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: back and chest pain major surgical or invasive procedure: cardiac catheterization with drug eluting stent to the left circumflex artery and obtuse marginal artery history of present illness: ms. is an 88 yo f with htn and hld who presented to the ed with chest and back pain . as per the pt's family, the episode started as left scapular back pain that radiated to the chest and was in intensity. it was associated with n/v, sob, but not diaphoresis. this has never happened before. this occurred at 11 pm, and the pt was transferred to the ed by ambulance around 1:30 am. she was given an aspirin 325 mg en route. . initial vitals in the ed were: hr: 56, bp: 122/57, rr 14, 100% on 2l by nc. in the ed, cardiac enzymes were drawn, and an ekg was done. the pt's pain in the ed was treated with slntg x 2, and 2 mg of morphine iv. when cardiac enzymes were +, the pt was started on a heparin drip, was bolused with 600 mg of plavix, was started on a ntg drip, and was sent to 3. . the pt arrived on 3 pain free, however soon developed back pain . the team on 3 sent her to ct urgently out of concern for aortic dissection, however after this was ruled out, the pt was sent to the cath lab. . in the cath lab, the pt was found to have thrombus in the proximal lcx as well as in om1. there was diffuse coronary artery disease, and high grade stenosis in the lad. des were placed in the lcx as well as in om1. the patient's bp were slightly low in the cath lab, and had a low o2 sat with an increasing o2 requirement, so she was transferred to the ccu for continuation of her care. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, syncope or presyncope past medical history: 1. cardiac risk factors: (-)diabetes,(+)dyslipidemia,(+)hypertension 2. cardiac history: negative -cabg: negative -percutaneous coronary interventions: negative -pacing/icd: negative 3. other past medical history: depression social history: -tobacco history: denies -etoh: denies -illicit drugs: denies family history: + early mi: grandmother had 5th heart attack at age 62. no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory physical exam: vs: t=96.4 bp=105/69 hr= 74 rr= 18 o2 sat= 94% on 6l by nc general: wdwn wf in nad. mood, affect appropriate. heent: ncat. sclera anicteric. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp not elevated cardiac: rr, normal s1, s2. grade holosystolic murmur best heard at the llsb with no radiation. no r/g. no thrills. no s3 or s4. lungs: no chest wall deformities. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no abdominial bruits. extremities: no c/c/e. no femoral bruits. right groin femoral site c/d/i with no obvious hematoma nor tenderness to palpation. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: femoral 2+ dp 1+ left: femoral 2+ dp 1+ pertinent results: laboratory investigations 06:15am blood wbc-9.8 rbc-3.86* hgb-10.4* hct-30.1* mcv-78* mch-27.0 mchc-34.6 rdw-14.6 plt ct-338 02:15am blood wbc-10.7 rbc-4.90 hgb-13.1 hct-38.1 mcv-78* mch-26.7* mchc-34.3 rdw-14.5 plt ct-391 02:15am blood neuts-82.0* lymphs-14.5* monos-2.7 eos-0.4 baso-0.4 06:15am blood pt-13.5* ptt-26.4 inr(pt)-1.2* 06:19am blood pt-12.8 ptt-25.8 inr(pt)-1.1 06:15am blood glucose-89 urean-21* creat-1.1 na-133 k-4.1 cl-102 hco3-24 angap-11 05:15pm blood glucose-114* urean-35* creat-1.7* na-137 k-4.0 cl-103 hco3-23 angap-15 02:15am blood glucose-141* urean-27* creat-1.2* na-138 k-4.0 cl-103 hco3-21* angap-18 06:19am blood ck(cpk)-2942* 12:19am blood ck(cpk)-3450* 03:35pm blood ck(cpk)-3638* 07:50am blood ck(cpk)-665* 02:15am blood ck(cpk)-70 06:19am blood ck-mb-136* mb indx-4.6 ctropnt-11.91* 12:19am blood ck-mb-196* mb indx-5.7 ctropnt-16.79* 03:35pm blood ck-mb-235* mb indx-6.5* ctropnt-19.95* 07:50am blood ctropnt-0.60* 07:50am blood ck-mb-45* mb indx-6.8* 02:15am blood ctropnt-0.03* 02:15am blood ck-mb-5 06:15am blood calcium-8.5 phos-2.8 mg-2.1 03:35pm blood calcium-8.3* phos-3.9 mg-2.1 06:50 wbc7.6 rbc 3.91* hgb 10.4* hct30.3* mcv78* mch 26.6* mchc 34.4 rdw 14.5 plt 334 glucose urean creat na k cl hco3 angap 06:50 glucose 88 craet= 1.1 sodium- 138 potassium- 3.9 chloride- 105 bicarbonate 25 ag 12 microbiology 01:00pm urine rbc-21-50* wbc-* bacteri-mod yeast-none epi- 01:00pm urine blood-lg nitrite-neg protein-75 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-tr 01:00pm urine hours-random urean-975 creat-299 na-34 k-80 cl-21 01:00pm urine osmolal-679 6:30 pm urine **final report ** urine culture (final ): no growth. 