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: no known allergies / adverse drug reactions attending: chief complaint: chest pain, respiratory failure major surgical or invasive procedure: - intubation with sedation, mechanical ventilation - cardiac catheterization - intra-aortic balloon pump placement - intubation, mechanical ventilation - cardiac catheterization - intra-aortic balloon pump placement history of present illness: 79 year-old male with h/o cad s/p cabg years ago, mi and htn initially presented with chest pain. pt has known 3vd, was evaluted by cath for chest pain with a positive stress test in . initially pt presented to . he has reportedly had chest pain intermittently for months. chest pain started 2 hrs prior to presentation at osh, described as substernal chest pressure, sudden onset and gradually worsening, radiating to l arm. pt denied radiation to back or tearing senation on initial presenation to osh ed, pain was . at osh pt was started on nitro gtt and heparin gtt, and then was chest pain free. ekg from osh while chest pain showed elevation in avr, depressino in i, ii, avf, v3-v6, which improved somewhat after chest pain free. no fevers, chills, nausea, vomiting, diarrhea, abd pain, neck pain, or other complaints. pain is similar to prior mi, has had episodes of short lived chest pain intermittently since cabg but never had to use nitroglycerin until today. pt transferred to for further management. . in ed initial vs were 97.4 90 148/76 16 95% 3l nasal cannula. pt was initially cp and then cp free here on nitro gtt, received aspirin 325 mg as well. cardiology consulted in ed and recommended addition of integrillin gtt instead of plavix given known 3vd, also received metoprolol 25 mg po. trop elevated at 0.18, ck/mb flat. admitted to service cath in the am. . right femoral artery was used for iabp, rhc via right femoral vein, and left femoral artery for pci. during cath, patient had sudden onset of respiratory distress thought secondary to chf (ischemic-induced), this lead to intubation in the cath lab. rhc was done and observed a pcwp of 40, which lead to placement of iabp. cath showed left main disease and om disease, these were interveined on sequentially. his pcwp was noted to have dropped to 20s at the end of the case. findings during his lhc included right dominant coronary arteries. lmca with diffuse 70-80% with ostial 90%. lad to origin. lcx prox 70%, om1 origin 90%. rca proximal and ostial 50-60%. svg none. lima to lad: free lima patent to lad. he had placement of des to lm and des/bms to cx om. he received heparin, integrilin, nitroglycerine drip, lasix, bivalirudin, norepinephrine, cefazolin. . in ccu, he was intubated, sedated. the patient had an iabp in place. . per floor team, review of systems: he denies any prior history of stroke, tia, 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 absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. coronary artery disease (cad s/p mi, ischemic cardiomyopathy ef 35-40%, cabg: lima-lad, svg-om1-om2) 2. hypertension 3. hyperlipidemia 4. peripheral vascular disease (s/p left carotid endarterectomy) 5. chronic totally occluded right internal carotid artery 6. s/p appendectomy 7. diverticulitis 8. cholelithiasis 9. herniated disc (status-post back surgeries) 10. reflux esophagitis, gerd 11. arthritis 12. s/p tonsillectomy social history: - tobacco history: smoked 1/2-1 ppd x 40-50 years, quit in - etoh: rare - illicit drugs:denies - herbal medications: denies patient lives with his wife and children family history: two brothers who had cabg both are deceased. father passed away at the age of 66 of an mi. no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam: vs: 97.6 127/73 67 18 96% 3l general: wdwn m in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with no jvd cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: ctab abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. extremities: 1+ pedal edema bilaterally, no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ patient expired pertinent results: 02:30am blood wbc-12.7* rbc-4.76 hgb-13.6* hct-40.2 mcv-84 mch-28.6 mchc-33.9 rdw-13.9 plt ct-257 . 02:30am blood neuts-75.0* lymphs-17.1* monos-6.8 eos-0.7 baso-0.4 . 02:17pm blood pt-18.3* ptt-67.6* inr(pt)-1.7* . 02:45am blood glucose-201* urean-28* creat-1.7* na-140 k-4.2 cl-103 hco3-29 angap-12 . 02:17pm blood alt-43* ast-217* ld(ldh)-586* ck(cpk)-* alkphos-132* totbili-0.5 . 02:17pm blood ck-mb-203* mb indx-10.4* ctropnt-6.58* 01:11am blood ck-mb-66* mb indx-3.6 ctropnt-6.50* 06:38am blood ck-mb-41* mb indx-2.8 ctropnt-5.62* . 02:17pm blood calcium-8.3* phos-2.0* mg-2.0 . 