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: chest pain major surgical or invasive procedure: coronary catheterization - stents x 2 to graft to om2 and lad. history of present illness: 72 yo m h/o 3vd s/p cabg in (cath in with chronically occluded svg to om1), htn, hyperlipidemia, copd, dm (diet controlled), and cri presents as tx from for cp. the cp began mon morning () while the pt was in bed. he describes one week of angina with increasing frequency that responded to nitro 1-2 tabs sl. the angina was generally associated with exertion, though some episodes occurred while the patient was in bed. he called emt's on monday because the pain did not respond to nitro sl x 3. at he was found to have ekg with st depression in inferior and anterior leads and a trop i of 0.47 (0.04 uln). he had an episode of cp at osh that resolved with sl nitro x 1. he was tx'd to for coronary cath on . on the morning of he went to cath and was stented in his graft to om2 and his lad distal to the lima touch down with good restoration of flow. (svg to om1 remained occluded.) ekg changes were resolving but not gone. after catheterization, when the sheath was pulled, the pt had a vagal episode that did not resolve with atropine promptly. he was started on dopa for pressure and was taken back to the cath lab as he developed substernal cp in the face of ekg changes re-emerging. in the cath lab he was noted to have patent stents. no further intervention was done. . the patient had a creat of 2.0 from osh - he received 180cc contrast in first cath and 30cc in second cath. past medical history: pmh: - cad s/p cabg after mi in with lima to lad, svg to om1 and svg to om2 - cath found om1 graft to be occluded and not amenable to pci. - hyperlipidemia - copd: asthma - dm, diet controlled (pt denies) - obesity - aflutter - cri (baseline creat 2.0) - bilateral cataract surgery ..... psh: - cabg () - colon surgery (?resection). no malignancy per pt - done at ). - appy ..... allergies: nkda social history: shx: machinist - retired. 50 pck yr hx smoking quit in after mi and cabg. etoh only very occasionally. ambulates independantly, uses a cane prn. lives in with wife, , and son, . ...... fhx: father died of mi age 71, 2 sisters have "heart problems." physical exam: gen: nad, in bed comfortable. vs: 113/58, 80, af. head: eomi, ncat neck: no bruits, thick neck, poorly visualized jvd, supple. lungs: crackles bilaterally laterally. heart: rrr, s1 and s2 present, ii/vi sem at usb abd: soft, ntnd +bs, no hsm groin: r groin with gauze in place, small ooze, no bruit, no hematoma. l groin with gauze (s/p angioseal) with some oozing, no bruit, no hematoma. extr: pulses dopplerable bilat at dp and pt. toes cool bilaterally, legs and feet warm. no skin color changes. pertinent results: day of admission: 05:24pm blood wbc-14.7*# rbc-4.28* hgb-13.1* hct-36.5* mcv-85 mch-30.7 mchc-36.0*# rdw-13.8 plt ct-256 08:30am blood inr(pt)-1.2 05:24pm blood pt-12.8 ptt-25.2 inr(pt)-1.1 05:24pm blood glucose-135* urean-30* creat-1.7* na-136 k-3.7 cl-96 hco3-30 angap-14 05:24pm blood calcium-8.5 phos-3.8 mg-1.9 04:10am blood %hba1c-6.2* -done -done . cardiac enzymes: 05:24pm blood ck(cpk)-50 10:50pm blood ck(cpk)-80 04:10am blood ck(cpk)-65 05:24pm blood ck-mb-notdone ctropnt-0.45* 10:50pm blood ck-mb-notdone ctropnt-0.54* 04:10am blood ck-mb-notdone ctropnt-0.63* . day of discharge: 07:05am blood wbc-10.0 rbc-3.53* hgb-10.7* hct-30.2* mcv-86 mch-30.4 mchc-35.5* rdw-13.9 plt ct-206 07:05am blood glucose-119* urean-33* creat-1.9* na-139 k-3.8 cl-98 hco3-33* angap-12 . . ekg: - pre-cath: sinus bradycardia. inferolateral t wave inversions with st segment depression consistent with an acute ischemic process. compared to the previous tracing of no definite change. cardiac cath #1: comments: 1. selective coronary angiography revealed a right dominant system with three vessel native cad, a patent lima, a chronically occluded svg to om1 and a stenotic svg to om2. the lmca had diffuse mild disease. the lad had a subtotal ostial occlusion and was totally occluded after the first septal branch. the distal vessel filled by a patent lima but there was an 80% native lad lesion after the touchdown of the lima. there was a very distal 80% apical lesion. the lcx had severe diffuse disease throughout its length and in its branches. it was occluded after the om2. the distal vessel filled via left to left and right to left collaterals. the svg to om1 was known to be occluded. the svg to om2 had a distal 90% lesion within the svg. the native lad and this svg were stented (see below). 