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 (sulfonamides) attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization history of present illness: the patient is a 78 yr old female with pmh significant for hyperlipidemia who presented to the outside hospital with substernal non-radiating chest pain that began at 4:15 am . she denied any associated nausea, vomiting, shortness of breath, or diaphoresis. her symptoms started shortly after she was woken up by thunderstorm and nearby lightning strike. she called the ambulance at 4:50 am and arrived to the er shortly thereafter. at the osh the patient was found to be hypotensive with bp 82/44 and bradycardic hr 42-47. she was also noted to be lightheaded and diaphoretic. her low blood pressure responded to 1l ns bolus. ekg showed st elevations in v3-v6, i, and q waves with elevations in inferior leads. pt received aspirin, integrillin, nitroglycerin and heparin drips and then transferred to for catheterization. past medical history: 1. hyperlipidemia, on lipitor 2. chronic sinusitis, on prednisone 5 mg q m,w,f 3. s/p hysterectomy 4. s/p cholecystectomy social history: lives alone with a dog. daughter liver nearby and is an er physician. history of tobacco use. family history: autoimmune disorders, including sle and raynaud's in the family. physical exam: physical examination following arrival to ccu after catheterization: afebrile, bp 110/70, hr 110, rr12, o2 sat 99% on 2l nc general: alert and oriented x 3, nad heent: nc, at, perrla, eom intact, sclera white, mm moist neck: no elevated jvp, no thyromegaly, no carotid bruits pulm: cta bilaterally cv: regular s1s2, no m/g/r abd: +bs, soft, nt, nd extr: no c/c/e, dp pulses strong and symmetric bilaterally r groin: no ecchymosis, no hematoma, no bruit pertinent results: 06:40am blood pt-12.7 ptt-81.0* inr(pt)-1.0 09:35am blood ck(cpk)-411* 05:02pm blood ck(cpk)-330* 11:45pm blood ck(cpk)-281* 05:44am blood ck(cpk)-239* 09:35am blood ck-mb-25* mb indx-6.1* ctropnt-1.40* 05:02pm blood ck-mb-17* mb indx-5.2 ctropnt-0.86* 11:45pm blood ck-mb-13* mb indx-4.6 05:44am blood ck-mb-11* mb indx-4.6 ctropnt-0.59* 09:35am wbc-8.0 rbc-3.60* hgb-11.8* hct-32.4* mcv-90 mch-32.7* mchc-36.3* rdw-12.4 09:35am plt count-215 09:35am neuts-76.2* lymphs-17.8* monos-3.6 eos-2.0 basos-0.5 09:35am glucose-105 urea n-15 creat-0.6 sodium-143 potassium-3.7 chloride-109* total co2-27 anion gap-11 09:35am calcium-8.1* phosphate-3.0 magnesium-1.9 iron-102 cholest-135 09:35am caltibc-285 vit b12-369 folate-greater th ferritin-55 trf-219 09:35am triglycer-79 hdl chol-75 chol/hdl-1.8 ldl(calc)-44 09:35am tsh-2.5 09:35am -negative 06:40am blood glucose-100 urean-14 creat-0.7 na-142 k-3.7 cl-107 hco3-29 angap-10 cardiac catheterization : pa mean 9 mmhg; rv 30/11 mmhg; pa 30/13/19 mmhg; pcw mean 15 mmhg; lv 110/20 mmhg; aorta 110/70/19 mmhg; co 5.0 l/min; ci 2.9 l/min/m2; svr 160; pvr 64; 72%. right dominant; lmca was free of obstructive disease; lad had mild proximal plaquing; lcx no angiographically significant disease; rca no disease. left ventriculography revealed extensive anteroapical and inferoapical akinesis, with hyperdynamic function of the anterior and inferior bases. the calculated ejection fraction was depressed at 33%. no significant mitral regurgitation was visualized. final diagnosis: 1. coronary arteries are free of angiographically-significant cad. 2. moderate systolic ventricular dysfunction. 3. mild diastolic ventricular dysfunction. 4. ekg evidence of anterolateral st elevation with extensive apical akinesis and non-obstructive coronary artery disease. possible explanations include transient apical ballooning syndrome, mi with recanalized artery, focal myocarditis, coronary vasospasm. transthoracic echocardiogram : la is normal in size. lv wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction (ejection fraction 45%). there is hypokinesis of the entire apex/distal of the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. brief hospital course: the patient was admitted to the ccu service. differential diagnoses for abnormal lv function in the setting of ekg changes and normal coronary arteries included acute coronary syndrome s/p spasm or s/p auto-lysis, eosinophilic cardiomyopathy, and takotsubo apical ballooning syndrome. given her history, presentation, and clinical findings, tokotsubo apical ballooning syndrome was thought to be most likely. 