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) / iv dye, iodine containing / tetanus attending: chief complaint: transferred from hosp for management of nstemi major surgical or invasive procedure: coronary catheterization x2 history of present illness: 84 yo f c htn, r breast ca s/p lumpectomy and xrt who presented from an osh with a nstemi, now s/p cath with iabp and dopamine gtt. the pt began to experience l shoulder pain that moved anteriorly into her substernal left chest on the morning of that occurred both at rest and exertion. she took 2 tylenol for the pain but it quickly returned so she presented to osh. at the time she had no sob, pnd, orthopnea, or ankle swelling. at the osh ekg demonstarted twi in i and avl with biphasic t waves in v2 and v3 an inverted t wave in v4. troponin i was 1.48 then 2.18. ck-mb was 13.2 then 14.8. she was started on heparin, integrilin, ntg, aspirin, metoprolol, and simvastatin and transferred to . overnight, she remained cp free on a nitro gtt. she was taken to the cath lab on which was significant for a 90% ulcerated proximal lesion in the mid lad, 70% prox lesion in the diagonal, focal 90% stenosis in large om, and 40% small mid rca lesion. a cypher stent was deployed in the lad lesion when the pt developed no reflow, hr 40s, sbp 40s, and elevations on the monitor. the pt was given aytropin 0.5 mg x 1, dopamine gtt at 5 mcg/kg/, a iabp was placed, and flow was restored in the lad with ic vasodilators. final angiography revealed normal flow, no dissection, and 0% residual stenosis in the lad and 40% stenosis at the origin of the diagonal. the pt denied any cp, sob, or lightheadedness during this episode. she was then transferred to the ccu for further management off of dopamine. patient has now been transferred from the ccu to the cardiology team. she is currently in stable condition and off of pressors and iabp. she denies chest pain, shortness of breath, palpitations, n/v, abdominal pain, fevers, chills or diarrhea. patient states she feels well and has no complaints. past medical history: - resection of a tumor, ?plasmacytoma, of the ethmoid sinus in , s/p xrt, now blind in l eye - htn - basal cell skin cancers - right breast cancer s/p lumpectomy and xrt - h/o patellar fracture - partial hysterectomy - r hip orif social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: father died at age 47 of lung ca, mother deceased at age 79 of unknown cause. mother with mi in 70s. physical exam: (on admission) vs - 97.2 100/52 67 21 100% 2l nc gen: frail elderly female in nad. oriented x3. tangential thought process but easily redirectable. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. blind in l eye and l ptosis, pt states her eyelid is always half open. neck: supple with jvp of approx. 8 cm. cv: pmi located in 5th intercostal space, midclavicular line. normal s1, s2. + systolic and diastolic flow murmurs iabp. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi heard anteriorly. abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. no femoral ecchymosis, + b/l groin arterial sheaths in place. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 06:25am blood wbc-12.2* rbc-4.06* hgb-12.4 hct-36.8 mcv-91 mch-30.4 mchc-33.7 rdw-14.3 plt ct-327 09:06am blood wbc-15.2* rbc-3.15* hgb-9.4* hct-27.8* mcv-88 mch-29.8 mchc-33.8 rdw-14.4 plt ct-248 05:53am blood wbc-9.1 rbc-3.25* hgb-10.0* hct-29.6* mcv-91 mch-30.7 mchc-33.7 rdw-14.4 plt ct-194 06:00am blood wbc-12.9* rbc-3.08* hgb-9.5* hct-27.6* mcv-90 mch-30.8 mchc-34.3 rdw-14.4 plt ct-174 06:25am blood pt-14.0* ptt-150* inr(pt)-1.2* 05:39am blood ptt-46.2* 05:39am blood plt ct-148* 06:00am blood plt ct-174 06:25am blood glucose-94 urean-20 creat-1.1 na-141 k-4.4 cl-104 hco3-25 angap-16 06:00am blood glucose-87 urean-16 creat-0.9 na-138 k-3.6 cl-103 hco3-25 angap-14 06:25am blood alt-9 ast-37 ld(ldh)-321* ck(cpk)-486* alkphos-73 totbili-0.5 10:45am blood ck(cpk)-411* 07:26pm blood ck(cpk)-370* 09:06am blood ck(cpk)-476* 05:04am blood ck(cpk)-560* 05:53am blood ck(cpk)-312* 09:11pm blood ck(cpk)-254* 06:25am blood