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: simvastatin attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization status post percutaneous intervention (2 bare metal stents) history of present illness: history of presenting illness: mr. is a 66 year old m w/ h/o pancreatic ca s/p sphincterotomy and chemotherapy with gemcitabine and erlotinib, dm type 2, and cad s/p mi and pci/stent who is transferred from osh with acute inferior stemi. patient presented to the afternoon of admission with chest pain, onset around noon and radiation to neck and left arm. pain occurred at rest and was worse with inspiration. associated with sob, no nausea or vomiting. of note, reported some pleuritic symptoms several days prior to this episode, though not as intense. pain was at its worst. presented to osh where ekgs were remarkable for ste and small q waves in ii, iii, avf with reciprocal st depressions in i and avl. patient was given asa, plavix 300, and started on a heparin drip. he was given nitro x 3 without relief of his symptoms and subsequently started on a nitro drip. he was transferred to for further management. . on arrival at patient was taken straight to cath lab. vitals at that time were hr 109, bp 128/68 rr 19 o2 sat 99%. cardiac catheterization showed a right dominant system with total occlusion of rca, minimal disease in the remaining vessels. the lesion was apparently difficult to cross and behaved more like a chronic to than an acute lesion. he underwent balloon dilation and then two bare metal stents were placed in the proximal and mid rca. . in the ccu, patient reported pain improved, but continued pleuritic pain in his upper chest/neck with inspiration and burping. in intensity. denied cough, hemoptysis, hematemesis, nausea, vomiting, abdominal pain, rashes. reports has been active at home, walking around and driving more than in recent times. ros is negative for diarrhea, black stools, bloody stools, and fevers. +chills. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . . past medical history: 1. cardiac risk factors: + diabetes, + dyslipidemia, + hypertension 2. cardiac history: cad s/p pci in 3. other past medical history: metastatic pancreatic cancer (currently on gemcitabine qoweek and erlotinib daily) embolic cerebral infarcts status post left mca stroke with left carotid artery stenosis s/p upper and lower gi bleed thrombocytopenia diabetic retinopathy cataracts glaucoma social history: - tobacco: currently smokes 1ppd x 40 years - etoh: previously was a heavy drinker, quit 20 years ago. denies current etoh use - illicits: denies lives with his wife. 3 children, numerous grandchildren. family history: the patient's father died of asbestosis and mesothelioma at 75 years. his mother is alive at years. he has three children and two brothers without health concerns. . physical exam: on admission: vs: t= 99.4 bp= 118/65 hr=99 rr=16 o2 sat=99% on 2l general: thin elderly man in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 6 cm, positive hepatojugular reflex. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. rub appreciated at llsb. no m/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi anteriorly. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. extremities: no c/c/e. no femoral bruits. dopplerable dps. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . on discharge vss general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, no jvd cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. rub appreciated at llsb. no m/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi anteriorly. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. extremities: no c/c/e. no femoral bruits. dopplerable dps. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: on admission: 09:50pm wbc-9.2 rbc-3.02* hgb-9.2* hct-27.3* mcv-90 mch-30.4 mchc-33.6 rdw-16.9* 09:50pm neuts-78* bands-3 lymphs-8* monos-10 eos-1 basos-0 atyps-0 metas-0 myelos-0 09:50pm glucose-347* urea n-24* creat-0.9 sodium-134 potassium-4.0 chloride-102 total co2-21* anion gap-15 09:50pm alt(sgpt)-55* ast(sgot)-79* ck(cpk)-363* alk phos-223* tot bili-0.6 09:50pm pt-14.1* ptt-46.1* inr(pt)-1.2* . on discharge: 06:45 wbc rbc hgb hct mcv mch mchc rdw plt ct 12.8* 2.96* 9.1* 27.5* 93 30.9 33.2 17.6* 120* . glucose urean creat na k cl hco3 angap 109 27* 1.1 138 4.1 106 22 14 . cardiac markers: ck-mb mb indx ctropnt 12:00 20* 7.8* 3.53*1 04:15 23* 6.4* 5.22*1 . hga1c: 8.3 . lipid panel: 04:15 cholest triglyc hdl chol/hd ldlcalc 136 111 11 12.4 103 . cardiac catheerization: procedure: percutaneous coronary revascularization was performed using placement of bare-metal stent(s). conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca discrete 100 2) mid rca normal 2a) acute marginal normal 3) distal rca normal 4) r-pda normal 4a) r-post-lat normal 4b) r-lv normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad normal 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 normal 10) diagonal-2 normal 11) intermedius normal 12) proximal cx normal 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 normal 16) obtuse marginal-3 normal 17) left pda normal 17a) posterior lv normal comments: 1. selective coronary angiography of this right dominant system revealed 1 vessel coronary artery disease. the lm, lad and lcx had minimal disease. the rca was totally occluded proximally. 