2. limited hemodynamics revealed normal central aortic blood pressures. 3. left ventriculography was not performed. final diagnosis: 1. three vessel coronary artery disease. 2. patent lima to lad. 3. occluded svg to om1 4. 90% stenosis of svg to om2. . . cardiac cath #2: stents patent . . ekg - post-cath: sinus bradycardia. first degree atrio-ventricular conduction delay. p-r interval 0.24. lateral t wave inversion with st segment depression. compared to the previous tracing of repolarization abnormalities are somewhat less prominent. . . echocardiogram (post-cath): conclusions: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. 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. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: preserved global biventricular systolic function.. mild mitral regurgitation. brief hospital course: # cardiac: 72 yo m with known cad, s/p nstemi/ +troponin. admitted for cath from osh. during cath, had 2 vessel intervention (lad and graft to om2). afterward, during sheath pull, developed severe and symptomatic hypotension and chest pain. pt was taken for re-look procedure. the stents were found to be patent. overnight had dopamine weaned and bp remained low normal. the patient was initially very confused but gradually became more oriented overnight. hct was stable. the next day, metoprolol was started at low dose for cardioprotection and the pat tolerated this well. the patient was known to have extensive 3vd, so was followed with daily ekg that showed resolution of small ischemic area. echo showed a preserved ef, small focal wma, and no effusion. ce's trended down (ck) while troponins increased. the patient diuresed well after the volume load in the cath lab and was euvolemic at discharge. the patient has a history in his chart of a flutter and had an episode of narrow complex tachycardia at this hospitalization that probably represented at. this never recurred. the patient was treated for diastolic heart failure with intermittent diuresis diet control, wt and bp monitoring. . # hypotension: the pt was hypotensive after catheterization and was on dopamine for pressor for 12 hours. thereafter pressures were low stable. metoprolol was started at a low dose and titrated up as bp tolerated. the patient was changed back to atenolol on discharge at a lower dose than on admission. his bp was to be checked regularly so that his atenolol could be titrated up as an outpatient. imdur was also restarted as an op. diltiazem was held and the pt was instructed to f/u with pmd to restart this medication and titrate other bp meds as his bp returned to his previous state of controlled hypertension. . # ? cholesterol emboli - on the day after cath, the pt was thought to have had mottled toes that were cool. interventional cards was called and suggested a vascular consult. vascular recommended no treatment for this symptom. by two days post-cath, there was no further evidence of emboli nor tissue damage. . # pvd - vascular suggested at w/u for pvd given the pt's history of claudication. le dopplers showed abi > 1 but some slowed flow to lle. the pt was instructed to f/u with vascular surgery to follow his symptoms and abi's. . # cri: the patient is noted to have a baseline creat in 2.0. was 1.8 at osh. likely etiology was dm and htn. - bicarb infusion per protocol was given prior to cath, but held post-cath as pt was volume overloaded. - observed creat/bun for 72 hours. dye load was relatively large given 2 caths (210cc). no acute contrast nephropathy developed. there was no evidence of cholesterol emboli to the kidneys. . # gout: the patient developed l mtp joint tenderness two days after catheterization. he has a history of gout but did not recall being treated for this. he was treated with colchicine for the acute flair. he would likely benefit from long-term allopurinol therapy, as his serum uric acid was elevated to over 10 and he has had repeated episodes. . # leukocytosis: pt had an elevated wbc in setting of cath x 2 on day of admission. this was thought to be due to demargination from stress, however, to be sure of this diagnosis she was given a ua and ucx, which were negative for