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: this 51-year-old female with known history of diabetes mellitus and a strong family history for coronary artery disease awoke on with some crushing chest pain radiating to her left arm and back and felt very lightheaded. she went to an outside hospital where her troponin was elevated and she ruled in for a non st elevation myocardial infarction. she was transferred into for cardiac catheterization on . past medical history: insulin dependent diabetes mellitus. status post cervical cancer in with hysterectomy. status post cerebrovascular accident in with slurred speech and left sided weakness but no residual effect. status post pin placement left knee. status post appendectomy. status post tonsillectomy and adenoidectomy. allergies: levaquin. morphine. demerol. both morphine and demerol produce nausea and vomiting. medications: 1. aspirin 325 mg p.o. q day. 2. insulin 70/30 mix 42 units q am, 30 units q pm. 3. glucophage 1000 mg p.o. twice a day. cardiac catheterization was performed on on her admission with the following results. ejection fraction 45%. left ventricular end-diastolic pressure 29. mild diffuse left main disease, moderate diffuse mid-lad disease, severe diffuse mid to distal left anterior descending coronary artery, totally occluded left circumflex and severe diffuse disease of the right coronary artery. review of symptoms: the patient reported an 80 pound recent weight loss that was intentional. she also admitted to frequent urinary tract infections, some wheezing and some abdominal pain with palpation which he has always had, the workup is negative. she also said she had no thyroid problems, bleeding or clotting problems. she worked as a manager of a convenience store, she had no tobacco or no alcohol history and no use of marijuana or cocaine and lived alone. physical examination: her pulse is 106, blood pressure 138/73, respiratory rate 16. she is sating 97% on two liters. she was awake, and alert and oriented. her pupils equal, round and reactive to light and accommodation. eom's were intact. her strength was equal upper extremities and lower extremities bilaterally. her heart was regular rate and rhythm with no murmur, with no rub. her abdomen was obese with positive bowel sounds, soft, nontender, with some tenderness to palpation as previously reported. the patient said her abdomen is always tender, the workup was negative prior to this admission. the patient did have some heme positive emesis in the catheter laboratory with small amount of not frank blood. preop laboratory: white count 10.7, hematocrit 37.0, platelet count 250,000, sodium 136, k 4.2, chloride 102, co2 24, bun 21, creatinine 0.8 with a blood sugar of 360. prothrombin time 13.2, inr 1.2, ptt 28.4, alt 30, ast 109, alkaline phosphatase 79, total bilirubin 0.6, amylase 39, lipase was pending. type and screen was placed on the computer. physical examination: pulses: the right femoral was in a sheath but popliteal, dorsalis pedis, posterior tibial, radial were all 2+. on the left leg, femoral, popliteal, dorsalis pedis and posterior tibial and radial were all 2+. the patient had no bruits appreciated in either carotid artery. her extremities had no edema or varicosities. chest x-ray and urinalysis were ordered. decision was made to try and get carotid ultrasounds prior to the operating room. aggrastat was to be discontinued at midnight which the patient had been placed on after her cardiac catheterization. later that evening the patient did complain of some heaviness in her chest with no shortness of breath, nausea, vomiting but a little bit of a cough. blood pressure was 157 and then went down to 119/62, heparin drip was to be started four hours after the sheath pull with a plan to start the patient on a nitroglycerin drip if the chest pain returned. the patient was pain free later on, on heparin drip. dr. saw the patient on the 28th and explained relative high risk of her case. he spoke to dr. to have him reassess the patient. the patient did go to the cardiac catheter laboratory on for preoperative intra- aortic balloon in preparation of her surgery. the patient's height is 5 foot, 1 inches with a weight of 229 pounds. the balloon was placed in the left femoral artery on prior to surgery and prior to the operating room she was on heparin and nitroglycerin drips. she also received midazolam preoperatively and received 10 units of regular insulin sliding scale for a blood sugar of 361 at 10 o'clock that morning. of note, the patient did not receive her carotid ultrasound due to the fact of her instability and intra-aortic balloon placement and moving to