2. limited resting hemodynamics revealed normal systemic arterial pressure of 133/53mmhg. final diagnosis: 1. bare metal stents placed in a patient with presumed stemi with st elevation in 3 and f. 2. he is still c/o of pleuritic chest pain. a spiral ct must be obtained to r/o pe as this may have been a chronic to. 3. asa and clopidogrel for as long as a year if he can tolerate it, but no less than a month. . tte: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with inferior and inferolateral akinesis, c/w rca disease. the remaining segments contract normally (lvef = 40%). the right ventricular cavity is mildly dilated with focal basal free wall hypokinesis. 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. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . impression: mild regional left ventricular systolic dysfunction, c/w cad. dilated and hypokinetic rv in a pattern, consistent with either proximal rca disease or acute pulmonary hypertension (e.g., pe). normal estimated pulmonary pressures argue in favor of cad as a cause of rv dysfunction. . cta chest: the pulmonary arterial tree is well opacified and there is no embolic filling defect. the aorta is normal in caliber, and there is no evidence of dissection. airways are patent to subsegmental levels bilaterally. note is made of small bilateral pleural effusions with overlying subsegmental atelectasis. in addition, there is more focal consolidation in the left lower lobe (4:67) with the possibility of pneumonia not excluded. the lungs are otherwise clear. the heart and great vessels are notable for extensive coronary arterial calcification as well as coronary arterial stenting. though there is no hilar, mediastinal or axillary lymphadenopathy by size criteria, note is made of many borderline sized hilar nodes as well as multiple mediastinal nodes, notable in number. the study is not tailored for precise characterization of subdiaphragmatic contents. nevertheless those included are notable for pneumobilia as well as a metallic common bile duct stent seen on the scout imaging. osseous structures reveal no suspicious sclerotic or lytic lesions. impression: 1. no pulmonary embolism. 2. small bilateral pleural effusions with overlying atelectasis as well as more confluent opacity at the left lung base. for the latter, the possibility of pneumonia is not excluded and should be correlated to the clinical presentation of the patient. 3. extensive coronary arterial calcification . ruq ultrasound : impression: 1. no intrahepatic biliary ductal dilatation. small pneumobilia in the cbd, likely introduced by the known biliary stent. 2. extensive metastatic disease in the liver, better assessed by the prior ct torso on . 3. cholelithiasis without acute cholecystitis. splenomegaly. no ascites. . brief hospital course: mr. is a 66 year old m w/ h/o pancreatic ca s/p sphincterotomy and chemotherapy with gemcitabine and erlotinib, dm type 2, and cad s/p mi and pci/stent who was transferred from osh with acute inferior stemi. . # stemi: patient presented with chest pain to osh that was severe and sharp in quality and acute in onset at rest. ekg consistent with inferior mi. total occlusion of rca on cath, but some suggestion of chronic state. now s/p pci with 2 bms to rca. given findings on cath and history of intermittent pleuritic pain prior to today's episode cannot be entirely sure about the timing of the mi. asa 325mg and clopidogrel 75mg needs to be taken daily for as long as a year if he can tolerate, but no less than one month. no statin was given history of rhabdomyolysis. pt has f/u appt wtih dr. at and will f/u with his pcp 1 week. . # pleuritic chest pain: thought mi related pericardial irritation. resolved over hospital stay. no pericardial effusion, small pleural effusions noted. chest cta showed no evidence of pe. he does have a friction rub noted on exam that persisted. . # acute systolic dysfunction: as of , intact ef with no evidence of systolic or diastolic dysfunction. echo after mi showed ef of 40%, no pericardial effusion. pt did not have symptoms of chf during his hospital stay but teaching regarding daily weights, low na diet and adherance to medicines done at discharge. he was not on diuretics in the past. acei was started as an inpatient and should be uptitrated if bp tolerate. . # rhythm: currently in sinus. no history of arrhythmias or syncope. no arrythmias noted on telemetry during hospital stay. . # pancreatic ca: followed by dr. . currently on gemcitabine 1000 mg/m2 days one and 15 of a 28-day cycle in combination with erlotinib 100 mg p.o. daily. this is his off week for gemcitabine. dr. was consulted during pts hospital stay and recommended continuing tarceva