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: sulfa (sulfonamide antibiotics) / bactrim attending: chief complaint: chest/back heaviness- major surgical or invasive procedure: 1.coronary artery bypass graft x 3 left internal mammary artery grafted to left anterior descending artery, saphenous vein grafted to obtuse marginal, saphenous vein grafted to posterior descending artery. 2.primary sternal repair using synthes plating system times 5. history of present illness: 75f who has c/o chest/back heaviness times several months. persantine stress test was abnormal and she was referred for cardiac catheterization. this revealed two vessel coronary artery disease. admitted pre-operatively for heparin drip before high risk cabg. past medical history: coronary artery disease s/p coronary bypass grafting secondary: chronic atrial fibrillation on coumadin, diagnosed stable primary biliary cirrhosis type ii diabetes hypothyroidism polymyalgia rheumatica diagnosed , on prednisone hypercholesterolemia osteoarthritis vulvar cancer s/p vulvectomy at (no chemo or radiation) urinary incontinence s/p vulvectomy nephrolithiasis chronic lower extremity edema r/t lymphedema urosepsis arthritis left knee- needs replacement past surgical history: right hip replacement right knee replacement back surgery x 4 appendectomy tonsillectomy social history: race: caucasian last dental exam: edentulous lives with: husband occupation: retired director of nursing at tobacco: quit 35yrs ago etoh: 1 drink/day family history: sister died last year at age 71. s/p cabg at age 39, repeat age 49, peripheral bypass. father had an mi at age 50, died at age 76 from ruptured aaa physical exam: pulse: 69 a-fib resp: 16 o2 sat: b/p right: 130/54 left: height: 5'" weight: 310lb general: nad, obese female skin: dry intact heent: perrla eomi pupils fixed (bilat. cataracts) neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur abdomen: obese, soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema: 2+ pitting edema varicosities: moderate varicosities and spider veins neuro: grossly intact x pulses: femoral right: 2+ left: 2+ dp right: doppler left: doppler pt : doppler left: doppler radial right: 2+ left: 2+ carotid bruit no bruits pertinent results: pre-op labs 07:16pm pt-14.3* ptt-23.1 inr(pt)-1.2* 07:16pm plt count-184 07:16pm wbc-7.7 rbc-3.82* hgb-11.2* hct-34.1* mcv-89 mch-29.5 mchc-33.0 rdw-14.3 07:16pm %hba1c-6.9* eag-151* 07:16pm albumin-3.8 magnesium-2.0 07:16pm lipase-25 07:16pm alt(sgpt)-11 ast(sgot)-17 ld(ldh)-199 alk phos-103 amylase-50 tot bili-0.3 07:16pm glucose-253* urea n-26* creat-1.1 sodium-139 potassium-3.7 chloride-103 total co2-27 anion gap-13 09:54pm urine rbc-1 wbc-63* bacteria-few yeast-none epi-5 09:54pm urine blood-neg nitrite-neg protein-tr glucose-150 ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 09:54pm urine color-yellow appear-hazy sp -1.014 discharge labs: 04:22am blood wbc-7.3 rbc-3.03* hgb-9.2* hct-27.3* mcv-90 mch-30.5 mchc-33.8 rdw-15.5 plt ct-107* 04:22am blood plt ct-107* 04:22am blood pt-14.3* inr(pt)-1.2* 04:22am blood glucose-167* urean-31* creat-1.7* na-139 k-4.8 cl-104 hco3-28 angap-12 04:22am blood mg-2.3 01:59am blood wbc-11.9* rbc-2.82* hgb-8.6* hct-24.9* mcv-88 mch-30.7 mchc-34.7 rdw-15.3 plt ct-105* 04:22am blood wbc-7.3 rbc-3.03* hgb-9.2* hct-27.3* mcv-90 mch-30.5 mchc-33.8 rdw-15.5 plt ct-107* 05:45am blood wbc-6.3 rbc-2.91* hgb-8.8* hct-26.4* mcv-91 mch-30.3 mchc-33.4 rdw-15.2 plt ct-129* 06:07am blood hct-26.5* 05:45am blood pt-15.6* inr(pt)-1.4* 05:45am blood plt ct-129* 06:07am blood pt-15.3* inr(pt)-1.3* 04:22am blood glucose-167* urean-31* creat-1.7* na-139 k-4.8 cl-104 hco3-28 angap-12 05:45am blood glucose-156* urean-32* creat-1.4* na-140 k-3.6 cl-102 hco3-32 angap-10 06:07am blood glucose-140* urean-30* creat-1.3* na-137 k-4.1 cl-97 hco3-34* angap-10 radiology report chest (portable ap) study date of 8:46 am final report: in comparison with study of , the left chest tube has been removed and there is no pneumothorax. right central catheter has been exchanged for a sheath in the internal jugular vein. remainder of the examination is unchanged. carotid us on the right systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 52/22, 68/22, 91/28, , cm/sec. cca peak systolic velocity is cm/sec. eca peak systolic velocity is 67 cm/sec. the ica/cca ratio is 1.9. these findings are consistent with <40% stenosis. -on the left systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 65/20, 71/30, 64/26, cm/sec. cca peak systolic velocity is 53 cm/sec. eca peak systolic velocity is 73 cm/sec. the ica/cca ratio is 1.3. these findings are consistent with <40% stenosis. -there is antegrade right vertebral artery flow. there is antegrade left vertebral artery flow. -impression: right ica stenosis <40%. left ica stenosis <40%. blunted rcca waveform may indicate more proximal cca or innominate stenosis. vein mapping right: the right greater saphenous is patent throughout its length with diameters in the lower leg ranging from 3.6-4.2 mm. the thigh diameters range from 3.6-6.3 mm. left: the left greater saphenous is patent throughout with lower leg diameters ranging from 3.7-5.2 mm and thigh diameters ranging from 3.9-6.1 mm. all veins are thin-walled and compressible. impression: patent bilateral greater saphenous vein with good quality and appropriate diameters for conduit. echocardiography report echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.9 cm <= 5.6 cm left ventricle - ejection fraction: 60% >= 55% aorta - sinus level: *3.8 cm <= 3.6 cm aorta - sinotubular ridge: 2.6 cm <= 3.0 cm aorta - ascending: *3.9 cm <= 3.4 cm aorta - arch: 2.9 cm <= 3.0 cm aorta - descending thoracic: 2.2 cm <= 2.5 cm aortic valve - peak velocity: 1.3 m/sec <= 2.0 m/sec aortic valve - lvot diam: 1.8 cm findings multiplanar reconstructions were generated and confirmed on an independent workstation. left atrium: mild spontaneous echo contrast in the body of the la. mild spontaneous echo contrast in the laa. right atrium/interatrial septum: no spontaneous echo contrast in the body of the ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). right ventricle: mildly dilated rv cavity. normal rv systolic function. aorta: mildy dilated aortic root. mildly dilated ascending aorta. normal aortic arch diameter. normal descending aorta diameter. focal calcifications in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). filamentous strands on the aortic leaflets c/with lambl's excresences (normal variant). no ar. mitral valve: mildly thickened mitral valve leaflets. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the rhythm appears to be atrial fibrillation. results were personally reviewed with the md caring for the patient. conclusions prebypass mild spontaneous echo contrast is seen in the body of the left atrium. mild spontaneous echo contrast is present in the left atrial appendage. no spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there are filamentous strands on the aortic leaflets consistent with lambl's excresences (normal variant). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. postbypass the patient is a-paced on a phenylephrine infusion. left ventricular function continues to be normal (lvef >60%), although it is underfilled. mitral regurgitation is now trace and there is still no aortic regurgitation. the thoracic aorta is intact post decannulation. brief hospital course: ms was admitted for surgical management of coronary artery disease. pre operatively she had a routine workup that included heparinization as a bridge for anticoagulation. she also had carotid ultrasound and vein mapping. on she was brought to the operating for for coronary bypass grafting, please see the operative report for details. in summary she had: 1.coronary artery bypass graft x 3 left internal mammary artery grafted to left anterior descending artery, saphenous vein grafted to obtuse marginal, saphenous vein grafted to posterior descending artery. 2.primary sternal repair using synthes plating system times 5. her bypass time was 53 minutes with a crossclamp of 42 minutes. she tolerated the procedure well and was transferred to the cardiac surgery icu in stable condition. she woke from anesthesia neurologically intact and was extubated. she remained in the icu on neosynephrine to support her hemodynamically, this was weaned to off over the first 24 hours. on pod2 she was transferred from the cvicu to the stepdown floor for continued post-operative recovery. the remainder of her post-operative course was generally uneventful. all tubes lines and drains were removed per cardiac surgery protocol. once on the floor she continued to make slow progress in advancing her activities of daily living, she remained hemodynamically stable throughout this period. she had atrial fibrillation and therefore her coumadin was resumed. on pod5 she was transferred to rehabilitation at - in stable condition. medications on admission: medications at home: medications - prescription estradiol - (prescribed by other provider) - dosage uncertain furosemide - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth daily gabapentin - (prescribed by other provider) - 300 mg capsule - 1 capsule(s) by mouth twice a day insulin glargine - (prescribed by other provider) - 100 unit/ml