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: atorvastatin attending: chief complaint: arm tingling, numbness major surgical or invasive procedure: left internal carotid artery stent placement. history of present illness: mr. is a 60 yo m w/pmhx sx for cad s/p cabg (), dm, hyperlipidemia, htn who presents with right arm tingling, numbness, and difficulty closing his hand into a fist upon wakening this morning. . patient has known cad, and is asymptomatic with his heart disease. he has yearly stress tests, and states that his stress test in of this year was abnormal. he does note gradual increase in his exertional dyspnea over the course of the past year, and this past thursday, developed a sharp midsternal chest pain, without associated nausea, diaphoresis, radiation, or sob, relieved by sl nitro. he then saw his cardiologist on , who performed an echo, and requested that he have a repeat catheterization done this wednesday. patient then developed the right arm tingling and presented to the osh ed (). patient has chronic visual blurriness from cataracts. he has chronic numbness and swelling of his legs from charcot foot. . of note, he had left arm shaking for 20 minutes one week ago after having lifted his arm during house work. disappeared on its own. no tingling or weakness associated. . patient was initially seen at an osh, with an unchanged ekg, negative head ct (per pt), and was given aspirin, plavix load, nitroglycerin, and started on a heparin gtt. his first set of ce there were negative. he was then transferred here where his sx did not seem compatible with acs, and his heparin gtt was discontinued. . on admission, the patient denied any cp, sob, palpitations, tingling/pain/numbness in his arms, trauma to his neck or arm. past medical history: - cad s/p 2v cabg in (at by dr. ; angina equivalent in the past: right arm pit discomfort; now sscp - stent to lad in (at cath with 90% mid-lad and 89%diag lesion; ef 45%, apical hypokinesis; cath c/b dissection in distal lad which was stable on re-cath); on asa/plavix since - htn - type ii dm with neuropathy and retinopathy; since age 40; strong fhx; fs run in low 200s and hba1c 8-9 per patient - s/p iii degree burn on l foot diabetic pnp (per pt) - s/p unnoticed fractures of r foot diabetic pnp/charot's foot (per pt) - hyperlipidemia - osa - gerd social history: lives with wife, daughter (33) and son (35), vp of sales, no tobacco, no etoh family history: father died of malignant hypertension in 40s, father's brothers died of heart disease in 50s, mother died of aneurysm rupture at 76, several family members on mothers side with dm physical exam: vs: 97.5 bp 157/60 hr 67 rr 14 o2sat 100% ra gen: well appearing. heent: mmm. hrt: rrr. 2/6 sem. lungs: ctab no rrw. abd: s/nt/nd. ext: warm. sensation to lt diminished below ankles. 1+ edema at ankles bilaterally. 1+ pulses bilaterally. no femoral bruits. neuro: strength full bilaterally. alert and oriented. sensation diminished as above. pertinent results: 141 103 19 --------------< 171 3.5 26 1.4 14.5 6.1 >----< 215 41 n:71.3 l:19.8 m:4.4 e:4.0 bas:0.5 . pt: 11.9 ptt: 49.9 inr: 1.0 . trends: wbc: 6.1 - 7.7 hct 41 - 36 creatinine 1.4 - 1.4 ck 98-73-67 trop 0.02-0.01-0.01 . ekg: nsr. twi i, avl. prwp. q iii, avf c/w old inferior mi. (no olds to compare). . echo (per outside records): inferobasilar hypokinesis, ef 50%, mild mr, lae . stress test : partially reversible infero-apical defect . mri mra brain: findings: circle of is normal with no evidence of aneurysms. there is a predominantly fetal circulation to the right posterior cerebral artery. there is a hypoplastic right a1 segment. impression: normal time-of-flight mra of the circle of . . carotid ultrasound: significant left-sided plaque with 80-99% carotid stenosis. of note, this extends fairly distally in the cervical internal carotid artery. on the right, there is less than 40% carotid stenosis. . mr spine: right paracentral and foraminal disc herniation at c6-7 could be causing neural impingement. this would correlate with patient's clinical symptoms. mild degenerative changes otherwise. brief hospital course: mr. is a 60 yo m w/pmhx sx for cad s/p cabg, htn, hyperlipidemia, and dm who presents with sharp shooting pain down arm concerning for tia. hosp course by problem: . # neuro/tia: patinet had neuro workup as above. he was evaluated by neurology and sx were concerning for a tia. given the carotid findings it was deemed that the source of the tia was likely carotid in origin. he