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: patient recorded as having no known allergies to drugs attending: chief complaint: found unresponsive major surgical or invasive procedure: s/p catheterization on history of present illness: mr. is a 66 year old male with a history of cad s/p multiple interventions, htn, dm2, hypercholesterolemia who was transferred from the micu due to concern of nstemi (elevated cardiac enzymes). he was found to be difficult to arouse by his wife on and was transferred to . he was electively intubated at due to altered mental status and transferred to . he was accepted into the icu and extubated on . he was noted to have rising cardiac enzymes and was transferred to the cardiology service. he reports that he has not felt the same since after his last cath in . he states that he has felt weak and that he gets some chest discomfort when he exerts himself. he reports that the discomfort only lasts a few minutes and that it resolves with rest. the day he was found to be unresponsive he does not recall much of the day. he denied havig any chest pain, shortness of breath, lightheadedness or palpitations. he only notes that he had 3 beers that day. as per his wife, she left him sleeping in the morining and found him still sleeping when she got home at 3pm. she notes he was making some gurgling sounds and was difficult to arouse. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: - cad nstemi (95) s/p ptca of proximal rca ptca (98) s/p stent proximal lad stemi (03) lad with severe isr s/p ptca/cutting balloon pci (09) s/p cypher stent to lad, taxus stent to rca. pci (10) - htn - hl - dm - gerd - depression cardiac risk factors: + diabetes, + dyslipidemia, + hypertension social history: lives w/ wife at home alone. currently under great financial stress, as lost much of prior wealth. the patient quit smoking in . he drinks approximately four to five beers per month. he is a small business owner. - tobacco: quit in , 50+pk years. - alcohol: night. - illicits: denied by wife. family history: father died at the age of 58 cad, diabetes. mother died of old age. no hx of strokes, ich. physical exam: vs - 98.8 66 114/44 992l gen: elderly male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with unremarkable jvp. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. 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. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: mse: aaox3 cn: ii-xii grossly intact, right eye prosthesis strength: bilaterally for both upper and lower extremitities reflexes: 2+ biceps/triceps and patellar bilaterally, babinski down going. pulses: right: carotid 2+ dp 2+ pt 2+ \ physical exam unchanged upon discharge left: carotid 2+ dp 2+ pt 2+ pertinent results: cardiac cath : cornary angiography showed a r dominant system. r radial approach was used. selective angiography of left system: lmca: normnal lad: 50-60% ostial lad, 70% origin diagonal branch, patent stents lcx: patnent stent in lcx, 60% stenoses of continuation of av circumflex. rca: 70% diffuse distal rca and 60% at the bifurcation. echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the distal left ventricular segments. the remaining segments contract normally (lvef = 40-45 %). the right ventricular size and systolic function are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion mri head : 1. multiple foci of restricted diffusion: in the bilateral basal ganglia, the subcortical left frontal white matter and the left subependymal region, compatible with focal infarcts. the distribution is most suggestive of a hypoxic or hypotensive event. alternatively, this could represent a thromboembolic etiology. 2. minimal irregularity of the right vertebral artery, with minimal luminal narrowing. this may be artifactual, or may be related to atherosclerotic disease. overall, the intracranial and neck vasculature is patent, with no significant stenosis or occlusion. 3. chronic small vessel ischemic change. eeg : impression: abnormal portable eeg due to the mildly slow background rhythm. this indicates a widespread encephalopathy. medications are likely the most common explanation of such tracings. metabolic disturbances and infection can produce similar tracings. there were no areas of prominent focal slowing, but encephalopathies may obscure focal findings. there were no epileptiform features. brief hospital course: 66 yo man w/ cad (nstemi in 95, ptca and stent to prox lad , stemi in , lad/pca stenting in , des to lcx in ), htn, hl, dm, gerd, depression who was found unresponsive by his wife in the afternoon of and found to have nstemi, arf, transaminitis, aspiration