and causing another heart attack. do not miss or stop taking plavix unless dr. tells you it is ok. you had some fluid retention during your hospital stay that is related to your weaker heart. please watch for swelling in your legs and follow a low sodium diet. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. we made the following changes to your medicines: 1. start taking aspirin 325 mg and plavix 75 mg to prevent the stent from clotting off 3. stop taking omeprazole, it interferes with the plavix, you can continue to take ranitidine 4. decrease the lisinopril to 5 mg daily 5. start taking metoprolol succinate to slow your heart rate and help your heart recover from the heart attack 6. start taking nitroglycerin as needed if you have chest pain at home. take up to 3 tablets 5 minutes apart. please call dr. if you take this medicine and call 911 if you still have chest pain after 3 . 7. start taking furosemide to prevent fluid retention. followup instructions: name: , j location: - address: 291 independence dr, , phone: when: tuesday, , 1pm department: cardiology location: - phone: , np date/time: at 1:00pm procedure: coronary arteriography using two catheters left heart cardiac catheterization implant of pulsation balloon right heart cardiac catheterization nonoperative removal of heart assist system insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism gout, unspecified depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) cardiogenic shock fever, unspecified hip joint replacement 

Answer: The patient is high likely exposed to