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: codeine attending: chief complaint: stemi major surgical or invasive procedure: cath history of present illness: 84f h/o mi in and cva , on coumadin for afib, denies cabg or stents, c/o 1 hr of chest tightness, nausea, diaphoresis, onset while at rest watching tv. followed by mark at . in ed had inferior stemi with 2>3 ste in inferior leads. she got asa and a heparin bolus. inr was >3 so no gtt started. she was not given plavix prior to procedure. she was taken to the cath lab where she was found to have 90-100% mid rca occlusion. the wire was delpoyed across the lesion but due to her inr of >3 and fragile appearing she was not felt to be a canditate for stenting. she underwent baloon angioplasty. . following proceure, as radial t band was being remove she vagaled and had sbp drop to 50's with hr in the 150's. was given 1-2 mg of atropine, started on dopamine. systolics rose to the 80's. she was then given 10mg iv diltiazem followed by 15mg iv metoprolol with control of her hr to the 130's and sbp to 100's. she arrives ont he floor on 10 of dopa. . on review of systems, s/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. s/he denies recent fevers, chills or rigors. s/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 chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: cad 2. cardiac history: - cabg: - percutaneous coronary interventions: - pacing/icd: 3. other past medical history: - knwon mi in - cva - afib on coumadin - social history: - tobacco history: quit smokign 21 years ago - etoh: occasional glass of wine - illicit drugs: none family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: 120 97/70 rr18 02 sat 100% general: 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 jvp elevation cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. . exam at discharge: vitals t 98.4 bp 125-156/76-86 hr 85-100rr 18 o2 94ra i/o: tele: af, rate 90's-low 100's no vea weight: 58.3(58.6) . general appearance: nad, sitting in chair head, ears, nose, throat: normocephalic cardiovascular: irregularly irregular (s1: normal), jvp 12cm h2o, no murmurs, rubs or gallops respiratory / chest: ctab abdominal: soft, non-tender extremities: right le with 1+, lle nl. neurologic: oriented to self, , month, year, good attention pertinent results: admission labs: 06:15pm blood wbc-6.6 rbc-3.59* hgb-12.1 hct-36.5 mcv-102* mch-33.8* mchc-33.3 rdw-12.6 plt ct-219 07:00pm blood pt-40.4* ptt->150 inr(pt)-4.0* 07:00pm blood glucose-113* urean-17 creat-1.0 na-144 k-3.0* cl-105 hco3-26 angap-16 06:15pm blood ctropnt-<0.01 12:54am blood ck-mb-88* mb indx-12.0* ctropnt-3.54* 05:11am blood ck-mb-87* mb indx-11.0* ctropnt-3.65* 12:54am blood calcium-7.8* phos-3.8 mg-1.5* 07:00pm blood %hba1c-5.9 eag-123 07:00pm blood triglyc-81 hdl-52 chol/hd-2.3 ldlcalc-52 06:22pm blood glucose-109* lactate-2.3* na-141 k-3.3 cl-102 calhco3-28 pertinent interval labs: 07:00pm blood wbc-7.0 rbc-3.35* hgb-11.0* hct-33.1* mcv-99* mch-32.9* mchc-33.3 rdw-12.7 plt ct-194 12:54am blood hct-32.2* plt ct-199 05:11am blood wbc-7.5 rbc-3.35* hgb-10.9* hct-33.4* mcv-100* mch-32.5* mchc-32.6 rdw-12.8 plt ct-203 01:31am blood wbc-8.5 rbc-3.13* hgb-10.4* hct-31.0* mcv-99* mch-33.3* mchc-33.6 rdw-12.9 plt ct-182 06:29am blood wbc-6.4 rbc-3.12* hgb-10.2* hct-31.6* mcv-101* mch-32.7* mchc-32.3 rdw-13.4 plt ct-179 07:00pm blood pt-40.4* ptt->150 inr(pt)-4.0* 05:11am blood pt-29.3* ptt-41.3* inr(pt)-2.8* 12:31pm blood pt-38.9* inr(pt)-3.8* 06:29am blood pt-29.0* ptt-38.1* inr(pt)-2.8* 07:00pm blood glucose-113* urean-17 creat-1.0 na-144 k-3.0* cl-105 hco3-26 angap-16 05:11am blood glucose-131* urean-18 creat-1.1 na-140 k-4.1 cl-103 hco3-26 angap-15 01:31am blood glucose-118* urean-22* creat-1.2* na-141 k-3.6 cl-104 hco3-22 angap-19 06:29am blood glucose-78 urean-21* creat-1.0 na-142 k-3.5 cl-107 hco3-25 angap-14 12:54am blood ck(cpk)-734* 05:11am blood ck(cpk)-788* 01:22pm blood ck(cpk)-633* 01:31am blood ck(cpk)-603* 06:29am blood alt-41* ast-67* alkphos-41 totbili-0.7 06:15pm blood lipase-59 06:15pm blood ctropnt-<0.01 12:54am blood ck-mb-88* mb indx-12.0* ctropnt-3.54* 05:11am blood ck-mb-87* mb indx-11.0* ctropnt-3.65* 01:22pm blood ck-mb-48* mb indx-7.6* ctropnt-2.35* 01:31am blood ck-mb-25* mb indx-4.1 ctropnt-1.88* 12:54am blood calcium-7.8* phos-3.8 mg-1.5* 01:31am blood calcium-8.0* phos-2.7 mg-1.8 06:29am blood calcium-8.3* phos-2.7 mg-2.1 07:00pm blood %hba1c-5.9 eag-123 07:00pm blood triglyc-81 hdl-52 chol/hd-2.3 ldlcalc-52 studies: ecg (): sinus rhythm. right bundle-branch block. inferior st segment elevation consistent with an acute inferior myocardial infarction and probable lateral extension with slight st segment elevation in leads v5-v6. there is reciprocal st segment depression in leads i, avl and v1-v2. no previous tracing available for comparison. cardiac cath (): comments: 1) selective coronary angiography of this right-dominant system demonstrated one-vessel coronary artery disease. the lmca, lad, and lcx had minimal disease but were free of angiographically-apparent flow-limiting stenoses. the mid-rca was subtotally occluded. 