infection. bcx and cxr were also negative for infection.. . # ms changes - the pt arrived in the ccu after cath with ms changes - trying to get out of bed, generally disoriented. these symptoms improved with time, and were likely were due to atropine. . # hyperlipidemia - continued lipitor at home dose. . # copd - continued advair and albuterol at home doses. . # dm - hba1c was <7. pt was placed on ssi but sugars were well controlled. . # ppx: the patient was maintained on sq heparin throughout the hospitalization. medications on admission: home meds: asa 325 mg po daily atenolol 100 mg po qd lipitor 80 mg po daily hctz 25 mg po daily imdur 60 mg po daily diltiazem cd 120 mg po daily bumex 1 mg po daily advair 100/50 albuterol 2 puffs flovent 220 mcg colace 100 mg po bid -------- meds on tx: mucomyst started at osh heparin gtt started at osh integrilin gtt at osh discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): to prevent stent closure. disp:*90 tablet(s)* refills:*4* 2. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual q5min () as needed for chest pain: take one tablet under tongue for chest pain. wait 5 minutes and repeat as needed. take a total of 3 tablets and if pain does not resolve, seek medical attention. disp:*20 tablet, sublingual(s)* refills:*0* 3. atenolol 50 mg tablet sig: one (1) tablet po once a day: for blood pressure. . disp:*30 tablet(s)* refills:*0* 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. imdur 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 6. atorvastatin 80 mg tablet sig: one (1) tablet po once a day: to reduce cholesterol. 7. bumex 1 mg tablet sig: one (1) tablet po once a day: to prevent water retention. 8. albuterol 90 mcg/actuation aerosol sig: puff inhalation once a day as needed for shortness of breath or wheezing. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. colchicine 0.6 mg tablet sig: one (1) tablet po q2h (every 2 hours) as needed for gout: in case of gout pain - take one tablet every 2 hours until the pain resolves or you develop diarrhea. do not take more than 7 doses. disp:*7 tablet(s)* refills:*0* 11. flovent 220 mcg/actuation aerosol sig: one (1) spray inhalation once a day. discharge disposition: home with service facility: greater vna discharge diagnosis: nstemi s/p 2 stents htn hypercholesterolemia pvd gout ckd copd discharge condition: good - free of chest pain. discharge instructions: you were admitted with chest pain and taken to the coronary cath lab. you received 2 stents. afterward, you had more chest pain and returned to the cath lab where it was found that the stents were in place. you are being discharged and will have a nurse come to your home to help you with your medications and to monitor your blood pressure and pulse. you should follow up with your primary care doctor, dr. within 2-3 weeks. you can call him to make an appointment by calling: . you should follow up with your cardiologist, dr. , within 4 weeks. you can schedule an appointment at . you should follow up with vascular surgery for an appointment to evaluate your leg pain. the circulation to your legs is somewhat impaired and the vascular surgeon will assess your blood flow to determine what the best therapy will be to reduce your pain. you have an appointment with dr. on at 4:15pm. you can call if you need to change your appointment: (. followup instructions: dr. within 2-3 weeks. -pt's atenolol dose was decreased and diltiazem has been held as he was hypotensive in the hospital. these medications should be adjusted based on bp readings as an outpatient. he was previously on 100mg atenolol and 120mg diltiazem. pt may benefit from allopurinol therapy as an outpatient. dr. within 4 weeks. dr. - , 4:15pm procedure: coronary arteriography using two catheters coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization left heart cardiac catheterization 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 two vessels diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of autologous vein bypass graft atherosclerosis of native arteries of the extremities with intermittent claudication gout, unspecified chronic kidney disease, unspecified peripheral vascular complications, not elsewhere classified old myocardial infarction chronic obstructive asthma, unspecified syncope and collapse tachycardia, unspecified 

Answer: The patient is high likely exposed to