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: latex / compazine / haldol / iodine containing agents classifier / nsaids / shellfish derived / soy / gluten attending: chief complaint: sob major surgical or invasive procedure: -v pacer with epicardial lead placement history of present illness: 64 yo man with htn, hl, ? metabolic syndrome, gerd, and multiple other chronic medical issues (mostly msk and insomnia) who presented to ed with cp this am at ~ 4am (onste 2am), was found to have a stemi. . pt. was in usoh until 11am, when he noted ss pain, burining and twisting sensation associated with diaphoresis. he hought this was related to his usual gerd sx, thus took 4 tums, 2 zantac and 40mg of omeprazole. with inactivity, his sx resolved after 2 hrs. he did not have sob, palpitations, or radiation of his pain. pain was described by pt with placing a fist onto his chest. . he continued about his day without further symptoms until bedtime for him around 2am. after laying to bed, he noted again the same substernal chest pain with diaphoresis and now subscapular in location. given this he was concerned and called ems. he notes that he had had no prior sx, no doe, no cp, no fatigu. workingt out in gym w/o sx. he had been rx asa in the past, but reports a senstion of sweating while taking it, thus stopped. in addition, was on statins in the past, however reported abd. dyscomfort, thus stopped also. has been taking nuvigil for the last 1.5 mo for insomina. . in the ed, initial vitals were 102 152/98 18 100% ra. he received 2 sl ntg, 600mg plavix, heparin gtt and 8mg of morphine and 2mg of ativan. ekg: 98, qrs 100, ste in v1-3 and std in ii, iii, avf with pvcs. troponin < 0.01. in the ed he received heparin gtt/plavix /asa 325mg/and ntg sl. he was taken to cath lab where he was found to have lad occlusion -> des with timi 3 flow thereafter. intracath was noted to have transient wide complex tachycardia that resolved with opening of the vessel. of note, he received integrillin at 15 mcg/min (greater than usual dose) thus was stopped prior to transfer. underwent an angioseal at 530am. in the lab he received 125mg iv solumedrol, benadryl, pepcid 20mg iv, ntg gtt with versed 2mg and 75mcg of fentanyl. baloon activated at 5:08am. bps ranged 139-183/102-116. post cath ecg: sr 90 w/ persistent but smaller ste in v1-3. . on review of systems, he denies any prior history of stroke, tia but is concerned he has some dysfunction with his midbrain (has esotropia). no hx of deep venous thrombosis, pulmonary embolism but has had intrabdominal hematomas in the past in a perioperative setting. . denies myalgias, joint pains, cough, hemoptysis, black stools or red stools. no recent fevers, chills or rigors. no exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for no 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: none -percutaneous coronary interventions: see above. -pacing/icd: none 3. other past medical history: - elevated psa - left foveal bleed. - cervical radiculopathy - median neuropathy - ? ulnar entrapment - bilateral s1 radiculopathy, complicated by higher lumbar root involvement - neuroma - sleep disturbance/insomnia - anxiety/depression social history: retired psychiatrist (was stalked and assaulted by patient, thus retired). lives in . -tobacco history: 2.5 pk yrs > 20 yrs ago -etoh: occasional -illicit drugs: denies family history: brother - cp s/p stenting at 55yo; htn, hl sister - estranged fa - died of pancreatic ca mo - ca of . origin. physical exam: general: nad. oriented x3 but inattitive. mood, affect appropriate. difficult heent: ncat. sclera anicteric. perrl, eomi but has esotropia. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: no jvd while laying flat. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2, +s4. no m/r/g. lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. small umbillical hernia. extremities: warm, no edema. r groin site intact, no femoral bruit, nt. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: femoral 2+ dp 2+ pt 2+ left: femoral 2+ dp 2+ pt 2+ pertinent results: labs at admission: 09:20am pt-12.4 ptt-21.9* inr(pt)-1.0 08:20am glucose-132* urea n-21* creat-1.3* sodium-139 potassium-4.1 chloride-101 total co2-23 anion gap-19 08:20am alt(sgpt)-65* ast(sgot)-296* ld(ldh)-675* ck(cpk)-2782* alk phos-54 tot bili-0.7 08:20am ck-mb-334* mb indx-12.0* ctropnt-9.42* 08:20am calcium-10.0 phosphate-1.8* magnesium-1.9 cholest-136 08:20am triglycer-303* hdl chol-28 chol/hdl-4.9 ldl(calc)-47 08:20am wbc-13.6* rbc-4.84 hgb-15.7 hct-44.2 mcv-91 mch-32.4* mchc-35.5* rdw-13.7 08:20am neuts-90.2* lymphs-8.1* monos-0.9* eos-0.4 basos-0.5 08:20am plt count-132* 04:20am ph-7.41 comments-green top 04:20am glucose-118* lactate-2.7* na+-143 k+-3.2* cl--97* tco2-31* 04:20am freeca-1.22 04:10am urea n-20 creat-1.2 04:10am estgfr-using this 04:10am ck(cpk)-256 04:10am lipase-26 04:10am ck-mb-8 04:10am ctropnt-<0.01 04:10am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 04:10am wbc-12.5* rbc-5.34 hgb-17.6 hct-48.5 mcv-91 mch-32.9* mchc-36.2* rdw-13.7 04:10am pt-12.2 ptt-19.4* inr(pt)-1.0 04:10am plt count-158 04:10am fibrinoge-349 imaging: cardiac cath comments: 1. selective coronary angiography in this left dominant system revealed single vessel coronary artery disease. the lmca was normal. the lad had a proximal total occlusion. the lcx was dominant and normal. the rca was small, nondominant and normal. 2. limited resting hemodynamics revealed moderately elevated systemic arterial pressures with central aortic pressure 171/91 with a mean of 121 mmhg. 3. successful export thrombectomy and ptca/stenting of proximal lad with 3.5 x 18 mm promus drug eluting stent. final angiogram showed 0% reisdual stenosis, no dissection and normal flow. 4. successful deployment of angioseal device with resultant good hemostasis. final diagnosis: 1. one vessel coronary artery disease. 