2) after the mid-rca angioplasty, she began complaining of nausea and dizziness and was noted to have a noninvasive sbp in the high 50s. the transducer was connected to the right radial arterial sheath sidearm, with blunted pressure recordings. noninvasive readings were consistently below sbp 70. she was given 2 mg atropine for presumed vagal reaction, and started on iv fluids and dopamine, up to 20 mcg/kg/min. a right common femoral arterial sheath was placed in preparation for possible iabp placement. however, her sbps were then noted to be in the 80s-90s. at that time, her heart rates were in the 140s-150s (transiently as high as 200) and appeared to be atrial fibrillation; she was then given 15mg iv metoprolol with resulting heart rates in the 120s and stable sbps in the 100s. the rcfa sheath was manually pulled and a tr band was applied to the rra site. she was transported to the ccu in stable condition. addendum: pci comments: initial angiography revealed a subtotally occluded rca. we planned to treat this using ptca. a 6 fr jr5 guiding catheter provided reasonable support throughout the procedure. chronic warfarin therapy with known inr of 3.2 48 hours prior. a prowater wire was successfully advanced across the target lesion and positioned in the distal vessel. an apex 2.0 x 8 mm balloon was used to pre-dilate the occlusion, restoring flow to the vessel. attempts were made to deliver a mini-vision 2.0 x 12 mm and then a 2.0 x 8 mm stent, however we were unable to advance these across the lesion. final angiography showed timi 3 flow within the vessel and no apparent dissection. it was elected to stop with conventional balloon angioplasty given her elevated inr. post angioplasty hemodynamic course as documented above. hemostasis achieved at right radial arterial access site using tr band. final diagnosis: 1. one vessel coronary artery disease status post primary balloon angioplasty of the mid-rca stenosis. 2. vagal reaction and hypotension requiring pressors and fluids. . ecg (): rate 84, baseline artifact makes p wave morphology difficult. this could be sinus rhythm with premature atrial contractions and ventricular premature beats versus atrial fibrillation with ventricular premature beats. right bundle-branch block. inferior and lateral st segment elevation consistent with an acute inferior myocardial infarction. compared to tracing #1 baseline artifact is more pronounced. . ecg : rate 133. probable atrial fibrillation with a rapid ventricular response and baseline artifact. right bundle-branch block. left anterior fascicular block. q waves in leads iii and avf consistent with an inferior myocardial infarction which is probably acute. compared to tracing #2 the inferior and lateral st segment elevation is less pronouced. q waves are more apparent in leads iii and avf. tracing #3 . ecg : rate 126. possible atrial flutter with variable block. right bundle-branch block with left anterior fascicular block. slight st segment elevation in leads iii and avf with q waves suggesting evolution of an inferior myocardial infarction. premature ventricular contraction is also present. lateral st-t wave changes consistent with ongoing ischemia. compared to tracing #3 atrial flutter may be present. the ventricular premature beat is new. . ecg : rate 123. probable atrial fibrillation with a rapid ventricular response. right bundle-branch block with left anterior fascicular block. inferior myocardial infarction which is evolving. st-t wave changes suggest ongoing ischemia. compared to tracing #5 the ventricular rate is slower. . ecg : rate 86. atrial flutter at an atrial rate of about 300 with variable block. right bundle-branch block with left anterior fascicular block. inferior myocardial infarction with inferior t wave inversions suggesting an evolving inferior myocardial infarction. non-specific t wave flattening in leads v4-v6. compared to tracing #6 the ventricular rate is slower. the st segment depression in leads v1-v2 is less pronounced. . echo : the left atrium is elongated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the basal half of the inferior septum, inferior and inferolateral walls. the remaining segments contract normally (lvef = 35 %). the right ventricular cavity is mildly dilated with normal free wall contractility. 