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 53-year-old male who was admitted to an outside hospital on with chf and chest pain. the patient ruled out by cardiac enzymes, but had a bnp greater than 1400. the patient was started on natrecor and sublingual nitroglycerin. on , he became hypotensive with systolic blood pressures in the 80s, also had chest pain. ck, at that time, was 278 with troponin 9.3. no catheterization secondary to it being the weekend. his hematocrit was 33 on . the patient then had chest tightness. he received sublingual nitroglycerin and iv lopressor. the patient was then sent here for management of chf with consideration of cabg and management of now acute renal failure. otherwise, the patient has a history of iddm since age 7, cad, mi x2, refused cabg in , and history of chf. recent echocardiogram revealed dilated lv with inferior akinesis, which was new. the patient also had moderate mr, severe pulmonary hypertension, and an ef of 30 percent. otherwise, the patient has had a cva in the past. he has a history of chronic renal insufficiency, peripheral vascular disease, bilateral fem-, status post amputation of his second toe in both feet, neuropathy, retinopathy, gerd, and the patient was admitted with chest pain and chf. on , the patient had systolic blood pressures in the 80s. he had chest pain. sublingual nitroglycerin, morphine, and fentanyl patch were given. he was admitted to the ccu, got iv nitroglycerin, heparin gtt, natrecor, lasix, and made pain free, ruled in; however, on the day of admission to the , had new st depressions in v4 through v6, received sublingual nitroglycerin, became chest pain free, and his chf regimen was then changed to natrecor and bumex. allergies: ativan and nsaid. past medical history: his past medical history is significant for type 1 diabetes, since the age of 7; mi x2, cad, refused cabg in , history of chf with an ef of 30 percent, history of cva, history of peripheral vascular disease, status post bilateral fem-, status post amputation of second toe in both feet, history of neuropathy, retinopathy, and gerd. medications: the patient's medications on admission included, 1. natrecor 0.1 mg/kg/min. 2. heparin 850 units/hour. 3. nitrate 250 mg. 4. bumex. 5. nph, 24 units in the morning and 6 units in the evening. 6. phoslo. 7. aspirin 81 mg 1 p.o. q.d. 8. zocor 80 mg 1 p.o. q.d. 9. plavix 75 mg 1 p.o. q.d. 10. protonix 40 mg 1 p.o. b.i.d. 11. multivitamin. 12. toprol xl 150 mg 1 p.o. q.d. 13. also the patient at home is on cozaar, lasix, glyburide, and zestril. social history: he is retired, wife is a ccu nurse, has children, no tobacco, no etoh. family history: his sister has a history of diabetes and has had an mi in the past. physical examination: physical exam on admission includes the following, heart rate 87, blood pressure 109/72, temperature is 98.2 degrees, weight is 92.2 kg, saturating at 99 percent on 2 liters, respiratory rate is 12. generally, the patient is a very pleasant male, in no acute distress. heent: normocephalic, atraumatic. extraocular movements are intact. oropharynx is clear with moist mucous membranes. neck is supple with no thyromegaly. jvd is to the jaw. cardiac exam revealed regular rate and rhythm with a holosytolic murmur at the apex radiating to the axilla. lungs are clear to auscultation with crackles one- half the way up bilaterally. no wheezes or rales. abdomen has good bowel sounds, soft, nontender, and nondistended with no hepatosplenomegaly. extremities are free of any clubbing, cyanosis, or edema. second middle toe is missing bilaterally. his extremities are cool, positive dopplerable dps bilaterally. positive dopplerable right pt, but no left pt. the patient's ekg on admission, normal sinus rhythm; left atrial enlargement; st elevations in v1, v2; st depressions in v4, v5; t-wave inversion in v5, v6; q wave in lead iii. echocardiogram from revealed a dilated left ventricle; inferior, inferolateral, distal, anterior, distal anterior septal and apical akinesis, ef of 30 to 35 percent, moderate mr, trace ai, mild tr, severe pulmonary hypertension, left atrial enlargement compared to , inferior wall motion abnormalities, new left ventricular function is worse and pa pressures are higher. on , the patient had a cardiac catheterization, which revealed a codominant system, lmca was normal, lad with 80 percent proximal stenosis, 90 percent d1 left circumflex, om1 with 80 percent lesion, rca 70 percent mid lesion. the patient's telemetry was normal sinus rhythm. his data on admission, white count 6.9, hematocrit 33.8, platelet count 191. calcium 10.0, sodium 139, potassium 3.8, chloride 101, bicarbonate 26, bun 85; creatinine is 5.8, baseline was 3.8. hospital course: cardiac. the patient had an echocardiogram performed on , which revealed the following: an ef of 20 percent, left atrium that is mildly dilated, mild symmetric left ventricular hypertrophy, left ventricular cavity