2. successful export thrombectomy and des of proximal lad for acute stemi. echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with anterior, septal and apical hypokinesis to akinesis suggested. 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 diameters of aorta at the sinus, ascending and arch levels 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. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: 64 yo man with htn, hl, ? metabolic syndrome, gerd, and multiple other chronic medical issues (mostly msk and insomnia) who presented to ed with cp this am at ~ 4am (onste 2am), was found to have a stemi . # coronaries: cp of unstable angina likely with plaque formation/resorption over the past 24 hrs. here with stemi. currently asymptomatic on low dose nitro gtt. hd stable. off intergrillin and off heparin gtt. his ntg gtt was weaned off, he was started on plavix 75mg daily, asa 325mg daily, atorvastatin, metoprolol and losartan. his ce peaked on . an echo showed moderate regional left ventricular systolic dysfunction with anterior, septal and apical hypokinesis to akinesis-. given his apical involvement and decreased ef, anticoagulation with coumadin was considered but given his ongoing gi bleed (to be followed as an outpatient with gi), this was defered for future consideration. he will have outpatient cardiology follow-up with dr. (appointment to be made). . # pump: no evidence of acute chf now. has s4 thus likely has diastolic dysfunction in setting of longstanding htn. his usual bps are in 150s. bp was controlled with the above medications. given his apical hypokinesis, he was started on coumadin (despite his known history of foveal bleed -per optho consult) but stopped given lower gi bleeding. . # rhythm: maintained sinus rhythm while monitored on tele while in hospital. . # hx of left foveal bleed. : coumadin was started despite the risk of rebleeding but stopped the next day. . # hematochezia: pt had several episdoes of frankly bloody stools, he had a stable hct however and known colonic disease. he had refused gi colonoscopy in the past, but gi was consulted for risk assessment of coumadin. gi did not recommended any inpatient studies but he will have outpatient follow-up. his hct and bp were stable and his coumadin was stopped. . # c spine and l spine pain. djd. he was kept on standing tylenol and lidocaine. medications on admission: amphetamine-dextroamphetamine 45 mg daily. armodafinil - 125 mg betamethasone dipropionate - 0.05 % cream - apply to affected area for short duration betamethasone valerate - 0.1 % lotion bupropion hcl 150 mg celecoxib 400 mg prn ketoconazole - 200 mg ketoconazole - 2 % shampoo daily losartan - 50 mg ondansetron 4 mg prn oxycodone-acetaminophen - 5 mg-325 mg prn ranitidine 300 mg prn tadalafil 20 mg not taking. salicylic acid-coal tar-sulfur prn ? atenolol ? b12 injection 1mg monthly . discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): please take for 12 months, do not skip any doses. disp:*30 tablet(s)* refills:*11* 3. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). disp:*60 tablet extended release(s)* refills:*2* 4. ketoconazole 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. losartan 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 7. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po twice a day. 9. ranitidine hcl 300 mg tablet sig: one (1) tablet po twice a day. 10. vitamin b-12 1,000 mcg/ml solution injection discharge disposition: home discharge diagnosis: primary: acute mi discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the medical center for treatment of an acute heart attack. you were treated with several medications to optimize your heart function and underwent a cardiac catherization with stent placement. you also had evidence of blood in your stools. the most likely cause of this is your radiation proctitis. during your hospitalization, your hematocrit was stable and the blood in your stools should be followed by a gi specialist. you should continue some of these new medications when you are discharged. please start: - aspirin 325mg daily - plavix 75mg daily - losartan 25mg twice a day - metoprolol succinate 100mg daily - atorvastatin 40mg daily please stop the following medications: - amphetamine-dextroamphetamine - atenolol - celecoxib (celebrex) - tadalafil (please discuss w your cardiologist) you should also continue to take all your other medications -nuvigil -bethamethasone cream/lotion -bupropion -ketoconazole -oxycodone-acetaminophen -ranitidine please return to the emergency room if your have shortness of breath or chest pain, followup instructions: you will have cardiology follow up with dr. and a gi follow up with dr. . they should call you at home and make these appointments. if you do not receive a phone call in the next 3 days please call to confirm these appointments. you also have an appointment with your pcp at the following time: department: when: thursday at 4:30 pm with: , md building: (, ma) campus: off campus best parking: on street parking procedure: coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization 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: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension dysthymic disorder other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cellulitis and abscess of leg, except foot malignant neoplasm of prostate infection and inflammatory reaction due to other vascular device, implant, and graft phlebitis and thrombophlebitis of superficial veins of upper extremities other specified disorders of rectum and anus radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hemorrhage of rectum and anus 

Answer: The patient is high likely exposed to