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: lovastatin / propranolol / elavil / niacin / l-arginine attending: chief complaint: chest pain major surgical or invasive procedure: left/right heart catherization history of present illness: 82 yo m w/ pmhx of dm w/ peripheral neuropathy, htn, hl, chf (ef ~30%) s/p icd, osa, ckd, gout and cad who presented to the ed with chest pain at rest and tachycardia to 140s. approximately at 8:30 pm on the evening of presentation, he developed gradual onset of achy chest pain associated with diaphoresis. he denied palpitations, sob. ems was called and enroute he received sl nitroglycerin without improvement in chest pain and induction of hypotension. . in the ed, initial vitals were 96.7 156 123/87 16 99%ra. he was noted to have signficant st depressions with tachycardia and without tachycadia. troponin trended up to 0.18 and ck to 404 and echo done in ed by the fellow showed no segmental wall motion abnormalities, but ef decreased from prior at 15-20%. integrellin gtt, heparin gtt, asa 325mg , plavix 600mg were initiated and he was taken to the cath lab. . in the cath lab, he received 60mg iv lasix and heparin was discontinued. he received 25mcg fentanyl, 0.5mg versed, 185cc contrast, and 200cc nsb during the procedure. a swan was placed which induced ectopy and broke the svt. lcx had 90% isr and pt received pci w/ a des. he was noted to be presistently hypotensive (sbp 80-90s) and a balloon pump was placed prior to admission to the ccu. . in the ccu, he was chest pain free and his only complaint was his chronic neck and back pain. . on review of systems, he reports recent rhinnitis and non-productive cough not associated with fevers or chills. he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, 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. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: - cabg: , redo in (see further interventions below) - s/p avr (tissue) ' - chf ef: 22-30% -percutaneous coronary interventions: . - cardiac cath, ef 63%, 80% am, 70% rpl, 80% lm, 80% lad, 50% d1, 95% lcx. he underwent a cabg x4 with lima to lad, vg to d1, vg to om and vg to pda . -: cardiac cath for recurrent angina. patent lima to lad and patent vg to rca, occluded vein grafts to d1 and om, 80% lm lesion, attempt at ptcra of lm, unable to pass wire successfully, ptca performed. . -: ptca and stent to lm. echo done at that time showed significant aortic stenosis with of 1.0cm2. . -: cath for atypical chest discomfort and cath revealed patent lm with 40% restenosis. . -: cath: 90% svg to pda and instent restenosis of the stent to the left main. s/p stent placement to the svg to pda and s/p rota and stent to lm. . - cath for continued pain/pre surgery: patent lima and svg to pda, mild as. . - cath/mi: svg to pda totally occluded, high thrombus burden. s/p thrombectomy and 4 stents to pda graft. . -: cath: native cad with occluded rca and lad and 90% lcx. bms to mid cx lesion, patent svg-pda and lima-lad . -pacing/icd: icd other past medical history: chf with ef 30% s/p icd nephrolithiasis gout dm ii w/peripheral neuropathy osa ckd - baseline creatinine 1.5 social history: pt lives with his wife in and is an architect. does not smoke, drink, or use any illicits. he has had numerous transfusions. family history: father - ami in his 80's mother - "enlarged" heart physical exam: vs: afebrile bp=112/43 hr=79 rr= 18 o2 sat= 99% on 5l nc general: wdwn, obese male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, unable to visualize jvp 2/2 body habitus. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. + accessory sounds from iabp. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, obese, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. right venous/arterial sheath in place. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral groin sheath in place popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: 06:40am wbc-7.9 rbc-3.60* hgb-9.9* hct-29.7* mcv-83 mch-27.5 mchc-33.4 rdw-15.0 plt ct-150 06:07am pt-12.7 ptt-50.3* inr(pt)-1.1 06:40am glucose-135* urean-35* creat-2.2* na-136 k-4.1 cl-105 hco3-20* angap-15 09:45pm ck(cpk)-200* 09:45pm ctropnt-0.02* 12:50am ck(cpk)-404* 12:50am ck-mb-21* mb indx-5.2 12:50am ctropnt-0.18* 06:07am ck(cpk)-770* 06:07am ck-mb-94* mb indx-12.2* ctropnt-2.08* 01:41pm ck(cpk)-1388* 01:41pm ck-mb-197* mb indx-14.2* 08:27pm ck(cpk)-1221* 08:27pm ck-mb-152* mb indx-12.4* ctropnt-3.50* 04:13am alt-30 ast-106* ck(cpk)-879* alkphos-123* totbili-0.7 04:13am ck-mb-88* mb indx-10.0* ctropnt-3.14* 06:40am alt-21 ast-48* ld(ldh)-427* alkphos-123* totbili-0.6 06:07am %hba1c-7.9* 06:07am triglyc-178* hdl-27 chol/hd-4.6 ldlcalc-60 ekg : probable atrial tachycardia with variable block. borderline intraventricular conduction delay. inferior lead qrs configuration raises consideration of prior inferior myocardial infarction, although it is non-diagnostic. delayed r wave progression with late precordial qrs transition. st-t wave abnormalities. findings are non-specific. clinical correlation is suggested. since the previous tracing of the same date ventricular response is now irregular and slower, precordial lead qrs configuration shows delayed r wave progression but is less suggestive of anterior myocardial infarction and further precordial lead st-t wave changes are present. . tte : the left atrium is dilated. 