the operating room for her coronary surgery which was performed on by dr. with a catheter coronary artery bypass grafting times three with a left internal mammary artery to the left anterior descending coronary artery, to the posterior descending coronary artery and to the obtuse marginal. the patient was transferred to the cardiothoracic intensive care unit on a propofol drip at 30 mcs per kilo per minute and a neo-synephrine drip at 0.5 mcs per kilo per minute in stable condition. in the evening of there is no examination note to be found in the chart from postop day one on however, there are a couple of events. the patient had already been extubated after her operation by the time she was seen by anesthesia for the postop check. she was on nordinone at that time for decreased cardiac output. she was otherwise stable. she was seen at 7 o'clock in the evening on postop day one by the cardiology fellow for a diffuse anterior st elevation. she was hemodynamically stable without any symptoms. tte was performed stat which showed that the walls were contracting vigorously and laterally and at the septum but the anterior inferior walls were less well seen but appeared to contract well also. there was some trace mr with an injection fraction of greater than 50% no effusion was seen on parasternal and apical views, no subcostal views were performed due to habitus, wires and chest tube drains. the assessment by dr. was that there was no evidence of acute ischemic territory on limited views and that he recommended if she became hemodynamically unstable or had symptoms to consider transesophageal echocardiography. on the evening of the patient remained on propofol and insulin drip. she was also started on malarone drip but was extubated by the time anesthesia saw her on postop day one. on postop day she remained on a neo- synephrine drip at 0.5 mcs per kilo per minute, on aspirin, plavix, lasix twice a day, and lopressor twice a day, off her beta-blockade. she continued with perioperative vancomycin for coverage. her balloon was at 1-to-1. she was in sinus tach at 114, blood pressure of 92/73 with a cardiac index of 2.1 with the balloon on 1-to-1. she was sating 96% on three liters. laboratory: white count 17.1, hematocrit 32.1, platelet count 140,000. sodium 141, k 5.3, chloride 104, co2 23, bun 24, creatinine 1.5 with a blood sugar of 129 and a lactate of 1.2. inr of 1.3, prothrombin time 13.8, ptt 29.1. her pacing wires remain in place. she was tachycardiac as noted. incisions were clean, dry and intact. she got a new a-line and the decision was made to at least discuss the sinatracor. she received lasix 60 mg times one to help boost her urine output. on postop day two at 11:30 in the morning her intra-aortic balloon pump was removed the cardiology fellow with good pulses and no hematoma formation on postop day three she remained on neo-synephrine drip at 0.25 mcs per kilo per minute, continuing with aspirin, plavix, lasix and lopressor. she was also on an insulin drip at 3 units per hour, still slightly tachycardiac at 108 with a blood pressure of 127/03, cardiac index of 2.27, sating 96% on three liters with a blood gas of 7.31/50/87/26/-1. labs: white count dropped to 11.8, hematocrit to 28.3, platelet count dropped again slightly to 113,000, bun 27, creatinine 1.3, blood sugar of 80. her lungs were coarse but relatively clear. heart was regular in rate and rhythm with tachycardia. incisions were clean, dry and intact. her sternum is stable. off milrinone and the intra-aortic balloon pump. the chest tubes have been pulled on the evening prior, . the patient was seen and evaluated by physical therapy also. on postop day four the patient had been weaned off neo- synephrine, the swann was discontinued. she was back on her insulin drip. continuing with her oral medications when insulin drip was still at 3 units per hour, blood pressure 149/81, temperature maximum of 98.9, sinus tachycardia at 110. lopressor at that time was at 25 mg twice a day. she was sating 97% on two liters nasal cannula. her creatinine dropped to 1.0, blood sugar was at 93 in the morning, platelet count rose slightly to 150 and white count continued to drop to 9.1. her heart was regular rate and rhythm. her sternal incision was clean, dry and intact. her lungs were clear bilaterally. abdominal examination and leg incisional exams were benign. her lopressor was increased to 50 mg p.o. three times a day and the patient was encouraged to be out of bed and ambulating. she was also evaluated by case management. on postop day five she remained in csru and was weaned off her insulin drip, a new line was placed for monitoring. she