size is normal, overall left ventricular systolic function is severely depressed; and left wall motion was as follows: the patient had resting regional left ventricular wall motion abnormalities as follows, mid anteroseptal akinetic, mid inferoseptal akinetic, mid inferior akinetic, mid inferolateral akinetic, anterior apex akinetic, septal apex akinetic, inferior apex akinetic, lateral apex akinetic. one plus tr was seen, one plus mr. underwent cardiac catheterization on , which revealed the following: right coronary diffusely diseased, proximal lad diffusely diseased, left main normal, distal lad diffusely diseased, d1 diffusely diseased, mid circumflex discrete 70 percent lesion, obtuse marginal discrete 80 percent lesion. selective coronary angiography demonstrated a right dominant circulation with three-vessel coronary artery disease. the lmca had no angiographically apparent flow-limiting stenosis. lad was diffusely diseased in the proximal portion with a more focal 80 percent stenosis and diffuse disease into the distal vessel, first diagonal branch was diffusely deceased, the left circumflex had a 60 to 70 percent mid vessel stenosis, om1 had focal 80 percent stenosis in proximal portion, rca was dominant diffusely diseased vessel, distal rca was subtotally occluded with timi 0-1 flow. selective angiography of the lima and rima demonstrated normal vessels without angiographic evidence of flow-limiting atherosclerotic disease, pull back of catheters from the left subclavian artery demonstrated no evidence of a hemodynamically significant stenosis in the major vessel. left ventriculography was deferred. the resting hemodynamics demonstrated moderate pulmonary hypertension with a mean pap pressure of 40. left and right sided filling pressures were moderately elevated with mean rap of 14, mean pulmonary- capillary wedge pressure 29. cardiac index is preserved at 2.6 liters per minute per sq. m. a 11.5 french and 19.15 cm long quinton dialysis catheter was placed in the right femoral vein at the end of the case. successful ptca and stent of the mid and proximal rca with a 2.0 x 13 mm pixel and then by 2.5 x 16 and then by 2.5 x 24 and 2.5 x 12 taxus stents back to the ostium. there was no residual stenosis, no dissection with timi 3 flow noted. coronary artery disease status post nstemi, status post cardiac catheterization. the patient was maintained on aspirin, plavix, lipitor, and lopressor. he was continued on heparin gtt initially. for afterload reduction, the patient was maintained on isordil and hydralazine. ace inhibitor was not entertained given his acute on chronic renal insufficiency. carotid ultrasound was obtained and revealed noncritical stenoses of his carotid arteries bilaterally. congestive heart failure. the patient was maintained on natrecor gtt. additionally, the patient had his femoral quinton pulled and a right ij quinton placed for hemodialysis. the patient was maintained on hemodialysis and had very good diuretic effect. renal failure. the patient was maintained on hemodialysis as stated above. he had evidence of hyponatremia during his hospitalization, which was felt secondary to congestive heart failure as well as acute renal failure. insulin-dependent diabetes mellitus. the patient was maintained on nph regular insulin sliding scale and the nph was titrated up during his hospitalization. prophylaxis. the patient was maintained on heparin, bowel regimen, and ppi. discharge diagnoses: type i diabetes. hypertension. end-stage renal disease. hypercholesterolemia. peripheral vascular disease. status post myocardial infarction with stents to the rca. fop: dr. , ct surgery, at . the patient is to call on to schedule an appointment within one week. the patient was to continue on outpatient dialysis at dialysis center beginning on . the patient is to set up an appointment with his primary care physician within one week of discharge. discharge medications: 1. calcium acetate 667 mg 1 p.o. t.i.d. with meals 2. multivitamin 1 p.o. q.d. 3. plavix 75 mg 1 p.o. q.d. 4. aspirin 325 mg 1 p.o. q.d. 5. nph, to be used as directed. 6. toprol xl 25 mg to be taken 5 tablets 1 p.o. q.d. 7. protonix 40 mg 1 p.o. q.d. 8. atorvastatin 40 mg 1 p.o. q.d. die status: he will be discharged to home. will follow up with dr. and have hemodialysis. discharge condition: stable. he is oxygenating well on room air. he is hemodynamically stable and had no further episodes of chest pain, shortness of breath, or other cardiac symptoms. , md 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 hemodialysis venous catheterization for renal dialysis angiocardiography of right heart structures injection or infusion of nesiritide insertion of drug-eluting coronary artery stent(s) diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified other chronic pulmonary heart diseases peripheral vascular disease, unspecified ulcer of heel and midfoot 

Answer: The patient is high likely exposed to