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. mild to moderate (+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with moderate regional systolic dysfunction c/w cad. severe tricuspid regurgitation. pulmonary artery hypertension. mild-moderate mitral regurgitation. labs on discharge: 06:55am blood wbc-6.3 rbc-3.12* hgb-10.2* hct-31.4* mcv-101* mch-32.6* mchc-32.4 rdw-13.6 plt ct-198 06:55am blood pt-26.2* inr(pt)-2.5* 06:55am blood urean-19 creat-0.9 na-144 k-3.8 cl-108 hco3-30 angap-10 06:56am blood calcium-8.4 phos-2.6* mg-1.9 brief hospital course: brief clinical summary: ms. is an 82 year old woman with history of cad, afib on coumadin and cva who presented with inferior stemi secondary to rca occlusion now s/p percutaneous balloon angioplasty with immediate post procedural course complicated by hypotension and tachycardia initially requiring pressors, hospitalization complicated by delirium. issues: # inferior stemi: because patient presented with supratherapeutic inr, decision was made not to commit patient to plavix with pci, so she underwent poba of the rca. she was chest pain free with resolution of st changes after intervention. she was initially hypotensive and bradycardic on presentation, requiring dopamine for support which was soon weaned off. she also received a dose of atropine on the night of presentation, after which she became more delirious. she was continued on aspirin, beta blocker. atorvastatin dose was increased to 80mg daily. lisinopril 2.5mg was started prior to discharge. tte showed ef of 35%, symmetric lvh with moderate regional systolic dysfunction, severe tr, moderate mitral regurgitation, and rv failure. hemoglobin a1c was 5.9% consistent with prediabetes. lipid panel showed hdl 54, ldl 47 and trigl 108. the patient has been arranged with cardiac follow-up. # acute systolic dysfunction: ef 35% on echo. no signs of chf during her hospital stay. her discharge weight is 128 pounds. she will require daiy weights with the consideration of starting a diuretic if her weight increases or she shows signs of chf. an echo should be scheduled in weeks to assess lv function. # delirium: icu course was complicated by significant delirium which quickly resolved on the floor. she was given several doses of olanzapine and quetiapine in the icu in efforts to restore her sleep-wake cycle. # afib with rvr: she remained in atrial fibrillation throughout hospitalization. chads score is 4. presented with supratherapeutic inr, so warfarin was initially held, then restarted prior to discharge. she was continued on metoprolol. # hypertension home antihypertensives were initially held in the setting of hypotension. when hemodynamically stable, she was restarted on metoprolol in setting of atrial fibrillation, and she was started on low dose lisinopril. her metoprolol was increased to 150 of succinate once per day. home hctz was discontinued. # code status was full code during this hospitalization # husband: : . transitional issues: 1. cardiology f/u 2. uptitrate lisinopril as tolerated 3. uptitrate metoprolol as tolerated medications on admission: warfarin 3.75-7mg calcium 600 d hctz 25 mg qd lipitor 10mg qd immodium prn maalox 2 tsp qhs metoprolol 50mg qd mvi probiotics tylenol 500mg prn - discharge medications: 1. metoprolol succinate 100 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day. :*45 tablet extended release 24 hr(s)* refills:*0* 2. coumadin 1 mg tablet sig: three (3) tablet po once a day: please adjust dose as instructed by your doctor. :*90 tablet(s)* refills:*2* 3. calcium 500 + d oral 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 5. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). :*30 tablet, delayed release (e.c.)(s)* refills:*2* 6. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. :*30 tablet(s)* refills:*2* 7. immodium sig: one (1) once a day as needed for diarrhea. 8. maalox rs oral 9. multivitamin tablet sig: one (1) tablet po once a day. 10. probiotics sig: one (1) once a day. 11. tylenol 325 mg tablet sig: 1-2 tablets po twice a day as needed for pain. discharge disposition: extended care facility: at discharge diagnosis: st elevation myocardial infarction delirium hypertension tachycardia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital because you had a heart attack. we started you on new medications to help protect your heart. you had some delirium (confusion) in the hospital, which is now improved. the following changes were made to your medications: - stop hydrochlorothiazide - decrease warfarin to 3mg daily and adjust your dose as instructed by your doctor - increase lipitor to 80mg daily to lower your cholesterol - start aspirin 325mg daily to prevent blood clots - increase metoprolol succinate to 150mg daily to slow your heart rate - start lisinopril 2.5mg daily it was a pleasure taking care of you, we wish you all the best! followup instructions: name: mark ,md location: cardiologists when: tuesday at 1pm address: , , phone: procedure: coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other primary cardiomyopathies other iatrogenic hypotension abnormal coagulation profile coronary atherosclerosis of native coronary artery unspecified essential hypertension atrial fibrillation paroxysmal ventricular tachycardia other specified cardiac dysrhythmias cardiogenic shock 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 personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits anticoagulants causing adverse effects in therapeutic use drug-induced delirium chronic total occlusion of coronary artery other specified retention of urine heart disease, unspecified parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to