06:38am blood %hba1c-6.8* eag-148* . microbiologic data: blood culture - pending blood culture - pending urine culture - negative sputum culture - no organisms, no growth . imaging studies: cardiac catheterization - selective coronary angiography of this right dominant system revealed 3-vessel coronary artery disease. there was an ostial 90% stenosis of the lmca which was diffusely diseased to 70-80%. the lad was 100% occluded proximally. the lmca gave rise to a patent lcx with a proximal 70% stenosis at the take-off of om1, which extended into om1 narrowing the ostial segment of om1 to 90%. there was diffuse plaquing of the distal lx. venous conduit angiography was not performed as the svg to om1/om2 is known to be occluded. selective arterial conduit angiography of the lima arising from the ascending aorta to the mid-lad revealed this to be patent. initial hemodynamics revealed markedly elevated left and right heart filling pressures with a mean right atrial pressure of 27mmhg and a mean pcw of 31 mmhg. there was mild pulmonary artery hypertension with pa 45/30mmhg but no significant transpulmonary gradient and a pvr of only 38dynes*sec*cm-5. the cardiac output and index were reduced at 4.2l/min and 2.1 l/min respectively. repeat hemodynamics after insertion of the iabp and baloon angioplasty of the lmca showed a decrease in the pcw to a mean of 18mmhg but persistently decreased mixed venous saturation (60%). native 3-vessel coronary artery disease. culprit lesion for presentation likley 90% ostial lmca. respiratory failure secondary to acute on chronic left ventricular systolic dysfunction requiring mechanical ventilation. iabp insertion for circulatory support in the setting of cardiogenic shock. mild pulmonary artery hypertension. . 2d-echo - poor image quality (echo contrast used). the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with mid to distal septal, anterior and apuical hypokinesis suggested. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. with borderline normal free wall function. the ascending aorta is mildly dilated. 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. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . cxr (portable) - single frontal view of the chest demonstrates evidence of prior cabg and median sternotomy. the lungs are mildly hyperinflated allowing for somewhat lordotic patient positioning, suggestive of emphysema. there is minimal interstitial edema. the heart is top normal in size. the mediastinal and hilar contours are unremarkable. patient expired brief hospital course: 79 year-old male with a pmh significant for coronary artery disease (s/p cabg years prior), prior mi, hypertension who presented to an outside hospital with chest pain who underwent pci who was intubated for respiratory failure in the cardiac catheterization lab and who required placement of an intra-aortic balloon pump for cardiogenic shock and subsequently expired due to ventricular tachycardia. . # cardiogenic shock - the patient presents with a known history of ischemic cardiomyopathy, with recent ef of 35-40%. during his left heart catheterization procedure this admission, the patient began to experience acute respiratory failure, likely secondary to worsening cardiogenic shock. the etiology of his cardiogenic shock was likely secondary to a cathecholamine surge which occurred during the catheterization procedure, as he was laid supine. there was also a component of anxiety associated with the procedure. his right heart catheterization revealed a pcwp of 31 mmhg, which was improved with the placement of an intra-aortic balloon pump (iabp) to 18 mmhg. the iabp was maintained in good position and was assisting ventricular contraction initially at a 1:1 ratio which supported his mean arterial pressures to an average of 55-60 mmhg. he was slowly weaned to a 2:1 ratio over the course of 48-hours with subsequent removal of the iabp 3-days into admission. a norepinphrine gtt was utilized to support his systolic pressures and peripheral vasculature while the balloon pump was being utilized. his systolic pressures actually remained elevated following the removal of the device and he requried transient use of a nitroglycerin gtt to control his systolic pressures. while the iabp was in place, his distal pulses were closely monitored and daily cxrs showed adequate balloon positioning. his platelets and hematocrit were also closely monitoring, with a drop in his platelets from 257 to 125 this admission. he showed no evidence of bleeding nonetheless. we added back his home anti-hypertensives once his blood pressure stabilized and his cardiac function improved. his digoxin level remained therapeutic this admission. he was also treated with iv lasix as needed, to promote diuresis. . # respiratory failure and hypoxia - the patient required urgent intubation in the cardiac catheterization lab likely secondary to pulmonary edema in the setting of his cardiogenic shock. he received lasix and nitroglycerin in the cath lab, and once his iabp was removed and diuresis was employed, he was successfully extubated without issues. he transiently required fentanyl and versed gtts to maintain sedation while intubated. following extubation, the patient was delirious. he had another episode of flash pulmonary edema which was responsive to lasix, nitroglycerin drip, morphine. . # coronaries - the patient presented with known coronary disease involving 3-vessels. the patient was found to have a 90% stenotic lesion of the left main coronary artery, which underwent drug-eluting stent placement. he also has a