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: transferred for catheterization in the setting of inferior stemi. patient initially complained of chest pressure and epigastric discomfort. major surgical or invasive procedure: 1. cardiac catheterization with pci and bare metal stent placement to the right coronary artery. 2. temporary pacemaker wire placement history of present illness: 61 year old male with history of lad stent in , rca stent in , and stent to the mid-lad and rpl in , all for crescendo angina, who presented to this morning complaining of 18 or so hours of "indigestion" and some chest pressure. these symptoms began on the day prior to admission, just after lunch. he noted chest heaviness and indigestion, that did feel better with belching. later that night the indigestion returned and he took alka-seltzer with improvement. he slept through the night but at 4 a.m. on the morning of admission he got up to use the bathroom and noted heaviness in his chest, and persistent "indigestion," unresponsive to tums, prompting him to go to . of note, his typical angina involves a tingling/numbness of his left arm, which he denies in the preceding days. at , initial ekg was without st elevations, with an isolated twi in iii. he was given a dose of dilaudid with resolution of his pain. however, later in the morning he developed epigastric discomfort and became pale and diaphoretic. an ekg in this setting now revealed 1- elevations in the inferior leads with st depression in avl. he was started on heparin and integrillin. he was given plavix 300 mg x 1. on review of symptoms, 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 denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. he complains of thinking he was having a gout flare yesterday because his 1st metatarsal joint was painful. he took indocin, allopurinol, and colchicine. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain (although did have pressure), dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. he does walk regularly, and does not experience angina. past medical history: 1) coronary artery disease status post multiple stents (see below). 2) hypertension. 3) hyperlipidemia. 4) hepatitis b, has received interferon. 5) gout. 6) gastroesophageal reflux disease. cardiac risk factors: (-) diabetes, (+) dyslipidemia, (+) hypertension cardiac history: no history of cabg. percutaneous coronary intervention, in anatomy as follows: 1. coronary arteriography reveals one vessel disease in this right dominant system. the lmca has no significant stenosis. the lad has serial 80-90% stenoses of proximal-mid segments. there is also 70-80% of stenoses of small and diffusely diseased d1. the lcx and the rca have no significant stenosis. 2. resting hemodynamics reveal mildly elevated right and left sided filling pressures (rvedp=14 mmhg, lvedp=14 mmhg). there is mild secondary pulmonary hypertension with mildly elevated mean pcwp of 11 mmhg. 3. left ventriculography reveals normal wall motions with an ef of 63%. there is no mitral regurgitation visualized. 4. the critical serial stenoses in the mid lad were successfully treated with palmaz stenting. (see ptca comments) final diagnosis: 1. one vessel coronary artery disease. 2. normal ventricular function. 3. successful stenting of the mid lad. percutaneous coronary intervention in , done for crescendo angina with mildly positive troponin demonstrated: comments: 1. coronary angiography in this right dominant circulation demonstrated two vessel and branch vessel coronary artery disease. the lmca was normal. the lad was widely patent at the prior stenting site, but had a 50% distal lesion. the lcx had mild luminal irregularity. the ramus intermedius was a small vessel with an 80% proximal lesion. the rca had an ulcerated 95% proximal lesion with slow flow into the distal vessel. 2. resting hemodyanmics demonstrated mildly elevated left-sided filling pressures with an lv edp of 14 mmhg. 3. left ventriculography demonstrated ef of 57% with no mitral regurgitatiion. 4. the rca stenosis was successfully treated with angioplasty and stenting using a 3.5 x 24 mm express2 stent, with no residual stenosis, no angiographic evidence of dissection, and timi 3 flow (see ptca comments). final diagnosis: 1. two vessel and branch vessel coronary artery disease. 2. normal ventricular function. 3. mildly elevated left-sided filling pressures. 4. successful stenting of the rca. percutaneous coronary intervention in prompted by increasing angina and abnormal dobutamine stress demonstrated: comments: 1. selective coronary angiography of this right dominant system revealed two vessel coronay artery disease. the lmca had no angiographic evidence of flow limiting lesions. the lad had a tubular 30% proximal in stent restenosis and a focal 90% distal lesion after the origin of the d1. the ramus was a small vessel with a 90% proximal stenosis which was unchanged from previous cath. the lcx was a small caliber vessel with no angiographic evidence of flow limiting stenosis. the rca was a dominant vessel with 30% in stent restenosis. there were two plb, the first had no angiographically apparent flow limiting lesions. the second plb had a 90% proximal stenosis. 