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: chest pain major surgical or invasive procedure: cardiac catheterization x 3 cardiac resuscitation history of present illness: 43 yo female w/ a h/o htn, tobacco abuse, and famhx of cad who p/w 1 week of intermittent chest pain. patient notes centrally located chest pressure associated w/ bilateral arm heaviness starting 1 week ago. the episodes were intermittent, lasting for hours at a time, and occurred at rest and with activity. patient thought it was heartburn and treated w/ tums w/o improvement. yesterday, the pain became more severe, , and did not remit. the pain yesterday was associated w/ sob and nausea. she presented to where ecg showed 0.5- elevations w/ qws and symmetric twis in iii, avf c/w missed event. cardiac enzymes were elevated w/ tropi of 3.4. she received asa 325 mg, plavix 600 mg, and was started on a heparin bolus and gtt. she was also hypertensive to 204/137 and received 20 mg of iv labetolol x2. she received multiple slntgs w/o improvement of symptoms as well as iv fentanyl and was started on a ntg gtt. she was transferred to for catheterization. . in the cath lab, she was found to have a diffusely diseased rca totally occluded with thrombus. she received thrombus could not be suctioned out, and multiple angioplasties were performed with residual thrombus at the end of the procedure. currently she is chest pain free. past medical history: # htn # s/p c-section x2 social history: lives in with husband. 5 children. 1 ppd smoking hx x 25 yrs. family history: brother had an mi @ age 53. father had an mi in late 50s. physical exam: vs: t: af, bp: 123/65, hr: 61, rr: 15, o2: 100% on ra gen: wdwn middle aged female in nad. oriented x3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp low sitting upright. 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: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. no organomegaly. groin: 2+ femoral pulses. cath site w/o hematoma or bruit. ext: wwp. no c/c/e. 2+ dp pulses. skin: no stasis dermatitis, ulcers, scars pertinent results: 09:00am blood wbc-10.2 rbc-4.25 hgb-13.3 hct-38.2 mcv-90 mch-31.3 mchc-34.8 rdw-13.1 plt ct-249 01:45am blood plt ct-224 07:45am blood k-3.8 09:00am blood glucose-95 urean-7 creat-0.7 na-138 k-4.0 cl-102 hco3-29 angap-11 07:45am blood ck(cpk)-605* 07:45am blood ck-mb-88* mb indx-14.5* 09:00am blood mg-1.8 cholest-201* 07:30am blood calcium-8.8 phos-2.4* mg-1.9 05:40pm blood caltibc-283 hapto-149 ferritn-127 trf-218 09:00am blood triglyc-222* hdl-45 chol/hd-4.5 ldlcalc-112 ldlmeas-134* 08:22pm blood type-art po2-356* pco2-35 ph-7.18* caltco2-13* base xs--14 08:22pm blood glucose-245* lactate-8.2* na-137 k-4.5 cl-117* 06:00am blood wbc-7.7 rbc-3.19* hgb-10.0* hct-28.5* mcv-89 mch-31.2 mchc-35.0 rdw-15.2 plt ct-135* 08:05am blood pt-12.9 ptt-29.7 inr(pt)-1.1 06:00am blood glucose-85 urean-8 creat-0.5 na-142 k-3.4 cl-108 hco3-24 angap-13 02:40pm blood ck(cpk)-3135* 06:10am blood alt-620* ast-686* ld(ldh)-1415* ck(cpk)-2762* alkphos-65 totbili-0.5 05:40pm blood ld(ldh)-703* ck(cpk)-1722* 07:45am blood ck-mb-88* mb indx-14.5* 09:00am blood ck-mb-98* mb indx-15.1* ctropnt-0.61* 07:30am blood ck-mb-34* mb indx-9.2* ctropnt-0.79* 11:50pm blood ck-mb-148* ctropnt-3.87* 06:10am blood ck-mb-161* mb indx-5.8 ctropnt-3.89* 02:40pm blood ck-mb-142* mb indx-4.5 04:54am blood ck-mb-68* mb indx-2.3 06:25am blood ck-mb-18* mb indx-0.9 ctropnt-2.33* 05:40pm blood ck-mb-13* mb indx-0.8 ctropnt-1.98* 06:00am blood calcium-8.0* phos-3.7 mg-1.8 08:39pm blood glucose-316* lactate-13.6* na-142 k-2.4* cl-108 12:02am blood lactate-3.9* . reports: c.cath study date of ptca comments: initial angiography revealed a total occlusion of the rca proximally with an aneurysmal area at the occlusion. there were left to right collaterals filling pda but no right to right collaterals. we planned to treat lesion with export and balloon angioplasty. heparin and integrelin were added to asa and plavix. a jr 4 guide was used initially which did not provide adequate support. we could not cross with a prowater wire and were directed into a thrombotic marginal branch. a pt intermediate wire did cross with moderate difficulty. flow was restored by dottering which revealed a large diffusely diseased aneurysmal vessel with very large thrombus burden. we were unable to advance export catheter and had to pull wire and exchange for a ar 2 guide which provided better support. we recrossed with a pt intermediate wire and exchanged for a stabilizer supersoft. we were then able to do 2 passess with export but could not reach all the way to distal rca due to support issues. no visible thrombus was retrieved. there were 2 areas of 90% stenosis, one proximally and the other in mid-distal rca. we dilated with a 2.5x15mm voyager balloon at distal lesion for 6-12atm x4 and the proximal lesion