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: shortness of breath major surgical or invasive procedure: : cardiac catheterization, no intervention history of present illness: 72 yo f with pmhx of 2vessel cad s/p rca atherectomy in ', htn, morbid obesity, hyperlipidemia who presents with dyspnea x 3days , worse past day with a dry cough. symptoms started abruptly on sunday night with sob while walking to bathroom. sob remaind persistent over the following days, with worsening doe. she initially presented to hospital and was found to be hypotensive and was transferred to ed with suggested diagnosis of pna, incidentally found to have elevated troponin of 1.73. she was started on heparain at osh. received azithro and ceftriaxone at osh. was on neo at 100 mcg. got rij in our ed. crackles at bases, febrile to 100.1. gave levofloxacin. put on levophed in ed. o2 sat high 90's on 4l. cxr here appears to have bilateral infiltrates. ecg here afib rate elevations v4-v6. patient denies chest pain. . on review of systems (limited as pt poor insight), she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. . cardiac review of systems is notable for absence of chest pain, but worsening dyspnea on exertion, she endorses unchanged paroxysmal nocturnal dyspnea and nocturia, orthopnea which is unchanged, no ankle edema, no palpitations, no syncope or presyncope. . past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: -percutaneous coronary interventions: 93, rca atherectomy 3. other past medical history: hypertension obesity paroxismal afib asthma social history: pt lives alone in an atp in . she is very sedentary and is able to function on a routine. she has 2 daughters who live nearby and help her extensively. will likely need placement at or other facility after discharge. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: pe on admission: vs: t= 99.0 bp= 111/90 hr= 85 rr= 25 o2 sat=97% 6l general: 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 , obese cardiac: limited due to obesity, rr, normal s1, s2. no m/r/g.] lungs: resp were mildly labored, some accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pe on discharge: o: vs - t 97.9 p 91(91-104) bp 126/66(93-142/58-66) rr 24 o2 97% on 1.5l i/o - 1204/1250 (-46) over 24 hrs, since midnight general - nad, aaox3 heent - mmm, jvd present cvs - nl s1, s2. rrr. distant heart sounds. pulm - cta-b abdomen - soft, nt, nd, obese. nl bs extremities - 4+ non-pitting edema pertinent results: labs on admission: 02:43am lactate-1.6 04:00am wbc-17.0* rbc-3.97* hgb-11.8* hct-37.3 mcv-94 mch-29.9 mchc-31.8 rdw-13.5 plt count-264 04:00am ck-mb-7 04:00am ctropnt-1.73* 04:00am ck(cpk)-113 04:00am glucose-150* urea n-26* creat-0.8 sodium-145 potassium-3.5 chloride-107 total co2-30 anion gap-12 11:31am ptt-32.6 11:36am ck-mb-11* mb indx-3.1 ctropnt-1.67* 11:36am ck(cpk)-356* 04:50pm tsh-2.9 04:50pm ck-mb-9 ctropnt-1.73* 04:50pm ck(cpk)-312* 10:09pm ck-mb-7 ctropnt-1.75* 10:09pm ck(cpk)-240* . labs on discharge: inr 1.9, wbc rbc hgb hct mcv mch mchc rdw plt ct 08:40am 9.3 3.83* 11.4* 36.4 95 29.7 31.2 13.9 273 glucose urean creat na k cl hco3 angap 08:40am 175* 14 0.7 141 3.3 100 34* 10 . bcx and ucx ngtd u/a : type color appear sp yellow clear 1.016 blood nitrite protein glucose ketone bilirub urobiln ph leuks lg neg 30 neg neg neg 1 7.0 mod rbc wbc bacteri yeast epi transe renalep * * occ none 0-2 . 2d echo the left atrium is mildly dilated. the estimated right atrial pressure is 0-10mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with near akinesis of the distal 2/3rds of the ventricle. the remaining basal segments contract normally (lvef = 20-25 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal with focal hypokinesis of the apical free wall. the aortic root and ascending aorta are mildly dilated. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion.there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is an anterior space which most likely represents a fat pad. impression: symmetric left ventricular hypertrophy with normal biventricular cavity size and extensive systolic dysfunction c/w diffuse process (multivessel cad, toxin, metabolic, etc.) at least mild moderate mitral regurgitation. dilated ascending aorta. . chest xray impression: 1. satisfactory right ij line position. 2. edeme-like pattern suggestive of volume overload/heart failure. repeat radiography after diuresis recommended to assess for underlying infection. 