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: chest pain major surgical or invasive procedure: cardiac catheterization with bare metal stent placement to the right coronary artery. history of present illness: the patient is a 75-year-old male with a pmh significant for hypertension, dyslipidemia, ischemic cardiomyopathy and coronary artery disease (status-post bms to rca in ) who presented to after a sudden onset of chest "discomfort" with associated diaphoresis. ems was called after the patient had chest pain and was found to be ashen. ekg showed ste in iii>ii and avf. he was initially taken to where he recieved asa 325mg, and was then transferred to for further management. in the ed here at he was given a plavix load of 600mg and taken emergently to the cardiac catheterization lab. cardiac catheterization revealed total occlusion of the rca at the site of his prior stent, into which a new bms was placed. there was also evidence of diffuse left main and lad disease. right sided filling pressures were also noted to be elevated. during the procedure the patient had an episode of vf and his implanted icd fired and converted him to back sinus rhythm. . of note the patient had also been experiencing melena for the past few weeks. his pcp had taken him off of daily asa for this in mid-. he was admitted to on for a recent admission after having melena with some concurrent "demand ischemia" as his troponins were noted to be elevated. . past medical history: past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: -percutaneous coronary interventions: : two vessel coronary artery disease, with proximal occlusion of the rca and 60% distal lad stenosis. successful angiojet thrombectomy and stenting of the mid-rca with a bms -pacing/icd: icd placed 3. other past medical history: -htn -dyslipidemia -coronary artery disease -atrial fibrillation (on coumadin) -ischemic cardiomyopathy: ef reportedly 30% -copd -recent hospitalization for a gi bleed with a-fib with rvr, troponins bumped, initially thought to be demand related -diverticulosis -grade i internal hemorrhoids -osteoarthritis -healing antral ulcer -sliding hiatal hernia social history: mr. is married and lives at home with his wife in , ma. he considers himself to be an active person for his age. he is a retired supervisor of . he quit smoking on after a history of 1ppd x 30 years. he denies any alcohol use and denies any history of illicit drug use. family history: both parents died of coronary artery disease in their 60s. physical exam: physical examination: vs: t=97.4, bp=112/61, hr=88, rr=14, o2 sat=100% ra general: well-appearing elderly male in no acute distress at rest. oriented to person , place and time with an appropriate affect and upbeat/pleasant demeanor. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesmas. neck: supple, no thyromegaly, jvd at ~ 5cm cardiac: regular rhythm, normal rate, no murmurs, rubs or gallops lungs: cta bilaterally atanterior / lateral / posterior fields abdomen: soft, ntnd. no hsm or tenderness. abdominal aorta not enlarged by palpation. no abdominial bruits. extremities: 2+ radial, 2+ femoral and 2+ dp/pt pulses bilaterally. no femoral bruits. skin: pale complexion, bruising (" surrounding)at right groin region locally at cath site, no hematomas or edema pertinent results: lab data: 07:32pm glucose-146* urea n-17 creat-0.9 sodium-139 potassium-3.7 chloride-105 total co2-25 anion gap-13 07:32pm calcium-8.4 phosphate-2.9 magnesium-1.9 02:37pm ck(cpk)-1367* 02:37pm ck-mb-204* mb indx-14.9* ctropnt-5.15* 06:57am glucose-107* urea n-21* creat-0.9 sodium-138 potassium-4.5 chloride-105 total co2-27 anion gap-11 06:57am alt(sgpt)-38 ast(sgot)-186* ld(ldh)-501* ck(cpk)-1611* alk phos-58 tot bili-0.6 06:57am ck-mb-285* mb indx-17.7* ctropnt-5.59* 06:57am wbc-9.1 rbc-3.76* hgb-10.0* hct-30.6* mcv-82 mch-26.5* mchc-32.6 rdw-15.0 12:56am wbc-9.0 rbc-3.91* hgb-10.6* hct-32.6* mcv-84# mch-27.0 mchc-32.4 rdw-14.1 12:56am neuts-89.8/bands-0/lymph-7.0/monos-2.3/eos-0.7/baso-0.1 02:37pm blood ck(cpk)-1367* 04:05am blood ck(cpk)-799* 06:57am blood alt-38 ast-186* ld(ldh)-501* ck(cpk)-1611* 06:35am blood ck-mb-10 mb indx-6.1* ctropnt-4.18* 02:37pm blood ck-mb-204* mb indx-14.9* ctropnt-5.15* 06:57am blood ck-mb-285* mb indx-17.7* ctropnt-5.59* 03:47am blood calcium-9.3 phos-2.8 mg-2.3 03:47am blood wbc-7.1 rbc-3.60* hgb-9.6* hct-29.5* blood glucose-118* urean-13 creat-0.9 na-140 k-3.8 cl-105 hco3-28 cardiac catheterization results/report: coronary angiography of this right dominant system demonstrated two vessel coronary artery disease. the lmca had a 60% stenosis at the origin. the lad was diffusely diseased, with a long 70% lesion