ck-mb-16* mb indx-3.3 ctropnt-0.35* 02:40pm blood ck-mb-9 ctropnt-0.37* 05:29pm blood ck-mb-9 ctropnt-0.35* 05:36pm blood ck-mb-6 ctropnt-0.41* 05:53am blood ck-mb-6 ctropnt-0.38* 06:25am blood calcium-8.9 phos-3.4 mg-2.7* cholest-238* 06:00am blood calcium-8.3* phos-3.3 mg-2.3 06:25am blood triglyc-110 hdl-68 chol/hd-3.5 ldlcalc-148* . ekg on admission: sr 71 nml axis with twi in i, avl, v2-v5, and 1mm st depression in iii. at osh, twi in i and avl were similar but v2 and v3 had biphasic t and v4 had an inverted t. . coronary cath (): lmca - without angiographically apparent flow-limiting stenoses. lad - proximal ulcerated 90% lesion extending into mid lad d1 - proximal 70% lesion lcx - focal 90% stenosis in om1 rca - small with a 40% mid vessel lesion. successful stenting of the lad with a 3.0 x 33 cypher des with no residual stenosis successful poba of the d1 with 40% residual stenosis iabp placement for circulatory support . ekg s/p cath : nsr @ 75 bpm, nl axis, nl intervals, twi v2-6, i, avl, 0. elev v2. . echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity is unusually small. there is mild to moderate regional left ventricular systolic dysfunction with akinesis of the anteroseptal wall, anterior wall and anterior apex. right ventricular chamber size and free wall motion are normal. no aortic regurgitation seen, no mitral valve prolapse. no mitral regurgitation is seen. . c.cath: comments: the left main demonstrated no flow limiting lesions throughout. the left anterior descending artery demonstrated widely patent stents with timi iii flow throughout. the first diagonal demonstrated a 50% lesion in the origin. the left circumflex artery demonstrated a 90% lesion in the mid portion of the first obtuse successful ptca and stenting of the first obtuse marginal with a cypher (3.5x18mm) drug eluting stent postdilated with a 3.5mm balloon. final angiography demonstrated no angiographically apparent dissection, no residual stenosis and timi iii flow throughout (see ptca comments). final diagnosis: 1. two vessel coronary artery disease. 2. severe central hypertension. 3. successful ptca and stenting of the om with a cypher drug eluting stent. . ck peak: 486 ck post-intervention: 370 --> 454 --> 560 --> 464 brief hospital course: pt was admitted to for further work-up and treatment of her nstemi. overnight, she remained cp free on a nitro gtt. she was taken to the cath lab on which was significant for a 90% ulcerated proximal lesion in the mid lad, 70% prox lesion in the diagonal, focal 90% stenosis in large om, and 40% small mid rca lesion. a cypher stent was deployed in the lad lesion when the patient developed no reflow, hr 40s, sbp 40s, and elevations on the monitor. she was given aytropin 0.5 mg x 1, dopamine gtt at 5 mcg/kg/, iabp was placed, and flow was restored in the lad with ic vasodilators. final angiography revealed normal flow, no dissection, and 0% residual stenosis in the lad and 40% stenosis at the origin of the diagonal. the pt denied any cp, sob, or lightheadedness during this episode. she was then transferred to the ccu for further management off of dopamine. pt was admitted to the ccu with a plan to return to cath lab for intervention of lcx lesion on . she continued to be hemodynamically stable with iabp off pressors, and remained chest pain free. we continued aspirin, plavix, statin, and heparin. initially, both bb and acei was held given bradycardia and hypotension in the cath lab. ms. was sent to the cath lab on and received successful ptca and stenting of the om with a cypher drug eluting stent. patient was then transferred to the cardiology service. she was hemodynamically stable on transfer and was chest pain free. she remained stable while on the floor and was discharged with instructions to follow up with cardiology per her outpatient appointment that was amde. . the following problems were in the hospital: . # ischemia: patient admitted for nstemi. she is now s/p des to prox ulcerated lad lesion complicated by no reflow, hypotension, and bradycardia requiring brief pressors, placement of