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: history of present illness: this is a 78 year old woman with a history of coronary artery disease, status post myocardial infarction at age 35 and six vessel coronary artery bypass graft in who presented with new onset of chest pressure associated with shortness of breath, dizziness, palpitation and nausea starting at around 10 am on the day of admission. the pain started at breakfast and it radiated to her throat and left arm. it was 7 out of 10 in onset and progressed to 10 out of 10 about one hour later. she took one sublingual nitroglycerin without significant improvement. she called her cardiologist, dr. who told her to call 911. she was brought in by emergency medical services and she felt better after being given oxygen and two baby aspirin (the patient had taken her baby aspirin 81 mg in the morning before the episode). of note, the patient also fell during the episode secondary to her left leg weakness. in the emergency room she was found to be in rapid atrial fibrillation with heartrate of 170, blood pressure 148/78, oxygen saturation 99% on 2 liters. she was given one dose of 25 mg intravenous diltiazem and her rhythm went back into sinus. she was admitted for rule out myocardial infarction. past medical history: coronary artery disease, status post myocardial infarction at age 35, status post six vessel coronary artery bypass graft in . aortic stenosis. echocardiogram in showed moderately severe aortic stenosis with significant progression since , aortic valve increased from 3 to 4.1 and gradient from 36 to 69. the aortic valve area estimated to be .7 cm. recent admission to hospital three weeks ago or syncopal episode, etiology thought to be vasovagal in the setting of moderately severe aortic stenosis. rheumatoid arthritis in the past three years on chronic prednisone and methotrexate. history of upper gastrointestinal bleeding, secondary to tear, status post right carotid endarterectomy in . status post episode of pneumonia. status post from outside hospital, exercise stress test in . heartrate maximum at 123, stopped secondary to shortness of breath, no chest pain or anginal symptoms. no significant electrocardiogram changes. perfusion scan is normal. normal wall motion, normal ejection fraction. echocardiogram in showed left atrial dilatation. concentric left ventricular hypertrophy, aortic valve peak gradient 69.6, mean of 31.9, aortic valve area estimated to be .7 cm, 2 to 3+ mitral regurgitation. pa pressure increased to 45 mm mercury. left ventricular ejection fraction estimated to be 60%. no wall motion abnormality. left ventricular size and function were normal. right ventricular size and function were normal. allergies: motrin and aspirin causing bleeding. medications on admission: baby aspirin 81 mg p.o. q.d.; zocor 80 mg p.o. q.d.; prilosec 20 mg p.o. q.d.; methotrexate 7.5 mg q. saturday; prednisone 5 mg p.o. q.d.; atacand 16 mg p.o. q.d.; folgard 1 p.o. q.d.; fosamax 70 mg q. sunday; lasix 40 mg p.o. q.d.; vitamin e; multiple vitamin; atrovent 2 puffs t.i.d. social history: no cigarettes for 45 years. had a history of 60 pack year history. social alcohol, has not been drinking for two years. lives alone. never married and had no children. family history: mother died at age 67, father died at age 72, brother died at age 62 all secondary to heart disease, sister at age 71 with heart problems. review of systems: syncopal episode three weeks ago, admitted to hospital, etiology thought to be vasovagal in the setting of moderate severe aortic stenosis. has been feeling tired in the past one to two weeks. three pillow orthopnea in the past year. increased from two pillow orthopnea, had been feeling increasingly weak in the past year, with decreased activity. positive for claudication and paroxysmal nocturnal dyspnea. physical examination: physical examination on admission revealed the patient to be afebrile, temperature 97.3, blood pressure 116/72, heartrate 76, respirations 22, oxygen saturation 96% on room air. in general, pleasant elderly lady, lying in bed in no acute distress. head and neck examination anicteric, sclera, jugulovenous pressure not elevated. mucous membranes moist. cardiovascular, regular rate and rhythm, iv/vi systolic ejection murmur, loudest at the left upper sternal border, radiating through the precordium and bilateral carotids can be heard. lungs, clear to auscultation bilaterally. abdomen soft, nondistended, nontender. bruit can be heard at bilateral renal artery, (questionable radiating murmur from the aortic stenosis). extremities, no edema, good distal pulses, bilateral bruits can be heard at the femoral artery sites (questionable radiating murmur from aortic stenosis). laboratory data: laboratory studies on admission revealed hemoglobin 13.7, hematocrit 33.3, platelets 368, 85% neutrophils, 8% lymphocytes, 4% monocytes and 3 eosinophils. mcv 80, sodium 137, potassium 4.1, chloride 103, bicarbonate 21, bun 37, creatinine 1.3, glucose 103. pt 12.6, ptt 26.6, inr 1.0. chest x-ray, slight prominence of pulmonary vasculature and upper zone with distribution suggestive of congestive heart failure, no effusions or infiltrates. electrocardiograms on admission showed atrial fibrillation/atrial flutter, rhythm at a rate of 152, normal axis, q waves in iii and avf, questionable left ventricular hypertrophy. hospital course: the patient was given sublingual nitroglycerin and diltiazem in the emergency room. her atrial fibrillation and atrial flutter was terminated with one dose of intravenous diltiazem. she has remained chest pain free in the emergency room. she was started on amiodarone for atrial fibrillation and lovenox for acute coronary syndrome. she was worked up with seronegative cardiac enzymes. she has remained in sinus rhythm on telemetry while she was on the floor. she had a repeated echocardiogram which showed mildly dilated left atrium and normal left ventricle with ejection fraction of about 55%. the right ventricle is normal. she had moderate aortic stenosis, mild aortic regurgitation, 2+ mitral regurgitation, no effusion was seen on the examination. she also had an magnetic resonance imaging scan, magnetic resonance angiography of her brain given her history of right carotid endarterectomy and syncopal episode three weeks