known history of prior cabg. prior to his cardiac intervention, given his chest pain, he was started on heparin gtt and maintained on aspirin therapy. integrillin was added given continued chest pain. his statin medication was optimized to high dose atorvastatin 80 mg po daily. he was also plavix loaded with 600 mg po x 1 prior to his catheterization. following his catheterization, stenting and resolution of his cardiogenic shock and removal of the balloon pump, he had no further issues with chest pain. he will continue on aspirin 325 mg po daily, plavix 75 mg po daily and a high dose statin medication. the patient had an episode of vt but was hemodynamically stable during the night of . he had sudden onset of ventricular fibrillation and was pulseless, he received acls including intubation, electrical shocks, epinephrine, lidocaine, magnesium. he was taken emergently to the cath lab, where his lima was found to be occluded. the patient required iabp, ventricular pacer wire and epinephrine drip. his family decided to make the patient dnr and he expired on around 1600. . # rhythm - the patient presented in sinus rhythm. he was carefully monitored in the post-intervention period for the development of arrhythmia. he was monitored via telemtry, his electrolytes were optimized. . # chronic renal insufficiency - the patient presented with an unclear baseline, but known chronic renal insufficiency. his last creatinine in our records was 1.4 and he presented with a creatinine in the 1.7 range, likely secondary to forward flow issues. his creatinine stabilized following cardiogenic shock treatment, with improvement in his cardiac index. we avoided nephrotoxic medications and renally dosed his medications. . # hypertension - hold amlodipine, valsartan, hydralazine, imdur for now . # gerd - he was continued on omeprazole at his home dosing. . transition of care issues: expired. medications on admission: amlodipine 2.5 mg tablet - 0.5 (one half) tablet(s) by mouth daily atenolol 100 mg tablet - 1.5 tablet(s) by mouth daily atorvastatin 40 mg tablet - one tablet(s) by mouth daily digoxin 125 mcg tablet - one tablet(s) by mouth daily furosemide 80 mg tablet - one tablet(s) by mouth twice daily hydralazine 25 mg tablet - one tablet(s) by mouth daily isosorbide mononitrate 60 mg tablet - one tablet(s) by mouth daily omeprazole - 20 mg capsule - one capsule(s) by mouth daily potassium chloride 10 meq capsule - one capsule(s) by mouth daily terazosin 1 mg capsule - one capsule(s) by mouth daily valsartan 160 mg tablet - one tablet(s) by mouth daily aspirin 325 mg tablet - one tablet(s) by mouth daily discharge medications: expired discharge disposition: extended care discharge diagnosis: primary diagnoses: 1. coronary artery disease 2. acute myocardial infarction 3. cardiogenic shock (placement of intra-aortic balloon pump device) 4. intubation and mechanical ventilation . secondary diagnoses: 1. hypertension 2. hyperlipidemia 3. coronary artery disease discharge condition: patient expired discharge instructions: patient expired. patient discharge instructions: . you were admitted to the coronary care unit (ccu) at on 6 regarding management of your coronary artery disease and cardiac issues. you initially presented to hospital with chest pain and your electrocardiogram (ekg) showed concerning findings for a myocardial infarction (heart attack). you were then transferred here, to , and had a cardiac catheterization which showed a blockage in your left main coronary artery which was stented. you had some respiratory issues during the procedure and were intubated and sedated (and mechanically ventilated) and required placement of an intra-aortic balloon pump (a device that supports your heart function and decreases the work on the heart while it improves) for cardiogenic shock. your cardiac status steadily improved and the device was removed. you were successfully extubated (the breathing tube was removed) without issues. your were overall in stable condition prior to discharge. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: . * upon admission, we added: we changed: increased your atorvastatin from 40 mg to 80 mg by mouth daily start: plavix 75 mg by mouth daily . * the following medications were discontinued on admission and you should not resume: none . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: patient expired. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters intraoperative cardiac pacemaker implant of pulsation balloon implant of pulsation balloon cardiopulmonary resuscitation, not otherwise specified insertion of drug-eluting coronary artery stent(s) 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] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of three vascular stents procedure on two vessels diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia acute respiratory failure cardiogenic shock old myocardial infarction cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute systolic heart failure coronary atherosclerosis of artery bypass graft physical restraints status 

Answer: The patient is high likely exposed to