in the mid-vessel, followed by serial 90% stenoses. the lcx was a small, nondominant vessel without significant stenoses. the rca was a superdominant, large vessel which was occluded proximally in the prior stent with a large thrombus. resting hemodynamics revealed moderately elevated right and left sided filling pressures (rvedp 15 mm hg, pcwp mean 25 mm hg, respectively). moderate pulmonary hypertension (pasp 54 mm hg). ci =3.0 l/min/m2. the svr was normal (864 dynes-sec/cm5). the pulmonary vascular resistance was mildly elevated (140 dynes-sec/cm5). the systemic aortic pressure was initially low (sbp 79 mm hg) prior to restoration of blood flow in the rca, but normalized to 138 mm hg after the blood flow resumed. during left coronary artery injection, the patient had a brief episode of ventricular tachycardia, degenerating to ventricular fibrillation, lasting <10 seconds. the rhythm was terminated with successful defibrillation by the patient's icd. a temporary pacing wire was placed in the rv for bradycardia, but did not need to be used after improved hemodynamics following reperfusion. successful manual thrombectomy, ptca, and placement of a 3.0x23mm vision stent postdilated proximally to 4.0mm were performed. final angiography showed normal flow, no apparent dissection, and no residual stenosis. final diagnosis: 1. acute inferior st elevation myocardial infarction. 2. two vessel coronary artery disease with left main artery disease. 3. moderate right and left ventricular diastolic dysfunction. 4. placement of a bare-metal stent in the proximal rca. *pressures right atrium {a/v/m} 14/15/12 right ventricle {s/ed} 51/15 pulmonary artery {s/d/m} 54/17/36 pulmonary wedge {a/v/m} 29/27/25 aorta {s/d/m} 138/76/80 **cardiac output heart rate {beats/min} 55 rhythm sinus o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 38 card. op/ind fick {l/mn/m2} 6.3/3.0 **resistances systemic vasc. resistance 864 pulmonary vasc. resistance 140 saturation data (nl)= pa main of 71 and ao of 97 cardiac 2-d echo / tte: the left atrium is mildly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is severely dilated. there is severe regional left ventricular systolic dysfunction with inferior, inferoseptal and inferolateral akinesis. there is mild hypokinesis of the remaining segments (lvef = 30%). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen, but may be underestimated given the degree of acoustic shadowing. estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: severe left ventricular systolic dysfunction, c/w cad. mild right ventricular systolic dysfunction. compared with echo pulmonary hypertension is no longer seen. the other findings appear similar. ekgs: ekg : rate 85-90, sinus rhythm. borderline left axis deviation. inferior wall myocardial infarction of indeterminate age. intraventricular conduction defect. lateral st-t wave changes which are non-specific ekg: rate 88, normal sinus rhythm. left atrial abnormality. delayed r wave transition. intraventricular conduction defect. possible prior inferior myocardial infarction. compared to the previous tracing of no diagnostic interval change. microbiology: right knee joint fluid: gram stain w/ 2+ (1-5 per 1000x field) polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth 11:20am joint fluid crystal report: crystal shape rhomboid, birefringence-positive, additional needle shaped crystals with negative birefringence c/w monosodium urate crystals as well 11:20am joint fluid wbc-4900/rbc-/poly-94/lymph-3/monos-3 brief hospital course: in summary, mr. is a 75-year-old male with a history of coronary artery disease, hypertension, ischemic cardiomyopathy and status post icd placement and status-post mi and mid-rca bare metal stent placement in who presented with acute substernal chest pain and diaphoresis. the patient recently had his aspirin discontinued due to melena, a decreased hematocrit and concerns over a gi bleed. on ems arrival, ecg demonstrated elevations in the inferior leads (iii >ii, and avf). mr. emergent cardiac catheterization with re-stenting of his rca with bms and recognition of additional mid-lad and left main diseased coronaries which will need to be followed-up at a later date. the hospital stay was also noted for a few brief bouts of atrial fibrillation and an episode of acute right knee effusion due to a mixed pseudogout/gout flare. details outlined below: . coronary artery disease / stemi: on cardiac catheterization the patient had a totally occluded rca which was opened with a bms placement. cardiac catheterization was remarkable for additional mid-lad disease and left main disease. he had mild bruising locally at the right groin cath