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: stemi, on iabp major surgical or invasive procedure: cardiac catheterization intubation/extubation history of present illness: 57 year-old woman with , cad s/p cabg and stents, pvd presented with chest pain. she initially presented to hospital on with chest pain and was found to have a tn of 0.23; however, as at the time she only was felt to have st elevations in v3, she was transferred to as an nstemi. once here, she was found to have a temp of 97.1, bp 137/92, hr 95, rr 16, spo2 97% on 2l nc. her first set of labs was not significantly different, but her ecg now showed st elevations v2-v5 (2-3mm). in the ed, she was continued on iv heparin and nitro drip. she also received plavix 600mg po and metoprolol 5mg iv x 3, morphine 4mg iv. she was emergently rushed to the cath lab where during the intervention she became hypotensive, so an iabp was placed. norepi and dopa were started. she arrested once and was intubated and cardioverted back to a nsr; she arrested a second time (vf) and was again cardioverted. past medical history: - syndrome -cva in and with mild dysphagia -seizure disorder -cad s/p emergent cabg (svg to lad, svg to om) after failed ptca (attempted to lad; lmca occlusion) ; stenting of svg to lad in -aorto-bifemoral bypass -gi bleed social history: she worked as a secretary but hasn't for some time due to health problems. lives with her husband in , daughter nearby. she had been smoking 1 pack per week. rare etoh. family history: father died of an mi at 78, mother healthy. physical exam: vitals- hr 104, bp 125/65, ac 500x30/5/100% general- intubated and sedated heent- pupils dilated and fixed, ett, ogt neck- r carotid pulse 1+, l carotid pulse diminished pulm- coarse breath sounds b/l cv- tachycardic but regular, abd- +bs, soft, nd extrem- no le edema, feet cool, slow cap refill neuro- sedated, spontaneously moving all 4 extremities, ?withdraws to nailbed pressure, rue +3 dtrs, lue//lle +2 dtrs pertinent results: cxr: impression: mild interstitial pulmonary edema. small left-sided pleural effusion and left lower lobe opacity which could be atelectasis or pneumonia. . cath: final diagnosis: 1. three vessel coronary artery disease. 2. cardiogenic shock managed with iabp and vaso pressors. 3. cardiac arrest; pulseless electrical activity followed by ventricular fibrillation. 4. pci of the svg-->lad. 5. attempted pci of the lcx. . echo: lvef 20% impression: extensive anteroseptal infarct, with multiple wall motion abnormalities consistent with multiple vessel obstructive coronary artery disease; probable apical thrombus . eeg: impression: this is an likely normal eeg in the waking and drowsy states. the generalized beta activity is most commonly due to medication effect. no focal, lateralizing or epileptiform features were noted. . echo: compared with the findings of the prior study (images reviewed) of , the mitral regurgitation is worse; the apical echodensity previously noted is no longer seen. . echo: compared with the findings of the prior study (images reviewed) of , there is less mitral regurgitation seen. overall ef unchanged (20-25%). . cxr: chest ap: there is no interval change in mild interstitial edema. the mediastinal, hilar contours, and heart size are unremarkable. mediastinal sutures and cardiovascular clips are in place. no consolidation present. . pertinent labs: peak ck- 4959 ck-mb-249* mb indx-12.8* ctropnt-6.08* on discharge: 07:40am blood wbc-9.8 rbc-4.15* hgb-12.4 hct-38.1 mcv-92 mch-29.9 mchc-32.6 rdw-16.5* plt ct-406 07:40am blood pt-12.9 ptt-69.6* inr(pt)-1.1 07:40am blood glucose-137* urean-34* creat-1.1 na-136 k-4.7 cl-96 hco3-30 angap-15 07:40am blood calcium-9.3 phos-4.2 mg-2.3 05:00am blood tsh-1.3 brief hospital course: ms. is a 57 year old female with moyamoya, h/o stroke, cad s/p cabg, pvd who presented with a stemi from cath lab; arrived intubated, with intraaortic balloon pump and triple pressors. she was stable but in critical condition. she was weened off of pressors and the iabp was discontinued. the following is a brief summary of her hospital course by problem list. . #stemi -- she presented with a massive stemi and went to the cath lab. she had a stent placed to the lad, and a failed om stent. ck peaked at 4959. currently getting medical management with asa, clopidogrel, atorvastatin, metoprolol, lisinopril. she has had complications with mr since the stemi as noted below. . # chf -- her chf was new and secondary to her massive stemi. she was revascularized at cath lab and had two cardiac arrests as described in the hpi. she was intubated and placed on an iabp and pressors for support. her admit echo showed an lv thrombis of 1.6 x 1.6 cm, ef of 20%, severe hypokinesis of the anterior septum and