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: cabgx4(lima->lad, svg->om1, diag, pda) history of present illness: mr. is a 49 year old male with multiple cardiac risk factors. he recently experienced radiating chest pain and shortness of breath. he subsequently stress testing which showed 0.5mm inferolateral st depression at peak exercise. nuclear imaging revealed a very small mild perfusion defect at the inferior base. his lvef was estimated at 64%. cardiac catheterization on showed severe three vessel disease and normal lv function. angiography showed an 80% mid lad stenosis, proximal 80% lesion in the circumflex, and a chronically occluded right coronary artery. lv gram showed no mitral regurgitation and an lvef of 60%. based on the above results, he was referred for surgical revascularization. past medical history: coronary artery disease, hypertension, insulin dependent diabetes mellitus, hypercholesterolemia, neuropathy, obesity, chronic back pain, anxiety, s/p toe amputation, s/p shoulder surgery, s/p vasectomy social history: 25 pack year history of tobacco, quit approximately 1 year ago. denies excessive etoh. currently married, lives with wife. as a sales associate. family history: mother and father cabg in their 50's physical exam: vitals: bp 123/50, hr 55, rr 12, sat 97% on room air general: obese male in no acute distress heent: oropharynx benign, perrl, eomi neck: supple, no jvd, no carotid bruits heart: regular rate, normal s1s2, no murmur or rub lungs: clear bilaterally abdomen: soft, nontender, normoactive bowel sounds ext: warm, 2+ pitting edema pulses: 1+ distally neuro: nonfocal, alert and oriented pertinent results: final report history: followup cabg. sob. pa and lateral chest (three images): the heart is borderline enlarged with previous sternotomy and cabg. no vascular congestion. there is elevation of the left hemidiaphragm with associated basal atelectasis and probable pleural disease. i doubt the presence of consolidation in the obscured left lower lobe and remainder lungs clear. moderately dilated stomach containing both gas and fluid. overall appearance is unchanged from exam one day previous. impression: no short interval change. no chf and i doubt the presence of pneumonia. dr. m. approved: wed 7:00 pm procedure date: final report indication: 49-year-old man with nausea and vomiting status post cabg times four. evaluate for ileus. supine abdominal radiograph: air is seen in nondilated loops of small and large bowel. there is no evidence of obstruction. degenerative changes are seen in the lower lumbar spine with prominent osteophytes seen off the l4 and l5 vertebral bodies. impression: 1. nonobstructive bowel gas pattern. the study and the report were reviewed by the staff radiologist. dr. dr. n. approved: 9:48 pm procedure date: 07:00am blood wbc-9.0 rbc-2.70* hgb-8.7* hct-25.4* mcv-94 mch-32.0 mchc-34.1 rdw-14.1 plt ct-364# 07:00am blood plt ct-364# 07:00am blood creat-0.9 k-3.9 09:10am blood alt-38 ast-24 ld(ldh)-296* alkphos-65 amylase-16 totbili-0.5 09:10am blood lipase-15 09:10am blood albumin-3.2* echocardiography report , (complete) done at 12:17:11 pm final referring physician information , r. division of cardiothoracic , status: inpatient dob: age (years): 49 m hgt (in): 78 bp (mm hg): / wgt (lb): 300 hr (bpm): bsa (m2): 2.68 m2 indication: intra-operative tee for cabg icd-9 codes: 745.5, 440.0, 424.1, 424.0 test information date/time: at 12:17 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2006aw03-: machine: echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.3 cm <= 4.0 cm left atrium - four chamber length: *5.7 cm <= 5.2 cm right atrium - four chamber length: *5.3 cm <= 5.0 cm left ventricle - ejection fraction: 55% >= 55% aorta - valve level: 2.2 cm <= 3.6 cm aorta - ascending: 3.3 cm <= 3.4 cm aorta - arch: 1.8 cm <= 3.0 cm aorta - descending thoracic: 2.2 cm <= 2.5 cm aortic valve - peak velocity: 1.5 m/sec <= 2.0 m/sec aortic valve - peak gradient: 9 mm hg < 20 mm hg aortic valve - mean gradient: 4 mm hg aortic valve - lvot pk vel: 0.90 m/sec aortic valve - lvot vti: 22 aortic valve - lvot diam: 2.1 cm findings left atrium: moderate la enlargement. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: mildly dilated ra. pfo is present. left-to-right shunt across the interatrial septum at rest. