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: history of present illness: the patient is a 78 year-old male with a past medical history of coronary artery disease status post coronary artery bypass graft, congestive heart failure, diabetes, and chronic renal insufficiency who is admitted for asymptomatic right carotid stenosis now here for stenting. as an outpatient the patient underwent ultrasound on , which showed a 40 to 60% stenosis and his right carotid artery and a 20 to 40% stenosis in his left carotid artery. the patient reports no associated symptoms with this and denies any weakness or neurological defects. he did have a left cea in . he also reports a previous mri that showed "old tiny strokes," but otherwise has no neurological history. the patient was admitted for an elective stenting of his right carotid artery. the patient underwent stenting of his right coronary artery without any complications. he was then admitted to the coronary care unit for close monitoring following this procedure. at the time of his admission to the coronary care unit the patient denies any concurrent complaints and confirms the above history. past medical history: 1. coronary artery disease status post coronary artery bypass graft in four vessel disease. cardiac catheterization in . 2. congestive heart failure. 3. diabetes mellitus type 2. 4. peripheral neuropathy. 5. chronic renal insufficiency. 6. hypertension. 7. hypercholesterolemia. 8. history of basal cell carcinoma status post resection. 9. history of diverticulosis. home medications: 1. nph insulin b.i.d. 2. lasix. 3. atenolol. 4. altace. 5. lipitor. allergies: no known drug allergies. social history: he lives at home with wife. tobacco or alcohol use. retired accountant. family history: noncontributory. physical examination on admission: vital signs temperature 96.5. blood pressure 158/58. pulse 67. respirations 18. satting 100% on room air. physical examination older gentleman in no acute distress, conversant. alert and oriented times three. heent bilateral surgical pupils. extraocular movements intact. oropharynx is clear. neck no jvd. cardiovascular regular rate. 2 out of 6 systolic murmur at the apex. lungs clear to auscultation bilaterally. abdomen positive bowel sounds, soft and nontender. extremities no edema or cyanosis. pulses intact in extremities times four. cranial nerves ii through xii intact. strength and sensation grossly intact. laboratories on admission: white blood cell count 8.4, hematocrit 31, platelets 160, bun 39, creatinine 2.8. chest x-ray cardiomegaly, large pericardial fat pad, no acute infiltrates. electrocardiogram sinus rhythm at a rate of 68, pr interval .256, right bundle, no acute st changes. hospital course: 1. right ica stent: the patient was admitted for elective stenting of his right ica. this was following a carotid duplex in , which showed significant occlusion in his right ica with moderate to severe disease with 40 to 60% stenosis on the right. the patient did undergo a right ica stent without any intraoperative complications. he was subsequently started on aspirin. initially plavix was held given plans for mitral valve replacement in the near future, however, later in the hospitalization following discussion with ct surgery staff he was started on plavix. the patient was closely monitored after the surgery and remained neurologically intact. initially his systolic blood pressures were kept elevated to ensure cerebral perfusion several days postop. these were slowly lowered as he was restarted on his outpatient antihypertensive medications. 2. cardiovascular: coronary artery disease, the patient with a history of coronary artery disease status post coronary artery bypass graft. he had a recent cardiac catheterization prior to admission at an outside hospital, however, this was a technically complicated procedure and his grafts were thought to not be well visualized during this catheterization. additionally the patient had no symptoms of ischemia at admission. several days into his hospitalization he did develop acute angina and had minor electrocardiogram changes, which did resolve with nitroglycerin. given the patient's new unstable angina and his recent catheterization, which showed poor visualization of his grafts the patient did undergo coronary catheterization. the catheterization revealed three vessel coronary artery disease. his lmca was without any significant stenosis. his proximal left anterior descending coronary artery was 50% stenosed and was totally occluded in the mid left anterior descending coronary artery. his left circumflex had a 50% stenosis at the origin, 70% stenosis proximally and 80% stenosis in the portion supplying collaterals to his right coronary artery. he was already known to have total occlusion of his right coronary artery graft and this was not further explored. his left internal mammary coronary artery left anterior descending coronary artery graft was widely patent. his saphenous vein grafts were already known to be occluded and were not further explored. the patient underwent percutaneous transluminal coronary angioplasty in the av groove branch of the lcx and also in the proximal lcx. subsequent repeat angiography showed these vessels to now be patent. the patient was maintained on a regimen of aspirin, plavix, statin and beta blocker. he did have occasional pauses on telemetry, thus his beta blocker was unable to be titrated up. the patient was briefly on heparin prior to catheterization given his unstable angina. following the catheterization with successful angioplasty he was taken off his heparin. pump, the patient admitted with diagnosis of congestive heart failure. he had no echocardiogram reports on file, but reportedly had an ef of approximately 30%. the patient had no active symptoms of heart failure throughout the hospitalization. he was maintained on ace inhibitor for after load reduction as per his outpatient regimen. valve, the patient with known mitral valve disease who was thought to need a mitral valve repair in the future. this surgery had been delayed until his right ica could be stented. the patient was maintained on an ace inhibitor for after load reduction. he had no acute symptoms related to his mitral disease. the patient was to follow up with ct surgery following discharge to formulate plans for mitral valve repair. rhythm, the patient maintained on telemetry throughout the hospitalization. he did have brief sinus pauses on telemetry, but related to nodal blockade. his beta blocker was titrated down and these symptoms resolved. the patient had no acute symptoms related to this and remained hemodynamically stable throughout the hospitalization. 2. renal: patient with chronic renal insufficiency with a baseline creatinine of approximately 2.1. he did have a mild bump in his creatinine at this admission thought to be due to dye nephropathy. he received intravenous fluids and mucomyst with his catheterization and his creatinine stabilized and returned to his baseline prior to discharge. 3. fen: the patient maintained on cardiac diet. his electrolytes were followed and his potassium and magnesium were maintained. discharge condition: stable. discharge status: to home with services. discharge diagnoses: 1. right ica stenosis status post stent placement. 2. coronary artery disease status post catheterization with percutaneous transluminal coronary angioplasty to his left circumflex. 3. urinary tract infection. discharge medications: 1. multivitamin q day. 2. atorvastatin 20 q day. 3. loperamide 2 mg q.i.d. prn. 4. aspirin 325 mg q.d. 5. ramipril 10 mg q.d. 6. plavix 75 mg q day. 7. metoprolol 37.5 mg b.i.d. 8. epo injections two times per week. 9. nph insulin 10 units b.i.d. 10. sliding scale regular insulin as directed per sliding scale. 11. ciprofloxacin 250 mg q day times seven days. die follow up: 1. follow up with ct surgery dr. on at 1:30 p.m. with plans for mvr in approximately one month as per dr. evaluations. 2. follow up with dr. on at 9:00 a.m. 3. follow up with dr. in approximately three months with a carotid ultrasound at this point. , m.d. dictated by: medquist36 procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization angioplasty of other non-coronary vessel(s) arteriography of cerebral arteries insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome pure hypercholesterolemia mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes occlusion and stenosis of carotid artery without mention of cerebral infarction 

Answer: The patient is high likely exposed to