at 10atm x2. this improved flow to timi 3 but large thrombus burden remained. at this time further intervention was aborted and plan is to continue heparin and integrelin for 36 hours. patient will be brought back to lab after that period for stenting of the two lesions with bms if thrombus resolves. of note patient was hemodynamically stable with bp 140 on tng drip througout the case and there were no tachy or brady arrhythmias. comments: 1. coronary angiography of this right dominant system revealed 2 vessel cad. the lmca and lad were without angiographically evident flow limiting epicardial stenosis. the lcx had a 60-70% proximal stenosis. the rca was totally occluded proximally with aneurysmal dilatation at the area of occlusion. 2. resting hemodynamics revealed normal systemic arterial pressures with aortic systolic pressure of 127 mm hg and mean arterial pressure of 88 mm hg. 3. left ventriculography was not performed. 4. poba of proximal and mid-distal rca lesions with 2.5mm balloon restoring flow in setting of sub-acute inferior stemi. final diagnosis: 1. two vessel coronary artery disease. 2. subacute inferior stemi. 3. angioplasty of rca. . c.cath study date of ptca comments: initial angiography revealed tandem lesions in the rca. there was a 60% lesion proximally (free of thrombus) and an 80% lesion distally with large thrombus burden at this site. we planned to perform ptca to the distal lesion with a view to stenting if this produced an unsatisfactory result. heparin and integrilin was commenced prophylactically. an ar2 guide engaged the rca providing adequate support. the rca was wired with some minor difficulty with a prowater wire. the distal rca lesion was then predilated with a 3.0x20mm voyager balloon inflated to 10atms with improvement of the distal lesion to 50%. we then opted for distal distal protection (with spider 7.0mm filter) and angiojet thrombectomy. initially no change but after removal of filter, thrombus not noted and pda occluded mid. pda was wired and ic nitroprusside was given. flow in pda did not return. decision made to proceed to stenting of distal and proximal rca lesion. we attempted to deliver a 4.5x28mm ultra stent which failed with loss of wire position. the rca was then engaged with an al1 guide and attempted to re-wire with a prowater wire leading to proximal large dissection. the dissected segment was eventually crossed with a cpt xs wire with some difficulty and exchanged for a pilot 50 wire to cross distally. the distal lesion was stented with a 4.5 x 24 liberte stent at 13 atm. the proximal lesion and dissected segment was then stented with a 4.5x24mm liberte stent deployed at 24atms. final angiography showed no thrombus. timi 3 flow and no dissection. pda slow flow. patient left cathlab with continuing chest pain and inferior st elevation. comments: 1. hemodynamics: bp 147/88/113 2. proximal 60% rca lesion. distal 80% rca lesion with significant thrombus burden 3. distal embolic protection with angiojet thrombectomy of distal rca. 4. thrombotic emboli with slow flow down pda. 5. successful ptca/stenting to distal rca with a 4.5x24mm liberte stent deployed at 13atms. successful ptca/stent to proximal rca lesion and dissected segment with a 4.5x24mm liberte stent deployed at 24atm. no apparent thrombus or dissection at end of procedure with timi 3 flow down vessel however slow flow down pda. final diagnosis: 1. one vessel coronary artery disease. 2. severe thombotic lesion in distal rca with further lesion in proximal rca (thrombus free). 3. ptca/stenting to distal rca with bare metal stent following angiojet thrombectomy with compromise of pda. 4. successful ptca/stenting of proximal rca with bare metal stent. . c.cath study date of brief history: 43 yo female with a history of coronary disease status post stemi with poba of the rca on and stenting with ventriuclar fibrillation and cardiac arrest the evening of with successful rescuscitation for emergent cath. intubated. ptca comments: the initial angiography revealed a totally occluded thrombosed rca at the proximal stent. heparin and integrilin were being administered for anticoagulation. the strategy was to dotter the vessel, perform thrombectomy and administer intracoronary 2b3a to reestablish flow and subsequently perform the mid-rca stenting. jr4 guide provided good support. choice pt xs wire crossed into the distal vessel with some manipulation. some flow was restored by dottering the vessel with a 3.0 x 12 mm voyager balloon. subsequent angioplasty was performed of the vessel with a 3.0 x 12 mm voyager balloon at 14 atms distally. intracoronary reopro was administered and the remaining thrombus was thrombectomized with multiple runs of the export catheter with improvement in flow. 5.0 x 20 mm quantum maverick balloon was used to further predicate the vessel at 14 atms. 4.0 x 23 mm vision stent was deployed at the distal rca at 18 atms. the mid rca was stented with a 5.0 x 28 mm ultra stent deployed at 18 atms. proximal rca was stented with a 5.0 x 18 mm ultra stent in an overlapping fashion. 