for now with close f/u after discharge to discuss further chemotherapy options. home dose of lovenox was continued. . # hypertension: currently normotensive. no hypotensive episodes at osh or in hospital. lisinopril continued and metoprolol uptitrated to goal hr in 70's. amlodipine was not continued. . # diabetes mellitus: on metformin and glipizide at home. last a1c 8.3. no medication changes were made. . # bacteremia: pt developed fevers and found to have klebsiella in his blood cultures. urine culture was negative. id was consulted given pts history of pancreatic ca and recommended a 12 day course of iv ceftriaxone. this was continued at discharge via new picc line. the source of bacteremia is unclear with no evidence of secondary infection via ct or ultrasound testing. his leukocytosis resolved and pt remained hemodynamically stable. he will f/u closely wtih id and his outpatient oncologist. there are 3 more sets of blood cultures pending at the time of his discharge. medications on admission: amlodipine 10 mg daily lovenox 100 mg sc qhs erlotinib 100 mg daily lisinopril 5 mg daily metoprolol succinate 200 mg daily omeprazole 20 mg daily prochlorperazine maleate 10 mg q6h prn for nausea/vomiting terazosin 1 mg qhs zolpidem 5 mg qhs prn for sleep mvi daily glyburide 5 mg metformin 1000 mg discharge medications: 1. enoxaparin 100 mg/ml syringe sig: ninety (90) mg subcutaneous once a day. 2. glyburide-metformin 5-500 mg tablet sig: two (2) tablet po twice a day. 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. metoprolol succinate 200 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po once a day. 5. ceftriaxone 1 gram recon soln sig: one (1) gram intravenous once a day for 12 days. disp:*12 bags* refills:*0* 6. outpatient lab work check chem-7, lft's and cbc on wed and wed and call results to dr. at infectious disease clinic: ( or at 617-632-page # 7. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 12. terazosin 1 mg capsule sig: one (1) capsule po at bedtime. 13. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*2* 14. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 15. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes as needed for chest pain: take no more than 2 tablets, call dr. or 911 for any chest pain. disp:*25 tablets* refills:*0* discharge disposition: home with service facility: critical care systems discharge diagnosis: st elevation myocardial infarction diabetes mellitus hypertension dyslipidemia pancreatic cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital because you had a heart attack. you underwent cardiac catheterization and two stents were placed in one of your coronary arteries. you were found to have bacteria in your blood and you were seen by the infectious disease team and started on an antibiotic called ceftriaxone. you will need to get this antibiotic for a total of 2 weeks. as of this time, we do not know why you developed this infection in your blood. you will need to have your blood drawn weekly to check your liver and kidney function on this antibiotic. you will see the infectious disease doctor . no lifting more than 10 poounds for one week, no pools or baths for one week. you may shower as usual. no driving for 3 days after you go home. . we made the following changes to your medicines: 1. stop taking amlodipine and omeprazole 2. start taking clopidogrel (plavix) every day and aspirin 325 mg for at least one month and possibly longer. do not stop taking plavix with aspirin or miss unless dr. tells you to. 3. decrease metoprolol to 100 mg daily 4. start ceftriaxone intravenously for 2 weeks to treat the bacteria in your blood 5. start famotidine twice daily instead of omprazole to decrease the acid in your stomach. 6. stop taking your tarceva, you can discuss this with dr. at your next appt. per dr. , you will not get your intravenous chemotherapy on while you are on antibiotics. followup instructions: name: , n location: health center address: 200 dr, , phone: appointment: tuesday 1:30pm department: infectious disease when: at 10:00 am with: , md building: lm bldg () campus: west best parking: garage department: hematology/oncology when: at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: at 12:00 pm with: , rn building: campus: east best parking: garage . department: cardiac services when: friday at 10:30am with: , md building: sc clinical ctr campus: east best parking: garage the cardiology office will call you in a few days with an earlier appt. procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery malignant neoplasm of liver, secondary unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified atrial fibrillation other and unspecified hyperlipidemia bacteremia acute myocardial infarction of other inferior wall, initial episode of care diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy chronic total occlusion of coronary artery other drugs and medicinal substances causing adverse effects in therapeutic use malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to