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: hypotension post pci major surgical or invasive procedure: crdiac catheterization with drug eluting stent to the left anterior descending coronary artery. history of present illness: 58 yo male with cad (s/p ami ) presenting with hypotension to the 60s-70s s/p cath today with des. he has an extensive past cardiac history and received a proximal lad de-cypher stent in and 3 bms to the circumflex in , dm, htn, hl, infarct-related cardiomyopathy ( tte: ef of 30%, s/p icd ) and presenetd for cardiac catheterisation following recurrent r-sided chest pains similar to previous anginal chest pains. he had noted recurrent chest pains occurring several times per week over the past few weeks on a background of angina over the past 2 years. his pains are r chest dull aches that radiated to the right shoulder lastimg 3-4 mins and often occurred after eating but could also occur at rest and were not associated with nausea, vomiting or light-headedness but had mild sweating. he saw a cardiologist 3-4 months ago regarding his chest pains who commenced ismn which helped and referred him for cath. he underwent cath on and found to have 100% proximal rca with left to right and right to right collaterals. lad with 90% in stent restenosis proximally and underwent a des to the ostial lad. lcx stents were patent. cardiac index 1.68 l/min/m2, rap mean 12, pcwp mean 27, pap 59/29/42, aop 131/89. patient underwent cath without any immediate complications. . upon making several attempts at a bowel movement in the bathroom, the patient was walking back to his bed and developed lightheadedness. his blood pressure was as low as 60/40mm hg with a hr of c60s. he felt confused and presyncopal but never lost consciousness. he denied chest pain/sob/palpitations. ekg showed no new changes. he was given a 1 liter bolus of ns and his blood pressure slowly increased to 90/50. patient was mentating well and it was unclear if he was urinating. given his hypotension unresponsive to fluids and marked nursing concern, he was transferred to the ccu for closer monitoring. on transfer, sbp 90mmhg, pulsus was 6-8 mmhg and there was no significant difference in arm bps. on arrival to the ccu, he was completely asymptomatic. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denied recent fevers, chills or rigors. he denied exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, or syncope. presyncopal symptoms as above. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: - inferior mi with occlusion of rca treated with medical management (') - anterior wall mi with cypher stent to lad -cabg: -percutaneous coronary interventions: pci of the proximal lad, ptca, rotational atherectomy, and stenting of the cx and om2 with overlapping bare metal stents () -pacing/icd: 3. other past medical history: - chf s/p icd placement (dr. (mode switch 170) - hyperlipidemia - htn - gerd - dm, type 2 - osa (nasal cpap at home) - anxiety - s/p cholecystectomy - s/p umbilical hernia repair - ?copd social history: smokes 1.5 pks/day for 30years. drinks per week, history of more alcohol use. denies drug use. drives a zomboni at a ice hockey rink. lives with his wife and 3 of his children, 4th child and his family live beneath them in the same building. family history: brother recently passed away during valvular surgery at age 55, father died of mi in his 70s, otherwise non-contributory. physical exam: vs: t=98.3 bp=95/62 hr=71 rr=16 o2 sat= 98% pulsus 6mmhg. bp 86/50 l vs 90/54 in r when checked at 00:15 general: in nad. oriented x3. mood, affect appropriate. asymptomatic. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 4 cm above sternal angle. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/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. abdomen: obese, soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. no r femoral bruit. femoral pulses palpable. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ no femoral bruits note r groin site clean. left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: admission labs 10:38pm wbc-8.9 rbc-4.54* hgb-13.0* hct-39.2* mcv-86 mch-28.6# mchc-33.1 rdw-15.2 10:38pm plt count-169 07:05pm sodium-135 potassium-3.9 chloride-96 07:05pm ck(cpk)-75 07:05pm ck-mb-2 07:05pm plt count-185 08:45am glucose-394* discharge labs 06:20am blood wbc-7.1 rbc-4.85 hgb-13.9* hct-41.3 mcv-85 mch-28.6 mchc-33.6 rdw-15.2 plt ct-175 06:20am blood plt ct-175 06:20am blood 06:20am blood glucose-290* urean-19 creat-0.9 na-136 k-4.2 cl-99 hco3-27 angap-14 06:02am blood ck(cpk)-79 06:02am blood ck-mb-2 ctropnt-0.01 06:20am blood calcium-9.5 phos-4.3 mg-1.6 . microbiology: no results pending - cardiac cath brief history: 58 yo male with cad (s/p ami 10/. he received a proximal lad de-cypher stent in and 3 bms to the circumflex in ), dm, htn, hl, infarct-related cardiomyopathy ( tte: ef of 30%, s/p icd ) who presents with r-sided chest pain similar to previo us anginal chest pains. indications for catheterization: chest pain - anginal equivalent procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through an 8 french introducing sheath. cardiac output was measured by the fick method. left heart catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 french left catheter, advanced to the ascending aorta through a 5 french introducing sheath. coronary angiography: was performed in multiple projections using a 5 french jl4 and a 5 french jr4 catheter, with manual contrast injections. percutaneous coronary revascularization was performed using placement of drug-eluting stent(s). conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 2.29 m2 hemoglobin: 14 gms % fick **pressures right atrium {a/v/m} 15/14/12 pulmonary artery {s/d/m} 59/29/42 pulmonary wedge {a/v/m} 33/34/27 aorta {s/d/m} 131/89/98 **cardiac output heart rate {beats/min} 80 rhythm nsr o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 74 card. op/ind fick {l/mn/m2} 1.9 **resistances systemic vasc. resistance 1787 pulmonary vasc. resistance 312 fick **% saturation data (nl) pa main 60 ao 99 other hemodynamic data: the oxygen consumption was assumed. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca discrete 100 **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad discrete 90 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 normal 10) diagonal-2 normal 12) proximal cx normal 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 normal **ptca results lad ptca comments: initial angiography revealed ostial/proximal lad 90% in-stent restenosis (isr). we planned to treat the lesion with ptca/stenting and the arterial access was exchanged to a 6fr sheath. a 6fr xblad guiding catheter provided good support for the procedure and bivalirudin was started prophylactically. a prowater wire was initially used but we were unable to cross the lesion. we then successfullly crossed the lesion with a choice pt wire with minimal difficulty. we then predilated with an apex otw 2.5x12mm (22atm for 20sec) followed by stenting with a promus 3.5x18mm drug-eluting stent (15atm for 20sec). we then post-dilated with an apex 3.5x15mm balloon (max 22atm for 22sec). final angiography revealed 0% residual stenosis, no angiographically apparent dissection and continued timi 3 flow in the lad vessel. patient left the lab angina free and in hemodynamically stable condition. technical factors: total time (lidocaine to test complete) = 1 hour 18 minutes. arterial time = 0 hour 43 minutes. fluoro time = 14.5 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 220 ml premedications: midazolam 1 mg iv fentanyl 50 mcg iv anesthesia: 1% lidocaine subq. cardiac cath supplies used: - , prowater 300cm - , choice pt 300cm 2.5mm , maverick 12mm 3.5mm , quantum maverick 15mm 6fr cordis, xblad 3.5 6fr , angioseal vip - allegiance, custom sterile pack - merit, left heart kit - merit, right heart kit - , priority pack 20/30 3.5mm , promus otw 18mm - , pulmonary wedge pressure catheter intra-procedure medications: bivalirudin - 90 mg, gtt at 205 mg/hr nitroglycerin - 600 mcg comments: 1. selective coronary angiography of ths right dominant system revealead a 90% in-stent restenosis of the des in the proximal lad. the lcx had no angiographically-aparent flow-limiting disease. the rca had a 100% occlusion proximally with left-to-right and right-to-right collaterals. 2. resting hemodynamics revealed biventricular diastolic dysfunction and moderate pulmonary hypertension with a mean ra pressure of 12mmhg, and a pcwp of 27 mmhg. systemic blood pressure was normal. 3. successful ptca/stenting of the ostial/proximal lad vessel with a promus 3.5x18mm drug-eluting stent (des). final angiography revealed 0% residual stenosis, no angiographically apparent dissection and continued timi 3 flow (see ptca/pci comments). 4. 6 6fr fa access closed with angioseal closure device: no complications. final diagnosis: 1. proximal lad 90% stenosis. proximal rca 100% occlusion with left-to-right and right-to-right collateralization. 