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: codeine attending: chief complaint: referred for cardiac catheterization major surgical or invasive procedure: stenting of the inominate artery intervention and right carotid stenting history of present illness: 50 year old female smoker with history of hypertension, copd, and hypercholesterolemia, who was admitted to an outside hospital with high grade bilateral ica stenoses in the setting of recent tia symptoms, now transferred from hospital for cardiac catheterization. she was admitted to after carotid duplex studies revealed bilateral severe to critical ica stenosis, reportedly done for asymptomatic carotid bruits. however, on further questioning she reported a history of minutes of right eye blindness in which resolved spontaneously that she didn't tell anyone about. she also describes several episodes over the ensuing months of diminished function of her left hand, including episodic numbness as well as episodic weakness and clumsiness. she had two of these episodes just 1 week prior to admission. she also tells me that just yesterday at the outside hospital she had a period of right eye "blurriness." at she had a ct of her head which demonstrated an old right parietofrontal cerebrovascular accident. she was started on iv heparin. an mra of the neck demonstrated probable stenosis in the right brachiocephalic artery, high grade stenoses in the proximal aspect of both internal carotid arteries, irregularity in the proximal left subclavian artery, and narrowing in the proximal right vertebral artery. it was felt that the patient should have an arch aortogram and simultaneous cardiac catheterization to evaluate the coronary anatomy and possible need for coronary artery bypass graft. given the complex combination of imaging and possible catheter based operative interventions, it was felt that the patient should be transferred to . on review of symptoms, she describes the episodes above. she denies any prior history of stroke, though as above, head ct demonstrates a chronic versus subacute right parietofrontal infarct, and she does seem to be having tias as above. denies history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, or myalgias. she has chronic joint pains. she has a chronic cough, but denies hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain, however her legs do "ache" at the end of the day - she is on her feet all day at work. all of the other review of systems were negative. cardiac review of systems is notable for occasional chest pain for years, not associated with exertion. she is on her feet all day at work and never gets chest pain. she does have chronic dyspnea on exertion but denies paroxysmal nocturnal dyspnea, orthopnea, ankle edema. she has had intermittent palpitations for years. denies syncope or presyncope. past medical history: 1) ica stenses, bilateral, as above. 2) hypertension 3) hypercholesterolemia 4) copd and chronic bronchitis. current smoker of packs per day. 5) prior substance abuse, none since when she underwent a recovery program. she used to abuse various substances intranasally, and smokes crack. 6) diverticulosis, status post hemi-colectomy in . 7) urinary frequency 8) hip pain 9) recent endometrial thermal ablation for dysfunctional uterine bleeding. underwent simultaneous bladder suspension for incontinence. cardiac risk factors: (- ) diabetes, (+) dyslipidemia, (+) hypertension cardiac history: none. percutaneous coronary intervention, not applicable. pacemaker/icd, not applicable. social history: social history is significant for the presence of current tobacco use, 1-2 packs per day. there is no history of alcohol abuse. she used iv cocaine in the past, but not in more than 10 years. she used to smoke crack frequently, but has been clean for 10 years. works at and resides in the - area with a significant other in a monogamous relationship. family history: there is no family history of premature coronary artery disease or sudden death. her parents both had copd. physical exam: t 97.1. blood pressure was 100/80 mm hg while seated. pulse was 78 beats/min and regular, respiratory rate was 18 breaths/min, and she was 98% on room air. generally the patient was well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jvp of 6 cm. the carotid waveform was dminished and she had bilateral carotid bruits. there was no thyromegaly. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. palpation of the heart revealed the pmi to be located in the 5th intercostal space, mid clavicular line. there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a systolic murmur at the lusb. there were no rubs, clicks or gallops. the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing or edema. there were no abdominal or femoral bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 1+ femoral not palpable, dp 2+ pt 2+, radial not palpable. left: carotid 1+ femoral not palpable, dp 2+ pt 2+, radial 1+ pertinent results: cardiac catheterization : comments: 1. coronary angiography of this left dominant system revealed single branch vessel coronary artery disease. the left main coronary artery had no angiographically apparent flow limiting stenoses. the lad had mild disease and a 70% stenosis in a small diagonal. the lcx had mild disease. the rca was a very small caliber vessel. 2. limited resting hemodynamics revealed moderately to severely elevated left sided filling pressures (lvedp was 26 mm hg). systemic arterial pressures were mildly elevated (aortic pressure 154/76 mm hg) and were approximately 60 mm hg higher than her cuff pressure. there was no significant gradient across the aortic valve upon pullback of the catheter from the left ventricle to the ascending aorta. 3. peripheral angiography revealed severe great vessel disease. the right innominate artery had a 90% proximal stenosis and the left subclavian artery had an 80% stenosis. no right renal artery was visualized and the left renal artery had a 30% stenosis. there was diffuse aortic atherosclerotic plaquing with a significant distal aortic shelf. final diagnosis: 1. one vessel branch coronary artery disease. 2. moderately to severely elevated left sided filling pressures. 3. severe stenosis of the right innominate artery and left subclavian artery. 4. no angiographically apparent right renal artery. 5. severe aortic atherosclerotic disease with a significant shelf-like plaque in the distal segment. . mri/a abd/pelvis/extr : 1. oclusion of the right main renal artery with associated marked atrophy of the right kidney. 2. atherosclerotic plaque along the course of the infrarenal aorta up to the aortic bifurcation, without aneurysm. 3. no evidence of in-flow or out-flow arterial vascular disease involving the lower extremities. 4. sludge and/or stones within the gallbladder. . ct abd/pelvis : 1. hematoma tracking along the left iliacus from the groin to the iliac crest. 