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: aspirin / ultram / vioxx / percocet / vicodin / cephalexin attending: chief complaint: exertional angina major surgical or invasive procedure: right and left cardiac catheterization history of present illness: history is obtained from the medical record and from the patient with her son serving as interpreter. please see also omr notes by dr. from and dr. from for additional information. briefly, ms. is a 80 year old persian woman who has multiple medical problems including diet-controlled type ii diabetes, hypertension, chronic joint pain (osteoarthritis and seronegative ra vs. pmr), and recent visual problems with ocular discomfort. she has had recent complaints of chest pain and progressive dyspnea on exertion (to the point where she has had to crawl up stairs and sit down while shopping) for which she has been evaluated by dr. . . in terms of her chest pain and doe, she describes both as occurring together. the chest pain is present constantly, ranging from severity of to and is worse with movement, pressure to the chest wall, deep breathing, or exertion. the shortness of breath is only with activity and does not occur at rest. she describes the chest pain as pressure-like in quality and occuring in the center chest to beneath the left breast. she has had these symptoms for several months but feels that they have been getting worse recently. she has had a cough for about the last two months which is occasionally productive of white sputum; she initially thought that this was due to a cold and had some associated runny nose, though now feels cough is not due to uri as it has persisted. . she underwent echocardiogram in which showed mild lvh with preserved ejection fraction (> 55%) and was otherwise unrevealing in terms of etiology for her dyspnea. in addition, she has had periodic complaints of heart palpitations for which she was been monitored by of hearts; 7 symptomatic episodes revealed sinus rhythm at rate 60s-80s with occasional apbs and atrial bigeminy. she did undergo stress test back in by persantine mibi which was negative for ischemia, but has had no further stress testing since that time. currently, she is awaiting ophthalmologic procedure for her eye discomfort, and her ophthalmologist at mass eye & ear has recommended complete cardiac work up prior to this procedure (details unclear as notes are out of our system; however, per dr. clinic note from it is "non urgent"). in addition, per dr. note from , cardiac catheterization is indicated to evaluate for left main disease prior to surgery requiring monitored anesthesia care, as well as to further evaluate for coronary artery disease given her multiple risk factors for atherosclerosis. she had cardiac catheterization planned recently, although this procedure was cancelled given her aspirin allergy and the possible need for intervention. the patient was given the option of waiting for allergy appointment to further evaluate this allergy or for ccu admission for rapid desensitization, and chose the latter. . on review of systems, she denies any recent fever, chills, nightsweats or rigors. she denies prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery. no pnd or clear orthopnea (must sleep on her side secondary to back/spine pain). she does have swelling of the ankles which has been stable, as well as swelling in the knees from her arthritis (l > r). she has had palpitations for which sh has worn koh monitor as above. she has multiple myalgias and joint pains for which she is followed in rheumatology clinic; these are stable. cough as per hpi with no hemoptysis. no n/v/d/c, no abdominal pain, no changes in bowel habits (last bm this morning, normal), no black stools or red stools. she has had several episodes of lh over the past several days, most recently two days ago when she felt lightheaded after getting out of a car and had to sit and hold her head. no syncope. no dysuria or hematuria. all of the other review of systems were negative. past medical history: 1. spinal stenosis 2. fibromylagia/polymyalgia rheumatica 3. hypertension 4. osteoarthritis 5. depression 6. s/p bilateral oopherectomy 7. glucose intolerance social history: denies alcohol and drugs. distant history of trying cigarettes many years ago. married to husband. involved and translates for her. persian. family history: denies cancer and cardiovascular problems in family. physical exam: admission exam: vs: t=none at time of exam bp=116/74 hr=77 rr=20 o2 sat=91% on ra general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. eomi though patient has pain in her left eye with upward gaze. erythema and irritation of medial sclera of right eye, involving , with overlying opacification. left pupil has irregular contours and is slightly larger than the right, though still reactive. conjunctiva were pale pink. no pallor or cyanosis of the oral mucosa; upper and lower dentures in place. no xanthalesma. neck: supple with no jvd. cardiac: slightly distant s1, s2 with no appreciable m/r/g. ttp over most of anterior chest wall especially at costosternal joints on the left. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. back: signficant tenderness to palpation of all vertebrae and also with tapping at cva bilaterally. abdomen: soft, ntnd. no hsm or tenderness. +nabs. extremities: non-pitting 1+ lower extremity edema, symmetric, no calf tenderness. dp 2+ pt 2+ bilaterally. . discharge exam: vitals - tm/tc: 98.1/97.2 bp: 116-136/60-70 hr: 64-93 rr:18 02 sat: 99-96 ra, 95-97% on ra with ambulation. in/out: last 24h: 1540/brp weight 64.5kg (65) general: elderly female in no acute distress heent: perrla, no pharyngeal erythemia, mucous membs moist, no lymphadenopathy, jvp non elevated chest: ctabl no wheezes, no rales, no rhonchi cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. ext: wwp, no edema. dps, pts 1+. right brachial cath site with mild ttp but no erythema. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. gait unsteady without cane. skin: no rash pertinent results: admission labs 03:50pm glucose-153* urea n-23* creat-1.0 sodium-142 potassium-5.0 chloride-106 total co2-24 anion gap-17 03:50pm calcium-9.3 phosphate-3.7 magnesium-2.1 03:50pm wbc-6.3 rbc-3.67* hgb-11.4* hct-33.7* mcv-92# mch-31.1 mchc-33.8 rdw-13.6 03:50pm neuts-60.4 lymphs-29.3 monos-6.0 eos-3.5 basos-0.8 03:50pm plt count-238 03:50pm pt-11.9 ptt-25.2 inr(pt)-1.0 discharge labs 06:25am blood wbc-5.7 rbc-3.84* hgb-12.1 hct-35.9* mcv-94 mch-31.5 mchc-33.7 rdw-13.9 plt ct-219 06:25am blood plt ct-219 06:25am blood glucose-133* urean-26* creat-0.7 na-140 k-4.0 cl-99 hco3-31 angap-14 cxr (): in comparison with the study of , there are lower lung volumes that accentuate the prominence of the transverse diameter of the heart. there is fullness of indistinct pulmonary vessels consistent with elevated pulmonary venous pressure, beyond that which would be expected with poor inspiration on a portable examination. cardiac cath (): 1. selective coronary angiography of this right dominant system revealed no angiographically-apparent flow-limiting stenoses. the lmca was free from angiographic disease. the lad had mild plaquing. the ostial diagonal branch demonstrated 60% focal stenosis. the lcx was a small vessel giving rise to a large om1 (functionally a ramus intermedis) and four other tiny oms. the rca was a large dominant vessel with mild plaquing. 2. resting hemodynamics revealed elevated right and left-sided filling pressures with rvedp of 12 mm hg and lvedp of 18 mm hg. there was moderate pulmonary arterial systolic hypertension with pasp of 52 mm hg. the cardiac index was preserved at 3.17 l/min/m2. there was significant systemic arterial systolic hypertension with sbp 181 mmhg. diastolic blood pressures was 82 mm hg. brief hospital course: primary reason for admission: 80 f with multiple medical problems and recent complaints of worsening dyspnea on exertion who presents for planned ccu admission for aspirin desensitization prior to cardiac catheterization for further work up of doe. . active diagnoses: . # diastolic chf: pt has diastolic chf based on cardiac cath, and given the absence of coronary disease, this is likely the cause of her exertional dyspnea. this is consistent with her longstanding history of htn. she was diuresed with iv lasix and her home lasix was increased to 20mg po daily. she was also started on metoprolol succinate 50 mg qday and lisinopril 2.5mg po qday. at the time of discharge she was asymptomatic and her weight was 64.5kg. . # pulmonary htn: pt has significant pulmonary htn (pa pressure 52/18/20) based on cardiac cath, and this is likely also contributing to exertional dyspnea. this is likely her left sided diastolic chf, but given history of bronchiectasis, cannot rule out a primary pulmonary component to her elevated pa pressures. she was discarged on acei, diuretic and beta blocker per above. . # asa allergy: pt underwent successful asa desensitization. asa reaction is documented as urticaria/angioedema, but during desensitization she only experienced pruritis without other manifestations of hypersensitivity. she was desensitized per protocol without indicent and should continue taking asa 81 indefinately to prevent recurrence of hypersensitivity. . # htn: her metoprolol tartrate 25mg qday was changed to metoprolol succinate 50mg qday. her lasix was increaed to 10mg qday and she was started on