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 akinesis of the inferior and inferolateral walls, hypokinesis of the anterior wall and septum. the lateral wall has relatively preserved function. overall left ventricular systolic function is severely depressed (lvef= 25-30 %). with borderline normal free wall function. the ascending aorta is mildly dilated. a bioprosthetic aortic valve prosthesis is present. the prosthetic aortic valve leaflets are thickened. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . compared with the prior study (images reviewed) of , image quality is better. the aortic prosthesis can be seen and appears to work well. wall motion can be adequately assessd on the current study. . cta chest : 1. no evidence of pulmonary embolism or acute aortic pathology. . 2. coronary artery disease with prior coronary bypass surgery and aortic valve replacement. . cxr : no acute cardiopulmonary process. stable moderate cardiomegaly. . lhc/rhc : comments: 1. selective coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had mild plaquing throughout. the lad had a proximal/ ostial occlusion. the cx had a 90% in stent restenosis in the mid portion of the vessel. the rca was known to be totally occluded and was not visualized. 2. arterial conduit angiography revealed the lima to be widely patent. the svg to the r-pda was widely patent. the svgs from the patients previous cabg were known to be occluded and not visualized. 3. limited resting hemodynamics revealed elevated left and right sided filling pressures. the lvedp was 33 mmhg and the ra a wave was 28 mmhg. the pasp was moderately elevated at 49 mmhg. there was systemic hypotension with an central aortic pressure of 81/50 mmhg. the cardiac index was low at 1.7 l/min/m2. . final diagnosis: 1. three vessel coronary artery disease. 2. moderate left ventricular diastolic dysfunction. 3. moderate pulmonary hypertension. 4. decreased cardic index. 5. systemic hypotension brief hospital course: # coronary artery disease: known 3vcad presenting with nstemi found to have in stent restenosis of left cx (bms placed in ) s/p angioplasty and placement of drug eluting stent. echo showed depressed ef 25%, essentially unchaged from previous. ck's peaked at 1388 with trop 3.5. pt tol cardiac catheterization and placement of intra aortic balloon pump well, right groin with only mild ecchymosis and no hematoma. sbp has been borderline low, 90's-110's, so initiation of ace and metoprolol has been slow. imdur was started for intermittant chest pain that was relieved with sl ntg. currently on full dose aspirin, clopidigrel, atorvastatin and metoprolol succinate. lisinopril was restarted on the day of transfer. pt should increase his metoprolol and lisinopril as tolerated. pt should take aspirin and plavix daily indefinitely to prevent in stent stenosis. hdl 27, ldl 60. . # acute on chronic systolic congestive heart failure: prior ef 25-30% s/p icd placement and iabp for hypotension. now ef 25% after nstemi. high filling pressures in cath lab, rec'd lasix iv x1 and restarted lasix po. currently has no peripheral edema or o2 requirement, needs to be assessed with activity. he should be weighed daily before breakfast and weight gain or more than 3 pounds in 1 day or 6 pounds in 3 days should be reported to provider. needs to follow a 2 gram sodium diet, he has been very non-compliant in the past. fluid restrict to 1500cc/day. he is on spironolactone as before. . # rhythm: on presentation in svt, now in sinus since right heart cath in the lab. . # acute on ckd - baseline creatinine 1.5, elevated to 1.9 on presentation and 2.2 currently. consistent with prerenal state for poor forward flow from acute mi and contrast nephropathy from cardiac catheterization and cta. foley pulled yesterday and replaced for no urine output in 8 hours. he has a history of urinary difficulty but has not been treated in the past. flomax was started and foley will be left in upon transfer. pt has an appt with urologist in 10 days for further evaluate. should have lytes done qod until stable, then weekly thereafter. . # type ii diabetes mellitus with complications, on insulin at home, very non-compliant per son. his sugars are moderately well controlled on 32 units of glargine here (home dose 30 units) with humalog sliding scale. a1c 7.9. need to uptitrate glargine further. . # chronic normocytic anemia - baseline hct 35, admitted above baseline but drifing down after procedures and phelbotomy. currently 29.7 and stable, no signs of bleeding. pt will need colonoscopy if he is not current in last 5 years once clinically more stable. . # gout - continue renally dosing of allopurinol. was taking colchicine 0.6mg at home, renally dosed at 0.3mg daily here. no