2. atrophic right kidney and persistent striated nephrogram of the left kidney along with large amount of vicarious excretion of contrast in the gallbladder is consistent with atn and impaired renal function. 3. 1.8 cm nodule within the medial left anterior subcutaneous fat may be a breast nodule and clinical correlation with prior mammograms is recommended. 4. adnexal asymmetry. if this patient is a postmenopausal woman, then an ultrasound is recommended. if the patient is not postmenopausal, then the asymmetry is within normal limits. nonetheless the patient has pelvic symptoms, there is no need for an ultrasound. . ct head : no acute intracranial hemorrhage or mass effect is identified. no interval change from the prior exam. if there is concern for acute infarction, mri with diffusion-weighted imaging would be more sensitive in evaluating this. . mra abd/pelvis impression: 1. oclusion of the right main renal artery with associated marked atrophy of the right kidney. 2. atherosclerotic plaque along the course of the infrarenal aorta up to the aortic bifurcation, without aneurysm. 3. no evidence of in-flow or out-flow arterial vascular disease involving the lower extremities. 4. sludge and/or stones within the gallbladder. . carotid u/s findings: duplex evaluation was performed of bilateral carotid arteries. there is heterogeneous plaque seen in the proximal ica bilaterally. on the right there is a blunted waveform in the proximal and distal common carotid suggestive of proximal stenosis. peak velocities are 104, 51 and 76 cm/sec in the ica, cca and eca respectively. normal velocity criteria are invalid in the presence of the proximal stenosis. on the left peak velocities are 227, 84 and 31 cm/sec in the ica, cca and eca respectively. the ica end-diastolic velocity is 85. the ica/cca ratio is 2.7. this is consistent with 60-79% stenosis. there is antegrade vertebral flow bilaterally. impression: likely stenosis in the proximal right cca or innominate. 60-79% left ica stenosis. brief hospital course: 50 year old female with hypertension, hypercholesterolemia, copd, with history of tia symptoms since last year, found to have high grade bilateral ica stenoses, transferred on heparin and plavix for catheterization with possible catheter based intervention. developed l rp bleed after complex right inominate artery and carotid artery stenting, requiring brief ccu stay for monitoring but did well and was discharged a day later. . 1) severe vascular disease/bilateral high grade ica stenoses: the patient went to the cath lab on the day after arrival, which demonstrated severe vascular disease in many locations, including the right innominate artery (90% proximal stenosis), left subclavian artery (80% stenosis), no right renal artery visualized, left renal artery with 30% stenosis, and diffuse aortic atherosclerotic plaquing with a significant distal aortic shelf. of note, her coronary arteries were relatively spared, with an isolated 70% stenosis in a small diagnoal. she had visual change symptoms and the neuro stroke team recommended an ct of her head which revealed old stroke. mra of her abdomen/pelvis (in setting of crf and small right kidney) and lower extremities which revealed an occlusion of the right main renal artery with associated marked atrophy of the right kidney, atherosclerotic plaque along the course of the infrarenal aorta up to the aortic bifurcation, without aneurysm, but no evidence of in-flow or out-flow arterial vascular disease involving the lower extremities. she went to the or on and had artery intervention and r carotid stent done by dr . she was continued on heparin drip until she was found to have an rp bleed (see below) which stabilized quickly. she was continued on asa, and clopidogrel and had an otherwise uncomplicated post-op course and was discharged home on . . 2) rp bleed: the patient developed a left-sided rp bleed after endoscopic right inominate artery and carotid artery stenting, requiring brief ccu stay for monitoring. her hct dropped from 39 to 30 but remained stable thereafter not requiring any blood transfusions. however, her blood pressure dropped briefly, requiring phenylephrin transiently. her bp meds were held. after having left the ccu, her blood pressure remained stable and her bp meds were restarted without event. heparin drip was also held after the rp bleed was detected. . 3) transaminitis: ast/alt were < 20 at the outside hospital, however were found to be in the 90s on arrival. hepatitis serologies were negative. this was felt to be probably statin related to her statin which was held. her transaminases trended down and she was resumed on statin prior to discharge . 4) hypertension: systemic pressure on catheterization was found to be at least 60 mm hg higher than her cuff pressure. continued amlodipine. benazepril not available here, therefore started lisinopril 5 mg but switched back to home lotrel prior to discharge. her bb was held during rp bleed and was continued prior to discharge when her bleeding subsided. . 5) copd: she is not on any medications for this, and was breathing comfortably on room air throughout admission. nebs were not necessary. . 6) smoking: she was on varenicline at the outside hospital, she continued her own meds while in house. . 7) incontinence: continued detrol. . medications on admission: asa 325 mg daily simvastatin 10 mg daily - hadn't yet started detrol lotrel (amlodipine and benazepril) 10/40 mg daily discharge disposition: home discharge diagnosis: vascular stenosis . hyperlipidemia htn discharge condition: stable discharge instructions: you were admitted for further evaluation of your occluded arteries in your chest and neck. you underwent successful stenting of the inominate artery intervention and right carotid stenting. post-procedure you experienced some bleeding and are now stable and ready for discharge. . seek medical attention immediately if you experience new symptoms including chest pain, shortness of breath, arm or jaw pain/numbness, fainting or other concerning symptoms. . please take all medications as prescribed. . follow up as per below followup instructions: pcp: , please call for an appointment within the next month procedure: coronary arteriography using two catheters left heart cardiac catheterization angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries aortography insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents procedure on two vessels diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery pure hypercholesterolemia tobacco use disorder unspecified essential hypertension chronic airway obstruction, not elsewhere classified atherosclerosis of aorta occlusion and stenosis of carotid artery without mention of cerebral infarction hemorrhage complicating a procedure atherosclerosis of renal artery other and unspecified angina pectoris stricture of artery urinary incontinence, unspecified personal history of other diseases of digestive system 

Answer: The patient is high likely exposed to