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 pressure major surgical or invasive procedure: cardiac catheterization with bare metal stents x7 (3 bms to om, 2 bms to lad and 2 bms to lcx) history of present illness: ms. is a 85yo female with history of htn, hypothyroidism, and gerd, who presents from osh with history of worsening chest pressure, with concern for acs, sent to for cardiac cath. pt states that for the past year, she has had shortness of breath and chest pressure with ambulation. she describes the chest pressure as central, substernal, non-radiating pressure, relieved by rest. she was at her ophthalmologist's office this monday, and was noted to have a high blood pressure. she then spoke with the her pcp regarding her high bp and sob, and he recommended she come to the this morning, so he could evaluate her. she said that for at least the last few weeks to months, her chest pressure has remained the same: associated with exertion, walking or doing household chores. in fact, she walked on the treadmill for 3 mins yesterday, and had to stop because of chest pressure , that was relieved after 5 minutes of rest. she has had occasional nausea, but denied vomiting, diaphoresis, presyncope, syncope, palpitations with this. she has only had one episode of rest pain, which occurred nights ago, while she was sitting on her couch watching a movie. the pressure lasted for 5mins and went away completely. today, at the osh ed, her initial vs were 202/73, 57, 14, 100% 2lnc. her bp went up to 232/86. at osh, pt was found to have st depressions ii, iii, avf, v4-v6, and st elevations in avr, v1, v2. trop i 0.23 with normal cr. cxr at osh read as no acute process. she was started on asa 325mg, nitro patch, plavix load 600mg, atorvastatin 80mg x1, and lovenox at osh. presented to for cardiac cath. . during her cardiac catheterization, she was found to have xxx stenosis of lcx, and had initially xxx stents to xxxx. however, she continued to have chest pain, and repeat ecg's showed st depressions in ii, iii, avf, with ii>iii, and depressions in v4-v6, with ste in avr, and v1-v3. pt then had xxx stents to lad and lcx. subsequently, she was chest pain free and repeat ecg showed resolution of st depressions in ii, iii, avf, and lessened depressions in v4-v6, with mild continued elevation in avr. she required nitro gtt for bp control, but was otherwise hemodynamically stable and chest pain free on transfer to the ccu for monitoring. . on presentation to the ccu, her vs were temp 96.9, bp 120/91, hr 80, rr 19, 96% on 2lnc. she was completely chest pain free and without complaints. . on review of systems, she reports occasional gerd and anxiety. but otherwise, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: - diabetes, - dyslipidemia, + hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: as below -pacing/icd: none 3. other past medical history: hypothyroidism htn tah for fibroids gerd social history: she lives at home by herself and performs all of her adl's. she has a friend near by (), and is close with her daughter , who accompanies her here today. -tobacco history: quit 56yrs ago -etoh: very rarely, a few drinks per year -illicit drugs: denies family history: brother with cabg at 68yo, mother with history of angina. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical: vs: 96.9 80 120/91 19 96% 2lnc general: wdwn pleasant, elderly female 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 jvp non-elevated cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no murmurs, no s3 or s4 lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab anteriorly, without appreciated crackles or wheezes though limited given pt lying down abdomen: +bs, soft, ntnd. no hsm or tenderness. no abdominal bruits. extremities: no edema, dressing in place on left groin without bleeding or evidence of hematoma. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: alert and oriented, cn ii-xii intact, intact to light sensation throughout . discharge physical: temp max: 98.4 temp current: 97.7 hr: 55-60 rr: 16-18 bp: 106-202/52-74 o2 sat: 99% ra gen: alert, anxious, walking around room heent: supple, no jvd cv: rrr, +s1 s2, no m/r/g resp: ctab without wheezes or crackles abd: +bs, soft, nt/nd extr: no peripheral edema, 2+ dp pulses bilaterally; right groin with ecchymoses, but without bruit neuro: alert, oriented, no halluciations skin: ecchymoses on right groin and abdomen access: piv tubes: none pertinent results: admission labs: hct 37 wbc 7.1 plt 269 na 134 k 4.3 cl 103 hco3 25 bun 14 cr 0.8 . discharge labs: hct 37.5 wbc 8.4 plt 269 na 143 k 3.9 cl 108 hco3 23 bun 17 cr 0.8 . pertinent labs: ce's: 9pm: ck-mb 5 trop 0.11 4am: ck-mb 10 mbi 12.8 trop 0.12 2pm: ck-mb 15 mbi 10.8 trop 0.33 10pm:ck-mb 11 mbi 7.7 trop 0.40 a1c: 5.9 lipid panel: total 222 ldl 145 hdl 58 tg 93 . studies: cardiac cath : prelim comments: 1. selective coronary angiography in this right dominant system demonstrated two vessel disease. the lmca had a 30% ostial stenosis. the lad had a 70% proximal stenosis. the cx had a 90% long mid vessel stenosis as well as a distal 80% stenosis. the rca had a very posterior origin and was difficult to engage but had only minimal plaquing throughout. 