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: lipitor / zetia / rosuvastatin attending: chief complaint: arm pain/abdominal pain - concern for anginal equivalent major surgical or invasive procedure: cardiac catheterization history of present illness: 73 y/o m with hx of cad, cva presents with intermittent chest pain/forearm pain x 1 week. the patient was seen by his pcp . in clinic today where he complained ot forearm/abdominal pain for the last 8 days - these symptoms were not associated with chest pain. symptoms were intermittent and occasionally at rest. on the day prior to admission patient notes walking with his grand son and developing medial arm pain and abdominal pain as well as feeling fatigued. patient sat in the air conditioning and rested and these symptoms resolved over 20 minutes. after dinner the day prior to admission the patient noted another episode with similar symptoms no chest pain, however also was associated with flushing, diaphoresis and headache. the patient reports his prior cad presented as tooth pain. today he has not had a recurrence of either the forearm pain or chest pain. no orthopnea, increased lower extremity swelling. . in the ed, initial vs were 98.4 58 147/75 16 97. he was given 325 mg aspirin. labs were significant for no elevation of cardiac enzymes. ekg showed no st changes, small q waves in lateral leads i, ii, avl, consistent with prior. he was seen by his outpatient cardiologist, dr. who requested admission to service. on transfer the patient's vs were hr 56 bp 159/73 rr 17 o2 95% on ra. . on the floor this morning patient denies recurrence of symptoms and feels well. . on review of systems, he denies any deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, 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 paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1) cerebral infarctions- left fronto-parietal infarct () presenting with right cortical hand symptoms, recent symptom of language deficit. 2) coronary artery disease- has left circumflex stent 3) dysphagia- found to have schatzki ring 4) left renal artery stenosis- status post stent 5) hypertension. 6) hypercholesterolemia 7) sleep apnea on cpap 8) abdominal aortic aneurysm s/p repair. 9) lyme disease- treated with 10 day course of doxycycline social history: he lives with his wife in , he is retired. he smoked 1.5 packs per day for 25 years, quit 25 years ago. he does not drink alcohol at present. no history of drug or alcohol abuse. family history: brother- had an mi at age 32. physical exam: vitals - t 97.7 hr 57 bp 143/76 rr 16 o2 97% on ra gen: oriented x3, occasionally has difficulty with word finding heent: perrl, eomi. neck: supple with flat jvp. cv: pmi located in 5th intercostal space, midclavicular line. irregularly irregular tachycardic, normal s1, physiologically split s2. no murmurs. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, mild crackles at right base, decreased breath sounds at left base, no wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no edema, no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: labs on admission: 07:00pm blood wbc-4.4 rbc-4.74 hgb-14.5 hct-43.2 mcv-91 plt ct-228 neuts-48.5* lymphs-38.2 monos-6.4 eos-5.6* baso-1.3 pt-29.4* ptt-29.3 inr(pt)-2.9* glucose-112* urean-23* creat-1.2 na-142 k-4.3 cl-108 hco3-24 . ck(cpk)-607* ck(cpk)-591* ck(cpk)-563* ck(cpk)-456* ck(cpk)-505* ck(cpk)-390* ctropnt-<0.01 ck-mb-14* mb indx-2.3 ctropnt-0.05* ck-mb-14* mb indx-2.4 ctropnt-0.05* ck-mb-14* mb indx-2.5 ctropnt-0.07* ck-mb-11* mb indx-2.4 ctropnt-0.08* ck-mb-13* mb indx-2.6 ctropnt-0.08* ck-mb-10 mb indx-2.6 ctropnt-0.05* . cardiac enzymes: admission: : ck(cpk)-607* ck(cpk)-390* ck(cpk)-1451* ck(cpk)-381* ck (cpk)- <0.01 ctropnt-0.08* ctropnt-1.65* . studies: chest pa/lat: findings: frontal and lateral views of the chest were obtained. lingular atelectasis/scarring is again noted. no new focal consolidation, pleural effusion or pneumothorax is seen. the aorta is tortuous and calcified. the cardiac silhouette is not enlarged. impression: no acute cardiopulmonary abnormality. cardiac cath study date of comments: 1- complex and high-risk ptca and stenting of the culprit distal rca ulcerated, thrombotic culprit lesion with a 3.0x15 mm promus des complicated by distal rca dissection, treated with placement of three (2.5x8, 2.5x12 and 2.5x12 mm) overlapping minivision stents distal to and overlapping with the promus stent and proximal dissection treated with an 3.0x12 mm vision bms proximal to and overlapping with the promus stent. final angiography shwoed excellent results (see ptca comments). 2- vagal event related to urinary retention treated with placement of foley catheter and supportive care 3- brief hypotensive event related to # 5 and hypovolemia 4- small and stable venous hematoma (noted following urgent placement of venous sheath for rhc). final diagnosis: 1. one vessel coronary artery disease. 