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. normal ascending aorta diameter. normal aortic arch diameter. focal calcifications in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. no as. trace ar. mitral valve: no ms. mild (1+) mr. tricuspid valve: mild tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-bypass: 1. the left atrium is moderately dilated. a patent foramen ovale is present. a left-to-right shunt across the interatrial septum is seen at rest. 2. a vascular structure is noted close to the interatrial septum, measuring 0.7cm in diameter with a low velocity, biphasic flow pattern. bubble study was negative for flow at rest across the interatrial septum or the vascular structure. no step up in o2 saturation noted. dr. notified of this finding. 3. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 4. right ventricular chamber size and free wall motion are normal. 5. there are focal calcifications in the aortic arch. there are simple atheroma in the descending thoracic aorta. 6. there are three aortic valve leaflets. there is no aortic valve stenosis. trace aortic regurgitation is seen. 7. mild (1+) mitral regurgitation is seen. 8. mild tricuspid regurgitation. 8. there is no pericardial effusion. post-bypass: pt is being atrially paced and is receiving an infusion of phenylephrine 1. biventricular systolic function is preserved 2. aorta is intact post decannulation 3. other findings are unchanged i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician ?????? caregroup is. all rights reserved. brief hospital course: on the day of admission, mr. coronary artery bypass grafting by dr. . the operation was uncomplicated and he transferred to the csru in stable condition. for further surgical details, please see separate dictated operative note. within 24 hours of arrival to the csru, patient awoke neurologically intact and was extubated. he maintained good hemodynamics and remained in a normal sinus rhythm. beta blockade was slowly resumed and advanced as tolerated. he was initially maintained on insulin drip for poor glycemic control. on postoperative day three, he transferred to the sdu. he remained fluid overloaded and continued to require diuresis. over several days, he continued to make clinical improvements and made steady progress with physical therapy. he remained in a normal sinus rhythm. abd. film done for nausea was negative.the rest of his postoperative course was uncomplicated and he was medically cleared for discharge to home with vna on postoperative day six. at discharge, his bp was 135/68 with a hr of 92. his chest x-ray showed small biteral pleural effusions and his room air saturations were 95%. pt. is to make all follow-up appts. as per discharge instructions. medications on admission: metformin 1000 , lantus 21 units qpm, avandia 8 qd, moexipril 15 qd, glipizide er 10 qd, norvasc 5 qd, neurontin 300 , lipitor 10 qd, atenolol 25 qd, plavix 75 qd, aspirin 81 qd, risperdal prn, oxycodone prn, nitro prn discharge medications: 1. aspirin 81 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:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. rosiglitazone 8 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 5. glipizide 10 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po daily (daily). disp:*30 tab,sust rel osmotic push 24hr(s)* refills:*2* 6. hydromorphone 2 mg tablet sig: one (1) tablet po every hours as needed for pain. disp:*50 tablet(s)* refills:*0* 7. metoprolol tartrate 50 mg tablet sig: two (2) tablet po three times a day. disp:*180 tablet(s)* refills:*2* 8. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. ferrous gluconate 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days: take with kcl. disp:*14 tablet(s)* refills:*0* 11. potassium chloride 10 meq capsule, sustained release sig: one (1) capsule, sustained release po twice a day for 7 days: take with lasix. disp:*14 capsule, sustained release(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: coronary artery disease - s/p cabg htn iddm hyperlipidemia postop anemia anxiety chronic back pain obesity discharge condition: good. discharge instructions: follow medications on discharge instructions. do not drive for 4 weeks. do not lift more than 10 lbs. for 2 months. shower daily, let water flow over wounds, pat dry with a towel. call our office for sternal drainage, temp>101.5 followup instructions: make an appointment with dr. in weeks. make an appointment with dr. in weeks. make an appointment with dr. in weeks. procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery intermediate coronary syndrome unspecified essential hypertension diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other and unspecified hyperlipidemia morbid obesity 

Answer: The patient is high likely exposed to