anterior free wall, with extensive apical akinesis and focal dyskinesis. the posterior wall is severely hypokinetic, no vst, 3+ mr. she developed significant pulmonary edema secondary to her severe mr. she was diuresed aggressively while maintaining her bp with the iabp and pressors. she was slowly weened off of pressors and the iabp was discontinued. she was extubated. a repeat echo showed some improvement with decreased mr (2+) with ef still 20-25%. she subsequently had episode of hypotension which was treated with dopamine, but discontinued shortly thereafter. the hypotension was thought to be related to overdiuresis and high dose medications. her bp medications have been adjusted to optimize her mortality and morbidity while maintaining her bp. she was discharged on lisinopril 5mg, toprol xl 12.5mg, furosemide 40mg. she was euvolemic at discharge. of note, her sbp tends to run in the 90's which is not surprising given her cardiac function and low ef. she remains asymptomatic from it. . # rhythm: she was monitored on telemetry throughout her hospitalization and had frequent especially sensitive to hypokalemia. she has had runs of nsvt at both slow and fast rates. the electrophysiology team was consulted regarding possible icd placement. they felt as though she may recover some of her heart function and they request a repeat echo 2 weeks from discharge. if her lvef is still less than 30%, they will consider placing an icd as a preventative measure. . # neuro: after her massive stemi and cardiac arrests, neurology was consulted to evaluate her brain function. an eeg suggested normal function immediately after the events. she is followed as an outpatient by dr. for her h/o of cva x 2 with baseline rue hyperreflexia and aphasia. through her hospitalization, she improved especially s/p extubation and neurology felt she had returned to her baseline neurologic function. . # arf: she had some rise in her cr during her hospitalization which was thought to be likely prerenal from hypovolemia. her peak cr was 1.8, but this has resolved and was around 1 on discharge. this is still elevated compared to her admission cr, but that may be secondary to the acei which is needed for her cardiac function. her cr should be monitored along with her electrolytes every mon, wed, fri. . # lv thrombis: her first echo post mi showed an lv thrombis. she was started on heparin gtt for this. repeat echos have not shown the thrombus, but she should probably remain anticoagulated as a lv aneurysm was also seen. she is being discharged on coumadin and heparin as bridge. . # infection: sputum cultures while intubated showed h flu pneumonia. she was treated with a seven day course of ceftriaxone for this. she also had some erythema at her line site and was treated with 2 weeks of vancomycin. later in the course of her hospitalization, she developed a leukocytosis without a fever and she had diarrhea. cxr was negative for infiltrates and all of her lines were removed (cvl and aline etc). despite 2 negative c diff toxins, she was treated with a 14 day course of metronidazole for c diff. a b toxin for c diff was sent and is still pending at discharge. she has a few more days of metronidazole treatment left at discharge. . # hypophonia: after extubation, ms. had hypophonia which persisted. an ent consult was obtained. they found that her left vocal cord was not functioning as well likely just secondary to intubation. throughout the course of her hospitalization, this was beginning to improve. she should follow up with ent as an outpatient. . # melena: ms. had a couple episodes of melana s/p extubation. a gi consult was obtained. they felt the most likely source of the bleeding was from traumatic intubation/extubation. given her other acute medication issues at the time (hypotension and severe mr), and her stable hct, they decided not to scope her at the time. she was placed on ppi and should follow up with an outpatient endoscopy. she had no further episodes of melana. . # anemia/thrombocytopenia: during her hospitalization, ms. developed anemia and thrombocytopenia. at the time, she had an iabp in place and it was thought that part of this was secondary to shear hemolysis from the balloon pump. a hit ab was sent and was negative. in the meantime, she was switched from all heparin products and placed on argatroban while on the iabp. her anemia was complicated by her gi loss with melana. this has subsequently resolved. again, she should follow up as an outpatient with gi for endoscopy and should remain on a ppi for total of 4 weeks, then to be decreased to daily ppi. . # fen: ms. has had intermittent poor motility. she was given reglan to help with motility. she had a speech and swallow evaluation and was found to have no aspiration. she should continue on her low sodium (<2g/day) heart healthy diet and fluid restriction of 1.2l/day. she should have her electrolytes checked every monday, wed, and friday initially and her electrolytes should be repleted as needed. . # ppx: ppi for gi ppx, heparin bridge to coumadin for lv thrombus and aneurysm seen on echo. . # code status: full code . # communication: husband (, ( . # dispo: to acute rehab medications on admission: outpatient meds (dose unknown): asa lipitor metoprolol lisinopril discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours) for 2 weeks: patient needs 2 more weeks of dosing, then could transition to 40mg qd. will need gi follow up. . 