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: transfer for treatment of chf and possible cardiac catherization major surgical or invasive procedure: cardiac catheterization s/p stent to lcx tunneled catheter placement history of present illness: pt is a 68 yo male with cad s/p mi in , chf, renal failure, dm, hypertension, hyperlipidemia, multiple myeloma presenting with sudden onset of sob and chest pressure starting this afternoon. he denies recent dyspnea on exertion or chest pain. he does report about 2 weeks ago that he had some sob, but it resolved. denies orthopnea or pnd and reports that he has been taking all of his medications. he has had hospital admissions in the past for chf exacerbations for which he was intubated. he first went to hospital and was transfered for potential cath and/or chf therapy as he continued to have chest pain and had ekg changes. at he was started om heparin drip, aspirin, nitro drip and was tranfered on 100% non-rebreather. his ck 1156, mb 46.3, index 4.0, trop i 4.4 from osh and his creatinine was 10.9. he became cp free on the ambulance ride to . denied cp on admission, but did have signiifcant sob. does not make very much urine at baseline and said that he was getting set up for dialysis. past medical history: 1. coronary artery disease, status post small myocardial infarction in , status post catheterization in for congestive heart failure with no intervention, status post persantine mibi in with a reversible defect in the inferior wall. 2. non-insulin-dependent diabetes mellitus. 3. congestive heart failure. 4. chronic renal insufficiency with a ? baseline creatinine of ? 1.5, thought due to diabetic nephrosclerosis. 5. chronic anemia with a baseline in the high 20s. 6. multiple myeloma. 7. hypertension, difficult to control. 8. hyperlipidemia. 9. gout. social history: quit smoking in , 35-pack-year history. denies recent alcohol. family history: mother died at 64 from renal cell carcinoma. father died in his 30s of unknown causes. three siblings with elevated cholesterol, diabetes, and hypertension. physical exam: vitals: afeb, 95% nrb general: elderly male breathing using accessory muscles with non-rebreather heent: could not appreciate jvp or carotid bruits cv: rrr, nl s1s2, could not appreciate murmur, b/l femoral bruits pulm: crackles throughout the lung fields bilaterally abd: normal bs, soft, nt/nd ext: warm, 2 +dp pulses and trace le edema neuro: aaox3 pertinent results: 01:39am blood wbc-10.0 rbc-3.48* hgb-9.3* hct-29.4* mcv-84 mch-26.9* mchc-31.8 rdw-20.4* plt ct-350 06:55am blood wbc-7.8 rbc-3.31* hgb-8.9* hct-28.9* mcv-87 mch-26.8* mchc-30.7* rdw-19.7* plt ct-236 01:39am blood pt-14.1* ptt-39.1* inr(pt)-1.3 06:55am blood plt ct-236 01:39am blood ret aut-1.6 01:39am blood glucose-147* urean-131* creat-10.3*# na-133 k-4.0 cl-94* hco3-17* angap-26* 06:55am blood glucose-142* urean-50* creat-4.5* na-140 k-3.0* cl-100 hco3-29 angap-14 hematology ck(cpk) 05:46am 106 04:00pm 135 05:50am 163 10:28am 840* 01:39am 1117* . cpk isoenzymes ck-mb mbindx ctropnt 05:46am 8 5.26* 04:00pm 12 8.9* 5.37 05:50am 13 8.0* 3.48 10:28am 53 6.3* 1.73 01:39am 43* 3.8 1.07 01:39am blood albumin-4.2 calcium-10.6* phos-7.7*# mg-1.9 iron-21* 01:39am blood ferritn-62 02:30pm blood caltibc-196* ferritn-150 trf-151* 07:11pm blood tsh-0.41 11:39am blood pth-39 05:50am blood pth-46 02:30pm blood pth-66* 02:45pm blood hbsag-negative hbsab-negative . cxr: congestive failure with pulmonary edema. pneumonitis at the bases cannot be excluded. . cardiac catheterization: 1. selective coronary angiography revealed a right dominant system with three vessel coronary artery disease. the lmca had a 40% stenosis. the lad had diffuse 40 to 50% disease with 50% lesions in the upper and lower poles of a large bifurcating diagonal branch. the lcx had a hazy ostial 90% lesion with diffuse 50% disease in the mid to dital vessel. the rca had diffuse 60% stenoses with distal occlusion of the pda and pl that filled via left collaterals. 2. resting hemodynamics demonstrated normal right sided pressures (mean ra 7 mmhg), severely elevated pulmonary (mean pa 45 mmhg), and mildly elevated left sided pressures (lvedp 15 mmhg) with no gradient upon movement of the catheter from the ventricle back to the aorta and a normal cardiac index (4.8 l/min/m2). 3. left ventriculography was deferred. 4. successful placement of a cypher drug-eluting stent in the ostium of the lcx. . echocardiogram: the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%) secondary to hypokinesis of the inferior and posterior walls. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. 