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: cardiac catheterization x2 stent placement to lcx and om1 history of present illness: 55y/o m w/ cad s/p stent at in , htn, osa, and hypercholesterolemia who presents with several hours of constant substernal chest pressure. the patient notes the gradual onset of chest pressure this afternoon ~3:30pm while sitting at the table and talking to his wife. in retrospect, he had been feeling odd throughout the day w/ occassional chest pressure but it became constant while speaking with his wife. over the next several hours, the pain grew progressively worse and only began to improve when he took 3 successive sl ntg. he had associated sob with his chest pressure but denies nausea, paresthesias, radiation, or diaphoresis. this pain is different from his previous anginal equilivant in that it is more severe and affects a broader aspect of his chest. . on review of systems, he recalls increasingly frequent episodes of chest pressure over the past week with his most recent occuring this weekend. he has been getting increasing dyspneic with exertion and was unable to climb 11 stairs w/out resting and had to stop shoveling snow recently after only ~1min chest pressure and sob. he denies current pnd and orthopnea but did often wake up gasping for air prior to initiating cpap therapy. other than the above symptoms, he denies any recent weakness, abdominal pain, fever, cough, ha, n/v, diarrhea, melena, or bprbr. he has been taking his medications w/out fail per his report. . at the osh, he was noted to have t wave inversions inferiorly although the morphology of his qrs complex suggests that avf and avl may have been switched. he was sent urgently to for furhter evaluation. here, his ekg was thought to be concerning for t wave inversions laterallly although his ce were flat. he was given morphine and started on a heparin and nitroglycerin drip with resolution of his chest pain (~1am). he was plavix loaded and cardiology consulted before the decision was made to defer integrillin for the time being. he was admitted to the floor for further management or unstable angina vs nstemi. past medical history: 1. cad s/p stent at in (2.5x8mm multilink pixel - anatomy currently unknown); total catheterizations 2. osa on cpap at home 3. chronic lbp 4. hypercholesterolemia social history: worked for post office but now on workers compensation lower back injury. currently 1ppd smoker (total ~60pk/yrs). denies etoh and drug use. lives w/ wife and 2 sons. family history: father w/ mi at 43. mother w/ mi later in life as well as maternal grandparents. physical exam: vs: af, 172/75, 58, 18, 96% 2l gen: overweight middle-aged lying in bed in nad heent: mmm, o/p clear cv: rrr, no m/r/g appreciated lungs: cta bilaterally abd: obese, soft, non-tender, no hsm, +bs ext: very slight lower calf edema bilaterally neuro: appropriate in conversation, moving all extremities spontaneously skin: no rashes pertinent results: ekg: sinus rhythm at 60 bpm. normal intervals and slight l axis. new t wave inversions in v4-6 (? old in v4). no st elevations or depressions. . cxr and : no acute cardiopulmonary process. . cardiac cath : the lmca had 20% ulcerated plaque extending into the lad. intravascular ultrasound interrogation of this plaque suggested a thin fibrous cap and echolucent core (? voulnerable plaque). the lad had mild diffuse disease. the lcx proximal stent was patent. an om branch had 60% proximal stenosis. the rca was a small nondominant vessel with distal occlusion. severe systemic htn (200/105 mmhg) and severely elevated left heart filling pressure (lvedp 27-33 mmhg); normal lv systolic function with lvef 65% and no mitral regurgitation. aortic root angiography showed dilated aortic root (4-4.5 cm) and no definite evidence of dissection. nonselective renal arteriography revealed 30% proximal l renal artery. . ct chest : no evidence of aortic dissection, pulmonary embolism, or acute cardiopulmonary disease. atherosclerotic change with small ulcerating plaques in the infrarenal aorta, but no aneurysm or dissection. . tte : the left atrium is moderately dilated. no atrial septal defect. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated athe sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . r groin us : wall-to-wall blood flow is demonstrated in both of these vessels. there is no evidence of arteriovenous fistula, pseudoaneurysm, or fluid collection in the right groin. . cardiac cath : 80% mid cx lesion and an 80% om1 lesion. there was mild to moderate disease in the remainder of the lad and cx. ptca and stenting was performed of the mid cx with overlapping 2.5x18 mm and 2.5x8 mm cypher drug eluting stents. ptca and stenting was performed of the om1 with a 3.0x8 mm cypher drug eluting stent and was postdilated with a 3.5 mm nc balloon. final angiography revealed 0% residual stenosis, no dissection, and timi 3 flow. left femoral arteriotomy site was closed with a 6f angioseal device. . ct abd/pelvis : there are moderate sized bilateral retroperitoneal hematomas in the lower abdomen, left greater than right. the left collection measures approximately 14 x 12 cm and the right collection 8 x 7 cm. likely originating from the left groin puncture site. hemorrhage tracks along the left pelvic side wall in a retroperitoneal fashion into the lower abdomen as above. brief hospital course: a/p: 55y/o m w/ cad here with several hours of sscp and ekg changes. . 1. chest pain: previous history of cad s/p stents at in . symptomatic over several days pta sscp and decreased exercise tolerance. patient was started on nitro gtt in the ed with resolution of his pain. ekg showed t wave inversions laterally (new) but ruled out for mi with 3 sets of negative ce. patient's acceleration of symptoms at rest were concerning for unstable angina. timi risk score of 4 so will benefit from early angiography. patient described chest pain as well as a component of pain in his back. given this history a cta was performed to rule out dissection prior to cath and this was negative. he was taken to cath on revealing a 20% ulcerated lmca plaque extending into the lad. the lad had mild diffuse disease. lcx proximal stent was patent. an om branch had 60% proximal stenosis. he had severe systemic htn (200/105 mhg) and severely elevated left heart filling pressure (lvedp 27-33 mmhg). left ventriculography revealed normal lv systolic function with lvef 65% and no mitral regurgitation. given his elevated filling pressures he was diuresed. given the ulcerated lmca plaque he was given 150mg plavix per recommendation from the interventionalist who performed the procedure. he was also continued on asa/bb/statin. . on the night of he again developed chest pain similar in character with no relief from sl nitro x3 and 2mg morphine. he was restarted on nitro gtt with relief. he was again noted to have dynamic lateral t wave changes in the lateral leads similar to his presentation. his cath films were reviewed and it was felt that he would benefit from intervention of a likely lcx culprit lesion. he was restarted on heparin and integrillin overnight and was taken back the cath on . repeat cath showed an 80% mid cx lesion and an 80% om1 lesion. they were stented with cypher stents. post cath he was continued on heparin and integrillin. approximately 1 hour post cath the patient complained of feelign poorly. he was found to have a sbp in the 80s and hr in 40s. he was symptomatic with diaphoresis and lightheadedness and described a feeling like he was going to pass out. he was given atropine x2, ns bolus with improvement in his vitals and symptoms. a stat ct was obtained that showed a large rp bleed. he was then transferred to the ccu for closer monitoring. in the ccu he received 2 units platelets, and 4 units of prbc. hct never dropped but was stable with the 4 units at 35. his antihypertensives were held given hypotension. once stabilized his acei was restarted and uptitrated. he was also restarted on his asa and plavix. he was transferred back to the floor for further care. on the floor he remained chest pain free, however he had significant tenderness of his lower abdomen in the location of blood pooling. his hct were checked and remained stable. he required no further transfusion. . 2. htn: the patient was on an impressively diverse and high dose regimen of antihypertensives as an outpatient. he stated that he was compliant with his medications. given that his bp was not easily controlled even on a large number of medications, secondary hypertension was considerd, particularly ras. during his first catheterization his renal arteries were visualized and showed no stenosis. he was initially continued on all of his outpatient medications. these were held in the setting of his rp bleed as above. he was transferred back to the floor on lisinopril 10mg daily. he was not adequately controlled with his so it was uptirated to 20mg daily. in addition he was restarted on norvasc 10mg and hctz 25mg daily. his bb was not restarted given his tendency to become quite bradycardic with it. he had no evidence of heart failure or wall motion abnormalities making it unnecessary given the potential se. his medications can be adjusted as an outpatient if necessary. . 