remained at lopressor 37.5 mg p.o. twice a day, she was in sinus rhythm at 95, with a blood pressure of 107/72, sating 96% now on room air with more normalization of her creatinine with a bun of 29 and a creatinine of 0.9. k 4.0. white count 9.1, hematocrit 28.8 and her platelet count rose slightly to 165,000. she was quite sleepy but easily arouseable. her examination was benign an d a discussion continued about whether or not to be able to transfer her to the floor. the patient was out of bed and ambulating in the csru. the patient was seen by dr. , cardiac catheterization attending on who noted her continuing tachycardia and recommended increasing her lopressor over the next 24 hours as her blood pressure would tolerate it. : the patient was screened for nutritional risks by the clinical nutrition team. the patient also had consult on for management of her diabetes mellitus. the patient also had a consult. the neurology stroke attending, dr. saw the patient on , was asked to consult by dr for a question of acute stroke verses old stroke that was expressed in this 51-year- old woman with a new hand paresthesia and an odd sensation. please refer to her neurologic examination. she recommended getting an magnetic resonance imaging with dwi/mra of brain to examine her for a new stroke and made other recommendations in terms of her laboratory work and blood pressure maintenance. she was noting that the patient may be re-expressing an old stroke or may have a new event and could not entirely rule out metabolic encephalopathy. please refer to dr. examination note. the patient also was seen by physical therapy where she complained that she could not really feel that arm very well. the ct of her head on showed a wedge shaped area of parenchymal infarct in the posterior aspect of the right frontal lobe. this was likely recent and clinical correlation follow-up was recommended. there was no intracranial hemorrhage or hydrocephalus noted. the patient also had an mra of the head done on which showed multiple acute infarcts involving the right posterior superficial water shed and bilateral deep water shed. her territories and left cerebellar hemisphere indicative of acute infarcts and small vessel disease. the mra of the head demonstrated normal flow signal within the arteries of anterior and posterior circulation which was normal mra of the head. a limited carotid ultrasound was done due to the central line placement on which showed no evidence of stenosis in the right or left carotid arteries. the patient continued to work with physical therapy. on the patient was alert and awake and moving all extremities. left side was stronger on and had sensation to left lower extremity and halfway up distally of left upper extremity, was able to follow directions. her mental status seemed to be improved. the patient from a respiratory point of view was better, was able to cough up her own sputum, was sating 97% on room air. on postop day six, the fluctuating neurologic deficits of the prior day which ultimately resulted in a diagnosis of stroke on ct of the head were noted. the patient remained on neo-synephrine drip at 1.8 with a blood pressure of 149/74 and sinus rhythm in the 90's. she is sating well on two liters nasal cannula. her neurological status continued to be monitored. previous results carotid ultrasound, and magnetic resonance imaging of the brain were noted in the prior paragraph. on postop day seven, the patient had a stable neurologic status, had occipital headache overnight which resolved with tylenol. she was on neo-synephrine drip at 04. mcs per kilo per minute. she continued on aspirin, plavix, lasix and metoprolol at 50 mg twice a day of metoprolol as well as lipitor and protonix. blood pressure is 132/83. sating 97% on room air in sinus rhythm in the 90's. with laboratory as follows: white count 11, hematocrit 28, platelet count 312,000. sodium 140, k 4.1. chloride 104, co2 28, bun 21, creatinine 0.7, blood sugar 230,000. inr 1.4, prothrombin times 14.5, ptt 26.1. her heart was regular rate and rhythm. her sternum was stable,, incision was clean, dry and intact. cranial nerves 3 through 12 she was not in any apparent distress and was alert and oriented. her eoms were benign. chest was clear bilaterally. she continued to improve and continue to get out of bed an d ambulate with physical therapy as tolerated. the patient was also seen again by clinic for management of her insulin and sugar control. was followed daily the stroke consult team and as she remained in the hospital. she continued to work with physical therapy. on she was transferred out to the floor. in the evening on postoperative