entry site but no hematomas post-procedure. during his ccu course, mr. was continued on aspirin, plavix, high dose atorvastatin, a low dose ace-inhibitor and metoprolol was gradually titrated up. he had no recurrence of any chest pain or shortness of breath throughout his hospitalization. cardiac surgery was consulted regarding the patient's left sided coronary disease and the team decided to have the patient recover from his current acute episode with plans to evaluate the patient's gi bleed status with an egd in the coming weeks and if he has no significant gi morbidity and can tolerate surgery/anticoagulation then he will plan to undergo a follow-up cabg in about 6 weeks time. . cardiac pump function: mr. cardiac catheterization demonstrated elevated right sided filling pressures and the patient has known ischemic cardiomyopathy. he was given some gentle diuresis with lasix as his blood pressure allowed. follow-up post-cath tte showed severe regional left ventricular systolic dysfunction with inferior, inferoseptal and inferolateral akinesis. there was mild hypokinesis of the remaining segments with lvef = 30%. mild right ventricular systolic dysfunction also exists. the patient had no rales or crackles on lung exam clinically and he had excellent oxygen saturations > 96% on room air. . rhythm: the patient has a known history of atrial fibrillation for which he takes dofetilide and he receives ongoing anticoagulation with coumadin. he typically has rate and rhythm controlled atrial fibrillation. as noted per hpi, mr. had an episode of vf during cardiac catheterization which abated after icd firing. he was monitored on telemetry and serial ekgs were also done during his ccu stay. he was noted to have a long qt interval on multiple ekgs and the team decreased his daily dofetilide dose to 250mcg dosing from his prior 500mcg dose. he had his potassium and magnesium repleted as needed to maintain k+ above 4 and mg above 2. telemetry was predominantly unremarkable with the exception of occasional pvcs and on the patient had a short run of nsvt and about a 2 hour period where he was in and out of atrial fibrillation on telemetry a day later. through these periods he remained asymptomatic with stable vital signs. the patient's beta-blocker (metoprolol xl) was uptitrated and at time of discharge he was in nsr with no significant arrhythmias. the patient was advised to have his primary cardiologist repeat his ekg at his next visit in 1 week. . recent gi bleed: as per osh records, just prior to admission the patient had an egd done on which showed a sliding type hiatal hernia, mild gastritis and an antral ulcer which had a white, healing base with no active clots or active bleeding. the patient was continued on ppi with protonix and his hct remained stable within 29.5-32 range and he never required any blood products. he denied any bloody stools during his stay. he will plan for a repeat egd in about 6 weeks leading up to his cabg. he will be instructed to stop his home plavix and coumadin (~4-5 days) prior to elective hospitalization and he'll be bridged with heparin in preparation for endoscopy studies, followed by cabg. (with dr. ) . hypertension: the patient's home hctz and diltiazem were initially held. he was treated with ace-inhibitors and beta-blockers for optimal blood pressure control and his lasix was continued. mr. carvedilol was changed to 75mg toprol xl and his lisinopril was reduced to 2.5mg daily at discharge. the patient's blood pressure was well controlled throughout his hospitalization with sbps predominantly in the 100s-130s range. . hyperlipidemia : the patient was placed on a high dose regimen of 80mg daily atorvastatin with his acs presentation. he was asked to continue this dose upon discharge and he will follow-up with his primary cardiologist regarding a repeat lipid profile as it would not have been an accurate read in the acute mi setting. . right knee pain : the patient complained of right knee pain the morning after his cardiac catheterization. on exam he had an effused, warm and tender joint with marked fluid in the suprapatellar areas. the patient has a history of osteoarthritis but he explained that this amount of pain and swelling was extreme. a rheumatology consult was called and a joint fluid tap/aspiration was performed for both therapeutic and diagnostic purposes. he had relief of pain immediately after the joint was aspirated and follow-up lab and culture data revealed a mixed picture consistent with pseudogout and gout as both rhomboid shaped, positively birefringent calcium pyrophosphate crystals were identified and needle-shaped, negatively birefringent monosodium urate