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: left heart catheterization with successful ptca of the lcx/om2 history of present illness: the patient is a y/o male w/ hx of cad s/ bms x 3 ('), sev as, s/d chf, htn presents with complaints of chest pain. patient admitted in w/ complaints appearing to be unstable angina. had dynamic ekg changes with st depressions in the precordial leads. underwent cardiac catheterization, w/ bms to om2, d1, lcx. had peak troponin of 0.33 at that time. patient has had two admissions since of similiar complaints of chest pain, and reportedly dynamic ekg changes, and was treated with medical manegment after ruling out by cardiac enzymes. the patient describes daily chest pain, but does not describe associated activity as an inciting factor. he says that he tries to avoid taking nitro. on the day prior to presentation he was walking when he began to feel substernal chest tightness without radiation for 5-10 minutes. it was relieved by taking nitro. again this morning, patient had a second episode of chest pain. he was in the shower with onset of squeezing chest pressure without radiation. chest pain again was relieved by slng. these past episodes are similar to daily chest discomfort, but more severe. . on review of systems, he 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. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. *** cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . . in the ed, initial vitals were t: 100.1 hr: 80 bp: 150/64 rr: 18 o2sat: 99% on 2l. patient had a further episode of chest pain, was given slng x 1, with resolution of chest pain. patient noted to have st segment depressions in anterolateral and anterior leads. he was started on a heparin and nitro drip, and and was admitted for further evaluation and management. . . on arrival to the floor, patient's t 98.6, bp 137/61 p 80 o2 100 % on 2l. he was friendly and cooperative throughout interview and denied any chest discomfort. nitro and heparin were discontinued, explained below in assesment and plan. patient then began to experience chest discomfort. became tachycardic and uncomfortable with a decreas of sats from 99 to 93% on 2l with new crackles on exam b/l way up lung fields. patient was given 1mg iv morphine, 1 slng, 20mg iv lasix with complete resolution of symptoms. past medical history: --coronary artery disease - s/p bms to om2, d1, lcx () for unstable angina with twi in v2-v4 --chf, systolic ef 40% and dysfunction with sever lvh --valvular disease - moderate aortic stenosis, mild to moderate aortic and mitral regurgitation, ?bicuspid congenital valves --htn --copd --gout --djd - bilateral knee pain --h/o chronic pyelonephritis --s/p bladder stone removal --colon cancer social history: social history is significant for occasional cigarrettes socially 20 years ago. he drinks about 1 glass of wine or alcoholic drink /week. he is from and worked as a general surgeon in . he retired at age 63 due to his hand tremor. he has been widowed for 8 years and lives alone in . he has children in the area who are helpful. . family history: there is no family history of premature coronary artery disease or sudden death. . physical exam: vitals: t 98.6 bp 150/72 p 100 o2 94% @l gen: elderly male in nad. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. no signs of conjunctivitis. neck: jvp 8cm. heart: pmi 5th ics & mcl, no thrills/heaves, rrr, normal s1, s2. midpeaking iii/vi murmur best heard at along left sb. lungs: ctab. abd: soft, slightly distended, non-tender ext: wwp, no edema, dp 2+ b/l. neuro: follows commands, spontaneously moves all 4 extremities pertinent results: 11:50am blood wbc-9.1 rbc-3.12*# hgb-7.9*# hct-26.1* mcv-84 mch-25.1* mchc-30.1* rdw-15.9* plt ct-205 11:50am blood neuts-76.6* lymphs-17.0* monos-4.7 eos-1.6 baso-0.1 11:50am blood pt-12.5 ptt-26.0 inr(pt)-1.1 11:50am blood glucose-106* urean-23* creat-0.9 na-143 k-4.2 cl-108 hco3-30 angap-9 11:50am blood ctropnt-0.02* 11:50am blood ck(cpk)-49 11:50am blood calcium-8.9 phos-3.4 mg-2.0 07:45am blood wbc-8.1 rbc-4.06* hgb-10.9* hct-33.6* mcv-83 mch-26.9* mchc-32.4 rdw-15.9* plt ct-203 11:50am blood wbc-9.1 rbc-3.12*# hgb-7.9*# hct-26.1* mcv-84 mch-25.1* mchc-30.1* rdw-15.9* plt ct-205 11:50am blood ck(cpk)-49 06:50am blood ck(cpk)-147 06:34pm blood ck(cpk)-33* 11:50am blood ctropnt-0.02* 06:21am blood ck-mb-notdone ctropnt-0.49* 11:54am blood type-art o2 flow-2 po2-79* pco2-44 ph-7.46* caltco2-32* base xs-6 intubat-not intuba comment-nc