iabp, and poba of lad stent and diagonal. patient was resent to cath lab on which showed good flow of lad and successful ptca and stenting of the om with a cypher drug eluting stent. patient is currently chest pain free and feeling well. she has been placed on a cardiac medication regimen and will continue on aspirin, plavix, atorvastatin, metoprolol and lisinopril. . # pump: tte with mild to moderate lv dysfunction. she is to continue on beta blocker and ace-i . # rhythm: patient in nsr while in the hospital . #leukocytosis-pt found to have wbc 15 on . a u/a was done which was mildly positive and she was started on a course of cipro. urine culture was sent. a cxr on did not show evidence of an infiltrate or acute pulmonary process. c. diff was also sent again and blood cultures were drawn. patient was started on cipro to complete a 7 day course. she remained afebrile and her wbc improved. she will need to continue the cipro as an outpatient and have her wbc rechecked in 2 days to make sure it continues to trend down. . # anemia - hct stable at around 27-30. . medications on admission: metoprolol 12.5mg po bid nexium 40mg po daily aspirin 325mg daily tylenol prn atorvastatin 80mg po daily clopidogrel bisulfate 75 mg po daily docusate sodium 100 mg po bid haloperidol 0.5-1 mg iv q4h:prn lisinopril 5 mg po daily senna 1 tab po bid:prn discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 8. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 days: please continue until sunday . 10. haloperidol lactate 5 mg/ml solution sig: one (1) injection q4h (every 4 hours) as needed. 11. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 12. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day as needed for constipation. discharge disposition: extended care facility: bay - discharge diagnosis: non-st elevation myocardial infarction, s/p cath with successful ptca and stenting of the om with a cypher drug eluting stent. urinary tract infection discharge condition: stable discharge instructions: you were admitted to with an non-st elevation myocardial infarction. please take your previous medications as prescribed. the following changes has been made to your medications: - please start taking aspirin 325mg daily for secondary cardiovascular prevention (to prevent another heart attack) - please start taking atorvastatin 80mg daily for your heart and for your cholesterol - please start taking lisinopril 5mg daily for your heart and blood pressure (prevents remodelling of the heart) - please start taking toprol xl 25mg daily for your heart and blood pressure (prevents remodelling of the heart) - please start taking clopidogrel (plavix) 75 mg daily to keep stents open if you develop chest pain, jaw pain, or chest pressure with pain radiating into arm, or if you for any reason become concerned about your medical condition please call 911 or present to nearest ed. - we also gave you nitroglycerin tablets to take if you experience chest pain, please call 911 or your doctor if chest pain recurs even if it dissapears with nitroglycerine **do not stop taking the aspirin or plavix unless instructed to do so by your cardiologist even if another doctor tells you to** followup instructions: please call your pcpc dr and make a f/u appt. follow up with dr wednesday at 11am procedure: injection or infusion of platelet inhibitor left heart cardiac catheterization left heart cardiac catheterization coronary arteriography using a single catheter coronary arteriography using a single catheter implant of pulsation balloon angiocardiography of right heart structures angiocardiography of right heart structures insertion of drug-eluting coronary artery stent(s) insertion of drug-eluting coronary artery stent(s) infusion of vasopressor agent cranial or peripheral nerve graft insertion of one vascular stent cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension personal history of malignant neoplasm of breast acute systolic heart failure personal history of irradiation, presenting hazards to health 

Answer: The patient is high likely exposed to