3. lbp: patient has chronic pain well controlled on home regimen. continued oxycontin and zanaflex. while in the ccu his long acting oxycontin was held given his hypotension and was treated with morphine iv prn. once stabilized he was restarted on his home regimen. . 4. osa: patient uses cpap at home but was unclear of his settings. he did not express a desire to continue this while admitted. . 5. hypercholesterolemia: continued outpatient atorvastatin initially. this was increased to 80mg when lipid panel showed total chol 229, ldl 136, hdl 43. . 6. anemia: after the patient's initial cath his hct was found to be 34 from 38.6 prior. there was no hematoma in his r groin, however there was a soft bruit noted by the cardiology fellow. given this a r groin us was obtained and showed no abnormalities. it was felt that a component of the decreased hct was the significant amount of ivf he received post-cath. following his second catheterization he was found to have a significant rp bleed requireing transfusion as above. his hct was stable at 36 on discharge. . 7. smoking: patient was counselled on smoking cessation. he requested something to help with his craving upon discharge and was given a prescription for varenicline. . fen: patient was kept on a cardiac/heart healthy diet. his k and mg were kept above 4.0 and 2.0 respectively. . full code medications on admission: asa 81mg atenolol 100mg oxycontin 10mg tid fa b12 500mg zanaflex 8mg diovan/hctz 320/50mg cardura 8mg prilosec 20mg norvasc 10mg lipitor 20mg lisinopril 10mg discharge medications: 1. oxycodone 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po three times a day. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. vitamin b-12 500 mcg tablet sig: one (1) tablet po once a day. 4. tizanidine 2 mg tablet sig: four (4) tablet po daily (daily). 5. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 6. doxazosin 4 mg tablet sig: two (2) tablet po hs (at bedtime). 7. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 8. amlodipine 5 mg tablet sig: two (2) tablet po bid (2 times a day). 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 11. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 12. lisinopril 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 13. varenicline 0.5(11)-1(3x14) mg tablets, dose pack sig: one (1) tablets, dose pack po once a day: days - take 0.5 mg once a day. days - take 0.5 mg twice a day. days 8- take 1 mg twice a day. take for 12 weeks. . disp:*1 tablets, dose pack(s)* refills:*0* discharge disposition: home discharge diagnosis: cad s/p stent to om retroperitoneal bleed chronic lbp hypertension osa discharge condition: afebrile. hemodynamically stable. chest pain free. ambulating without difficulty. discharge instructions: you were admitted to the hospital for chest pain. you had a cardiac catheterization with a stent to one of your coronary arteries. you will need to be on plavix every day due to your stent. . please follow the instructions for routine post-cath care provided to you. . you should continue to take your medications as prescribed. . if you experience chest pain, difficulty breathing, worsening abdominal pain, numbness or weakness in your legs, bleeding or other concerning symptoms please call your doctor or go to the emergency room. you have been counseled extensively on smoking cessation. we have provided you with a prescription for a medication called chantix (varenicline). it will aide in your smoking cessation. the first pack will last you one month. you will need to get a refill from your primary care doctor for an additional two months after you finish it. followup instructions: please follow up with dr. in weeks. you can call ( to schedule an appointment. . please follow up with your pcp weeks as well. you should have your blood counts checked (hct) at that time to make sure they are stable. procedure: coronary arteriography using two catheters coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor left heart cardiac catheterization left heart cardiac catheterization aortography transfusion of packed cells arteriography of renal arteries insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of three vascular stents diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery intermediate coronary syndrome pure hypercholesterolemia unspecified essential hypertension cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft accidents occurring in other specified places 

Answer: The patient is high likely exposed to