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: cp; transfer for cardiac catheterization major surgical or invasive procedure: cardiac cathererization with drug eluting stent to lima graft of left anterior descending artery history of present illness: 82 yo with hx of dm, cad s/p cabg redo , chf (ef 51%) admitted to hospital on with cp. his course was complicated by dts etoh w/d and he was intubated in the icu. he was in normal healthy until the am of when he experienced substernal cp which was "squeezing" while watching tv. it lasted for 30 minutes without associated radiation, sob, nausea, diaphoresis, palpitations or lightheadedness. he did not take medications for this incident. after dinner he lies down normally for approx 1/2 hour but has noticed sob when supine over the past week. he has gained 30 lbs over the last year. he has had cp approximately 1x/year for which he usually takes nitro. patient's history is currently more variable. he reports cp the night prior to presentation for which he took sl nitro x3. he had chest pain the next am which did not respond to nitro. he had assocaited nausea. patient notes that he had seizures during these episodes- as he gets seizures the more he drinks. however, he states that he has not had a drink in 3 weeks since he went to rehab 2 weeks ago after being given an ultamatum by his wife. he went to the ed, and on the way experienced substernal chest squeezing, which lasted a couple of minutes and resolved spontaneously. in the ed his vs were: 98.3, 92, 136/78, 92%/ra. his sbp dropped to 77 and he received 2l ns and asa. he was initially started on high dose ppi given suspicion for reflux. the patient noted orthopnea and was found to be in respiratory distress. he was admitted to the icu with chf and etoh withdrawal. he was agitated, tachycardic and hypertensive and then dyspneic with 3 inches of nitro paste, 120mg lasix, 6mg iv ativan, 8mg iv morphine, 10mg iv lopressor. he required intubation for hypoxemic respiratory failure as his rr was 45, he was sating 85% on nrb. he was treated while intubated with versed and fentanyl. he was treated with unasyn for a question of aspiration pneumonia. he was extubated on with continued aggressive diuresis. he ruled in for a nstemi with trops up to 1.5. he was intubated and admitted ot he icu and extubated on . he was also requiring detox secondary to etoh abuse. on he had a persantine stress with hr to the 80s, <70% of target, with no ischemic ekg changes. apbs in receovery. negative sxs for angina. nuclear imaging revealed lvef 51%, septal/inf wall and apical hypokineais with large mixed, primarily ischemic septal defect extending into the anterior wall. there was a mod/large inferior mixed, primaritly ischemic defect extending into a portion of the lateral wall with apical ischemia. there was a suggestion of lv dilation. ros negative for fevers or chills. positive for cough and sputum which is present more when he drinks. he has had dysuria since having the foley catheter at the osh. cardiac review of systems is notable for absence of current chest pain. he does have dyspnea on exertion, orthopnea, ankle edema. denies palpitations. past medical history: - cad s/p cabg with redo in at see omr for complete graft information. - : stent - diabetes diagnosed in - chf with ef 55% - hypercholesterolanemia - etoh abuse drinks a pint of whiskey a day dt's in the past - multiple falls - gerd - anxiety/depression - obesity - tia . tte: ef 55% 7/05 social history: married with supportive wife who helps with medications. tob: quit etoh: 1 pint whiskey/day. has had hospitalization for w/d in the past family history: father died at 47 of cad, mother died at 73 of cad. physical exam: vs - 98.1, 126/64, 18, 94%/ra gen: nad. oriented x3. mood appropriate, affect inpatient and axious. heent: perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: unable to assess jvp. cv: rr, normal s1, 2/6 sem. no s3 or s4. chest: resp were unlabored, no accessory muscle use. shallow bs. abd: soft, ntnd. no hsm or tenderness. no femoral bruits. ext: 2+ b/ . 2+ dps skin: significant erythema (chronic) anterior left shin; scv line on right nt without erythema pertinent results: ekg compared to : nsr 84, na, mild pr prelongation stable from prior, nl qrs, nl qtc, q waves ii, avf new from prior, loss of r wave progression from prior osh: ua: trace protein, large blood, neg nitrite, 119 rbc, 2 wbc, <1 sq, few bacteria : ethyl etoh 193 130/4/96/25/9/0.9<64 ca 8.8 . cpk 82, mb 2.8, index: 4.6 mb 54.4 trop i 0.09 1.59 (unclear time or date) . alb 3.6 . 5.7>35.9<155 (wbc peaked at 9.1 on ) pt 14.1, inr 1.1, ptt 25.2 bnp 151 . b/l le u/s: no dvt bit valf levels not fully evaluated edema cxr: cardiomegaly with pulmonary vasculature congestion on repeated on which showed improvement in b/l pleural effusions. ekg: nsr 94 with septal infarct . sputum ctx: at osh blood ctx: at osh . cxr : the uppermost and the lowest sternal wires are fractured and although a fragment of the lowest wire has migrated laterally, the alignment of the sutures is as expected and undisturbed. lungs are clear. heart is mildly enlarged. there is no appreciable pleural effusion. right subclavian line tip is just above the junction of the brachiocephalic veins. no pneumothorax, mediastinal widening or pleural effusion. . admission labs: 06:46pm blood wbc-6.8 rbc-3.41* hgb-10.8* hct-33.1* mcv-97 mch-31.6 mchc-32.6 rdw-13.4 plt ct-221 06:46pm blood pt-14.3* ptt-26.7 inr(pt)-1.2* 06:46pm blood glucose-135* urean-14 creat-1.1 na-147* k-3.8 cl-105 hco3-30 angap-16 06:46pm blood ck(cpk)-115 06:46pm blood ck-mb-2 ctropnt-0.04* 06:46pm blood calcium-9.2 phos-2.7 mg-1.8 cardiac catheterization: selective coronary angiography in this right-dominant system demonstrated native three-vessel disease. the lmca was occluded distally. the rca had a proximal total occlusion. 