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: elective cardiac catheterization major surgical or invasive procedure: cardiac catheterization with deployment of 3 drug eluting stents history of present illness: 79 yo female with hx sjogren's syndrome, htn, hld with complaints of new onset exertional anginal symptoms with diaphoresis and lightheadedness, found to have abnormal sress test, admitted for cardiac catheterization. . the patient reports she has been experiencing progressively worsening dizziness, nausea, and diaphoresis on exertion over the past year. about 2-3 months ago, she began experiencing worsening symptoms of lightheadedness, nausea, diaphoresis, and weakness with climbing stairs and when she cooked or did housework for about an hour. she became more sedentary to avoid the symptoms, though she is normally very active. due to these symptoms, the patient underwent a persantine mibi at at on , which showed a moderate sized septal infarct in addition to anteroseptal and apical ischemia with an lvef of 68%. she was referred to for cardiac catheterization. . of note, in the setting of her lightheadedness symptoms, her amlodipine dose was recently decreased by half to 2.5mg daily with no impact in her symptoms. she denies presyncope or syncope. . in the cath lab, the patient was found to have 1 vessel disease with 90% stenosis of the lad and had three des placed to the lad. she complained of significant back pain between her scapula, and also had nausea and emesis. during the intervention, the lad was dissected. ~425cc of contrast was used during the procedure. she was admitted to the ccu for further monitoring. . of note, the patient has had unchanged chronic back pain for years, which she describes as pain between her scapula which occurs when she is under significant emotional stress or when she is fatigued. . on review of systems, s/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. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . 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: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: no prior cabg, pci, pacing/icd 3. other past medical history: hypertension sjogren's syndrome anxiety moderate arthritis tonsillectomy chronic back pain social history: tobacco: denies. alcohol: denies. drugs: denies. originally from . married. owns her own business manufacturing military boot laces loops. family history: mother died of mi at 65yo, two maternal aunts died of mis in 60's. physical exam: on admission: vs: t=95.8 bp=133/63 hr=68 rr=13 o2 sat=99%ra general: wdwn in nad. oriented x3. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities. resp were unlabored, no accessory muscle use. ctab anteriorly and laterally, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. r groin site with small amount of blood around angioseal closure site. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: 2+ dp 2+ pt 2+ . on discharge: vs: tm/tc: 98.2/98.2, bp: 112/57 (112-141/52-75), hr: 73 (64-74), rr: 18 (16-18) o2 sat: 95%ra general: wdwn in nad. oriented x3. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities. resp were unlabored, no accessory muscle use. ctab anteriorly and laterally, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. dressing c/d/i skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ radial 2+ dp 2+ pt 2+ left: carotid 2+ radial 2+ dp 2+ pt 2+ unchanged from prior pertinent results: 09:30pm blood wbc-5.6 rbc-3.95* hgb-12.2 hct-34.7* mcv-88 mch-30.8 mchc-35.1* rdw-13.7 plt ct-197 04:30am blood wbc-6.4 rbc-3.97* hgb-12.1 hct-34.8* mcv-88 mch-30.5 mchc-34.8 rdw-13.6 plt ct-199 05:35am blood wbc-5.9 rbc-3.90* hgb-11.9* hct-35.7* mcv-91 mch-30.6 mchc-33.5 rdw-13.6 plt ct-206 09:30pm blood pt-13.7* ptt-30.6 inr(pt)-1.2* 09:30pm blood plt ct-197 04:30am blood pt-13.0 ptt-23.6 inr(pt)-1.1 04:30am blood plt ct-199 09:30pm blood glucose-154* urean-12 creat-0.7 na-138 k-4.2 cl-103 hco3-28 angap-11 04:30am blood glucose-114* urean-10 creat-0.7 na-140 k-3.3 cl-104 hco3-27 angap-12 05:35am blood glucose-97 urean-12 creat-0.7 na-137 k-4.0 cl-102 hco3-28 angap-11 09:30pm blood ck(cpk)-53 04:30am blood ck(cpk)-151 01:00pm blood ck(cpk)-169 09:30pm blood ck-mb-4 ctropnt-0.03* 04:30am blood ck-mb-19* mb indx-12.6* ctropnt-0.18* 01:00pm blood ck-mb-19* mb indx-11.2* ctropnt-0.21* 09:30pm blood calcium-8.8 phos-2.8 mg-2.2 04:30am blood calcium-8.9 phos-3.5 mg-2.1 cholest-147 05:35am blood calcium-9.0 phos-3.1 mg-2.2 04:30am blood triglyc-70 hdl-72 chol/hd-2.0 ldlcalc-61 ldlmeas-61 . echocardiogram (): conclusions left ventricle - ejection fraction: 45% to 50% the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of the mid to distal anterior septum and anterior wall. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. 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. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: mild focal lv systolic dysfunction consistent with lad ischemia/infarction. no pathologic valvular abnormality seen. . cardiac catheterization report was pending at the time of discharge. brief hospital course: 79 yo female with hx sjogren's syndrome, htn, hld presenting with exertional angina and abnormal stress test, admitted following a complicated cardiac catheterization. . # cad: the patient denies frank chest pain, and describes her anginal equivalent as diaphoresis, nausea, lightheadedness, and weakness presenting as atypical chest pain. persantine mibi on at showed moderate sized septal infarct and anteroseptal and apical ischemia. cardiac catheterization revealed 1 vessel disease with 90% stenosis of the lad, complicated by dissection of the lad during intervention. patient is now s/p 3 des to the lad and denies symptoms including