2. biv diastolic dysfunction 3. moderate pulmonary hypertension 4. normal systemic blood pressure 5. successful ptca/stent of the ostial/proximal lad with a promus 3.5x18mm drug-eluting stent (des) with no complications (see ptca/pci report above). . ekg sinus rhythm. intraventricular conduction delay. st-t wave abnormalities. since the previous tracing the qrs duration is somewhat longer. tracing #3 intervals axes rate pr qrs qt/qtc p qrs t 68 150 112 426/440 25 60 45 brief hospital course: 58 yo male with cad (s/p ami and proximal lad de-cypher stent in and 3 bms to the circumflex in ) presented for elective coronary angiography following increasing right-sided chest pains similar to his previous angina. cardiac catheterisation on revealed a 100% proximal rca stenosis with left to right and right to right collaterals. the lad had 90% in-stent restenosis proximally. lcx stents were patent. he underwent a des to the ostial lad without immediate complications. at pci he was treated with iv furosemide and this produced a significant diuresis. on the evening of his pci he developed presyncope following straining to pass a bowel movement and this was associated with hypotension to c60s/40s and a normal hr. whilst he was initially briefly symptomatic, he was placed in the head-down position and received 1l iv fluids and had no further symptoms. unfortunately his bp did not improve following his fluids and for observation he was transferred to teh ccu on . he remained asymptomatic and his bp improved without further intervention. this hypotensive event was considered to be vasovagal presymcope in the context of aggressive diuresis. he was transferred to the cardiology on . troponin was negative and ecgs were unchanged from baseline. other than a possible run of nsvt for which he was asleep and asymptomatic (pt has icd and no shock delivered) he remained well and was discharged home on after mild hypomagnesemia (1.6) was corrected. 58m post pci to ostial lad (in stent restenosis prev des to lad and bms to cx) with b/g of ihd, mix2 and icd in situ presents with likely vagal episode in the context of diuresis and resultant prolonged hypotension admitted to the ccu for monitoring. 1 episode of possible nsvt. . # prolonged hypotensive episode. this was felt likely due to a vagal episode in the context of diuresis following iv furosemide post cardiac catheterisation. mr developed symptoms of pre-syncope following straining/valsalva on the toilet and following this became profoundly hypotensive with sbp in the 60s. he was put head-down and did not develop any further symptoms but despite 1l iv n saline his bp did not significantly improve. bp was unchanged in both arms and there was no significant pulsus paradoxus. he was transferred to the ccu for observation and he remained stable and his bp improved without further intervention. hct/hb were unchanged and tnt was normal. antihypertensives and imdur were held while in hospital and gradually re-introduced prior to discharge. his bp improved and he was discharged home. . # cad - pci with des to prox lad. : mr presented for elective coronary angiography following a several month history of worsening right-sided chest pains similar to his previous angina. at angiography there was evidence of a 100% proximal rca stenosis with left to right and right to right collaterals. the lad was also heavily diseased with 90% in stent restenosis proximally. lcx stents were patent. there was also evidence of biventricular diastolic dysfunction and moderate pulmonary hypertension with a mean ra pressure of 12mmhg, and a pcwp of 27 mmhg. he underwent a des to the ostial lad. due to elevated filling pressures furosemide 20mg iv was administered. there were no immediate complicatiosn of her cardiac catheterisation. he was monitored on telemetry and had a presyncopal episode as above. hct and hb were stable and cardiac enzymes were negative. he should continue on clopidogrel for 1 year and will be followed up by dr. in 1 month. . # possible nsvt: mr had a possible episode of nsvt for which his icd did not deliver a shock and did not recur. he was noted to have mild hypomagnesemia on and this was repleted. . # hypertension: given his hypotensive episode, mr anti-hypertensives were held and restarted on discharge. his imdur was stopped. . # hyperlipidemia: he will continue on simvastatin 80 mg daily. . # diabetes type 2 on insulin - metformin was held for 48 hours and his