pneumonia vs. pneumonitis and metabolic/resp. acidosis who came to the micu intubated at osh. # nstemi: new twi in lateral leads and elevated trop, likely lad territory and restenosis of prior lad. pt was started on a heparin gtt, goal ptt of 60-90. continued on asa, plavix, atenolol, statin, isosorbide. pt was then transferred to ccu for further management of nstemi. since pt with known osa, and perhaps etoh intake earlier in evening caused increased myocardial demand -> nstemi -> hypotension -> multiorgan involvement (see below). repeat echo revealed mild symmetric left ventricular hypertrophy with normal cavity size, mild left ventricular systolic dysfunction with focal hypokinesis of the distal left ventricular segments, lvef = 40-45 %, normal right ventricular size and systolic function. cardiac cath did not show disease that needed intervention. # ams: etiology unclear. u and stox negative, but pt with h/o etoh use. non focal neuro exam, unlikely stroke, though could not r/o tia, so ordered mri/mra head and neck. also could not rule out potential post-ictal somnolence, so ordered 20min eeg recording to investigate potential epileptiform activity. also did infectious work-up, but cx (bcx, ua, sputum cx) pending at time of transfer. # arf: potentially related to hypoperfusion, and ratio of bun/cr suppportive of hypoperfusion. ua positive for blood, ketones, and protein, but no wbc. urine electrolytes with feurea<35%, which supports prerenal etiology. gave fluid challenge. # cad: see above, nstemi. # aspiration pneumonitis vs. pna: pt initially intubated, but once in micu, weaned off ventilator and extubated since not intubated for respiratory status. because of aspiration risk, started zosyn, though antibx can be discontinued if cxr improves significantly. # htn. currently normotensive. continued home meds with holding parameters. # hyperlipidemia: pt with known cad, so continued statin. also checked fasting lipids, which revealed ldl 49 and hdl 52. incidentally, these numbers also support a higher-than-admitted use of etoh. # metabolic acidosis, metabolic alkalosis, and respiratory acidosis: metab. acidosis likely due to renal failure, lactate is normal (which goes agains a hypoperfusion theory). trended electrolytes. # transaminitis. likely a hypoperfusion episode, could be due to myocardial injury/muscle leak. trended lfts. # dm: hba1c = 6.5, continued on half of home-dose humulin and started on iss. medications on admission: atenolol - 25 mg tablet qpm citalopram - 20 mg tablet morning clopidogrel 75 mg morning cyanocobalamin - 1,000 mcg/ml solution - 1 qam esomeprazole 40 mg capsule glipizide - 5 mg tablet extended rel qam irbesartan 150 mg qam isosorbide mononitrate sr 60 mg lorazepam - 0.5 mg prn nitroglycerin 0.4 mg prn pioglitazone 45 mg qam rosuvastatin 20 mg qpm sitagliptin-metformin - 50 mg-1000 mg twice a day aspirin 325 mg am hctz - dose unknown discharge medications: 1. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. irbesartan 150 mg tablet sig: one (1) tablet po daily (). 5. isosorbide mononitrate 20 mg tablet sig: three (3) tablet po bid (2 times a day). 6. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 8. cyanocobalamin 1,000 mcg tablet sig: one (1) tablet po once a day. tablet(s) 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. glipizide 5 mg tablet sig: one (1) tablet po once a day. 11. lorazepam 0.5 mg tablet sig: one (1) tablet po prn as needed for anxiety. 12. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn as needed for pain. 13. pioglitazone 45 mg tablet sig: one (1) tablet po once a day. 14. janumet 50-1,000 mg tablet sig: one (1) tablet po twice a day. discharge disposition: home discharge diagnosis: primary diagnosis: s/p unresponsiveness secondary diagnosis: type 2 diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted because you had elevated cardiac enzymes in your blood concerning for a small heart attack. you had a catheterization to see if you had any blockages. there were no significant blockages in your artery. medications changed upon discharge: start ranitidine 150 mg twice a day stop esomeprazole followup instructions: please make a follow up appointment with your primary care physician 2 weeks of discharge. please make a follow up appointment with your cardiologist within 4 weeks of discharge. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours coronary arteriography using two catheters left heart cardiac catheterization diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus old myocardial infarction altered mental status mixed acid-base balance disorder nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to