was taken to the cath lab for stent placement in the left ica on . procedure was tolerated well without complication. he was monitored in the ccu postprocedure. his groin site was stable and his neuro exam remained nonfocal. he was treated with a nitro gtt temporarily given that many of his antihypertensives had been on hold. this was weaned as his meds were titrated up. his goal sbp was 110-170 given recent carotid manipulation. after remaining stable overnight, he was evaluated by neuro again and there were no deficits. he was stable for d/c to home. he has f/u with neuro/stroke attng within one month. . #. cardiac. a. ischemia. patient's ekg without active ischemic changes, and ce negative. however per patient report abnormal stress and scheduled for cath this week given sscp last thursday, relieved by sl nitro. the cath was put on hold given neuro workup. patient will f/u with cardiologist and will likely have elective cath in 1 month. we continued asa 325, plavix, metoprolol, statin b. rhythm. nsr. monitor on telemetry. c. pump. euvolemic. ef 50% on last echo in . . #. htn. his home meds were adjusted pre-stent to allow for some autoregulation. postprocedure, we gradually added back some antihypertensives but held the hctz and verapamil on discharge given the new carotid stent will likely decrease bp. he will have close f/u with his pcp and will contact him sooner if develops dizziness, lightheadedness, headache, or low bp on self-exam. . #. hyperlipidemia. continued statin. . #. dm2. continued home insulin. . #. cri. gfr 54. cr 1.3-1.4 and stable. he received pre-carotid stent hydration . #. dispo status: well. ambulating without issue. no neuro deficits. medications on admission: asa 325 qd plavix 75 qd omeprazole 20 mg qd insulin 70/30 40 u qam, 55 u qpm verapamil sr 240 mg qpm welchol 625 mg diovan 160/12.5 qd tricor 145 qd zetia 10 mg qd norvasc 2.5 mg qd metoprolol 100 niacin 50 qd vit e fish oil discharge medications: 1. amlodipine 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 2. insulin 70/30 sig: variable units twice a day: take 40 u every morning and 55 units every pm. take as previously instructed. 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. colesevelam 625 mg tablet sig: one (1) tablet po bid (2 times a day). 5. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 7. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 8. lasix 20 mg tablet sig: one (1) tablet po once a day. 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. niacin 500 mg tablet sig: one (1) tablet po once a day. 11. vitamin e 400 unit tablet sig: one (1) tablet po once a day. 12. multi-vitamin tablet sig: one (1) tablet po once a day. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home discharge diagnosis: primary diagnosis: - arm numbness, tingling - tia - carotid stenosis left sided s/p stent - cad, s/p 2 vessel cabg in - htn - type ii diabetes secondary: - hyperlipidemia - osa - gerd secondary diagnosis: 1. hyperlipidemia discharge condition: afebrile. hemodynamically stable. ambulating. tolerating po. discharge instructions: you have been evaluated for arm tingling and numbness. you have been found to have a transient ischemic attack. you had a carotid stent placed which you tolerated well. . we made some adjustments to your medications. please take them as instructed. if you experience any lightheadedness, dizziness, or headache your blood pressure medications may need to be adjusted. check your blood pressure and contact your pcp if necessary. . the adjustments to your meds are as follows: 1. decreased metoprolol to 50mg 2. holding diovan/hctz 3. starting losartan 160mg daily 4. holding verapamil sr . if you experience any chest pain, shortness of breath, neurological findings, or palpitations please contact your pcp, , or emergency department. . it is very important for you to continue taking your plavix daily. . please followup with dr. in preparation for a cardiac cath as previously discussed followup instructions: please follow up with , f. , at 9:45. . please also follow up with your neurologist, dr. . his number is (. your appointment is at 9:30. building . . please followup with dr. on at 11:15am. please followup with dr. in weeks. his office number is (. md, procedure: percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux intermediate coronary syndrome hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy arthropathy associated with neurological disorders 

Answer: The patient is high likely exposed to