ago which showed mild narrowing of the left carotid artery at the bifurcation, small irregularity at the right carotid artery bifurcation. there was also found chronic microvascular ischemia changes. no major vascular territory infarction. she went for diagnostic catheterization on , to evaluate her coronary artery bypass graft paths and aortic stenosis which showed right dominant situation disease with proximal aneurysm with severe native three vessel deep coronary artery disease, left main coronary artery was diffusely diseased with 80% distal narrowing. the left anterior descending was aneurysmal dilated at its ostium and was staying diffusely diseased throughout its course with stenosis up to 90% and finally it occluded in the mid vessel. the left circumflex was diffusely diseased with a 90% ostial lesion. the right coronary artery was diffusely diseased and subtotally occluded to 99% throughout its course. the graft angiograph demonstrated a treated left internal mammary artery which was totally occluded in the mid vessel, saphenous vein graft to posterior descending artery was widely patent and filled moderately sized posterior descending artery and plv branches as well as diffusely diseased distal right coronary artery via retrograde flow. saphenous vein graft to d1 with jump graft to obtuse marginal 2 was widely patent, though seemed to fill left anterior descending, left circumflex and left main coronary artery via retrograde flow. saphenous vein graft to obtuse marginal 1 (likely cord saphenous vein graft to r1 in the coronary artery bypass graft report), was widely patent. attempts to find additional proximal saphenous vein graft to distal left anterior descending were unsuccessful. resting hemodynamics revealed mildly elevated left ventricular field pressure with left ventricular end diastolic pressure of 17 mm of mercury in the setting of mild systemic arterial hypertension. there was evidence of some primary pulmonary hypertension with pa pressure of 43/10/25 mm of mercury and pulmonary vascular resistance of 209. the cardiac output was preserved at 4.6 liters/minute. the aortic valve assessment revealed a mean gradient of 48 mm of mercury and a calculated aortic valve area of .7 cm to a left ventricular graft, demonstrating mild anterior and apical hypokinesis with a calculated left ventricular ejection of 48%. moderate (2+) mitral regurgitation was seen. unfortunately, post catheterization the patient developed the sudden onset of dense right-sided hemiplegia. urgent magnetic resonance imaging scan and magnetic resonance angiography was performed which revealed a new area of restricted effusion involving a portion of two post superior left frontal gyri and underlying white matter in the region of the distal left right coronary artery territory consistent with acute embolic stroke. magnetic resonance angiography revealed good flow in the distal internal carotid artery, the distal vertebral artery and basilar artery. there is some irregularity at the junction of the distal vertebral artery and the basilar artery, unchanged from the magnetic resonance angiography scan two days ago. the major branches of the cerebral artery remained symmetric and good flow is seen in both segments without change. no evidence of major vascular occlusion. no thrombolytics were given for the acute strokes since the patient just had cardiac catheterization. the patient was admitted to ccu over night for observation after two strokes. she received one unit of packed red blood cells in the unit for a hematocrit of 29.3. she was also given hydrocortisone 50 mg intravenously q. 6 for episodes of hypotension. her systolic blood pressure will be maintained between 130s to 170s for severe perfusion after acute strokes. plavix was also started after acute stroke. lasix was also added. the patient's right-sided cranial nerve deficits including facial droop, speech and swallow improved significantly after acute stroke. however, her right arm and leg weakness remained severe. she can only move her right fingers and right thigh a little bit. she had repeated magnetic resonance imaging scan, magnetic resonance angiography two days later which revealed subacute infarction of the left parietal lobe involving the premodel and model cortex. the majority tributaries of bruits are patent. no mass effect was seen. the patient has remained relatively stable otherwise. metoprolol was discontinued given her relative hypotension with systolic blood pressure 110 to 130. the patient was evaluated by a physical therapist and rehabilitation was recommended for acute stroke. discharge condition: stable. discharge status: hospital for acute rehabilitation. discharge diagnosis: 1. acute left anterior cerebral artery stroke 2. unstable angina, rule out myocardial infarction 3. new onset atrial fibrillation 4. aortic stenosis 5. coronary artery disease, status post six vessel coronary artery bypass graft 6. rheumatoid arthritis discharge medications: 1. aspirin 81 mg p.o. q.d. 2. plavix 75 mg p.o. q.d. 3. metoprolol 12.5 mg p.o. b.i.d., hold for systolic blood pressure less than 140 4. zocor 80 mg p.o. q.d. 5. amiodarone 400 mg p.o. q.d., switched to 200 mg p.o. q.d. 6. prevacid 30 mg p.o. q.d. 7. prednisone 5 mg p.o. q.d. 8. iron sulfate 325 mg p.o. q.d. 9. atrovent 2 puffs q.i.d. 10. multivitamin one tablet p.o. q.d. 11. alendronate 70 mg p.o. q. sunday 12. methotrexate 7.5 mg p.o. q. saturday 13. flovent 2 puffs b.i.d. 14. colace 100 mg p.o. b.i.d. 15. dulcolax 10 mg p.o. q.d., hold for bowel movements greater than two per day 16. maalox prn for heartburn 17. tylenol prn for pain diet - cardiac diet. discharge follow up: follow up with dr. (patient's cardiologist) as an outpatient. please call dr. office at for appointment. dr. can also follow the patient at . , md dictated by: medquist36 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures arterial catheterization diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome chronic airway obstruction, not elsewhere classified atrial fibrillation other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation primary pulmonary hypertension mitral valve insufficiency and aortic valve stenosis other complications due to other cardiac device, implant, and graft iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to