1. cad - the patient received integrillin x 18 hours following catheterization. cardiac enzymes peaked ck 440 and ckmb at 25 and had been trending down. then she was started on heparin b/o low ef with wall motion abnormalities. after echo was obtained, the patient was started on coumadin. she was discharged with inr 1.0, on lovenox to bridge her to oral anticoagulation until her inr will become therapeutic. she will continue coumadin 5 mg po qhs and she was given prescription for inr check to be done in 3 days. the results will be called to her primary care physician who will manage her coumadin. lovenox teaching was done prior to the patient's discharge. she should remain on oral anticoagulation for at least 2 months depending on improvement of lv function with goal inr 2.0-3.0. the duration of her anticoagulation therapy will be decided by her cardiologist. the patient was also started on aspirin, low dose beta-blocker, and ace inhibitor that were titrated up as bp and hr tolerated. prior to discharge, the patient's beta-blocker and ace inhibitor were changed to longer acting once-a-day formulations. her bp was stable with sbp in 110's on the day of discharge on her outpatient regimen. 2. cardiomyopathy - again, this was thought to be due to takotsubo apical ballooning syndrome. echocardiogram was done on hd #3 and revealed ef 45%. tsh, iron studies, and were checked and were all within normal limits. the patient was started on the ace inhibitor and beta-blocker. 3. sinusitis - the patient was continued on her outpatient regiment of prednisone 5 mg po 3x/week. the possibility of adrenal insufficiency was entertained in the patient presenting with hypotension, but was felt to be unlikely with small doses of steroids and every other day dosing. medications on admission: calcium 1500 mg po qd, lipitor 10 mg po qd, prednisone 5 mg po 3x/week (monday, wednesday, friday), oxybutynin, zantac 150 mg po bid discharge medications: 1. enoxaparin sodium 60 mg/0.6ml syringe sig: one (1) subcutaneous q12h (every 12 hours) for 4 days: please contact your primary care physician regarding when you should stop taking lovenox. . disp:*8 * refills:*0* 2. calcium carbonate 500 mg tablet sig: one (1) tablet po every eight (8) hours. 3. metoprolol succinate 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po qd (once a day). disp:*30 tablet sustained release 24hr(s)* refills:*2* 4. prednisone 5 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 5. lisinopril 5 mg tablet sig: 0.5 tablet po qd (once a day). disp:*15 tablet(s)* refills:*2* 6. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*10 tablet(s)* refills:*0* 7. atorvastatin calcium 10 mg tablet sig: one (1) tablet po qd (once a day). disp:*30 tablet(s)* refills:*2* 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po qd (once a day). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. zantac 150 mg capsule sig: one (1) capsule po twice a day. 10. oxybutynin chloride 5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. outpatient lab work please draw serum k, mg levels and pt-inr on thursday . please call results to dr. (. thanks. discharge disposition: home with service facility: diversified vna discharge diagnosis: 1. probable takotsubo apical ballooning syndrome 2. hyperlipidemia 3. sinusitis discharge condition: stable discharge instructions: please take all your medications as prescibed. please contact you primary care physician for you coumadin monitoring and dose adjustment. please have you blood drawn for inr, k, mg level. the results will be called to your primary care physician, . (. in addition to your medications listed on this discharge form, you may continue taking your inhalers as you did prior to this admission. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. followup instructions: 1. dr. (primary care physician) at 10 am ( 2. dr. (cardiologist) at 12 noon ( md, procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor diagnoses: other primary cardiomyopathies subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified other and unspecified hyperlipidemia combined systolic and diastolic heart failure, unspecified unspecified sinusitis (chronic) heart disease, unspecified 

Answer: The patient is high likely exposed to