cxr : findings: bedside ap examination labeled "up at 12:00 p.m.", is compared with study dated . though the lung volumes appear larger, there is diffuse interstitial prominence with b-lines and pulmonary vascular congestion, as well as stable cardiomegaly. there is no overt edema or pleural effusion. no focal consolidation is seen. there are atherosclerotic changes involving the thoracic aorta. impression: interstitial edema, new since . tte : the left atrium is mildly dilated. the estimated right atrial pressure is 0-5 mmhg. there is severe symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with inferior akinesis and inferior septal/inferior lateral hypokiensis. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is moderate to severe aortic valve stenosis (area 0.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) 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: mild to moderate regional lv dysfunction. moderate to severe aortic stenosis and mild aortic regurgitation. mild to moderate mitral regurgitation. dilated thoracic aorta. cardiac cath: comments: 1. selective coronary angiography of this right-dominant system demosntrated two vessel coronary artery disease. the lmca had 40% proximal and 30% distal stenosis. the lad was a moderately calcified vessel. the 30% proximal lad lucency seen on prior angiogram was unchanged. a 70% calcific mid lad lesion was noted at the d1 origin. the d1, which was stented in with a bms, was stump-occluded without antegrade flow. the d1 post the occluded stent filled via right- to-left collaterals. the proximal lcx had 50% in-stent restenosis extending into the stented om2 branch. the om2 had 65% in-stent restenosis at the proximal segment of the stent and 60% at the distal end of the stent. the av groov lcx was diffusely diseased with 80% stenosis in a small lower pole of om2. the rca is a large caliber dominant vessel with diffuse mild plaquing and focal heavy calcification. the flow within the rca system was rather slow consistent with microvascular dysfunction. the rca system gave collaterals to the occluded d1. 2. resting hemodynamic assessment revealed a 12 point step-up from the svc to the pa. a full saturation run was performed (see table above) and the findings were consistent with a possible small left-to-right intracardiac shunt at the upper chamber (ra) level. systemic arterial pressure was normal (134/46 mmhg) and the pulmonary arterial pressure was mildly elevated (39/12 mmhg). the mean pulmonary capillary wedge pressure was mildly elevated (11 mmhg). 3. the aortic valve was not crossed based on the primary service's request. hence, left ventriculography was deferred. 4. successful ptca of the isrs of the lcx and om2 with a 2.75 x 15 mm and a 3.0 x 12 mm balloons. final angiography revealed a 20% residual stenosis in the stents, no dissection and timi iii flow (see ptca comments) final diagnosis: 1. two vessel coronary artery disease. 2. mild pulmonary arterial hypertension and mildly elevated pcwp. 3. step up o2 saturation from 53% in the svc to 65% in thebpulmonary artery suggestive of a possible left-to-right shunt on the ra level. 4. successful ptca of the lcx/om2. final diagnosis: 1. two vessel coronary artery disease. 2. systemic arterial systolic hypertension. 3. successful stenting of the om2, lcx and d1 with bare metal stents brief hospital course: #. cad: the patient has a history of pronounced cad status post bms x 3. patient presented with complaints of chest pain, similar to prior mi. has had two subsequent admission for similar complaints, with negative rule outs. st segment depressions noted on ekg seem to be similar multiple baseline ekgs in omr, but degree of st depressions seems to deponstrate a dynamic component with correlates with the patients complaint of chest pain. was unclear if respresented ischemia from acs vs. repolarization abnormalties vs subendocardial ischemia with severe as and lv thickness. hct drop of 10 pts from baseline was thought to be exacerbating factor. patients chest pain persisted, despite transfusion. heparin was initally held due to concern of gi bleeding, but with persisent chest pain and rising of troponins to peak of 0.49, patient was transfered to the ccu for monitored heparinization. he underwent cardiac cath with ptca of the lcx/om2. he was chest pain free following cath, with trending down of ck to baseline and resolution of ekg changes. he was discharged on aspirin, metoprolol, lipitor, and plavix. . #. pump: the patient has known valvular disease with mod-sev as, mod ar/mr and systolic hf. had appeared euvolemic on intial presentation, and did not endorse symptoms of heart failure. during admission patient became sob in setting of chest pain with fall in o2 sats and new pulmonary edema on cxr. symptoms improved with morphine, lasix, and slng. in setting of severe as, patient may have had increased stiffness in setting of ischemia. also have had been overloaded with increased pre-load after discontinuing nitro gtt. patient had no further episodes during hospitalization. . #. rhythm: nsr, maintain on telemetry . # gi bleed: the patient presented with a hct 10 pt lower since with history of colon ca and guaic positive stool. no hx of melena or hematochezia. decision was made to transfer patient to ccu for monitored heparinization. patient was transfused and responded appropriatly. endoscopy was deffered until stable from a cardiac view point, and patinet scheduled to follow up with dr. upon discharge. . #. hypertension: continued metoprolol and amplodipine for afterload reduction. . # full code medications on admission: 1. aspirin 325 mg tablet po daily 2. clopidogrel 75 mg tablet daily 3. allopurinol 150 mg tablet po once a day. 4. atorvastatin 40 mg po daily 5. amlodipine 2.5 mg po daily 6. docusate sodium 100 mg po bid 7. ferrous sulfate 325 mg tablet po daily 8. ranitidine hcl 300 mg capsule po daily 9. isosorbide mononitrate 30 mg tablet sustained release po once a day 10. colchicine 0.6 mg one (1) tablet po bid as needed for pain: take regularly for gout pain. 11. toprol xl 25 mg po once a day 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. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. hexavitamin tablet sig: one (1) cap po daily (daily). 5. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 6. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 7. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 doses. disp:*5 tablet(s)* refills:*0* 8. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for angina: if chest pain does not resolve after 3 doses five minute apart call your pcp 911. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 10. colchicine 0.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for gouty pain. 11. outpatient lab work hct, k, bun, creat, call results to dr. 617= 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 13. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home with service facility: family care extended discharge diagnosis: primary diagnosis: nstemi acute on chronic congestive heart failure gi bleed with anemia secondary diagnosis: coronary artery disease severe aortic stenosis goutty attack hyptertension mild pulmonary arterial hypertension discharge condition: stable discharge instructions: you are being discharged from the hospital after admission for chest pain. you were found to have a small heart attack. you had a cardiac catheterization with balloon angioplasty of the left circumflex and om1 arteries. you also had mild pulmonary hypertension and acute heart failure that improved with diuresis. you had pseudomonas in your urine and have been on a 7 day course of ciprofloxacin. please continue to take your plavix every day without missing a day. consult your cardiologist before stopping the medication. your imdur has been stopped and lisinopril has been started. you should take a proton pump inhibitor twice daily. you should weigh yourself every day and report a weight gain of more than 3 pounds in 1 day or 6 pounds in 3 days to dr. . if you develop chest pain, shortness of breath, palpitations, light headedness, or any other concerning symptoms, you should call your pcp or go to the emergency room. followup instructions: you have an appointment with dr. of gastroenterology on at 11:30am. you have an appointment with , md phone: date/time: 3:40 you have an appointment with , m.d. date/time: 8:20 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters transfusion of packed cells excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases blood in stool cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mitral valve insufficiency and aortic valve stenosis other complications due to other cardiac device, implant, and graft personal history of malignant neoplasm of large intestine accidents occurring in other specified places pseudomonas infection in conditions classified elsewhere and of unspecified site acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to