chest pain, dyspnea, diaphoresis, lightheadedness, nausea. she was monitored in the ccu post procedurally and did well. she had no episodes of chest pain and her ekgs remained unchanged. her enzymes were trended with a slight bump associated with the dissection. she had an echo that showed a depressed ef to 45-50% and evidence of septal wall infarct. she was loaded with plavix and placed on dosing for one week to be followed by daily dosing. her aspirin 325mg was continued. we initiated metoprolol and discontinued her amlodipine. she was continued on her statin 40mg. we did not start an acei out of concern for her kidney function with a high contrast load. she will need to be started on a small dose of acei as an outpatient so long as her kidney function remains normal. . # lad dissection: patient with lad dissection during catheterization, s/p 3 des for the dissection. she had no events on telemetry during her stay. her ekgs were unchanged with a sinus rhythm and lbbb with elevated j points, but no changes after catheterization. cardiac enzymes were trended and had a slight expected increase in troponins. repeat ekgs were unchanged from prior. . # renal function: patient with baseline normal renal function. she recieved ~425cc of contrast during the catheterization. given the amount of contrast and the patient's age, she was at increased risk for contrast induced nephropathy. we gave 2l of normal saline as well as 2 doses of mucomyst and 6hours of sodium bicarb for renal protection. her creatinine was at 0.7 on discharge. we will have her get labs drawn monday to make sure her renal function is stable. . # hypertension: normotensive while in the ccu. we discontinued her home amlodipine and initiated metoprolol 12.5mg with transition to metoprolol xl 25mg daily on discharge. . # migraines: she has a history of migraines, and while in house she was given iv compazine which helped. she takes pr migraine medications at home and we gave her a dose before she left. . # chronic back pain: stable. we gave tylenol prn and one dose of flexeril 5mg which worked. . # sjogren's: stable, we continued hydroxychloroquine 200 mg per her home regimen. medications on admission: - amlodipine 2.5mg daily - simvastatin 40mg daily - aspirin 325mg daily - hydroxychloroquine sulfate 200mg daily - prevacid 15mg daily - ambien 2.5-5mg qhs prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. hydroxychloroquine 200 mg tablet sig: one (1) tablet po daily (daily). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po every twelve (12) hours. disp:*60 tablet(s)* refills:*2* 5. clopidogrel 75 mg tablet sig: one (1) tablet po bid (2 times a day) for 6 days: please take your evening dose tonight () and take 1 pill two times a day until . disp:*12 tablet(s)* refills:*0* 6. clopidogrel 75 mg tablet sig: one (1) tablet po once a day: please take one pill by mouth daily starting . disp:*30 tablet(s)* refills:*11* 7. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. metoprolol succinate 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* 9. outpatient lab work please draw chem 7 on monday and fax results to dr. fax: discharge disposition: home discharge diagnosis: primary diagnoses: coronary artery disease migraines . secondary diagnoses: hypertension hyperlipidemia decreased left ventricular systolic function sjogren's syndrome discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to for a cardiac catheterization to fix a blockage in one of the arteries in your heart. during the procedure, 3 stents were placed to open the obstruction in the artery to help improve blood flow. the procedure was complicated because your artery has a lot of twists and turns, and because of that, the wire formed a flap in the wall of the artery. the flap was fixed with one of the stents that were placed. you were monitored in the cardiac intensive care unit to closely watch for signs of chest pain. you did well overnight and were transitioned to the floor, and you were in good condition at the time of your discharge. . also during the procedure, because of the difficulty, a lot of contrast dye was used. contrast can cause injury to the kidneys. we gave you ivf and medications to protect your kidneys after the procedure your kidney function was excellent. . we made the following changes to your medications: we stopped your amlodipine 2.5 mg daily we stopped your lansoprazole (prevacid) 15mg daily we added metoprolol xl 25 mg by mouth daily we added clopidogrel (plavix) 75 mg by mouth twice a day until . then take clopidogrel (plavix) 75 mg by mouth once a day ongoing (starting ) we started ranitidine 150 mg by mouth 2 times a day . you will need to start an ace inhibitor at the time of your next primary care doctors . . please have your labs drawn next monday to check your kidney function. the results will be faxed to your primary care physicians office. . please drink plenty of fluids at home. . it has been a pleasure taking part in your care. followup instructions: name: , address: , , phone: : friday 10:00am we are working on a follow up in cardiology with dr. within 1 month. the office will contact you at home with an . if you have not heard or have any questions please call . fax: md procedure: coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of three vascular stents diagnoses: other chronic pain coronary atherosclerosis of native coronary artery intermediate coronary syndrome unspecified essential hypertension other and unspecified hyperlipidemia other left bundle branch block backache, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus arthropathy, unspecified, site unspecified dissection of coronary artery sicca syndrome 

Answer: The patient is high likely exposed to