2. ptca and stenting of the rca with total of 5 overlapping stents (see comments for details) 3. integrilin for 18 hours (renal dose) 4. iv rehydration 5. plavix 150 mg po dialy x 2 weeks then 75 mg daily for minimum of 12 months 6. asa 325 mg indefinitely 7. secondary prevention of cad . portable tte (focused views) done at 3:11:21 pm focused study to exclude effusion: the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. . cardiac catheterization (): 1. limited coronary angiography in this right dominant system demonstrated single vessel disease. the left system was not injected. the rca had a proximal hazy 30% stneosis representing uncovered dissection from prior case, patent stents in the mid to distal vessel with timi 2 flow, subtotal 90% occlusion of the distal av groove rca into the major rpl, and a 50-60% stenosis in the proximal to mid rpda. 2. limited resting hemodynamics revealed normal central pressures with a systolic pressure of 127mmhg, diastolic of 59mmhg, and mean of 84mmhg. 3. unsuccessful attempt to wire the true lumen of the rpl secondary to residual dissection from the previous catheterization. final angiography revealed a 90% residual stenosis in the rpl, a grade iii dissection in the rpl, and timi 2 flow. (see ptca comments for details) final diagnosis: 1. one vessel coronary artery disease. 2. normal ventricular function. 3. unsuccessful attempt to wire the true lumen of the rpl due to residual dissection from the prior pci procedure. 4. supraventricular tachycardia. . echo : the left atrium and right atrium are normal in cavity size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with probable basal to mid lateral akinesis/hypokinesis (lvef ?45-50%) but views are technically suboptimal for assessment of regional wall motion. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , regional wall motion abnormality is now detected but studies are technically suboptimal for comparison. brief hospital course: 73m with h/o cva on coumadin, cad s/p des->lcx , s/p l renal artery stent , infrarenal aaa s/p repair admitted with forearm, chest, and tooth pain (prior anginal equivalent) who went to cardiac catheterization for nstemi, s/p pci complicated by mid vessel rca dissection, followed by stemi (distal rca + rpl, felt to be secondary to dissection). . # nstemi and stemi: the patient was admitted to the floor and his cardiac enzymes were trended peaking at 0.08 from <0.01 on admission. he was taken to cardiac catheterization, which revealed a rca thrombus thought to be the culprit lesion that was treated with one des. this was complicated by a distal rca dissection requiring three overlaping bms distal to and overlapping with the des as well as one proximal bms and overlapping with the des with the final result being timi-3 flow. bedside tte was performed and was notable for the absence of pericardial effusion with normal wall motion. he was started on plavix 75mg, which he will take 75mg for one week and then change to 75mg daily. he was continued on aspirin 325mg daily. he was maintained on an integrillin drip for 18hours post catheterization. he was started on rosuvastatin, as he had a history of poor tolerance to other statins. he was pain-free until afternoon at which time he developed chest pressure, arm pain, and teeth pain. at that point he was noted to have st-elevations in inferior leads and code stemi was called. he was brought immediately to the cath lab at which time angiography showed occlusion of the rpl off the mid-distal rca felt to be due to his prior dissection. the proximal pca appeared patent. given the dissection flap, a wire could not be passed into the vessel and no intervention was performed. he was chest pain free several hours later and remained so throughout the remainder of his hospital stay. follow-up echocardiogram showed basal/midlateral akinesis/hypokinesis (although technically sub-optimal) that was new from priors. . # history of cva: given his history of recent stroke, thought to be embolic, he was maintained on systemic anticoagulation with coumadin. heparin was initiated while his inr was subtherapeutic. in consultation with his outpatient neurologist the goal inr is 1.8 to 2.5. the patient was discharge home with lovenox injections twice daily until he began therapeutic again on his coumadin. . # atrial tachycardia: he was monitored on telemetry during the course of his hospitalization. he was primarily in sinus rhythm with a rate in the 80s although he did have asymptomatic episodes of atrial tachycardia to the 110s. his metoprolol dose was increased to 37.5mg q8hr. . # hand cellulitis: this was thought to be due to an infiltrated iv site. there was a pustule that was lanced with culture growing mssa. he was started on keflex + bactrim with plans for a 7 day course (bactrim d/c'd once sensitivities available). he remained afebrile with a normal white count and site clinically improved prior to discharge. . # hypertension: he was continued on losartan and metoprolol. as above, metoprolol dose increased to 37.5 tid. losartan held for arf. . # acute renal failure: creatinine trended up from baseline 1.2 -> 1.4 after cath . it rose again from 1.4 -> 1.6 after second cardiac cath. this was felt to be due to potential contrast nephropathy as he received substantial contrast load for both procedures. was held with some improvement in his renal function. creatinine at baseline for this patient is 1.1-1.2 and 1.4 upon discharge. . # hyperlipidemia: he was initially continued on niacin and cholestyramine. this was changed to rosuvastatin 10mg daily, however he developed myalgias and he was changed back to home cholestyramine. medications on admission: cholestyramine-aspartame 4 gram clopidogrel 75 mg daily fexofenadine 60mg prn losartan 25 mg qd metoprolol tartrate 25 mg tid nitroglycerin 0.4 mg prn warfarin 5 mg qd calcium citrate 250 mg chlorhexidine gluconate 4 % liquid - use once a day magnesium 250mg multivitamin qam niacin 250 mg sr qhs discharge medications: 1. coumadin 5 mg tablet sig: one (1) tablet po once a day. 