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: amoxicillin / hydrochlorothiazide attending: chief complaint: chest pain major surgical or invasive procedure: -cardiac catheterization with stenting of ramus history of present illness: 72m h/o cad s/p cabg (/redo ), chf (ef<20) s/p biv/icd , af, dm2 s/p stent to ramus & lima anastomosis now presents with hypotension and nstemi, transfer from cath lab. he presented on with ongoing chest pressure for a week, chest pressure radiating down his r arm and to his neck, non-pleuritic, associated with nausea while working as an at park. in the ed, patient ruled in for nstemi and cardiology was consulted. ck 273-218, mb 48-24 trop 1.48. ecg was v-paced rhythm uninterpretable for ischemia. he had ongoing pain. bp was mostly 80's systolic. he was taken for cath on and found to have isr of ri stent, treated with taxus. transiently required dopa during cath for maps dropping into high 40s-50s. transferred to ccu for further monitoring. past medical history: cad (cabg and ); ptca of ramus takeoff and lima anastamosis in chf w/ ef 20%, diastolic dysfxn, s/p biv pacer and icd placement atrial fibrillation (s/p ablation) dm (hba1c = 7.2) ckd gerd pud gout claudication s/p ccy s/p cataract s/p back surgery r common iliac artery stenosis, s/p stent social history: pt is a retired electrial engineer for . currently works as at . lives w/ wife, daughter and granddaughter in . quit tobacco >15 years ago; 50 pk-yr history. social etoh (2 drinks/week), no illicits. wife is hcp. daughter was cardiac nurse. family history: noncontributory. physical exam: vs: t: 97.2 p: 76 r: 18 bp: 90/47 sao2: 98% ra weight: 82.3 (s) gen: lying in bed, nad heent: at, nc, perrla, eomi, anicteric, op clear, mmm cv: rrr, nl s1, s2, no m/r/g, no carotid bruits appreciated pulm: diffuse scattered crackles, otherwise clear abd: soft, nt, nd, + bs, no hsm ext: warm, dry, +2 pitting edema to knees bl, l > r (which is usual for him) +1 distal pulses bl skin: open shallow skin tear over l shin neuro: alert & oriented x 3, cn ii-xii grossly intact; no abnormal movements noted. pertinent results: 10:15pm wbc-8.7 hct-29.6 plt ct-119 05:25am wbc-8.3 hct-25.7 plt ct-110 11:41pm hct-29.7 plt ct-95 06:02am wbc-9.2 hct-26.9 plt ct-89 02:35pm hct-28.7 . 10:15pm pt-13.8 ptt-30.4 inr(pt)-1.2 . 10:15pm ck-273 ck-mb-30 mb indx-11.0 ctropnt-1.43 probnp- 05:25am ck-218 ck-mb-24 mb indx-11.0 ctropnt-1.48 04:19pm ck-210 ck-mb-28 mb indx-13.3 03:48am ck-231 ck-mb-20 mb indx-8.7 03:49pm ck-137 ck-mb-9 . 06:02am caltibc-324 ferritn-144 trf-249 . cardiac catheterization: selective coronary angiography of this right dominant system demonstrated a known three vessel coronary disease. the lmca had a 90% in-stent restenosis of the left main-ramus bifrucation. the lad had a known proximal occlusion. distal lad filled via lima graft. the lcx had a known total occlusion. the rca had a known occlusion and was not injected (distal rca filled via svg). arterial conduit angiography revealed that the lima to lad had a less than 50% instent restenosis that was not flow limiting. the svg to distal rca was widely patent. resting hemodynamics revealed elevated right and left sided filling pressured with rvedp of 19 mmhg and a pcwp of 25 mm hg. there was a moderate pulmonary artery systolic hypertension with a pasp of 51 mm hg. the cardiac index was preserved at 2.5 l/min/m2. there was a significant arterial hypotension with a central aortic pressure of 74/41 mm hg necessitating initiation of dopamine infusion. left ventriculography was deferred give patients declining renal function. of note, arterial and venous access was obtained via left groin given dimished right femoral pulse and a history of right iliac stent placement. successful ptca and stenting of the ramus intermedius and left main bifurcation with a 3.5x8 mm taxus stent. final angiography revealed minimal residual stenosis, no angiographically apparent dissection, and timi 3 flow in the vessel. brief hospital course: a/p: 72m h/o cad s/p cabg (/redo ), chf (ef<20) s/p biv/icd , af, dm2 s/p stent to ramus & lima anastomosis now presents with hypotension/nstemi. had in-stent restenosis of ramus, which was re-stented with des. . ## cardiac: - ischemia: pt had nstemi, underwent cardiac cath which revealed lmca with a 90% in-stent restenosis of the left main-ramus bifrucation. this area was stented. there were other stenotic areas (see report) that were not stented as they were not felt to be culprit lesions. the pt was treated with asa 325, clopidogrel 75, atorvastatin 20 po qd. his carvedilol was resumed after his bp improved. post-procedure the pt was hypotensive and required pressors; however, he was weaned off of these & was eventually re-started on 3.125 of carvedilol. - pump/hypotension: pt has history of severe cardiomyopathy/chf with an ef <20%. right heart cath revealed elevated right and left sided filling pressured with rvedp of 19 mmhg and a pcwp of 25 mm hg. there was a moderate pulmonary artery systolic hypertension with a pasp of 51 mm hg. the cardiac index was preserved at 2.5 l/min/m2. there was a significant arterial hypotension with a central aortic pressure of 74/41 mm hg necessitating initiation of dopamine infusion. the pt required dopamine off and on during his stay; however, with aggressive diuresis he was able to be weaned off it completely. the pt was significantly volume overloaded upon arrival and post-cath. though he tolerated resumption