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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: : 1. urgent coronary artery bypass graft x4: left internal mammary artery to left anterior descending artery; saphenous vein grafts to right coronary artery and distal circumflex; and left radial artery to the 1st obtuse marginal. 2. endoscopic harvesting of the long saphenous vein. history of present illness: 53 year old male was seen in pcp last week for flu/uri like symptoms, and started on zithromax by pcp. awakened overnight with shortness of breath. went to er with cough/sob, o2 sat in traiage low 80s on ra, found to be in chf, given 40 mg iv lasix. ekg with ste and q-waves in v2-v3. given sublingual nitro, iv heparin started, iv nitro initiated for bp 200/100, at 80 mcg with bp 174/100, hr 80's pain free at present. he was also put on 100% nrb. very pale but at baseline per patient. he was transferred to for further evaluation. he was found to have coronary artery disease and is now being referred to cardiac surgery for revascularization. past medical history: iddm dyslipidemia hypertension chronic kidney disease, stage 1 diabetic neuropahty, diabetic retinopathy l5 radiculopathy hypothyroidism psh: s/p left hand middle digit amputation tonsillectomy social history: lives with:wife contact: (wife) phone # occupation:on disability cigarettes: smoked no yes hx:quit 10 years ago, smoked 1.5-3ppd x9-10 years other tobacco use:denies etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use:denies family history: family history:premature coronary artery disease- father died of mi at 59, mother had cva at 69 physical exam: admission: pulse:68 resp:20 o2 sat:92/ b/p 141/66 height:5'8" weight:83.9 kgs general: nad, aaox3 skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur grade ______ abdomen: soft non-distended non-tender extremities: warm , well-perfused edema mild b/l varicosities: none neuro: grossly intact pulses: femoral right: palp left: palp dp right: palp left: palp pt : palp left: palp radial right: palp left: palp carotid bruit right: none left: none pertinent results: admission labs: 03:54pm pt-11.2 inr(pt)-1.0 03:54pm plt count-248 03:54pm wbc-10.7 rbc-3.70* hgb-11.8* hct-35.8* mcv-97 mch-31.8 mchc-32.8 rdw-12.9 03:54pm tsh-7.7* 03:54pm %hba1c-9.2* eag-217* 03:54pm vit b12-1029* 03:54pm albumin-3.7 03:54pm ck-mb-6 03:54pm alt(sgpt)-21 ast(sgot)-21 alk phos-56 amylase-47 tot bili-0.4 03:54pm glucose-265* urea n-30* creat-1.3* sodium-136 potassium-4.4 chloride-102 total co2-27 anion gap-11 discharge labs: 04:55am blood wbc-8.6 rbc-2.91* hgb-8.9* hct-28.2* mcv-97 mch-30.5 mchc-31.6 rdw-13.7 plt ct-187# 04:55am blood plt ct-187# 04:55am blood glucose-185* urean-34* creat-1.5* na-137 k-4.3 cl-94* hco3-35* angap-12 04:55am blood mg-2.3 : 1. selective coronary angiography in this co-dominant system revealed severe 3 vessel cad. the lmca had no angiographically apparent disease. the lad had a long 80-90% lesion from the proximal to mid vessel with timi 2 flow noted in the distal lad. the lcx had a focal 80% proximal stenosis followed by a 80% tubular lesion in the proximal om@ and 60% lesion in the av groove beyond the om2 takeoff. the rca had a long 80-90% lesion in the mid vessel with appearance of possibly recanalized occlusion. 2. resting hemodynamics revealed elevated biventricular filling pressures with lvedp 42mm hg, mean pcwp 30mm hg, rvedp 16mm hg. mild-moderately pulmonary arterial hypertension with mean pa 37mm hg and pasp 56 primarily from transmitted left-sided pressures with transpulmonary gradient of 7mm hg and normal pvr of 109 dyne-sec/cm5. severely systemic arterial hypertension with central pressures of 154/77mmhg on nitroglycerine drip at 1.19 mcg/kg/min. final diagnosis: 1. severe 3 vessel cad. 2. severely elevated left-sided filling pressures. 3. moderately elevated right-sided filling pressures. 4. moderate pulmonary arterial hypertension. echocardiogram: left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.9 cm <= 5.6 cm left ventricle - ejection fraction: 40% to 45% >= 55% left ventricle - stroke volume: 65 ml/beat left ventricle - cardiac output: 3.75 l/min left ventricle - cardiac index: *1.89 >= 2.0 l/min/m2 left ventricle - lateral peak e': *0.08 m/s > 0.08 m/s left ventricle - ratio e/e': 11 < 15 aorta - annulus: 2.3 cm <= 3.0 cm aorta - sinus level: 2.8 cm <= 3.6 cm aorta - sinotubular ridge: 2.6 cm <= 3.0 cm aorta - ascending: 2.6 cm <= 3.4 cm aorta - arch: 2.4 cm <= 3.0 cm aorta - descending thoracic: 2.3 cm <= 2.5 cm aortic valve - lvot vti: 17 aortic valve - lvot diam: 2.2 cm mitral valve - e wave: 0.9 m/sec mitral valve - a wave: 0.2 m/sec mitral valve - e/a ratio: 4.50 pericardium - effusion size: 0.6 cm findings left atrium: no spontaneous echo contrast in the body of the laa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: mild symmetric lvh. normal lv cavity size. mild-moderate regional lv systolic dysfunction. moderately depressed lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: no ms. trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: small pericardial effusion. conclusions pre-bypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with focalities in mid and apical segments of anterior, septal and inferior walls. overall left ventricular systolic function is moderately depressed (lvef=35- 40 %). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. trivial mitral regurgitation is seen. there is a small pericardial effusion. post-bypass: the patient is in sinus rhythm. the patient is on no inotropes. biventricular function is unchanged. valvular regurgitation is unchanged. the aorta is intact post-decannulation.lvedf35- 40%. : duplex evaluation was performed of bilateral carotid arteries. on the right there is mild heterogeneous plaque seen in the ica . on the left there is mild heterogeneous plaque seen in the ica. on the right systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 109/26, 103/35, 96/31, cm/sec. cca peak systolic velocity is 69 cm/sec. eca peak systolic velocity is 249 cm/sec. the ica/cca ratio is 1.5. these findings are consistent with <40% stenosis. on the left systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 104/30, 109/36, 86/36, cm/sec. cca peak systolic velocity is 99 cm/sec. eca peak systolic velocity is 152 cm/sec. the ica/cca ratio is 1.1 . these findings are consistent with <40% stenosis. there is antegrade right vertebral artery flow. there is antegrade left vertebral artery flow. impression: right ica <40% stenosis. left ica <40% stenosis. radiology report chest (pa & lat) study date of 10:20 am final report: small-to-moderate bilateral pleural effusions persist. there is persistent bibasilar atelectasis, left greater than right. heart size is enlarged. no pneumothorax is detected. sternal wires and mediastinal clips are again noted. impression: persistent small to moderate bilateral pleural effusions and bibasilar atelectasis, left greater than right. brief hospital course: mr. was transferred from for coronary artery by-pass surgery elevation myocardial infarction and three-vessel coronary artery disease. heparin was continued and he was taken to the operating room on for urgent coronary artery bypass graft x4. please see operative report for details, in summary he had: left internal mammary artery to left anterior descending artery; saphenous vein grafts to right coronary artery and distal circumflex; and left radial artery to the 1st obtuse marginal. endoscopic harvesting of the long saphenous vein. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. on pod 1 the patient was extubated, alert, oriented and breathing comfortably. he was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. beta blocker was initiated and the patient was gently diuresed toward his preoperative weight. he was followed by endocrine service and his insulin was titrated. the patient transfer to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. the patient progressed slowly with physical therapy and increasing endurance, he continued to have episodes of desating oxygen levels with activity despite supplemental oxygen. on pod5 the patient was discharged to rehabilitation nursing and rehab in for continued work with physical therapy. at that time he was in good condition with appropriate follow up instructions provided. medications on admission: simvastatin 80mg daily, ezetemibe 10mg daily, gabapentin 100mg tid, atenolol 25mg daily, levyothyroxine 0.1mg daily, lantus 40 - 60 units qam (per sliding scale), tramadol 50mg tid, mutlivitamin daily, vitamin d units discharge medications: 1. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 5. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 7. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 8. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. gabapentin 100 mg capsule sig: one (1) capsule po q8h (every 8 hours). 11. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 12. isosorbide mononitrate 20 mg tablet sig: three (3) tablet po once a day. 13. hydromorphone 2 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 14. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 15. furosemide 80 mg tablet sig: one (1) tablet po q8h (every 8 hours). 16. insulin glargine 100 unit/ml solution sig: sixty (60) units subcutaneous once a day. 17. insulin regular human 100 unit/ml solution sig: sliding scale units injection qac&hs. 18. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: health care center - discharge diagnosis: coronary artery disease iddm dyslipidemia hypertension chronic kidney disease, stage 1 diabetic neuropahty, diabetic retinopathy l5 radiculopathy hypothyroidism psh: s/p left hand middle digit amputation, tonsillectomy discharge condition: alert and oriented x3 nonfocal ambulating with asssistance incisional pain managed with dilaudid incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema: 2+ discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: wound care nurse phone: date/time: 10:00 in the building , md phone: date/time: 1:15 in the cardiologist: , md phone: date/time: 1:00 on the clinical center please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries left heart cardiac catheterization other bypass anastomosis for heart revascularization diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified polyneuropathy in diabetes personal history of tobacco use other and unspecified hyperlipidemia long-term (current) use of insulin family history of ischemic heart disease acute myocardial infarction of unspecified site, initial episode of care background diabetic retinopathy diabetes with neurological manifestations, type ii or unspecified type, uncontrolled diabetes with renal manifestations, type ii or unspecified type, uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled other finger(s) amputation status thoracic or lumbosacral neuritis or radiculitis, unspecified chronic kidney disease, stage i 

Answer: The patient is high likely exposed to