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: cc: cp and sob major surgical or invasive procedure: cardiac catheterization history of present illness: hpi: 63 yo m with h/o htn, hl, cva in , mi in , and as well as cabgx4 in who underwent routine stress testing in which was significant for ischemia. he was asymptomatic at the time and chose to postpone catheterization. over the past 3 months, he has reported progressively worsening achy chest pain that radiates into both shoulders and is associated with sob, but not nausea, diaphoresis or palpitations. the symptoms develop after walking for 10 minutes, sooner if he walks too quickly, and initially resolved with rest over 10-15 minutes. recently, the chest pain has become more frequent ( x per day), and is no longer relieved with rest, but requires nitros. as a result of these symptoms, he presented for cath on at which showed lad 60% proximal stenosis, rca diffusely diseased with 90% discrete pda. lima-diag occluded, svg-lad occluded, radial graft-om 40-50% stenosis, svg-rca occluded. he was subsequently transferred to for intervention. r heart cath showed ra mean 8, pcwp 9. l heart cath showed serial 90% lesions in a tortuous vessel with the plb /pda having origin 90% lesions. he received 2 cypher stents to the proximal rca and a cypher stent to the distal pda with occlusion of the plb and rescue angioplasty. in the process, the pda was perforated with extravasation of dye, likely into the myocardium. a stat tte was ordered which showed no evidence of pericardial effusion. he was subsequently sent to the ccu for monitoring. on admission to the ccu, he was hypertensive with sbp in 170s. he was started on a ntg drip with drop in sbp to 80s and hr to 40s. he received 0.5 mg atropine and bolus 250 cc ns with hemodynamic stabilization. the interventional fellow was present during the episode of hypotension and bradycardia. ros: pt denies pnd, orthopnea, edema, lightheadedness past medical history: pmh: - cardiac catheterization after (+) stress test showed lad 60% proximal stenosis, rca diffusely diseased with 90% discrete pda. lima-diag occluded, svg-lad occluded, radial graft -om 40-50% stenosis, svg-rca occluded. mi and balloon angioplasty @ mi and cabg (lima-diag, svg-lad, svg-rca, radial graft-om) mi and cath showed occluded rca, used medical therapy htn high cholesterol cad cva with loss of vision on the left diverticulitis s/p spine surgery and djd in spine social history: social history: married for 27 years with four sons. his son and wife will drive him to and from the procedure. family history: family history: (+) cad mother died of mi at age 54. physical exam: ht: 5'7" wt: 176 lbs pulsus 12. bp 112/68 hr 70 rr 18 o2sat 99% 2l nc gen: tan, wdwn man lying in bed in nad jvp: not visualized while lying flat cv: rrr, nl s1, s2, no m/g/r lungs: ctab, no w/r/r from chest abd: bs+, soft, nt, nd ext: r fem pa cath and arterial sheath in place. 2+ dp and pt bl neuro: a&o, moving all 4 ext pertinent results: ck(cpk) 06:40am 143 09:15pm 179* 04:30pm 213* 12:50pm 165 03:52am 134 12:31am 85 cpk isoenzymes ck-mb mb indx ctropnt 06:40am 7 0.24 09:15pm 10 5.6 0.22 04:30pm 14 6.6 0.25 12:50pm 17 10.3 03:52am 13 9.7 12:31am 7 lipid/cholesterol cholest triglyc hdl chol/hd ldlcalc 03:52am 123 160 38 3.2 53 ekg pre-cath: nsr at 65, lad, poor r wave progression, twi in iii studies: post-cath tte pericardium: no pericardial effusion. there is an anterior space which most likely represents a fat pad, though a loculated anterior pericardial effusion cannot be excluded. conclusions: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. there is an anterior space which most likely represents a fat pad. c.cath study date of brief history: presents for pci of the rca. he has a h/o cabg in . he pressetned with recent onset angina with an angiogram in showing occluded lima to d, svg to lad and svg to rca. his radial graft to the om is patent. he is a non smoker and had hypercholesterolemia. indications for catheterization: for pci of the rca. procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 6 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 6 french 0.75 catheter, advanced to the ascending aorta through a 6 french introducing sheath. coronary angiography: was performed in multiple projections using a 6 french 0.75 and a 6 french .75 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. technical factors: total time (lidocaine to test complete) = 2 hours 10 minutes. arterial