2. limiting resting hemodynamics revealed mildly elevated left sided filling pressures. 3. left ventriculography revealed an ejection fraction of 63%. there was to the aorta. 4. successful placement of 2.5 x 23 mm cypher drug-eluting stent in the mid-lad. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). 5. successful placement of 2.25 x 12 mm minivision stent in the r-pl. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). 6. successful placement of 6 french angioseal in right femoral arteriotomy at the conclusion of the procedure without complications. final diagnosis: 1. coronary angiographic evidence of two vessel coronary artery disease. 2. preserved left ventricular function. 3. mildly elevated left sided filling pressures. social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: blood pressure was 122/70 mm hg while seated. pulse was 59 beats/min and regular, respiratory rate was 20 breaths/min, 99% on 2l via nasal cannula. generally the patient was well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jugular venous pressure of about 7 cm h2o. the carotid waveform was normal. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to anterior ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. palpation of the heart revealed the pmi to be located in the 5th intercostal space, mid clavicular line. there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. he had a holosystolic murmur at the apex. there were no rubs, clicks or gallops. the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing or edema. there were no abdominal, femoral or carotid bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 2+ pt difficult to palpate left: carotid 2+ femoral 2+ dp difficult to palpate pt 2+ pertinent results: cardiac cath : 1. coronary angiography of this right dominant system revealed three vessel coronary artery disease. the left main coronary artery had minimal luminal irregularities. the lad had a 30% stenosis proximally (proximal edge versus in-stent restenosis) with a patent mid lad stent and diffuse plaquing with timi 2 fast flow. the apical lad had a 90% stenosis with septal collaterals to the rpda. the lcx had mild diffuse luminal irregularities. the ramus had a proximal 80% stenosis followed by a mid 80% stenosis. the rca had a proximal tapering to 80% at the proximal edge of the prior stent with timi 1 flow distally. 2. resting hemodynamics revealed moderately to severely elevated right sided filling pressures (mean ra pressure was 16 mm hg and rvedp was 20 mm hg). pulmonary artery pressures were mildly elevated (pa pressures were 42/22 mm hg). left sided filling pressures were moderately elevated (mean pcw pressure was 21 mm hg). prominent v waves were noted in the pulmonary artery and pulmonary capillary wedge pressure tracings suggestive of mitral regurgitation. systemic arterial pressure was normal (aortic pressure was 116/62 mm hg). cardiac output was normal (ci was 3.0 l/min/m2). 3. successful pci/stent to proximal rca with a 3.5x15mm vision stent postdilated with a 3.5x15mm nc ranger balloon. excellent result with no resiudal and normal flow down vessel. patient left cathlab painfree. . tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild mitral regurgitation with normal valve morphology. preserved global and regional biventricular systolic function. brief hospital course: 61 year old male with history of hypercholesterolemia, hypertension, and significant coronary artery disease status post multiple pcis involving lad stent in , rca stent in , and stent to the mid-lad and rpl in , who presented with predominantly epigastric discomfort, found to have st elevations in the inferior leads and progression of rca disease on cath, now status post bare metal stent to the rca. also with elevated filling pressures. almost 48 hours after presentation, early in the morning the patient was found to be in complete heart block on telemetry, prompting admission to the ccu and temporary wire placement. the hospital course by problems follows below. 1) stemi: on arrival he went to the cath lab. cath revealed that the lad had a 30% stenosis proximally (proximal edge versus in-stent restenosis) with a patent mid lad stent; the apical lad had a 90% stenosis with septal collaterals to the rpda. the lcx had mild diffuse luminal irregularities. the ramus had a proximal 80% stenosis followed by a mid 80% stenosis, and the rca had a proximal tapering to 80% at the proximal edge of the prior stent with timi 1 flow distally. given the inferior elevations on ekg the rca lesion was felt to be the culprit lesion and he received a bare metal stent to rca. post catheterization the patient was chest pain free, with resolution of st elevations on post-cath ekg, new q waves and twi. it was unclear why the patient was on amlodipine rather than an ace-inhibitor (possibly for angina?), therefore his amlodipine was held in favor of an ace-inhibitor. he tolerated lisinopril well. he was continued on asa, plavix (which he needs for at least 1 year), pravastatin 80 mg, niacin sa, ezetimibe. bblocker held given chb as below; may be restarted as an outpatient in several weeks time. he should be referred to cardiac rehabilitation as an outpatient as well as nutrition counseling for diet and lifestyle modification. 