3. if necessary repeat pa/lateral could help better evaluate the right lung base given the concern for pneumonia. . cardiac cath comments: 1. coronary angiography in this right dominant system revealed diffuse calcific coronary artery disease. the lmca was not well-visualized. the lad was highly calcified, and had a 90% ostial lesion with diffuse disease throughout the mid-portion of 90%. the lcx was tortuous and was without any angiographically apparent disease. the rca was calcified and had a 60% stenosis in the mid-portion. 2. resting hemodynamics revealed elevated left and right sided filling pressures with mean ra pressure of 21 mmhg and mean pcw pressure of 33 mmhg. the patient also had elevated pulmonary artery pressures with mean pa pressure of 42 mmhg and peak pa pressure of 71 mmhg. both mean and peak pa pressures decreased during the case following administration of iv furosemide. the cardiac output, calculated from the fick equation, was normal at 5.5 l/min. final diagnosis: 1. single vessel severe coronary artery disease not well suited for pci. 2. elevated left and right sided filling pressures. brief hospital course: 72 yo f hx cad s/p atherectomy in ', htn, hld, paroxysmal atrial fibrilliation (not anticoagulated), and morbid obesity who presented subacutely with anterior stemi and systolic congestive heart failure. . # coronaries: coronary cath on showed 90% mid-lad disease and 60% stenosis of mid-rca but tortuous, calcific vessels that were not amenable to intervention. patient's anterior stemi was medically managed with aspirin 81 mg, plavix 75 mg, atorvastatin 80 mg, and metoprolol. she was started on 81 mg dose of aspirin to minimize risk of hemorrhage secondary to triple anticoagulant therapy. the patient's beta blocker was slowly titrated due to episodes of hypotension, and she was discharged on metoprolol succinate xl 50mg once daily with good blood pressure control. timi risk score for stemi was calculated to be 10, predicting 36% mortality at 30 days. the patient was discharged with cardiology follow up as an outpatient for further management and evaluation for an icd. . # systolic heart failure: initial presentation of patient was concerning for cardiogenic shock, and the patient was briefly treated with pressors to achieve a mean map of > 60%. a tee on showed systolic heart failure w/ lvef of 20-25%, dilated la, mild lvh, severe lv systolic dysfunction with near akinesis of distal ventricle, no masses or thrombi, rv with focal hypokinesis of apical free wall, and + mr. clinically, patient appeared to be volume overloaded with pulmonary edema causing dyspnea and hypoxia. diuresis was achieved with lasix 20mg iv prn; total of >6l net fluid was removed throughout hospital stay. patient was discharged on lasix 20mg po daily for symptomatic relief of chf. in addition, she was started on an ace inhibitor, and titrated up as blood pressure would allow; at discharge, she was able to tolerate lisinopril 5 mg daily. spironolactone was not initiated due to low bp. given the degree of myocardial hypokinesis seen on echo, the patient was anticoagulated to minimize risk of thrombus formation. she was initially started on heparin ggt with bridge to coumadin. on the day of discharge, she was switched from heparin to fondaparinox, with a plan for daily fondaparinox until inr > 2. . # id: in the ed, the patient had a leukocytosis and low grade fever and initially treated with levofloxacin for questionable infiltrate versus pulmonary edema on cxr. however, given evidence of stemi and chf with tte showing severely decreased ef, the patient's hypotension was felt to be more consistent with cardiogenic shock rather than sepsis. the patient was afebrile for remainder of hospitalization and white count normalized. blood cultures x2 were obtained which did not show any growth at time of discharge. urine culture was positive for mixed flora, c/w contaminated specimen, and patient was treated for uti with a 2-day course of ciprofloxacin (completed ). . # hypoxia: hypoxia was likely secondary to volume overload from systolic heart failure. the patient required noninvasive oxygen supplementation, and was gently weaned off o2 was she was diuesed; o2 saturation was 94% on ra prior to discharge. she was able to ambulate without becoming hypoxic or significantly dyspneic, although she was noted to desat to the 80s while sleeping at night. due to nocturnal hypoxia and morbid obesity, patient is strongly recommended to obtain a sleep study as outpatient to evaluate for obstructive sleep apnea. . # rhythm: patient was in atrial fibrillation on initial presentation put converted to and maintained in sinus rhythm. patient was kept on telemetry. rate control was achieved with metoprolol which