2. limited resting hemodynamics revealed a central aortic pressure of 157/62 mmhg. there was elevated left sided filling pressures with an lvedp of 30 mmhg. 3. careful pullback of the catheter from the lv to the aorta revealed no transvalvular gradient. 4. successful stenting of the mid lcx with a minivision otw 2.0x23 mm bare-metal stent (bms) overlapped with a minivision otw 2.0x12 mm bms (distally). successful stenting of the lcx distal to new stents with two overlapping minivision otw 2.0x12 mm bare-metal stents. successful stenting of the distal lcx/om1 with a minivision 2.0x8 mm bms. final angiography revealed normal timi 3 flow, no angiographically apparent dissection and 0% residual stenosis in the new stents deployed. (see ptca comments) 5. successful stenting of the proximal-mid lad with two separated minivision otw 2.0x12 mm bare-metal stent (bms). final angiography revealed normal timi 3 flow, no angiographically apparent dissection and 0% residual stenosis in the new stents. (see ptc comments) 6. r 6fr femoral artery angioseal closure deviced deployed without complications. (see ptca comments) final diagnosis: 1. two vessel coronary artery disease. 2. moderate left ventricular diastolic dysfunction. 3. successful stenting of the prox-mid lad and mid-distal lcx/om1 with multiple bare-metal stents. (see ptca comments) 4. dynamic changes in the diameter of the ostium of the left main and catheter dampening consfor 18 hours post procedure 4. asa indefinitely; plavix (clopidogrel) 75 mg daily for at least one month for bare-metal stents (see ptca comments) 5. r 6fr femoral artery angioseal closure device deployed without complications (see ptca comments) . tte : prelim conclusions the left and right atria are normal in size. lefft ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. impression: nomal biventricular systolic function. . cxr : findings: the lung volumes are normal. borderline size of the cardiac silhouette without pulmonary edema. no pleural effusions. minimal bilateral symmetrical apical thickening. normal appearance of the hilar and mediastinal structures. . micro: ucx : urine culture (final ): no growth. brief hospital course: hospital course: ms. is a 85yo female with history of htn, hypothyroidism, and gerd, who presents from osh with history of worsening chest pain, concern for transferred to for cardiac cath, now s/p 7 bms to lcx and lad. pt is hemodynamically stable, and transferred to ccu for close monitoring. . active issues: . # coronaries: differential included acs vs. demand ischemia uncontrolled htn. pt's anginal symptoms seemed to be stable in nature rather than increasing or crescendo in nature to suggest unstable plaque. pt had been severely hypertensive with lvh findings suggested on ecg. pt went to cardiac cath with 2 stents initially to lcx; however, pain continued post-procedure, with concern for spasm of left main given elevations in avr. pt subsequently had 3 more stents placed to lcx and 2 to lad. cardiac enzymes were cycled and peaked post-procedure and down-trended. she was started on asa 325, plavix 75mg daily, atorvastatin 80mg daily, and integrilin for 18hrs. she was started on metoprolol for beta blockade. acei was initially held given large dye load and concern for contrast-induced nephropathy. this was restarted as below. tte demonstrated preserved biventricular systolic function. a1c was sent for risk factor stratification and was 5.9. lipid panel was sent and showed ldl of 145. she was continued on atorvstatin 80mg daily. pt consult was placed. she remained completely chest pain free. she was discharged to continue asa, plavix, atorvastatin, lisinopril and metoprolol succinate. . # pump: no history of heart failure. pt appeared euvolemic with elevation of jvp and clear lungs. cxr demonstrated no evidence of pulmonary edema. as above, tte demonstrated preserved systolic function. . # rhythm: initial ecg at osh and prior to cardiac cath demonstrated shortened pr interval, with question of possible junction rhythm. repeat ecg's demonstrated sinus rhythm. she was monitored on telemetry without events. . # htn: pt presented with hypertensive urgency with sbp to 230 at osh. on transfer, blood pressure improved from cath, on nitro gtt. she required titration of nitro gtt for control. we were able