5.0 x 20 mm quantum maverick balloon was used for postdilation at 16-18 atms. there was less than 20% residual stenosis in the proximal stent and no residual stenosis in the mid to distal vessel. flow was timi iii.the patient was hemodynamically stable and following commands at the end of the procedure. comments: 1. coronary angiography of this right dominant system revealed acute stent thrombosis of the proximal rca. there was mild disease in the lmca, lad, and lcx vessels. the rca had an acute thrombotic lesion causing a 100% occlusion of the proximal rca with some left to right collaterals. 2. resting hemodynamics after successful cpr in the ccu revealed mildly elevated systemic arterial pressure with an sbp of 142 mm hg. 3. successful thrombectomy and stenting of the rca with 4.0 x 23 mm vision bare metal stent distally and 5.0 x 28 mm and 5.0 x 18 mm ultra stents proximally in an overlappig fashion (see ptca comments for detail). final diagnosis: 1. one vessel coronary artery disease. 2. acute inferior myocardial infarction, managed by thrombectomy, ptca of the proximal rca vessel. 3. successful stenting of the rca with bare metal stents. . c.cath study date of brief history: ms. is referred for repeat catheterization after acute chest pain and st elevations in v1, iii, and avf. comments: 1. selective coronary angiography of this right dominant system revealed widely patent rca stents with distal rca thrombus unchanged from the last catheterization. there was no angiographically evident stent thrombosis. the left coronary system was not injected. 2. resting hemodynamics revealed elevated right and left sided filling pressures with rvedp of 21 mm hg and mean pcwp of 22 mmhg. pulmonary arterial pressures were moderately elevated at 43 mm hg. systemic arterial pressures were normal with aortic sytolic pressure of 112 mm hg and mean arterial pressure of 78 mm hg. cardiac index was preserved at 3.56 l/min/m2. 3. left ventriculography was not performed. final diagnosis: 1. one vessel coronary artery disease with unchanged rca disease. 2. no evidence of stent thrombosis. 3. elevated right and left sided filling pressures with preserved cardiac index. . echo : conclusions the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%) secondary to hypokinesis of the midventricular segment of the inferior and posterior walls. there is no ventricular septal defect. right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: inferior posterior infarct with preserved ejection fraction . echo conclusions 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 inferior and inferolateral hypokinesis. the remaining segments contract normally (lvef = 50%). the estimated cardiac index is borderline low (2.0-2.5l/min/m2). the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , inferior/inferolateral left ventricular hypokinesis is new. the right ventricle is now mildly dilated, and the severity of mitral regurgitation and tricuspid regurgitation have increased. . ecg study date of 11:46:22 pm sinus bradycardia. possible prior inferior myocardial infarction. no previous tracing available for comparison. . ecg study date of 7:42:50 am sinus rhythm. there are q waves in the inferior leads with associated st-t wave changes consistent with prior inferior myocardial infarction. compared to the previous tracing there is no significant change. . ecg study date of 11:58:36 am sinus rhythm. inferior myocardial infarction of indeterminate age. there are non-specific t wave changes compared to the previous tracing of . tracing #1 . ecg study date of 1:49:28 pm sinus rhythm. inferior myocardial infarction, could be recent. non-specific anterior st-t wave changes. compared to the previous tracing of there is now inferior st segment elevation and st segment elevation in leads v3-v6. tracing #2 . ecg study date of 2:59:56 pm sinus rhythm. inferior st segment elevation could be acute/recent myocardial infarction. anterior and lateral st segment depression could be reciprocal. compared to the previous tracing of there is evolution of the st-t wave changes. tracing #3 . ecg study date of 10:16:50 pm sinus rhythm. inferior myocardial infarction, probably recent. non-specific anterolateral st-t wave changes. compared to the previous tracing of the inferior st segment elevation is resolved and the q waves are more prominent. tracing #4 . ecg study date of 7:46:56 am sinus rhythm. inferior myocardial infarction of indeterminate age. early r wave transition. non-specific anterolateral t wave flattening. compared to the previous tracing of no significant change. tracing #5 . ecg study date of 4:04:44 pm sinus rhythm. there are q waves in the inferior leads consistent with prior myocardial infarction. non-specific lateral and anterolateral st-t wave changes. compared to the previous tracing there is no significant change. . chest (portable ap) 4:12 am impression: endotracheal tube has been placed into the right main stem bronchus and needs to be pulled back 3 cm. otherwise, no active disease in the chest. discussed with house officer at the time of dictation. . chest (portable ap) 8:02 am impression: 1. status post extubation. 