time = 2 hours 6 minutes. fluoro time = 42 minutes. contrast: non-ionic low osmolar (isovue, optiray...), vol 230 ml anesthesia: 1% lidocaine subq. anticoagulation: heparin 3000 units iv other medication: atropine 600 mcg fentanyl 150 mg integrilin 14.6 cc tng 200 mcg tng 500 mc midazolam 2.5 mg cardiac cath supplies used: - guidant, whisper - guidant, whisper - , pt , 300cm - guidant, whisper - guidant, whisper 1.5 , maverick, 15 2.0 guidant, voyager 15 2.5 , quantum maverick, 8 3.25 , quantum maverick, 20 1.5 guidant, voyager 15 6 cordis, im 6 cordis, .75 150cc mallincrodt, optiray 150cc 2.5 cordis, cypher otw, 13 3.0 cordis, cypher otw, 33 3.0 cordis, cypher otw, 23 attending physician: , . referring physician: , . cardiology fellow: , attending staff: , a. brief hospital course: 63 yo m with h/o htn, hl, cva in , mi in , and as well as cabgx4 in presenting for elective interventional cath of rca lesion complicated by jailing of the pda and subsequent perforation. the patient has an extensive cad history with lad 60% proximal stenosis, rca diffusely diseased with 90% discrete pda. lima-diag occluded, svg-lad occluded, radial graft-om 40-50% stenosis, svg-rca occluded. he is s/p repeat cath with 2 cypher stents to the proximal rca and a cypher stent to the distal pda with occlusion of the plb and rescue angioplasty. in the process, the pda was perforated with extravasation of dye, likely into the myocardium. he received no integrillin following his catheterization given the perforation. a stat echo after catheterization showed no evidence of pericardial effusion. his pulsus was monitored q6 the day following catheterization without elevation. his ck peaked at 213 with a peak troponin t leak of 0.25 (normal 0-0.01) post-procedure and was down to 143 at time of discharge. a repeat echocardiogram the day following catheterization showed only a trivial/physiologic pericardial effusion and normal ejection fraction of > 55%, normal rv and lv cavity size. his lipitor was increased to 40 once a day, his norvasc was decreased to 2.5 once a day and his imdur was decreased to 30 once a day, otherwise he was continued on his pre-cath medications including metoprolol 100 in the am, 50 in the pm, ramipril 10 qd, and niacin, as well as aspirin and plavix. medications on admission: toprol 100mg qam and 50mg qpm lipitor 20mg daily asa 325mg daily altace 10mg daily plavix 75mg daily norvasc 7.5mg daily imdur 60mg daily niacin, kcl, magnesium discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). disp:*30 tablet(s)* refills:*2* 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). disp:*30 tablet(s)* refills:*2* 6. ramipril 5 mg capsule sig: two (2) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 7. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 8. norvasc 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. potassium chloride 20 meq packet sig: one (1) po once a day: resume your home dose of potassium. 10. mag-oxide 400 mg tablet sig: resume your home dose tablet po once a day: resume your home dose of magnesium. 11. lipitor 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. niacin powder sig: continue your home dose po once a day. discharge disposition: home discharge diagnosis: unstable angina coronary artery disease discharge condition: good discharge instructions: 1. always take your aspirin and plavix. please consult your cardiologist before before making any changes to these medications. 2. please take all medications as prescribed. your lipitor has been doubled to 40 mg once a day. your norvasc has been decreased to 2.5 once a day, and your imdur has been decreased to 30 once a day. 3. please keep all follow-up appointments. 4. please seek medical attention if you develop chest pain, shortness of breath, nausea, vomiting, sweating, fevers, chills or have any other concerning symptoms. 5. do not drive for 1 week. no heavy lifting or vigorous activity for the next 2 weeks. please talk to your cardiologist before beginning an exercise regimen. followup instructions: please follow-up with your cardiologist dr. (, within the next 1-2 weeks. please follow-up with your primary care doctor, dr. at , within the next 2-4 weeks. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome pure hypercholesterolemia unspecified essential hypertension coronary atherosclerosis of autologous vein bypass graft accidental puncture or laceration during a procedure, not elsewhere classified 

Answer: The patient is high likely exposed to