2. arterial conduit angiography revealed the lima->lad to have 80% in-stent restenosis at the anastamosis. 3. venous conduit angigoraphy revealed the svg->diagonal branch to be widely patent. the svg->om1 had 80% in-stent restenosis. 4. resting hemodynamics revealed elevated left- and right-sided filling pressures, with a pcwp of 34 mm hg and an ra pressure of 12 mm hg. there was moderate pulmonary arterial hypertension with a pasp of 53 mm hg. the cardiac index was preserved at 3.1 l/min/m2. the systemic arterial blood pressure was normal. there was a 15 mm hg gradient upon pullback of the catheter from the left ventricle to the aorta. 5. successful pci of the ostial svg-om in-stent restenosis with a 3.0x15mm promus des, post-dilated to 3.25mm. 6. successful closure of the right femoral arteriotomy site with a 6f angioseal device. final diagnosis: 1. three-vessel native coronary artery disease. 2. patent svg->diagonal. 3. in-stent restenosis of the ostial svg->om stent and lima->lad anastamotic stent. 4. severely elevated left- and right-sided filling pressures. 5. moderate pulmonary arterial hypertension. 6. successful pci of the svg-om with des. tte: the left atrium is moderately dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is moderate global left ventricular hypokinesis (lvef = 30-35 %). the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. left ventricular cavity enlargement with moderate global hypokinesis. mild aortic valve stenosis. moderate mitral regurgitation. ccath: 1. successful pci of the lima-lad isr with a 2.5x15mm promus des. 2. successful closure of the left femoral arteriotomy site with a 8f angioseal device. final diagnosis: 1. successful pci of the lima-lad with des. cxr: as compared to the previous radiograph, the nasogastric tube has been removed. the left-sided intravenous access line is in unchanged position. unchanged size of the cardiac silhouette, minimal increase in extent of the retrocardiac opacity caused by atelectasis. otherwise, no relevant change. no newly occurred focal parenchymal opacities. no indication of pulmonary edema. brief hospital course: 82 year-old male with history of cabg, dm, etoh abuse, transfered for cardiac catheterization s/p stent to des to lima-lad, course complicated by respiratory failure requiring intubation. #. coronary artery disease: the patient had symptoms concerning for unstable angina and presented to an osh. at that time he had a slight increase in cardiac enzymes. there were no ekgs from the outside hospital. the patient was maintained on aspirin, heparin gtt, high-dose atorvastatin, plavix and metoprolol tartrate. he had a cardiac catheterization the morning of admission finding in-stent restenosis of ostial svg->om stent and lima->lad. the patient had a des in the svg-om. the patient developed agitation in the cath suite and was transfered to the cardiac icu for further monitoring. it was thought to be secondary to a paradoxical effect of the benzos he was given during the procedure. he was resent to the cath lab and had a successful pci of the lima-lad with des. the patient was discharged on metoprolol tartrate, lisinopril, atorvastatin, aspirin and plavix. he had one episode of chest pain without ekg changes or cardiac enzyme elevations. he received 1mg of morphine which relieved his pain. he was hemodynamically stable at discharge. he should follow up with an outpatient cardiologist within 2 weeks of discharge. #. acute on chronic systolic heart failure and respiratory failure: a tte was done which showed decreased ef of 30-35%. the patient was intubated for hypoxemic respiratory failure. he was diuresed and quickly extubated to a bipap. he was quickly weaned to face mask and then 3l nc. he receieved an 8 day course of vancomycin and cefepime for ventilator associated pneumonia. he was weaned slowly off of oxygen and had no oxygen requirement upon discharge. the patient was discharged on diuretics with torsemide 30 mg daily. #. delirium: the patient initially had both hypoactive and hyperactive delirium; hypoactive delirium resolved, but hyperactive delirium at night persisted for weeks with gradual resolution. initially it was thought to be secondary to paradoxical effect of benzos. usual precautions were done including minimizing lines, frequent orientation, etc. the patient was started on large standing of seroquel in the evening with an additional smaller morning . his qtc was not prolonged. he was followed by both geriatrics and psychiatry throughout his hospitalization. despite an improvement in delirium the patient had persistent difficulty with behavioral control. despite aggressive medical management the patient had continued difficulty. he was started on trazadone and seroquel with some improvement. his dose was changed to seroquel 25mg qam, 100mg qhs and 25mg given at midday to attempt to prevent increased agitation in the late afternoon. he continues on trazodone 50mg qhs. per psychiatry, pt should be wslowly weaned off the seroquel but discontinuing the day time dose in about 2 weeks, then decrease the bedtime dose by 25 mg per week until off. . #. sinus tachycardia: the patient had sinus tachycardia. he was evaluated for potential pathological causes and none were found. the likely