2) complete heart block: he was catheterized on the morning of . early in the morning of a code was called when the patient was found to have complete heart block without ventricular escape on telemetry. he regained a rhythm and consciousness very quickly spontaneously. he was transferred to the ccu where he had a temporary pacing wire placed in his right ventricle. he did not require any further pacing during his stay here in teh ccu and the complete heart block was attributed to temporary edema in teh setting of his rv infarct along with a possible contribution from osa and vagal tone. the temporary pacemaker wire was removed after 36 hours of not requiring any pacing. he was sent to the floor in good condition. his bblocker was held given concern for av nodal block and this can be restarted as an outpatient in several weeks. 3) elevated filling pressures: filling pressures were elevated in catheterization, however he had no clinical evidence of chf. echocardiogram post-cath demonstrated preserved global and regional biventricular systolic function, with mild mr. did not require diuresis. 4) right groin bruit: a femoral ultrasound was done, which did not demonstrate any av fistula or pseudoaneurysm. 5) hypercholesterolemia: as above, continued pravastatin 80 mg, niacin sa 500 mg qhs, and ezetimibe 10 mg daily. 6) hypertension: his amlodipine was held in favor of an ace-inhibitor. he was discharged on his usual medications, plus lisinopril 10mg daily. 7) gerd: continued pantoprazole. 8) gout: no signs of gout flare during this admission, although he had taken colchicine and allopurinol and indocin on the day prior to admission. it was explained to him that he should not start taking allopurinol when he thinks he's having a gout flare if he's not already on it (that this can worsen an acute flare). 9) osa: given patient's body habitus, clinical history of concern for osa, as well as possible contribution to nocturnal apnea and chb as above, patient was set up for a sleep study 1 week after discharge. the results of this study should be followed up with by his pcp. 9) fen: cardiac, heart healthy diet. 10) ppx: given sq heparin and colace. 11) code: full. medications on admission: aspirin 325 mg daily ezetimibe 10 mg daily metoprolol xl 50 mg daily pravastatin 80 mg daily amlodipine 5 mg daily niacin sa 500 mg qhs pantoprazole 40 mg daily indocin prn allopurinol prn colchicine prn discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 3. pravastatin 20 mg tablet sig: four (4) tablet po daily (daily). 4. niacin 500 mg capsule, sustained release sig: one (1) capsule, sustained release po qhs (once a day (at bedtime)). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*11* 7. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. clonazepam 1 mg tablet sig: 2.5 tablets po qhs (once a day (at bedtime)). discharge disposition: home discharge diagnosis: primary: 1. st-elevation myocardial infarction 2. temporary complete heart block - now resolved 3. hypertension secondary: 1. gastroesophagael reflux disease discharge condition: stable to be discharged to home. discharge instructions: you were admitted and found to have a inferior wall heart attack. you subsequently had complete heart block requiring a temporary pacemaker. it will be extremely important for you to follow-up with your cardiologist and your primary care doctor. in addition, you should plan to see a sleep specialist given that sleep apnea may have caused the heart block (an appointment was made for you on the date below). your toprol xl was held - do not restart this until you have seen a cardiologist. you had a stent placed in your right coronary artery - you must take plavix 75mg every day for a minimum of 1 year. if cannot take your dose of plavix, you must contact your doctor immediately. please do not take norvasc any longer - lisinopril 10mg daily was started in its place. all of your other home medications remain the same (see list below). if you develop chest pain, shortness of breath, lightheadedness, passing out, or any other concerning symptoms, please call your doctor or report to the nearest er. followup instructions: please follow up with your cardiologist, dr. in 1 month after dicsharge. previously scheduled appointments: provider: . /dr. phone: date/time: 9:00. this appointment is to further evaluate the possibility of obstructive sleep apnea. please follow up with your primary care physician . in weeks. procedure: venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of temporary transvenous pacemaker system cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension cardiac complications, not elsewhere classified gout, unspecified percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia atrioventricular block, complete acute myocardial infarction of other inferior wall, initial episode of care cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure 

Answer: The patient is high likely exposed to