day 8, she was on the floor sating well 94% on room air. the blood pressure 100/58 with a heart rate of 94 and in sinus rhythm. her fasting sugar was 114 that morning, she had some mild crackles left side greater than the right, her examination was otherwise unremarkable. her right ij line remained in place. repeat labs were drawn. her central line was discontinued later in the day and a follow-up magnetic resonance imaging was to be scheduled. she continued also to see occupational therapy and consult physician all of whom noted her diagnosis with the neurologic deficits that have been identified. on postop day nine, she had some premature ventricular contractions on telemetry, she was shortness of breath and desated with some vigorous walking once but was okay and made a good recovery after that. she had a blood pressure of 102/76. her examination was unremarkable. the patient continued to do well and was alert and oriented neurologically. stroke consult recommended keeping her systolic blood pressure above 130. her insulin at that time was lispro 75/25 mixed and she was also on metformin for sugar control which was managed by consult recommendations. seh continued to work with physical therapy, she continued to have some numbness of her hand but continued overall improvement. on she did have some diarrhea, c. diff was sent. the patient was taking tylenol for pain at that point with good relief. remained afebrile with a blood pressure of 126/84, sating 97% on room air. on postop day ten, she complained of some aching around her sternum. telemetry showed a question of some pvcs. her heart rate was 96 in sinus rhythm with a blood pressure of 134/83. sating 94% on room air with a t-max of 99.4. she had some slight crackles bilaterally. she remained on strict i&o's. lab: white count 8.1, hematocrit 23.3, sodium 142, k 4.7, bun 20, creatinine 0.8 with a blood sugar of 91. magnesium was given for repletion and a culture repletion and the culture for c. diff was waited. the patient continued to receive p.o. lasix and was very anxious to get home. the patient was seen again by case management on . the patient was also seen by neurological again on , she reported in the hallway that bothered her eyes and her vision blurred a little bit and objects were not well she reported in the hallway that light bothers her eyes, her vision blurred a little bit and objects were not well distinguished. she had no other visual field deficits and was able to see anything but the lights appeared extremely bright to her. assessment: follow-up with the ophthalmologist and this was discussed with the patient by the stroke consult team and recommended to, continue her on aspirin, plavix and a statin for stroke prevention. on postop day 11, which was the day of discharge the examination was as follows. the patient had a t-max of 99.5., was in sinus rhythm at 98 with a blood pressure of 101/68, sating 95% on room air. her exam was completely unremarkable. her chest x-ray showed bilateral pleural effusions. the c. diff culture was negative and the patient continued to do very well with a plan for her to be able to go home that day. she had a final evaluation by physical therapy and was able to be discharged to home on . discharge diagnosis: status post coronary artery bypass graft times three. coronary artery disease. status post cerebrovascular accident postoperatively. insulin dependent diabetes mellitus. obesity. myocardial infarction. cervical cancer. old cerebrovascular accident. discharge medications: 1. metoprolol 50 mg p.o. twice a day. 2. potassium chloride 20 meq p.o. twice a day times seven days. 3. colace 100 mg p.o. twice a day. 4. aspirin 325 mg p.o. q day, delayed release entericoated. 5. protonix 40 mg delayed release entericoated p.o. q day. 6. lipitor 20 mg p.o. q day. 7. metformin 1000 mg p.o. twice a day. 8. plavix 70 mg p.o. q day. 9. lasix 20 mg p.o. twice a day times seven days. 10. insulin 70/30 suspension mix 42 units q am, 30 units q pm. the patient was instructed to follow-up with dr. for her postoperative surgical visit in six weeks in the office. to follow-up with dr. of neurology in one month. to follow-up with dr. the primary care physician in two to three weeks and to see her cardiologist also postoperative in approximately two to three weeks. the patient was discharged to home on . , procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of two coronary arteries angiocardiography of left heart structures left heart cardiac catheterization coronary arteriography using a single catheter implant of pulsation balloon diagnoses: acidosis nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to