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: history of present illness: the patient is a 77 year old male with a history of coronary artery disease, status post coronary artery bypass graft in 05/98, left internal mammary artery-d1, saphenous vein graft to left circumflex, saphenous vein graft to right coronary artery, and bovine aortic valve replacement, noninsulin dependent diabetes mellitus, hyperlipidemia, peripheral vascular disease, who presents to an outside hospital complaining of three week history of substernal chest pain with minimal exertion, now increasing at minimal exertion or at rest, increasing in frequency and severity, requiring more frequent use of sublingual nitroglycerin as well as associated shortness of breath. he reported only intermittent stable angina since coronary artery bypass graft in , until now. just prior to presentation at outside hospital, he took four to five sublingual nitroglycerin without significant relief of the chest pain, and his wife drove him to the emergency department. he was found to have non st elevation myocardial infarction and was treated with aspirin, beta blocker, nitroglycerin, heparin, plavix, but no iib-iiia. apparently he then underwent a persantine mibi stress test showing fixed defect in the septum and inferior and posterior wall and moderately reduced left ventricular function. he was then transferred to for emergent cardiac catheterization. past medical history: 1. coronary artery disease, status post coronary artery bypass graft as above in , left internal mammary artery to d1, saphenous vein graft to left circumflex, saphenous vein graft to right coronary artery. 2. status post bovine aortic valve replacement in . 3. peripheral vascular disease. 4. benign prostatic hypertrophy, status post transurethral resection of prostate. 5. noninsulin dependent diabetes mellitus. 6. hyperlipidemia. 7. aortic stenosis/mitral regurgitation. allergies: no known drug allergies. medications on transfer: 1. zocor 40 mg once daily. 2. atenolol 25 mg once daily. 3. glyburide 5 mg once daily. 4. aspirin. 5. nitroglycerin sublingual p.r.n. 6. colace twice a day. social history: he had a remote history of tobacco. he quit actually twenty years ago. he admits to occasional alcohol. no intravenous drug abuse. he is a cartoonist. he lives with his wife. cardiac catheterization , right heart catheterization shows right atrial mean of 10, right ventricular pressure of 56/11, pulmonary artery pressure of 56/25, wedge mean 22. cardiac index is 2.7, svr is 1192, pvr 289. left heart catheterization shows three vessel disease and a right dominant system, proximal right coronary artery with 90% lesion, mid right coronary artery with diffuse disease. his left main has 100% lesion, proximal left anterior descending 100% lesion and his proximal circumflex has 100% lesion. meanwhile his saphenous vein graft one and two show 100% lesions. the patient subsequently underwent pci to his proximal right coronary artery lesion with two hepacoat stents. he was unable to undergo pci stent to mid right coronary artery lesion and underwent percutaneous transluminal coronary angioplasty with ultimately 30 to 40% residual stenosis. post pci for proximal right coronary artery revealed timi-3 flow. transthoracic echocardiogram on , showed ejection fraction of 10 to 15%, normal left atrium and right atrium, left ventricular wall thickness is normal with normal cavity size with severe global left ventricular hypokinesis. right ventricular cavity thickness and chamber size are within normal limits but right ventricle does show depressed systolic function. aortic valve prosthesis present without aortic insufficiency. severe 3+ mitral regurgitation. no pericardial effusion. hospital course: 1. cardiovascular - coronary artery disease - the patient transferred from outside hospital, status post non st elevation myocardial infarction. cardiac catheterization reveals native vessel disease with two out of three grafts down. he underwent intervention to his proximal and mid right coronary artery lesion with stenting of proximal right coronary artery and percutaneous transluminal coronary angioplasty of mid right coronary artery lesion with 30 to 40% residual stenosis. post cardiac catheterization in ccu, the patient underwent abbreviated course of integrilin secondary to episode of hemoptysis. he was continued on aspirin and plavix. he was also continued on his statin. he was also started on low dose beta blockade and ace inhibitor. these final two medications had to be adjusted slowly as the patient had marginal blood pressure and was felt to be in moderate to severe congestive heart failure during his hospital course. his cks trended until they peaked at 450, and the patient denied having chest pain during the remainder of his hospital course. pump function - transthoracic echocardiogram on hospital day three showed severely depressed left ventricular function with ejection fraction of 10 to 15% and with severe mitral regurgitation. his right heart catheterization also revealed elevated filling pressures although reasonably normal cardiac index. post cardiac catheterization and ccu, the patient initially underwent aggressive diuresis for his elevated filling pressures. he was negative approximately two to three liters in his first day. the patient subsequently became hypotensive with the addition of ace inhibitor and beta blockade. his urine output began to decrease and his cardiac index was decreased consistent with cardiogenic shock. subsequently, he briefly required dobutamine. the patient's pulmonary artery pressures and cardiac index were followed continuously and the patient did show improved cardiac function with the addition of low dose dobutamine, low dose ace inhibition and gentle diuresis. by hospital day four, his pulmonary artery diastolic pressures had decreased. his cardiac index had improved and the patient had pulmonary artery catheter subsequently discontinued. by this time, the patient was off dobutamine. he was continued on low dose ace inhibition, continued on lasix and also had digoxin added for additional inotropic support. during the remainder of the hospital course onto the floor, the patient was continued to be gently diuresed 500 to 1000cc per day. he will be discharged on lasix 20 mg once daily and will be reassessed