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 10. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 11. loperamide 2 mg capsule sig: one (1) capsule po every eight (8) hours as needed for diarrhea. 12. trazodone 50 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for insomnia. 13. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. 14. metoprolol succinate 25 mg tablet sustained release 24hr sig: 0.5 tablet sustained release 24hr po hs (at bedtime): only hold for sbp < 85. pt has baseline of 80-90's. . 15. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 5 days. 16. dolasetron 12.5 mg/0.625 ml solution sig: one (1) intravenous q8h (every 8 hours) as needed for nausea. 17. sodium chloride 0.9 % piggyback sig: three (3) ml intravenous daily (daily) as needed: to flush piv as per protocol. 18. coumadin 5 mg tablet sig: one (1) tablet po at bedtime: please check inr's daily and adjust as needed. use heparin to bridge. . 19. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: per sliding scale intravenous continuous: to use until patient with inr between . goal ptt of 60-80. please use attached heparin scale. . discharge disposition: extended care facility: - discharge diagnosis: primary diagonosis: stemi cad s/p stent to lad chf with lv systolic dysfunction with ef 20-25% mitral regurg. 2+ arf s/p vap hypophonia with l vocal cord dysfunction gi bleed (melana) discharge condition: stable. ef of 20-25%. baseline blood pressure 80-90's systolic (should not go higher heart failure). discharge instructions: you were admitted with a large heart attack. you have residual damage to your heart including mitral regurgitation and congestive heart failure with systolic dysfunction and an ejection fraction of 20-25%. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet per day fluid restriction: 1.2l/day . -electrolytes including sodium, potassium, bun, cr, chloride, bicarb, magnesium, calcium and phosphorous and glucose should be checked every monday, wed, and friday initially. her electrolytes should be repleted as needed. . -site: sacrum description: 2cm x4cm x.5cm with yellow center and pink edges. pt had a purple area on sacrum post arrest in cath lab that opened up over last 10 days. care: area is cleansed with wound cleanser,duoderm gel followed by a acqacel ag to cover the wound, followed by dsd/hy tape. . -monitor on telemetry. . -encourage incentive spirometry . you should continue to take your medications as prescribed below. . you should have a repeat echo of your heart in ~2 weeks to evaluate your heart function. you should then follow up with the electrophysiology cardiologists to see if you might need an icd placed. . please return to the ed or see your doctor if you have increasing shortness of breath, chest pain, fevers >100.5, chills, weight gain, excessive swelling in your legs, or any other symptoms which are concerning to you. followup instructions: -f/u with ent as outpatient to assess vc movement provider: , .d. phone: date/time: 10:45, . -follow up with pcp . -follow up with cardiology: 1) provider: phone: date/time: 10:00, in center on the 2) provider: . phone: date/time: 1:40, center -follow up with gastroenterology: general gi number at procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor other and unspecified coronary arteriography insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart insertion of temporary transvenous pacemaker system implant of pulsation balloon pulmonary artery wedge monitoring transfusion of packed cells nonoperative removal of heart assist system cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified coronary atherosclerosis of autologous vein bypass graft other convulsions moyamoya disease hypopotassemia paroxysmal ventricular tachycardia acute respiratory failure cardiac arrest cardiogenic shock blood in stool pressure ulcer, lower back diarrhea hypovolemia late effects of cerebrovascular disease, aphasia candidiasis of skin and nails other non-autoimmune hemolytic anemias other voice and resonance disorders 

Answer: The patient is high likely exposed to