3:35 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. cardiology investigations: cardiology report cardiac cath study date of brief history: 88 year old female with htn admitted with chest discomfort radiating to her back. cta was negative for aortic dissection. she ruled in for mi and ekg showed evolving anterior st depressions and t wave inversions. she is referred for cardiac catheterization. indications for catheterization: posterior stemi, ongoing chest pain procedure: left heart catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 french right catheter, advanced to the left ventricle through a 5 french introducing sheath. coronary angiography: was performed in multiple projections using a 5 french jl4 and a 5 french jr4 catheter, with manual contrast injections. percutaneous coronary revascularization was performed using placement of drug-eluting stent(s). conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca diffusely diseased 2) mid rca discrete 100 **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad normal 6a) septal-1 normal 7) mid-lad discrete 80 8) distal lad normal 9) diagonal-1 normal 10) diagonal-2 discrete 80 12) proximal cx normal 13) mid cx discrete 100 14) obtuse marginal-1 discrete 90 **ptca results cx ptca comments: initial angiography revealed a total occlusion of the lcx just after take off of a high om1 which had an ostial 90% stenosis as well. we planned to treat these lesions with ptca and stenting. heparin gtt had already been started prior to the procedure and a therapeutic act was confirmed. a 6f xb3.5 guide provided adequate support for the procedure. we first passed a prowater wire across the om stenosis with minimal difficulty. another prowater wire crossed the lcx stenosis with minimal difficulty. the proximal lcx lesion was dilated with a 2.5x12mm apex otw balloon at 6 atms. a 2.5x15mm promus stent was deployed in the proximal lcx at 8 atms. we then turned our attention to the high om1 ostial stenosis. the om1 lesion was predilated with a 2.5x12mm apex balloon at 12 atms. a 2.5x8mm promus stent was then deployed in the proximal om1 at 10 atms. we then turned our attention back to the main lcx and post dilated the lcx stent was a 2.5x12mm nc quantum balloon at 14 atms distally and 14 atms more proximally in the stent. the flow was mildly slow in the lcx and this improved with ic nicardipine. final angiography revealed no residual stenosis in either stent, no angiographically apparent disease and timi 3 flow. there remained diffuse distal lcx disease that was not suitable to pci. technical factors: total time (lidocaine to test complete) = 1 hour 20 minutes. arterial time = 1 hour 10 minutes. fluoro time = 21.6 minutes. irp dose = 2652 mgy. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 165 ml premedications: fentanyl 25 mcg iv asa 325 mg p.o. anesthesia: 1% lidocaine subq. anticoagulation: heparin units iv other medication: nitroglycerine 100 mcg ic nitroglycerine 60 mcg/min iv nicardipine 200 mcg ic sodium bicarbonate 117 cc/hour iv cardiac cath supplies used: - , prowater 300cm - , prowater 300cm 2.5mm , maverick 12mm 2.5mm , quantum maverick 12mm 6fr cordis, xb 3.5 6fr , angioseal vip - allegiance, custom sterile pack - merit, left heart kit - , priority pack 20/30 2.5mm , promus otw 15mm 2.5mm , promus otw 08mm comments: 1. selective coronary angiography in this right dominant system demonstrated three vessel disease. the lmca was normal. the lad had an 80% stenosis at d2 and an 80% ostial occlusion of d2. the lcx had a very high om1 with an ostial 90% stenosis; the lcx was occluded after om1. the rca had severe disease proximally and was occluded mid-vessel; there were small collaterals to the distal vessel from the left. 2. limited resting hemodynamics revealed moderately elevated left sided filling pressures with lvedp of 28 mm hg. there was no gradient on pullback of the catheter from the lv to the aorta. there was systemic normotension with sbp of 113 mm hg and dbp of 67 mm hg. 3. successful ptca and stenting of proximal lcx with a 2.5x15 promus with a 2.5mm balloon. 4. successful ptca and stenting of ostial high om1 with a 2.5x8mm promus des. 5. successful closure of right femoral arteriotomy with 6f angioseal. final diagnosis: 1. three vessel coronary artery disease with acute occlusion of lcx. 2. elevated left sided filling pressures. 3. successful pci of lcx with des. 4. successful pci of ostial high om1 with des. 5. successful deployment of 6f angioseal in rfa. i, dr. , was physically present during the entire procedure and in compliance with the cms regulations. attending of record: , j. referring physician: , . fellow: , , invasive attending staff: , j. electronically signed by: , on mon 6:31 pm cardiology report ecg study date of 2:09:12 am sinus bradycardia. prolonged a-v conduction. intra-atrial conduction defect. diffuse st-t wave changes. since the previous tracing of voltage for left ventricular hypertrophy is more marked. st-t wave changes are new. left anterior hemiblock remains present echocardiography report , portable tte (focused views) done at 11:46:47 am final referring physician information , institute , 4 , status: inpatient dob: age (years): 88 f hgt (in): 62 bp (mm hg): 100/59 wgt (lb): 160 hr (bpm): 65 bsa (m2): 1.74 m2 indication: hypotension s/p stemi. left ventricular function. murmur. icd-9 codes: 410.91, 424.1, 424.0 test information date/time: at 11:46 interpret md: , md test type: portable tte (focused views) son: cardiology fellow doppler: limited doppler and color doppler test location: west ccu contrast: none tech quality: suboptimal tape #: 2010w000-0:00 machine: vivid q-1 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.1 cm <= 4.0 cm left atrium - four chamber length: *5.4 cm <= 5.2 cm right atrium - four chamber length: *5.9 cm <= 5.0 cm left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.3 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 3.6 cm <= 5.6 cm left ventricle - ejection fraction: 45% >= 55% aorta - sinus level: 2.6 cm <= 3.6 cm aorta - ascending: 3.4 cm <= 3.4 cm aortic valve - lvot diam: 2.1 cm findings this study was compared to the report of the prior study (images not available) of . left atrium: elongated la. right atrium/interatrial septum: mildly dilated ra. left ventricle: mild symmetric lvh with normal cavity size. mild regional lv systolic dysfunction. no vsd. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: mildly thickened aortic valve leaflets. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. moderate mitral annular calcification. severe thickening of mitral valve chordae. mild (1+) mr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. emergency study performed by the cardiology fellow on call. regional left ventricular wall motion: conclusions the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with inferior/inferolateral akinesis (ef 40-45%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is severe thickening of the mitral valve chordae. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. mild mitral and aortic regurgitation. compared with the report of the prior study (images unavailable for review) of , regional lv dysfunction, c/w rca and/or lcx disease is final report echocardiography report , portable tte (complete) done at 11:35:00 am final referring physician information , institute , 4 , status: inpatient dob: age (years): 88 f hgt (in): 62 bp (mm hg): 87/49 wgt (lb): 157 hr (bpm): 72 bsa (m2): 1.73 m2 indication: stemi. left ventricular function. icd-9 codes: 410.91, 424.0, 424.2 test information date/time: at 11:35 interpret md: , md test type: portable tte (complete) son: , rdcs doppler: full doppler and color doppler test location: west ccu contrast: none tech quality: suboptimal tape #: 2010w053-0:20 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: 3.7 cm <= 4.0 cm left atrium - four chamber length: *5.7 cm <= 5.2 cm left atrium - peak pulm vein s: 0.4 m/s left atrium - peak pulm vein d: 0.3 m/s right atrium - four chamber length: *5.2 cm <= 5.0 cm left ventricle - septal wall thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 3.5 cm <= 5.6 cm left ventricle - ejection fraction: 50% >= 55% left ventricle - lateral peak e': *0.03 m/s > 0.08 m/s left ventricle - septal peak e': *0.04 m/s > 0.08 m/s left ventricle - ratio e/e': *23 < 15 aorta - sinus level: 3.4 cm <= 3.6 cm aorta - ascending: *3.6 cm <= 3.4 cm aortic valve - peak velocity: 1.7 m/sec <= 2.0 m/sec aortic valve - pressure half time: 546 ms mitral valve - e wave: 0.8 m/sec mitral valve - a wave: 1.1 m/sec mitral valve - e/a ratio: 0.73 mitral valve - e wave deceleration time: 242 ms 140-250 ms findings left atrium: elongated la. right atrium/interatrial septum: mildly dilated ra. normal ivc diameter (<2.1cm) with >55% decrease during respiration (estimated ra pressure (0-5mmhg). left ventricle: mild symmetric lvh with normal cavity size. mild regional lv systolic dysfunction. tdi e/e' >15, suggesting pcwp>18mmhg. no resting lvot gradient. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. mild (1+) mr. tricuspid valve: indeterminate pa systolic pressure. pericardium: there is an anterior space which most likely represents a fat pad, though a loculated anterior pericardial effusion cannot be excluded. general comments: suboptimal image quality - poor echo windows. conclusions the left atrium is elongated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with severe hypokinesis of the basal half of the inferolateral wall. the remaining segments contract normally (lvef = 50 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be quantified. there is a prominent anterior fat pad. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w cad (lcx distribution). mild mitral regurgitation. increased pcwp. dilated ascending aorta. compared with the prior study (images reviewed) of , the findings are similar. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. cardiology report ecg study date of 8:33:20 am probable sinus rhythm. left atrial abnormality. p-r interval prolongation. left anterior fascicular block. early r wave progression. st-t wave abnormalities. since the previous tracing of probably no significant change. radiology reports: radiology report cta chest w&w/o c&recons, non-coronary study date of 10:25 am , 10:25 am cta chest w&w/o c&recons, non- clip # reason: ? dissection contrast: optiray amt: 100 medical condition: 88 year old woman with chest pain radiating to the back, making troponins, r/o type a dissection prior to cath lab reason for this examination: ? dissection contraindications for iv contrast: none. provisional findings impression: kkgc sat 12:45 pm pfi: 1. no acute thoracic aortic dissection or pulmonary embolism is detected. 2. dilation of the ascending thoracic aorta measuring up to a maximum of 4.8 cm x 4.0 cm, has minimally progressed since the prior study. recommended continued surveillance. 3. mild pulmonary arterial enlargement suggestive of pulmonary arterial hypertension. the findings were discussed with dr. immediately after the study. final report indication: 88-year-old woman with chest pain radiating to back, increasing troponins, to rule out type a dissection before cardiac catheterization. comparison: . technique: mdct images were acquired through the chest before and after administration of 100 cc of optiray intravenous contrast. sagittal, coronal, and oblique reformats were generated and reviewed. findings: the pulmonary arteries are opacified up to the subsegmental levels bilaterally without evidence of acute pulmonary emboli. the ascending thoracic aorta measures up to 4.8 cm in the axial plane, similar to prior study, but this measurement may be spuriously high due to the obliquity if the aorta to the imaging plane. the sagittal reformats demonstrate a maximum diameter of 4.1cm, mildly dilated. no acute aortic dissection is present. trace pericardial fluid is present. main pulmonary artery measures 3.5 cm and is mildly dilated, suggesting mild pulmonary arterial hypertension. the major airways are patent up to subsegmental levels bilaterally. bilateral dependent basal atelectasis is present. no pleural effusions or pneumothorax is detected. minimal upper zone interlobular septal thickening is seen, suggesting mild interstitial edema. no suspicious pulmonary nodules are detected. this study is not tailored for evaluation of the subdiaphragmatic organs. within this limitation, visualized portions of the liver, spleen, the right adrenal gland appear unremarkable. osseous structures and soft tissues: no bone lesions suspicious for infection or malignancy are detected. mild degenerative changes of the thoracic spine are noted. impression: 1. no acute thoracic aortic dissection or pulmonary embolism is detected. 2. mild dilation of the ascending thoracic aorta, unchanged. 3. mild pulmonary arterial dilation suggestive of pulmonary arterial hypertension. 4. basal pulmonary atelectasis and minimal upper lobe interstitial edema. the findings were discussed with dr. immediately after the study. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sun 10:51 am radiology report chest (pa & lat) study date of 5:43 am , 5:43 am chest (pa & lat) clip # reason: please perform pa/lat medical condition: 88 year old woman with acs, portable concerning for pna reason for this examination: please perform pa/lat final report chest, two views clinical information: acute coronary syndrome concerning for pneumonia. comparison is made to the prior study of the same day from 0454 hours. there is mild congestive failure and bibasilar atelectasis with small bilateral pleural effusions, relatively unchanged from the prior study. aorta is tortuous. heart is within normal limits. dr. portable chest clinical information: chest pain. findings: portable chest radiograph is compared to the prior study from . since that time, there has been the development of interstitial opacification, possibly pulmonary congestion. there is bibasilar atelectasis. there are small bilateral pleural effusions. the heart is mildly enlarged. mediastinum is prominent with tortuous aorta. there are low lung volumes. radiology report chest (portable ap) study date of 4:45 am impression: new mild congestive failure. small bilateral pleural effusions and mild bibasilar atelectasis. the study and the report were reviewed by the staff radiologist. dr. dr. approved: sat 1:32 pm brief hospital course: asessment: ms. is an 88 yo f with htn and hld who presented to the ed with chest and back pain who had a posterior stemi now s/p cath with des to the lcx and om1 with remaining lad disease that will require intervention in the future. transferred to 3 on . plan: . # coronaries/posterior stemi: admitted with left scapular back pain radiating to the anterior chest (cardiac