to wean off the nitro. as above, acei was initially held given large dye load and concern for development of contrast-induced nephropathy. she was started on metoprolol succinate 25mg daily. lisinopril dose was increased to 40mg daily. she was instructed to follow-up with her pcp for further bp management. . # large dye load: received 440cc of contrast. pt was started on ivf due to concern for contrast-induced nephropathy. cr and lytes were monitored and remained stable without cr bump. pt had dark urine on hospital day 2, with rbc's in urine attributed to foley placement, and negative ucx. urine output remained normal and discoloration resolved. cr remained normal. as above, acei was initially held and restarted prior to discharge. . # nausea/ha: likely nitro and relatively low bp, and nausea likely also gerd. resolved after bp better control. started on h2 blocker for gerd with improved. symptoms. . inactive issues: . # hypothyroidism: continue home regimen of levothyroxine 25mcg qod. . # gerd: pt had symptoms prior to admission. she was started ranitidine 150mg po bid, with improvement of her symptoms. . transitional care: 1. code: full 2. follow-up: pcp . 3. medical management: - started asa 325mg, plavix 75mg daily, atorvastatin 80mg daily, metoprolol xl 25mg daily; increased dose of lisinopril from 20mg daily to 40mg daily - pt instructed to have f/u labs to monitor cr/lytes on increased dose of acei with pcp; also to discuss further uptitration of bp meds as needed medications on admission: lisinopril 20mg daily levothyroxine 0.25mg every other day coenzyme q10 receives avastin shots every few weeks for macular degeneration discharge medications: 1. 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:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. levothyroxine 25 mcg tablet sig: one (1) tablet po every other day (every other day). 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*2* 7. coenzyme q10 oral 8. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual every 5 min for total of 2 doses: call 911 or dr. for any chest pain. disp:*25 tablets* refills:*0* 9. lisinopril 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: non st elevation myocardial infarction hypertension delerium discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you during this admission. you had a small heart attack and needed a cardiac catheterization. we found many blockages in your heart arteries and you received a total of 7 stents during the course of 2 catheterizations. an echocardiogram showed that your heart is functioning well. your blood pressure was high so we gave you some intravenous medicine to help lower it. you were confused overnight, perhaps from a sleeping pill called trazadone. do not take this medicine again. you received a large dose of dye during the catheterizations so we are concerned that your kidney function will worsen. so far, that has not happenend but we will need to follow your kidney function closely after you leave. you will follow up with dr. on monday. we made the following changes to your medicines: 1. start taking aspirin and plavix (clopidogrel) daily to keep all the stents open. this is extremely important to prevent another heart attack or even death if the stents suddenly closed. do not stop taking aspirin and plavix unless dr. tells you it is ok. 2.start using nitroglycerin if you have any chest pain or trouble breathing similar to the symptoms that preceded your hospitalization. you can take 2 nitroglycerin tablets under your tongue 5 minutes apart. please call 911 for any pain or severe trouble breathing. 3. start taking atorvastatin to lower your cholesterol 4. start taking metoprolol to lower your heart rate and blood pressure 5. start taking ranitidine to prevent stomach upset from the plavix and aspirin 6. we increased the dose of your lisinopril from 20mg daily to 40mg daily to help control your blood pressure. **again, it is very important to have your blood checked on monday with dr. to check for your kidney function and electrolytes now that we increased the lisinopril. you may also need additional blood pressure medication or increased doses. please discuss this with dr. . followup instructions: name: , t. location: internal medicine associates address: , , , phone: appointment: monday at 2pm procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] insertion of four or more vascular stents destruction of cranial and peripheral nerves procedure on three vessels diagnoses: hypocalcemia subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension unspecified acquired hypothyroidism anxiety state, unspecified drug-induced delirium acquired absence of both cervix and uterus barbiturates causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to