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. mild to moderate (+) mitral regurgitation is seen. the mitral regurgitation jet is eccentric. there is no pericardial effusion. compared with the findings of the prior report (tape unavailable for review) of , left ventricular contractile function is reduced. brief hospital course: 68 yo m a/w sob and cp, found to have pulmonary edema and nstemi. . 1. nstemi: on admission patient extremely sob on 89% on 100% nrb. he was placed on heparin gtt, nitro, asa, bb and reopro. patient underwent cardiac catheterization with stenting of his lcx which was uncomplicated. after catheterization he was on asa, metoprolol, lipitor, reopro for antiplatelet activity, and plavix. he was cp free throughout his admission and remained hemodynamically stable. he was continued on asa, metoprolol, plavix, lipitor, imdur and hydralazine. . 2. chf/pulmonary edema: on admission patient was had significant pulmonary edema initially satting 89% on 100% nrb then briefly on bipap with 100% o2 sat. he was diuresed with lasix drip and diuril to which he was able to put out significant amounts of urine (up to 2 liters over 24 hours). however, he soon required hd after tunneled line placement on . he was afterload reduced with hydralazine and imdur. he had significant improvement in his respiratory status within 24 hours with improvement in pulmonary edema on chest x-ray and was satting 95 % on ra by discharge. . 3. renal: on admission creatinine was 10.3 indicative of arf on crf likely secondary to myeloma. he was able to make urine on lasix drip however. a tunneled hd catheter was placed on which he tolerated well. he was started on hd with significant improvement in his pulmonary status as mentioned above. his creatinine was 4.5 at discharge. he will follow up for dialysis at the dialysis center. . 4. myeloma: it was unclear what work up and treatment has been done. free calcium levels ranged from 1.19-1.30. this will be follow up as an outpatient. . 5. dm ii: fingersticks well controlled on riss. restarted on prandin as an outpatient. . 6. gout: allopurinol was originally held, but was restarted and continued at discharge. . 7. hypercholesterolemia: started on high dose lipitor. lfts will be monitored as an outpatient. medications on admission: hydralazine 20 mg postassium cl er micro 20 meq qd toprol-xl 200 mg p.o. q.d. clonidine 0.1 mg qd lasix 120 mg qd minoxidil 10 mg lipitor 20 mg p.o. q.d allopurinol 100 mg p.o. q.d. prandin 2 mg at dinner only procrit 40k/60k as directed metolazone 2.5 mg 1 tab aspirin 81 mg p.o. q.d., cartia xt 180 mg 1 capsule discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin calcium 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 9. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. toprol xl 200 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. disp:*30 tablet sustained release 24hr(s)* refills:*2* 11. hydralazine 10 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* 12. prandin 2 mg tablet sig: one (1) tablet po at dinner time. 13. procrit injection 14. allopurinol 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: esrd now on hemodialysis cad s/p stent to lcx, ef50% diabetes mellitus type ii chronic anemia multiple myeloma hypertension hyperlipidemia gout discharge condition: chest pain free, no shortness of breath, hemodynamically stable discharge instructions: if you have any chest pain, shortness of breath, palpitations or any other concerning symptoms call you doctor or go to the emergency room. your next scheduled dialysis is on tuesday at dialysis center. the following changes have been made to you medications: 1. your lipitor has been increased to 80 mg per day 2. do not take your clonidine, metolazone, minoxidil, lasix or cartia xt. these can be added back by dr. as your blood pressure dictates. 3. continue your hydralazine 20 mg twice per day and toprol xl 200 mg once per day 4. take the other medications on the attached medication list as directed and follow up with dr. and you primary doctor for titration of medications. followup instructions: you will need to follow up with a nephrologist dr. at the dialysis center. you will need dialysis at the dialysis center on tuesday. these arrangments ahve already been made. please make a follow up appointment with dr. within the next week to follow up your blood pressure medications as you need close monitoring. please make a follow up appointment with dr. within 1 month. procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters hemodialysis transfusion of packed cells insertion of drug-eluting coronary artery stent(s) diagnoses: anemia of other chronic disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified gout, unspecified atrial fibrillation other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia multiple myeloma, without mention of having achieved remission 

Answer: The patient is high likely exposed to