was titrated up as discussed above. as discussed above, the patient was anticoagulated primarily for prevention of apical thrombus and was bridged to coumadin therapy with heparin ggt followed by fondoparinox. at discharge, she had inr of 1.9 and planned to continue daily fondaparinox until inr therapeutic at > 2. she should have frequent inr checks for coumadin dosing monitoring. . # hyperglycemia: the patient experienced mild hyperglycemia while admitted, thought to be secondary to the stress of stemi and acute chf, with a likely component of insulin-resistance. her glucose was well-controlled on an insulin sliding scale. hemoglobin a1c was 6.3. glucose control should be reassessed on an outpatient basis. . # asthma: patient initially had wheezing secondary to chf as well as asthma that was improved significantly with ipratropium nebulizaer q6h and prn albuterol nebs. . # s/p recent cataract surgery: home prescriptions of prednisolone and acular eye drops were continued. . # fen: patient was kept on cardiac diet. # prophylaxis: dvt ppx with heparin gtt. bowel regimen with senna, colace, miralax. . access: piv's x 2 . code: full code medications on admission: pravastatin 80 atenolol 25 diltiazem 360 er plavix 75 mg daily claritin 10 asa 325 zymar eye drops 0.3% acular 0.5% pred forte 1% aricept 10 mg daily discharge medications: 1. aricept 10 mg tablet sig: one (1) tablet po once a day. 2. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. prednisolone acetate 1 % drops, suspension sig: one (1) drop ophthalmic qid (4 times a day). 5. ketorolac 0.5 % drops sig: one (1) gtt od ophthalmic qid (4 times a day). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for wheezing, shortness of breath. 7. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 11. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours). 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 14. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily): hold sbp < 80, hr < 60. 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily): hold sbp < 80. 17. outpatient lab work please check inr on . d/c fondaparinox if inr is >=2.0. 18. fondaparinux 10 mg/0.8 ml syringe sig: one (1) syringe subcutaneous daily (daily): d/c when inr >=2.0. 19. insulin lispro 100 unit/ml solution sig: per sliding scale units subcutaneous asdir (as directed). discharge disposition: extended care facility: rehab discharge diagnosis: acute myocardial infarction acute systolic congestive heart failure hypertension hyperlipidemia discharge condition: stable. vital signs stable. discharge instructions: you had a heart attack and your heart is weaker than it was. you were treated for acute congestive heart failure and will need to take new medicines to help your heart pump better. we believe that your heart function will improve as it recovers from the heart attack. we were unable to open the blockage in your artery that led to the heart attack. you also had atrial fibrillation, a common irregular heart rhythm. this rhythm increases your risk of stroke so you were started on warfarin (coumadin) to prevent blood clots and stroke. you will need to be aware of medicines that interact with warfarin and that it might cause your to have minor or more serious bleeding. please refer to the information packet we gave you regarding warfarin use. you will take fondaparinox until your inr is >=2.0. weigh yourself every morning, md if weight increases by > 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet fluid restriction:1500cc . medication changes: 1. pravastatin was changed to atorvastatin, a stonger cholesterol medicine 2. your atenolol was changed to metoprolol xl 3. your cartia xt and hctz was discontinued 4. start lisinopril: a medicine to help your heart pump better 5. start colace, senna and miralax to prevent constipation 6. start warfarin to prevent blood clots and stroke. 7. start furosemide to prevent swelling and fluid in your lungs. 8. start ipatroprium and albuterol nebs for wheezing 9. start insulin sliding scale to treat high blood sugars. 10. start fondaparinox unitl inr >=2.0 followup instructions: primary care: dr. , p phone: date/time:please make an appt to see after you get out or rehabilitation. . cardiology: , m.d.phone: ( address: , , date/time: at 11:15am. procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation asthma, unspecified type, unspecified acute myocardial infarction of anterolateral wall, initial episode of care other and unspecified hyperlipidemia cardiogenic shock morbid obesity acute systolic heart failure 

Answer: The patient is high likely exposed to