signs of flare at present. . # chronic neck/back pain - sees orthopedic physician (dr. uses conservative measures at home w/ soft cervical collar and special pillows. was on nabumetome and possibly ibuprofen at home, held because of arf. lidocaine patch was continued. narcotics tend to make pt confused, would use high dose tylenol instead. . comm: - ; . medications on admission: allopurinol 100 mg tablet 1 tablet(s) by mouth once a day amoxicillin 500 mg tablet 4 tablet(s) by mouth x 1 prn as needed for 1 hr prior to dentist bd ultrafine pen needles colchicine 0.6 mg tablet one tablet(s) by mouth twice a day insulin glargine 100 unit/ml cartridge 30 units once a day lidocaine 5 % (700 mg/patch) adhesive patch, medicated apply once a day as needed for apply in morning and remove after 12 hrs lisinopril 5 mg tablet 1 tablet(s) by mouth once a day metoprolol succinate 25 mg tablet sustained release 24 hr one tablet(s) by mouth once a day nabumetone 500 mg tablet one tablet(s) by mouth twice a day simvastatin 80 mg tablet 1 tablet(s) by mouth once a day spironolactone 25 mg tablet 1 tablet(s) by mouth once a day venlafaxine 37.5 mg capsule, sust. release 24 hr 1 capsule(s) by mouth once a day aspirin 325 mg tablet, delayed release (e.c.) 1 tablet(s) by mouth once a day guar gum powder by mouth prn (otc) ibuprofen 200 mg capsule two capsule(s) by mouth twice a day omeprazole 20 mg tablet, delayed release (e.c.) 1 tablet(s) by mouth daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 2. aspirin 325 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). disp:*30 tablet(s)* refills:*2* 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 5. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime. 6. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 9. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). disp:*1 bottle* refills:*2* 10. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 11. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. benefiber sugar free(guar gum) powder sig: one (1) packet po once a day. 13. effexor xr 37.5 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 14. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day: apply to neck or back for total of 12 hours per day. disp:*30 patches* refills:*2* 15. colchicine 0.6 mg tablet sig: 0.5 tablet po daily (daily). 16. ranitidine hcl 150 mg capsule sig: one (1) capsule po daily (daily). 17. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 18. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 19. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for back/neck pain. discharge disposition: extended care facility: for the aged - discharge diagnosis: non st elevation myocardial infarction acute on chronic congestive heart failure acute on chronic kidney disease hypertention urinary retention discharge condition: mental status:confused - sometimes 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 a drug eluting stent be placed in your left circumflex artery. you will need to take plavix every day for at least one year, do not stop taking plavix or miss unless dr. tells you to. this is to prevent the stent from clotting off again and causing another heart attack. you also had trouble urinating after we took out the foley catheter. the catheter was put back in and you will need to keep it in until you see dr. , a urologist, in 10 days. new medicines: 1. flomax: to help shrink the prostate so you can urinate without the catheter. 2. plavix: to prevent the stent from clotting off and causing another heart attack. 3. continue to take aspirin daily along with the plavix. 4. stop taking ibuprofen and nabumetome 5. start taking flonase to stop your runny nose 6. start imdur, a long acting nitroglycerin to prevent chest pain 7. take metoprolol succinate 1 tablet per day and titrate up as tolerated. 8. start taking furosemide to prevent fluid build up. 9. restarted lisinopril at 2.5 mg po daily . weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. follow a low sodium diet. followup instructions: orthopedics: provider: , orthopedic private practice phone: date/time: 9:00 . primary care: , m. phone: date/time: please make an appt after you get to your new home. . cardiology: , md phone: date/time: office will call you with an appt. . urology: dr. clinical center, , , . phone:( date/time: at 11:45am. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor implant of pulsation balloon angiocardiography of right heart structures insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other primary cardiomyopathies anemia in chronic kidney disease obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes atrial flutter chronic kidney disease, unspecified cardiogenic shock long-term (current) use of insulin other complications due to other cardiac device, implant, and graft retention of urine, unspecified automatic implantable cardiac defibrillator in situ heart valve replaced by transplant acute on chronic systolic heart failure knee joint replacement 

Answer: The patient is high likely exposed to