2. mild atelectasis right lung base, otherwise clear. . chest (portable ap) 10:49 am impression: right linear basilar atelectasis. no evidence of pulmonary edema or consolidations. . shoulder views non trauma left 10:15 am impression: questionable lucency through the distal acromion adjacent to the acromioclavicular joint. degenerative changes versus possible fracture. correlate with point tenderness. brief hospital course: a/p: 43 y.o.f. w/ htn, smoking history, and fh cad s/p inferior stemi s/p initial catheterization w/ poba and incomplete resolution of thrombus, then second cath with stent to rca complicated by dissection and 35 minute vfib arrest associated with in-stent thrombosis, documented by later cath to be clear. . # cad/ischemia: she presented to where ecg showed 0.5- elevations w/ qws and symmetric twis in iii, avf. cardiac enzymes were elevated w/ tropi of 3.4. she received asa 325 mg, plavix 600 mg, and was started on a heparin bolus and gtt. she was also hypertensive to 204/137 and received 20 mg of iv labetolol x2. she received multiple slntgs w/o improvement of symptoms as well as iv fentanyl and was started on a ntg gtt. she was transferred to for cath on which revealed a diffusely diseased proximal rca, totally occluded with thrombus with aneurysmal dilation. the thrombus could not be sucked out, and poba of proximal and mid-distal rca lesions with 2.5mm balloon was performed, restoring flow in setting of sub-acute inferior stemi. due to the residual thrombus, no stent was placed due to concern for distal emboli of thrombus. the lcx had a 60-70% proximal stenosis. . she was transferred back to 3 on and did well with plan for repeat catheterization on (hoping for resolution of thrombus by that time). had some mild nsvt. on the patient was taken to the cath lab where there remained a large amount of thrombus burden. a distal filter was placed and attempts at suctioning out clot and using angioget failed. filter was pulled out and subsequent films showed dislodgement of the clot into the pda. patient developed pain and nitroprusside boluses/nitro gtt given for vasodilatation, as well as versed/fentanyl for pain. was bradycardic transiently and per nursing report received atropine, but no atropine recorded in med log. attention was then moved to stenting the rca, c/b dissection in the proximal rca with a transient period of no flow in the rca. both a proximal and distal stent were placed to the rca with restoration of flow to rca but minimal restoration of flow in the pda. patient was transferred to the holding area where she reported chest discomfort, and was therefore transferred to the ccu for further monitoring. she then experienced a vfib arrest, requiring a 35 minute successful code, instent thrombosis. she was taken back to the cath lab, where instent thrombosis in the proximal rca was noted. she received successful thrombectomy and stenting of the rca with 4.0 x 23 mm vision bare metal stent distally and 5.0 x 28 mm and 5.0 x 18 mm ultra stents proximally in an overlappig fashion. a subsequent cath done for shoulder pain showed clean coronary arteries and stents. . she was then transferred back to , where she had no further chest pain and no apparent neurologic sequela of the arrest. she was maintained on plavix 150mg with plans to decrease to 75mg after one month as per discharge instructions, asa 325, enoxaparin 80 x 1 month, lipitor 80, lopressor 25 , lisinopril 5. her ck peaked at 3135. she was counseled on smoking cessation and given a nicotine patch. . # rhythm: nsr with bradycardia intracath. s/p vib arrest in setting in-stent thrombosis. she was monitored on telemetry on the floor with no further events. her bb was continued as above. . # pump: echo on with ef 50% and hypokinesis of the midventricular segment of the inferior and posterior walls. clinically appeared euvolemic. lopressor and lisonpril as above. she should have repeat echo as an outpatient. . # anemia: per ccu team, stools have been guaiac negative. she continues to drift down despite two units of prbcs on without appropriate bump. some might be from fluids and reequilibration, but also question hemolysis, iron deficiency, and/or bone marrow suppression given acute illness. she required a total of three units of prbcs. iron studies were wnl and her hct was stable upon