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 4. niacin 250 mg capsule, sustained release sig: one (1) capsule, sustained release po qhs (once a day (at bedtime)). 5. lovenox 100 mg/ml syringe sig: one (1) subcutaneous twice a day for 5 days: please continue lovenox until your informs you to stop. . disp:*10 qs* refills:*1* 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). disp:*135 tablet(s)* refills:*2* 12. cholestyramine-sucrose 4 gram packet sig: one (1) packet po bid (2 times a day): please take at a different time than your warfarin to avoid interactions . 13. nitrostat 0.4 mg tablet, sublingual sig: one (1) tablet sublingual q5min as needed for chest pain: please go to the er if your chest pain does not resolve after 3 tablets. disp:*100 tablets* refills:*0* 14. magnesium 250 mg tablet sig: one (1) tablet po twice a day. discharge disposition: home discharge diagnosis: primary: cad htn hld skin infection of right hand secondary: hx of cva hx of abdominal aortic aneurysm discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you while you were admitted with arm pain/abdominal pain thought to be related to your heart. a cardiac catheterization was performed which showed a blockage in one of the arteries surronding the heart. stents were placed in this artery. the procedure was complicated by a dissection of this artery which was managed by placing other stents. several days later you again developed chest pain and were brought emergently for cardiac catheterization. this showed a blockage in one of the smaller branches of the coronary arteries. you were monitored in the intensive care unit. an echocardigram was performed before your discharge and showed good heart function, similar to before you had the heart attack and stents placed. . during your stay you developed an infection of the skin on the top of your right head. you were treated with antibiotics and the hand surgeons drained a small amount of infected fluid; it is healing well. . you were tried on a new cholesterol medication - rosuvastatin (crestor) but developed leg cramps so this was stopped. . please follow up with dr. in the week following discharge for follow up regarding your skin infection and dr. with cardiology on . furthermore, your inr (level of anticoagulation) will need to be checked at your appointment with dr. . based on the inr, the lovenox you were discharged on may be able to be stopped. . the following changes were made to your medication regimen: - start: lovenox 100 mcg twice daily until your informs you that you to discontinue your lovenox and take only your coumadin. - start: asa 325mg daily - change: metoprolol tartrate 25mg three times daily to 37.5 three times daily - stop: losartan 25mg as your blood pressures have been well controlled on metoprolol only - also, make sure to take your cholestyramine and warfarin at different times, as they can interact with each other and make warfarin less effective at blood thinning. . again it was a pleasure participating in your care. followup instructions: primary care: please follow-up with dr. on , . make sure you have your inr level checked prior/during that appointment to decide if you should continue lovenox. . cardiology: dr. , , wednesday, :20pm. , , . other appointments. worth, ms slp phone: date/time: 8:30 worth, ms slp phone: date/time: 8:30 worth, ms slp phone: date/time: 8:30 md, procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters injection or infusion of platelet inhibitor injection or infusion of platelet inhibitor other incision with drainage of skin and subcutaneous tissue insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of four or more vascular stents diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified hematoma complicating a procedure personal history of tobacco use percutaneous transluminal coronary angioplasty status accidental puncture or laceration during a procedure, not elsewhere classified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified cardiac dysrhythmias methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site ostium secundum type atrial septal defect acute myocardial infarction of other inferior wall, initial episode of care cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of anticoagulants retention of urine, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits acute systolic heart failure urinary complications, not elsewhere classified cellulitis and abscess of hand, except fingers and thumb infection following other infusion, injection, transfusion, or vaccination dysphagia, unspecified allergic rhinitis due to other allergen 

Answer: The patient is high likely exposed to