normal regime was restarted. . # gerd - continue ranitidine 150 mg . # osa - cpap as required . prophylaxis: -he received dvt ppx with sc heparin whilst an inpatient. medications on admission: medications on transfer: ranitidine 150 mg po bid insulin sc atropine sulfate 0.5 mg iv x1:prn symptomatic bradycardia & hypotension alprazolam 0.5 mg po/ng :prn anxiety trazodone 50 mg po/ng hs:prn insomnia simvastatin 80 mg po/ng daily paroxetine 20 mg po/ng daily metoprolol succinate xl 25 mg po daily lisinopril 20 mg po/ng daily furosemide 40 mg po/ng clopidogrel 75 mg po/ng daily potassium chloride po sliding scale aspirin 325 mg po daily simethicone 40-80 mg po qid:prn abdominal discomfort aluminum-magnesium hydrox.-simethicone 30 ml po qid:prn indigestion nitroglycerin sl 0.3 mg sl q5min:prn chest pain acetaminophen 650 mg po q4h:prn fever, pain oxycodone-acetaminophen 1 tab po q4h:prn pain discharge medications: 1. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual q5min () as needed for chest pain: take one tablet under tongue and wait 5 minutes. if still have chest pain take one more tab and call 911. disp:*25 tablet* refills:*0* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 4. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 5. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 6. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 7. alprazolam 1 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 9. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 10. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 11. colchicine 0.6 mg tablet sig: one (1) tablet po once a day as needed for pain: for gout. 12. advair diskus 250-50 mcg/dose disk with device sig: one (1) disk inhalation twice a day. 13. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. 14. slow fe 47.5 mg (iron) tablet sustained release sig: one (1) tablet sustained release po once a day. 15. mirapex 0.125 mg tablet sig: 1-2 tablets po at bedtime. 16. byetta 10 mcg/0.04 ml pen injector sig: one (1) injector subcutaneous twice a day. 17. metformin 1,000 mg tablet sig: one (1) tablet po twice a day: please restart on . 18. insulin glargine 100 unit/ml (3 ml) insulin pen sig: sixty (60) units subcutaneous at bedtime. 19. insulin aspart 100 unit/ml insulin pen sig: as per sliding scale units subcutaneous four times a day. 20. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 21. cialis oral discharge disposition: home discharge diagnosis: coronary artery disease hypertention diabetes mellitus type 2 hyperlipidemia chronic systolic congestive heart failure: ef 30% discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a cardiac catheterization and the stent in your left anterior descending artery was stenosed. we opened it with another drug eluting stent and the blood flow is now improved. the stents in your ofther arteris are ok. after the catheterization, your blood pressure and heart were low because of a vagal reaction during a bowel movement. this resolved and your blood pressure and heart rate are now normal. there was no evidence of bleeding or complication from the procedure. . medication changes: 1.resume your home doses of insulin 2. continue to take plavix (clopidogrel) every day with aspirin to keep the stent open. do not stop taking plavix or miss s unless dr. tells you to. 3. stop taking your imdur for now because of your low bp here. 4. start taking nitroglycerin as needed for chest pain. call dr. if you have any chest pain at home. do not take nitroglycerin and cialis within 24 hours of each other as they can cause low bp when taken together. . please see a nutritionist at . your endocrinologist was contact about setting up an appt for you. . weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. please subscribe to caremark to get your medicines, you will be able to get them at reduced cost. followup instructions: name: , c. location: healthcare - medical group address: ,8th fl, , phone: appointment: wednesday 9:00am department: cardiac services when: friday at 10:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 11:00 am with: , m.d. building: campus: east best parking: garage procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other and unspecified angina pectoris old myocardial infarction cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure chronic systolic heart failure automatic implantable cardiac defibrillator in situ disorders of magnesium metabolism 

Answer: The patient is high likely exposed to