in one to two weeks by his cardiologist, dr. . secondary to marginal blood pressure and concern about a possible posterior cerebrovascular accident, he had lower reserve for beta blockade and ace inhibition and he was discharged on coreg 1.56 mg twice a day and lisinopril 2.5 mg once daily for his congestive heart failure. he was also continued on digoxin throughout his course with his end dose being 125 mcg once daily. hemodynamics - as mentioned above, the patient had marginal blood pressure throughout his hospital course. he actually became hypotensive early in the hospital course in the setting of aggressive diuresis and combined beta blockade and ace inhibition and briefly requiring inotropic support with dobutamine for cardiogenic shock. his blood pressure did improve slightly during his hospital course. later in his hospital course, his marginal blood pressure prevented the team from aggressively titrating his beta blockade and ace inhibitor especially in the setting of a possible posterior circulation cerebrovascular accident. he did end up being discharged on beta blockade and ace inhibitor as above. rhythm - the patient was initially tachycardic early in his hospital course felt secondary to congestive heart failure. his electrocardiogram does show an intraventricular conduction delay. given his coronary artery disease and his severe congestive heart failure, the team had considered possibly having the patient evaluated for a biventricular pacer and icd. this further evaluation did not take place during his hospital course but may be initiated as an outpatient at the discretion of his cardiologist. 2. pulmonary - despite the patient's severe congestive heart failure and ultimate cardiogenic shock, the patient remained stable from respiratory standpoint. he was briefly mildly hypoxic requiring one to two liters of oxygen via nasal cannula. these oxygen requirements decreased with continued diuresis. 3. neurologic - later during his hospital course, the patient began complaining of visual disturbances and was found to have a left homonymous hemianopsia on examination. stroke team was consulted and magnetic resonance scan/mra of the head were obtained. mra showed acute right thalamus and right posterior corpus callosum and right occipital infarct. magnetic resonance scan revealed normal anterior circulation of , but posterior circulation was not seen. subsequent mra of the aortic arch and neck vessels demonstrates proximal occlusion bilaterally of the vertebral arteries and eventual retrograde filling on venous phasing of study. cerebral angiography was not obtained at this time. given his dilated vasculature, his decreased ejection fraction and his recent cerebrovascular accident, it was decided per neurology to begin anticoagulation for a goal inr between 2.0 and 3.0. he will be continued on aspirin and plavix and team was cautious with any further blood pressure control at this time. he was to follow-up with neurology clinic in two to three weeks time. 4. hematology - the patient did require two units of packed red blood cells earlier during his ccu course in the setting of his cardiac shock. his hematocrit subsequently remained stable during the remainder of his hospital course. as mentioned above, he was anticoagulated for his recent cerebrovascular accident and depressed ejection fraction. his goal inr is 2.0 to 3.0. he was discharged on coumadin 5 mg q.h.s. until , and then was instructed to decrease to 2.5 mg q.h.s. his inr will be followed with dr. . 5. infectious disease - the patient remained afebrile during his hospital course. he was treated prophylactically with three days of levaquin as prophylaxis following urethral dilatation by urology for post cardiac catheterization foley. 6. renal - the patient did have mild elevation in his creatinine early in the ccu course in the setting of cardiogenic shock. he subsequently improved with mild dobutamine and the patient was able to tolerate ace inhibition and gentle diuresis throughout his hospital course. meanwhile, the patient was evaluated by urology post cardiac catheterization with difficulty with placing a foley catheter. he underwent urethral dilatation for presumed stricture in the prostatic urethra. cystoscopy later confirmed stricture in the bulbar urethra. foley was placed following dilation and left in place for the first weeks of his hospital course. the patient was able to urinate after removal of the foley catheter. however, subsequent urinalysis did show residual hematuria. as such, he was instructed to follow-up with urology in one to two weeks. 7. endocrinology - the patient's glyburide was increased to 7.5 mg for increased blood sugar during his hospital course. he will need follow-up blood sugar control. discharge diagnoses: 1. coronary artery disease, status post non st elevation myocardial infarction and status post proximal right coronary artery pci/stent and percutaneous transluminal coronary angioplasty of mid right coronary artery lesion. 2. congestive heart failure/cardiogenic shock, resolved. 3. status post acute right sided occipital cerebrovascular accident with mra evidence of complete occlusion of posterior circulation. 4. urethral stricture/hematuria. 5. type 2 diabetes mellitus. condition on discharge: good. medications on discharge: 1. aspirin 325 mg once daily. 2. plavix 75 mg once daily. 3. zocor 40 mg once daily. 4. digoxin 125 mcg once daily. 5. glyburide 7.5 mg once daily. 6. coreg 1.56 mg twice a day. 7. senokot twice a day. 8. colace twice a day. 9. lasix 20 mg once daily. 10. lisinopril 1.25 mg once daily. 11. coumadin 5 mg q.h.s. until , and then 2.5 mg q.h.s. follow-up plans: 1. the patient was to call dr. , cardiologist, for appointment in one to two weeks and will be faxing over results of inr. 2. he was also instructed to call dr. from neurology stroke team for appointment in two to three weeks. 3. he was to call the urologist, dr. , in one to two weeks for appointment for evaluation of his hematuria. , m.d. dictated by: medquist36 procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor angiocardiography of right heart structures transfusion of packed cells diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiogenic shock other complications due to other cardiac device, implant, and graft iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to