discharge. . # shoulder pain: likely refered pain from diaphragm (inferior mi) vs. msk pain since increased with movement s/p long code. ap film showed possible fracture near ac joint. saw pt., recommend supportive tx, outpatient f/u in clinic. . # neuro: pt. with remarkably intact ms s/p prolonged arrest, appears neurologically intact . # htn: had htn 11 yrs ago, but all antihypertensives stopped with pregnancy. - regimen as above . # prophylaxis: ppi, bowels, ac, riss . # code: full medications on admission: home medications: none . medications on transfer: aspirin plavix metoprolol heparin gtt ntg gtt discharge medications: 1. enoxaparin 80 mg/0.8 ml syringe sig: one (1) syringe subcutaneous (2 times a day). disp:*60 syringe* refills:*1* 2. outpatient lab work sodium, potassium, chloride, bicarb, bun, creatinine, glucose, calcium, magnesium, phosphate on . please give result to dr. or covering physician. 3. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. toprol xl 100 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* 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily) for 1 months. disp:*60 tablet(s)* refills:*0* 8. plavix 75 mg tablet sig: one (1) tablet po once a day: to be started after one month of plavix 150mg daily. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: inferior st elevation mi ventricular fibrillation cardiac arrest acute systolic ventricular dysfunction coronary artery disease hypertension . secondary: s/p c-section x2 discharge condition: good, stable, cardiac chest pain free discharge instructions: you were seen at for chest pain and found to have a heart attack, for which you received stents and angioplasty. you had a cardiac event which required you to stay in the cardiac care unit for a couple days. your medication regimen has changed, including new medications called toprol xl, atorvastatin, lovenox, aspirin, and lisinopril. you will need to stay on the lovenox injections for at least one month. your plavix should continue at the current dose for 1 month, and then you will be on 75mg daily. please take your medications as prescribed. . you have been set up with dr. cardiology office because he referred you to . his office will call you for an appointment time. we also gave you numbers of a couple other cardiologists if you choose to follow up with them instead of with dr. . . you should stay out of work for two weeks, and then only go back part time (5 half days, not 3 full days) for the next 2 weeks. you may then need cardiac rehab after those 4 weeks. please discuss cardiac rehab with your cardiologist. . the orthopedists saw you because of your shoulder pain. you may have a small fracture in your shoulder. you have follow-up as below for repeat xray of your shoulder. . your potassium was also low. we have set you up with a lab draw appointment at your primary care physician's office as below to make sure your potassium is ok. . please follow-up as below. . you should call your primary care provider or your cardiologist, or return to the emergency department if you experience chest/arm/jaw pain, shortness of breath, palpitations, lightheadedness/dizziness, loss of consciousness, nausea/vomiting, or any other symptoms that concern you. followup instructions: please go to office to have your blood drawn on at 8:30am. they are expecting you. we have given you a prescription for this blood draw. . provider: office, with , pa. at 2:20pm. . provider: xray (scc 2) phone: date/time: 4:00 . provider: , md, orthopedics phone: date/time: 4:20 . provider: . , cardiology. their office will call you for an appointment. his office number is . . other cardiologists in your area: cliff . please call if you need to reschedule. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) insertion of non-drug-eluting coronary artery stent(s) injection or infusion of platelet inhibitor injection or infusion of platelet inhibitor left heart cardiac catheterization left heart cardiac catheterization left heart cardiac catheterization coronary arteriography using a single catheter coronary arteriography using a single catheter coronary arteriography using a single catheter coronary arteriography using a single catheter insertion of endotracheal tube angiocardiography of right heart structures angiocardiography of right heart structures angiocardiography of right heart structures angiocardiography of right heart structures transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on single vessel procedure on single vessel insertion of three vascular stents diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension hypopotassemia cardiac arrest acute myocardial infarction of other inferior wall, initial episode of care other complications due to other cardiac device, implant, and graft ventricular fibrillation 

Answer: The patient is high likely exposed to