sounding with nausea and vomitng, no diaphoresis) and was rx aspirin en route in the ambulance. on presentation to the ed, cardiac enzymes were sent and an ecg confirmed posterior st-elevation and cardiac enzymes revealed a peak troponin t of 16.79 on and max ck 3450 (mb fraction 196). she was treated with sublingual nitroglycerin and was started on an iv heparin infusion. she was also loaded with clopidogrel 600mg. she was then transferred to 3 where she had recurrence of her subscapular back pain and a ct-angiogram ruled out aortic dissection. she was taken to the cath lab on where angiography demonstrated severe 3-vessel disease. she had drug-eluting stents placed in the proximal lcx and om1 due to severe stenotic disease.the lad had an 80% stenosis at d2 and an 80% ostial occlusion of d2. the lcx had a very high om1 with an ostial 90% stenosis; the lcx was occluded after om1. the rca had severe disease proximally and was occluded mid-vessel and there were small collaterals to the distal vessel from the left she was transferred to the ccu post-procedure and other than an episode of pulmonary edema which was successfully treated with iv furosemide 20mg on she remained stable. atorvastatin 80mg was started on transfer to the ccu. an echo on revealed an ef 40-45% with mild lv systolic dysfunction with inferior/inferolateral akinesia and mild mr/ar. due to persistent hypotension, anti-hypertensives were held. a repeat echo on revealed mild lvh, mild mr/ar as previously and a increased pcwp and associated dilated ascending aorta with ef50%.she had no further chest pain and when no longer hypotensive low dose metoprolol and lisinopril were restarted fit for discharge. a stress echocardiogram is planned as an out-patient to better assess her remaining cad with a view to possible further intervention. . # acute on chronic diastolic chf: ef 50%. thought mi with lvedp of 28 in cath lab. rec'd iv furosemide 20mg on but hypotension precluded further diuresis although she wa no longer symptomatic and there was no clinical evidence of pulmonary edema on exam. by discharge appeared euvolemic with no o2 requirement of or evidence of pulmonary edema clinically. i/o's were inaccurate but she initially had adequate diuresis. has hx of htn so element of chronic diastolic chf is possible although no documented in pmh. . # htn: pt is on lisinopril and metoprolol at home. previous hypotension and acei and beta-blocker commenced prior to discharge . # hypercholesterolemia: pt was on lovastatin 20 mg qhs at home, now on atorvastatin 80 mg. . # acute renal failure: she developed pre-renal failure (feurea 15.8%) post cardiac catheterisation which was pre-renal in nature although time frame for cin was consistant. from a baseline of 1.1-1.2 with a peak cr 1.7 which resolved to 1.1 (baseline) on discharge. . # rhythm: in nsr for now. rate on tele 60's-mid 70's, at goal. was on telemetry throughout ccu stay. . # depression: pt is on citalopram at home, now restarted. pt is at acure risk for worsening of depression s/p mi. . code: full medications on admission: lisinopril 10 mg po daily lovastatin 20 mg poqhs citalopram 10 mg po daily metoprolol tartrate 50 mg po bid discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 3. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 4. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: take up to two tablets 5 minutes apart. call dr. __________ if you have any chest pain. . disp:*25 tablet* refills:*0* 5. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: extended care facility: house rehabilitation discharge diagnosis: st elevation myocardial infarction dyslipidemia hypertension depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: medication changes: 1. start taking aspirin 325 mg and plavix 75 mg daily. do not stop taking plavix and aspirin for any reason or miss unless dr. _______ tells you to. this is very important to prevent another heart attack. 2. start taking atorvastatin (lipitor) daily to prevent further blockages in your coronary arteries. 3.stop taking lovastatin. 4. use nitroglycerin if you get any chest pain at home. sit down, take one tablet under your tongue, then wait 5 minutes. if you still have chest pain you can take another tablet under your tongue but please call dr. or dr. _______. if the chest pain worsens, please call 911. 5. followup instructions: name: ,md specialty: primary care when: tuesday, at 2:15pm location: primary care address: 1180 beacon stree ste 1b, , phone: please cancel this appt if you are at rehabilitation. department: cardiac services when: tuesday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified acute on chronic diastolic heart failure depressive disorder, not elsewhere classified true posterior wall infarction, initial episode of care 

Answer: The patient is high likely exposed to