cartridge - 24 units hs levothyroxine - (prescribed by other provider) - 137 mcg tablet - 1 tablet(s) by mouth daily metoprolol tartrate - (prescribed by other provider) - 50 mg tablet - 1 tablet(s) by mouth twice daily oxybutynin chloride - (prescribed by other provider) - 5 mg tablet extended rel 24 hr - 2 tablet(s) by mouth twice a day pravastatin - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth at hs prednisone - (prescribed by other provider; dose adjustment - no new rx) - 1 mg tablet - 6 tablet(s) by mouth once a day tramadol - (prescribed by other provider) - 50 mg tablet - tablet(s) by mouth prn trimethoprim - (prescribed by other provider) - 100 mg tablet - 1 tablet(s) by mouth daily ursodiol - (dose adjustment - no new rx) - 300 mg capsule - 3 capsule(s) by mouth twice a day warfarin - (prescribed by other provider) - 4 mg tablet - 1 tablet(s) by mouth daily resume on friday and inr on tuesday per usual medications - otc cyanocobalamin (vitamin b-12) - (prescribed by other provider) - dosage uncertain discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain. 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 9. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 10. cyanocobalamin (vitamin b-12) 50 mcg tablet sig: one (1) tablet po once a day. 11. trimethoprim 100 mg tablet sig: one (1) tablet po q24h (every 24 hours). 12. vitamin a 10,000 unit capsule sig: two (2) capsule po daily (daily). 13. oxybutynin chloride 5 mg tablet sig: two (2) tablet po bid (2 times a day). 14. prednisone 1 mg tablet sig: six (6) mg po daily (daily). 15. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 16. ursodiol 300 mg capsule sig: three (3) capsule po bid (2 times a day). 17. levothyroxine 137 mcg tablet sig: one (1) tablet po once a day. 18. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 19. warfarin 1 mg tablet sig: as directed to keep inr 2-2.5 tablets po once daily at 4 pm: target inr 2-2.5 was taking 4mg daily(pre-op). 20. lasix 40 mg tablet sig: one (1) tablet po twice a day. 21. insulin glargine 100 unit/ml solution sig: twenty five (25) units subcutaneous once a day. 22. insulin regular human 100 unit/ml solution sig: sliding scale injection q ac&hs. 23. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease secondary: chronic atrial fibrillation on coumadin, diagnosed stable primary biliary cirrhosis type ii diabetes hypothyroidism polymyalgia rheumatica diagnosed , on prednisone hypercholesterolemia osteoarthritis vulvar cancer s/p vulvectomy at (no chemo or radiation) urinary incontinence s/p vulvectomy nephrolithiasis chronic lower extremity edema r/t lymphedema urosepsis arthritis left knee- needs replacement past surgical history: right hip replacement right knee replacement back surgery x 4 appendectomy tonsillectomy discharge condition: alert and oriented x3 nonfocal activity-oob to chair with assist incisional pain managed with percocet incisions: sternal - keep tegaderm intact until appt with dr. . healing well, no erythema or drainage. jp drain to bulb suction- to be removed by dr. in 1 week. bilat le: + bilat pedal edema; with staples no erythema, serosang drainage d/t edema. leg staples may be removed by rehab np/md in 2weeks discharge instructions: **keep sternal tegaderm dressing on until postop appointment with plastic surgery-dr. . he will remove dressing and jp drain in one week- please call to make this appointment. please do sponge bath every day. wash legs daily, but keep sternum dry. you can wash with with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra at all times to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr : on at 1pm cardiologist: dr on at 3:40pm **please call to schedule the following: primary care dr. in weeks ( plastic surgeon: dr. in one week - will remove jp drain and sternal dressing at this appointment. ., , , office phone: ( **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** please call to schedule appointments with your primary care dr , in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication: atrial fibrillation goal inr:2-2.5 first draw : day after discharge procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of two coronary arteries diagnoses: coronary atherosclerosis of native coronary artery polymyalgia rheumatica pure hypercholesterolemia long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation long-term (current) use of insulin morbid obesity long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, lower leg personal history of malignant neoplasm of other female genital organs biliary cirrhosis body mass index 45.0-49.9, adult 

Answer: The patient is high likely exposed to