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: patient recorded as having no known allergies to drugs attending: chief complaint: angina major surgical or invasive procedure: cardiac catheterization history of present illness: this is a 76 year old male with history of coronary artery disease, hyperlipidemia, who presented to ccu s/p pci with 2 svg-diag, after developing angina at home and ekg changes consistent with inferior stemi. mr has a known history of coronary disease s/p cabg years ago; he most recently underwent cardiac catheterization in with native three vessel disease, known occlusion of vein graft to the rca, and 70% distal left main stenosis. he has undergone multiple recent noninvasive studies of his cardiac function including a 2d echo in which revealed an ef of 40% and inferior hypokinesis; he also had an exercise mibi which showed an ef of 30%. to evaluate this discrepancy, mr primary cardiologist decided upon cardiac mr for further evaluation of his ef which was performed on the morning of this admission. per the patient, mr was at home and while talking on the phone developed left sided substernal chest pain radiating to the left arm consistent with prior episodes of anginal pain. over the past two months, mr states he's had repeated episodes of similar pain while at rest which resolve within minutes, whereas the episode on day of admission lasted > 30 minutes without resolution until he received nitro in the ed. no nausea, diaphoresis, shortness of breath associated with this. in the ed he received asa, nitroglycerin, plavix, and heparin. on ekg he was noted to have st elevations in the inferior leads. he was sent for cardiac catheterization. of note, he recently discontinued plavix about 2 weeks prior to this admission; he had been taking it for over > 1.5 years since his last intervention. . on cardiac cath, he had 2 placed to the svg to the diagonals proximally and distally; upon placement of stents the distal jump to the lad was seen to be largely patent with mild stenoses distally that was nonintervenable. mr was chest pain free upon transfer to the ccu. he was hemodynamically stable with bp of 140/60 and heart rates in the 70s. past medical history: -cad -hypothyroidism -hyperlipidemia -hypertension -localized prostate cancer -colonic adenoma history -mild aortic and mitral regurgitation -gout social history: patient was born in bombay and moved to united states so that he could accompany his wife, a scientist, who is offered her job had state . he completed law school in and in he worked as a corporate lawyer. in this country he worked at insurance company doing sales. he retired from this but felt board so he returned to work corp. doing accounting. he was married for 17 years but has been widowed for the last 12 years. he lives in a house in with his son. family history: mother died age 87 with coronary disease father died age 87 with coronary artery disease which was probably premature family history is notable for longevity in three of his for grandparents who died in their 90s. it is also notable for coronary artery disease in both of his parents and both his paternal grandparents. there is no cancer, diabetes, premature blindness in the family. there was some tuberculosis in the family. physical exam: bp 140/60 hr 70 afebrile rr 12 o2 sat 98% ra gen: lying flat in bed in nad cardiac: nl s1/s2, mild systolic murmur loudest at llsb resp: clear bilaterally in anterior lung fields abd: soft nontender with normoactive bowel sounds ext: 1+ le edema noted neuro: alert + oriented x 3 pertinent results: admission 09:40pm blood wbc-8.8 rbc-4.58* hgb-13.1* hct-38.8* mcv-85 mch-28.5 mchc-33.6 rdw-13.4 plt ct-240 09:40pm blood pt-11.5 ptt-23.7 inr(pt)-1.0 09:40pm blood glucose-178* urean-23* creat-1.2 na-137 k-4.1 cl-98 hco3-28 angap-15 09:40pm blood calcium-9.1 phos-4.1 mg-2.3 . cardiac enzymes 09:40pm blood ck-mb-6 09:40pm blood ctropnt-0.06* 09:40pm blood ck(cpk)-141 04:08am blood ck-mb-29* mb indx-6.8* ctropnt-1.45* 04:08am blood ck(cpk)-425* 12:36pm blood ck-mb-21* mb indx-5.9 ctropnt-0.88* 12:36pm blood ck(cpk)-356* . discharge labs: 05:10am blood wbc-7.2 rbc-4.29* hgb-12.5* hct-36.3* mcv-85 mch-29.1 mchc-34.5 rdw-13.5 plt ct-184 05:10am blood pt-12.7 ptt-35.1* inr(pt)-1.1 05:10am blood glucose-107* urean-18 creat-1.1 na-137 k-3.7 cl-99 hco3-30 angap-12 05:10am blood calcium-9.3 phos-3.7 mg-2.1 . catherization: comments: 1. coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had a 70% distal stenosis. the lad had a 60% ostial stenosis and a long 80% mid stenosis. the lcx had a 70% proximal stenosis and 50% stenoses in om1 and om2. the rca was not engaged as it was known to be occluded. 2. arterial conduit arteriography demonstrated 60% in-stent restenosis proximally and 99% stenosis distally (at the bifurcation of the jump graft) in the svg-d1 segment. the svg-rca was not engaged as it was known to be occluded. 3. limited resting hemodynamics revealed moderate systemic arterial hypertension with sbp 165mmhg and dbp 71mmhg. 4. sucecssful primary angioplasty of the svg-diag/jump graft to lad with placement of two dess: 2.5x23 mm into the distal svg-diagonal anastomosis and 2.75x15 mm into the cypher stent placed for isrs. fianl angiography shwoed good results (see ptca comments for details). 