of carvedilol, his ace inhibitor was held during the hospitalization. his sbps ranged from 90's-100's near time of discharge. - rhythm: the pt was in biventricular paced rhythm. his coumadin was initially held because he was anemic & had dark, guiac (+) stools. after stabilization of his hct, coumadin was restarted at 2.5 qod and 5mg qod. . ## anemia/bleed: pt has h/o gi bleeding & was found to guaiac positive stool during admission. gi was consulted & deferred endoscopy until the pt was stabilized and an outpt. pt also had multiple nosebleeds during hospitalization. ent was consulted: they felt that there was no serious underlying pathology. they recommend affrin. these eventually resolved. upon work-up of his anemia, pt was found to be iron deficient. he was started on po iron. he was also continued on his outpt epo dosing (for cri). during hospitalization, he required multiple transfusions, the last of which was given the day prior to discharge. the pt's hct responded appropriately to the transfusion & he was asymptomatic. . ## renal: arf on crf. pt's baseline thought to be approximately cr 1.9. however, his pcp reported that just prior to admission he had a crt of 3. upon admission, his crt was 3.5. it peaked at 3.9. he had low urine output & fena < 1%. renal was consulted and they felt that the arf was primarily due to chf--poor forward flow. hd was deferred and the pt was aggressively diuresed. with diuresis, his sbp improved (as did his uop), and the crt trended down to 2.3 on day of discharge. the pt did have hematuria after foley removal, which was thought to be secondary to trauma. this resolved over a few days. will follow closely for anuria given risk of clot. s-pep & u-pep were checked (upon renal's rec's) & were negative. . ## hyponatremia: likely cardiomyopathy and arf. the pt was free water restricted. ## thrombocytopenia: ? hit vs. liver dz. lfts normal except for slight elevation of ast on admission. it was thought that perhaps low count may be due to congestive hepatopathy with chf. pt did not have hit antibodies. . ## dm: the pt was maintained on riss. his glyburide was discontinued given his renal function. we began glypizide the day of discharge. . ## ppx: pt received heparin sc and protonix. ## code: full medications on admission: asa plavix coreg epogen lisinopril zocor glyburide coumadin mg ox lasix (120 po bid) nexium zaroxylyn digoxin discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 4. epoetin alfa 4,000 unit/ml solution sig: two (2) ml injection qmowefr (monday -wednesday-friday). 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days. disp:*3 tablet(s)* refills:*0* 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. warfarin 5 mg tablet sig: 0.5 alternating with 1 tablet po hs (at bedtime): please 2.5mg take every other day, alternating with 5mg. 8. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day): you use your old tablets that are 6.25 mg, but be sure to split them in half!. 9. furosemide 40 mg tablet sig: three (3) tablet po bid (2 times a day). 10. glipizide 5 mg tablet sig: 0.5 in am 1 in pm tablet po bid (2 times a day): please take 2.5mg in am and 5mg in pm. disp:*45 tablet(s)* refills:*2* 11. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 12. nexium 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: home discharge diagnosis: primary: -non-st-segment elevation myocardial infarction -severe cardiomyopathy/congestive heart failure -iron deficiency anemia w/ gi bleed -acute on chronic renal failure -urinary tract infection -atrial fibrillation secondary: -thrombocytopenia -diabetes mellitus -gastroesophageal reflux discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1 liter. -please stop taking your magnesium supplement as your magnesium level was elevated on admission. -please continue taking the anti-biotic ciprofloxacin for 3 more days (last day ) for a urinary tract infection. -please take the iron pills prescribed for your iron deficiency anemia. -please take your coumadin as prescribed and have your inr checked on monday w/ your . -please take your new medication glipizide (for your diabetes). this will replace your glyburide. do not take glyburide. -please call your doctor or go to the er if you note any chest pain, shortness of breath, nausea/vomiting, blood in your stool, or any other change in your health. -continue your aspirin & plavix as prescribed. do not stop these unless dr. instructs you to do so. followup instructions: -please call dr. office # by monday to make an appointment with him within 1-2 weeks after discharge from the hospital. -please make an appointment with your primary care doctor, , within 2 weeks of discharge from the hospital. -please attend the following appointments: -provider: , o.d. phone: date/time: 10:30 -provider: clinic phone: date/time: 10:00 -provider: , : date/time: 10:30 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of right heart structures transfusion of packed cells insertion of drug-eluting coronary artery stent(s) infusion of vasopressor agent cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia atherosclerosis of native arteries of the extremities with intermittent claudication gout, unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease long-term (current) use of anticoagulants other complications due to other cardiac device, implant, and graft automatic implantable cardiac defibrillator in situ hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to