lisinopril 2.5mg qday. her bp was well controlled on this regemin while hospitalzied, but her medications should be further titrated by her pcp as an outpatient. . chronic diagnoses: . # diabetes: last hba1c in was 5.7%. currently off all medication. she was covered with iss while in house her bg was well controlled . # anemia: her home folic acid and b12 were continued. her hct remained stable in the low/normal range throughout her hospital course and no intervention was undertaken. . # joint pain: multifactorial (has ra vs. pmr and osteoarthritis by history, also status post bilateral total knee arthroplasty). she was continued on her home voltaren 1% gel, sulfasalazine and ca/vit d and her pain was well controlled on tylenol prn. pt is followed by rheum, who will see her as an outpatient. . # vasoactive symptoms s/p menopause: she was continued on her home premarin 0.9 mg po daily; should follow up with pcp regarding weaning estrogen. . # psychiatric issues: she was contined on her home mirtazapine and venlafaxine. . transitional issues: she was discahrged home with cardiology, pcp, and allergy/immunology follow up. dietary teaching was performed regarding the importance of low na diet and warning signs about fluid overload. medications on admission: - premarin 0.9 mg po daily (dose recently decreased per patient) - voltaren 1% gel apply to affected area qid prn pain (not currently using) - folic acid 1 mg po daily - furosemide 10 mg po daily (actual dose unclear) - gabapentin 300 mg po qid (takes tid per patient) - isosorbide mononitrate er-24 hr 30 mg po daily - metoprolol tartrate 25 mg po bid - mirtazapine 7.5 mg po qhs - omeprazole 20 mg po daily - sulfasalazine 1500 mg po bid - venlafaxine 75 mg po daily - acetaminophen 325 mg tid prn cold symptoms (not currently taking) - calcium carbonate-vitamin d3 600 mg-200 unit tablet po bid - vitamin b12 1,000 mcg po daily discharge medications: 1. conjugated estrogens 0.3 mg tablet sig: three (3) tablet po daily (daily). 2. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 5. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*2* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 8. sulfasalazine 500 mg tablet sig: three (3) tablet po bid (2 times a day). 9. venlafaxine 75 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po daily (daily). 10. calcium 600 + d(3) 600 mg(1,500mg) -200 unit tablet sig: one (1) tablet po twice a day. 11. cyanocobalamin (vitamin b-12) 1,000 mcg tablet sig: one (1) tablet po once a day. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 13. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: acute on chronic diastolic constestive heart failure aspirin desensitization hypertension chronic joint pain coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for a cardiac catheterization to test for heart problems that were causing your breathing trouble and chest pain. you did not have any significant blockages in your heart arteries but we did find that you had too much fluid in your body that wa affecting your breathing and making you tired. we gave you some intravenous furosemide to get rid of the fluid and will have you take 20 mg of furosemide daily instead of 10 mg to keep the fluid from coming back. if your breathing worsens again, this means that the fluid is coming back. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. it is very important that you avoid salt in your cooking and check the ingredients for high salt content. you can have about 2000mg of salt daily. . we made the following changes to your medicines: 1. increase furosemide to 20 mg daily 2. stop taking metoprolol tartrate, take metoprolol succinate instead once a day 3. start aspirin 81 mg daily, do not stop taking this medicine unless dr. tells you to. 4. start lisinopril 2.5 mg daily to lower your blood pressure. followup instructions: department: when: wednesday at 10:10 am with: , md building: campus: east best parking: garage department: orthopedics when: tuesday at 4:45 pm with: , md building: sc clinical ctr campus: east best parking: garage department: medical specialties when: wednesday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: thursday at 9:40 am with: , md building: sc clinical ctr campus: east best parking: garage md, procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute on chronic diastolic heart failure other chronic pulmonary heart diseases need for desensitization to allergens other and unspecified angina pectoris bronchiectasis without acute exacerbation knee joint replacement other specified anemias visual discomfort personal history of allergy to analgesic agent osteoarthrosis, generalized, multiple sites 

Answer: The patient is high likely exposed to