crystals were also identified. joint culture was negative and joint fluid showed 4900 wbcs, rbcs with 94% pmns. the patient was given tylenol and he continued asa daily which also benefited his joint inflammation but any additional nsaids were avoided in the setting of his recent gi bleed symptoms and steroids were not deemed necessary given his quick resolution of knee pain after the knee aspiration/tap. he will follow-up with his outpatient pcp in the next few weeks or sooner if symptoms return. . prophylaxis/code status: the patient was initially given iv anticoagulation in the acs setting which served as dual dvt ppx and he was restarted on his coumadin with heparin bridge later in his hospital course. he was continued on daily protonix for gi protection and th edose was increased given his recent gi bleed history. the patient was given a bowel regimen of senna, dulcolax and colace to maintain regularity and he was maintained as a full code status for the entirety of his hospital stay at . mr. was asked to please return to the emergency room or call his cardiologist or pcp as soon as possible if he had any additional chest pain , shortness of breath, dizziness or lightheadedness after discharge. . the patient was set up for a follow-up appointment with his primary cardiologist next week and he was given a script to have his inr checked on with instructions for the lab to call results to dr. his pcp . the patient was told that the cardiology staff would be contacting him in the coming days to set up his next hospitalization for his egd and cabg. medications on admission: medications: asa 325mg daily lisinopril 10mg daily carvedilol 6.25mg lasix 20mg daily coumadin 3.5mg daily pantoprazole 40mg daily diltiazem 180mg daily tykosyn 0.5mg (dofetilide) discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. warfarin 1 mg tablet sig: 3.5 tablets po once daily at 4 pm. 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. 6. dofetilide 250 mcg capsule sig: one (1) capsule po q12h (every 12 hours). 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. metoprolol succinate 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). disp:*90 tablet sustained release 24 hr(s)* refills:*2* 9. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 11. glucosamine 500 mg tablet sig: one (1) tablet po once a day. 12. chondroitin sulfate-vit c-mn 400-60-2.5 mg capsule sig: one (1) capsule po once a day. 13. multiple vitamin tablet sig: one (1) tablet po once a day. 14. calcium 600 + d(3) 600 mg(1,500mg) -200 unit tablet sig: one (1) tablet po once a day. 15. outpatient lab work please check inr on . call results to dr. at . discharge disposition: home with service facility: home care discharge diagnosis: st elevation myocardial infarction right knee pseudogout/gout compensated systolic heart failure ischemic cardiomyopathy discharge condition: stable at time of discharge inr 2.2 hct: 29.4 discharge instructions: you had a heart attack and had a bare metal stent was placed in your right coronary artery. you will need to have a bypass surgery in about 6 weeks. you will be admitted first for a scope of your stomach called an egd to make sure you have no bleeding in your stomach and then will have the heart surgery. new medicines: 1. plavix: to keep your stent open, you will need to take this every day for at least one month. do not stop taking this unless dr. tells you to. 2. your lisinopril was decreased to 2.5 mg daily 3.your simvastatin was changed to atorvastatin and increased to 80 mg daily 4. your dofetilide was decreased to 250mcg because your ekg had some changes. 5.your carvedilol was changed to toprol xl . 6.stop taking your cardiazem and meloxicam. 7. continue to take protonix 40mg twice daily for protection from stomach bleeds/gi bleeds . lbs. adhere to 2 gm sodium diet. . we will contact you at home to arrange your next hospitalization. followup instructions: cardiology: dr. / np: ( date/time: thursday at 3pm. please check an ekg for qtc at this time. primary care: , md phone: date/time: please call your doctor to set up an appt in weeks. procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor angiocardiography of right heart structures arthrocentesis cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia chronic systolic heart failure long-term (current) use of anticoagulants ventricular fibrillation acute myocardial infarction of inferolateral wall, initial episode of care automatic implantable cardiac defibrillator in situ gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction osteoarthrosis, localized, not specified whether primary or secondary, lower leg 

Answer: The patient is high likely exposed to