5. sucecssful closure of the rcaf arteriotomy with a 6f angioseal with adequate hemostasis. final diagnosis: 1. three vessel coronary artery disease. 2. in-stent restenosis of the proximal svg-d1 and significant distal stenosis of the svg-d1. 3. successful ppci of the svg-diagonal with placement of 2 4. sucecssful closure of teh rcaf arteriotomy with a 6f angioseal 5. consider complex pci of the lmca into the lcx vs. repeat cabg. 6. plavix (75 mg po bid x 2 weeks then 75 mg po daily x minimum of 12 months) and asa 325 mg po daily indefinitely 7. admit to ccu for monitoring . mri impression: 1. ischemic cardiomyopathy with mildly increased left ventricular cavity size, mild septal hypertrophy, and regional systolic dysfunction consistent with multivessel coronary artery disease with moderately depressed left ventricular ejection fraction (lvef 38%). 2. normal right ventricular cavity size and systolic function. the rvef was normal at 64%. 3. mild mitral and tricuspid regurgitation. 4. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was normal. 5. moderate -atrial enlargement. . ekg: sinus rhythm. occasional ventricular premature beats. non-specific st-t wave changes. brief hospital course: 76 year old male with history of cad p/w anginal episode and ekg changes consistent with inferior stemi found to have 70% distal left main stenosis, native three vessel disease, and new in-stent restenosis of proximal svg-d1 and distal stenosis of svg-d1 s/ 2 to svg-d1. . # coronary disease - ekg changes consistent with inferior stemi found to have 70% distal left main stenosis, native three vessel disease, and new in-stent restenosis of proximal svg-d1 and distal stenosis of svg-d1 s/ 2 to svg-d1. recent discontinuation of plavix would suggest possibility of in-stent thrombosis however no thrombus was seen on cardiac cath. patient had 2 placed to the prox and distal svg. inferior changes were thought to be secondary to lad territory providing collaterals to inferior aspect of heart. he was started on plavix 75mg for one week that would then decrease to once a day. he was continued on his aspirin 325mg once a day. atenolol was switched to metoprolol and he was started on lisinopril. he had follow up with his outpatient cardiologist scheduled. in the near future, he will likely need repeat 2d echo and stress test to determine whether he is symptomatic following intervention. . # hypothyroidism - continue thyroid . # hyperlipidemia - increase lipitor to 80 mg daily . # hypertension - continue beta-blockade, ace inhibitor medications on admission: - atenolol 25 mg daily - plavix 75 mg daily - finasteride 5 mg daily - levothyroxine 88 mcg daily - nitro 0.4 sl prn chest pain - simvastatin 40 mg daily - aspirin 325 mg daily - multivitamin daily discharge medications: 1. atenolol 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 2. clopidogrel 75 mg tablet sig: one (1) tablet po bid (2 times a day): continue plavix twice a day up through , then switch to 75 mg once a day on . disp:*9 tablet(s)* refills:*0* 3. clopidogrel 75 mg tablet sig: one (1) tablet po once a day: start on . disp:*30 tablet(s)* refills:*0* 4. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 5. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn as needed for pain. 6. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: (1) coronary artery disease (2) hypertension (3) hyperlipidemia discharge condition: stable for home, chest pain free, oxygenating normally on room air. discharge instructions: dear mr , you were admitted to the hospital for chest pain that was the result of a small heart attack. we found that you had two blockages that we could intervene on that were likely responsible for your symptoms. we placed two "drug-eluting stents" to help resolve these blockages. you were chest-pain free following stent placement. in the near future, your cardiologist may recommend a stress test to determine whether any further treatment is required. he may also perform an echocardiogram to determine whether your heart attack resulted in any significant heart damage. . we made the following adjustments in your medications while you were in the hospital. (1) increased your atenolol from 25 mg daily to 50 mg daily. (2) restarted your plavix: you should take 75 mg twice a day up through and then switch to 75 mg daily starting . (3) stop taking your simvastatin. instead, you should take lipitor 80 mg daily. (4) increase aspirin to 325 mg daily. (5) increase lisinopril to 10 mg daily. followup instructions: please follow up with your cardiologist , m.d. phone: and your primary care doctor pcp: , . within 1 week of discharge. they may continue to adjust some of your medications. md, procedure: injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery unspecified acquired hypothyroidism gout, unspecified personal history of malignant neoplasm of prostate other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia acute myocardial infarction of other inferior wall, initial episode of care other complications due to other cardiac device, implant, and graft 

Answer: The patient is high likely exposed to