etiology was volume depletion and agitation. as the patient's delirium improved the tachycardia improved. #. nutrition: the patient required an ng tube for medications and tube feeds while in the icu. the tube was removed and he was able to eat and take medications by mouth. speech and swallow evaluated the patient was cleared for a full diet with supervision. #. diabetes mellitus: the patient was continued on insulin nph at bedtime and in the morning as well as an insulin sliding scale. #. etoh abuse: he was initially monitored on valium per ciwa scale. a social work consult was ordered. the patient showed no signs of withdrawal. #. hyperlipidemia: continued statin per above. #. hypertension: continued medications per above. #. gerd: changed to h2 blocker from ppi as patient is now on plavix. #. code: full code for this hospitalization. medications on admission: current medications: home medications ( hospital which had contact cvs) 4mg daily ativan 1mg prn metolazone 2.5 mg twice a week insulin, 52u per patient ?spironolactone 25mg daily not refilled since asa plavix gabapentin 600mg qhs . medications on transfer: prilosec 40mg daily heparin sc 5000u tid insulin nph 20u before meals insulin s/s: 131-180 4 u, 181-240 8u, 241-300 10u, 301-350 12u, 351-400 16u robitussin syrup mom 30ml daily senokot prn tyelnol 650mg q4h nitrostat 0.4mg prn mucomyst asa 81mg daily lipitor 80mg daily oscald 500mg plavix 75mg daily lasix 40mg daily neurontin 600mg daily hs lisinopril 2.5mg daily lopressor 25mg mvi discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): do not stop medicine or miss for at least one year. 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. torsemide 10 mg tablet sig: three (3) tablet po once a day. 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po twice a day as needed for constipation. 8. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for wheezing, sob. 12. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours) as needed for wheezing, sob. 13. senna 8.6 mg capsule sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 14. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for redness in groin area. 15. quetiapine 25 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 16. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 17. metoprolol succinate 50 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po daily (daily). 18. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 19. quetiapine 25 mg tablet sig: one (1) tablet po 1600 (). 20. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 21. humalog 100 unit/ml solution sig: as per sliding scale subcutaneous four times a day. 22. nph insulin human recomb 100 unit/ml suspension sig: twenty eight (28) units subcutaneous before breakfast with humalog. 23. nph insulin human recomb 100 unit/ml suspension sig: twenty two (22) units subcutaneous before dinner with humalog. discharge disposition: home with service facility: vns of greater discharge diagnosis: non st elevation myocardial infarction acute delerium diabetes mellitus hypertension discharge condition: mental status:confused - sometimes level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted to the hospital because you had a heart attack. you received a drug eluting stent to one of your coronary arteries. it is extremely important that you take plavix and aspirin every day for at least one year. do not stop taking plavix or aspirin unless dr. tells you to. you then became delerious and have been improving slowly, we have started new medicines to help you stay calm and oriented. . your heart function is weaker after the heart attack and you will need to take new medicines to help it pump better. you were treated also for a pneumonia with antibiotics. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days once you are home. . medicaton changes: 1. stop taking pravastatin, lorazepam, spironolactone, bumetanide, klor con, gabapentin, garlic, twice daily metoprolol and metolazone 2. increase your aspirin to 325 mg daily to keep the stent open 3. start using clobetasol ointment for your back. 4. start using torsemide daily to prevent fluid accumulation in your lungs 5. start seroquel to help you relax and keep your mind sharp. your doctor will start tapering this medicine slowly in about 2 weeks. 6. start taking simvastatin to lower your cholesterol 7. take the long acting metoprolol to control your heart rate 8. start taking trazadone to help you sleep at night. followup instructions: please be sure to keep all of your followup appointments. . primary care: ,iqubal s phone: date/time: friday at 1:00pm. . provider: , md phone: date/time: 2:30 . cardiology: , c. phone: date/time: at 1:15pm. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters enteral infusion of concentrated nutritional substances alcohol detoxification alcohol detoxification insertion of drug-eluting coronary artery stent(s) insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of autologous vein bypass graft other chronic pulmonary heart diseases dysthymic disorder other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mitral valve insufficiency and aortic valve stenosis other complications due to other cardiac device, implant, and graft accidents occurring in other specified places altered mental status cerebral embolism with cerebral infarction accidents occurring in residential institution acute on chronic systolic heart failure alcohol withdrawal delirium acute alcoholic intoxication in alcoholism, continuous 

Answer: The patient is high likely exposed to