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: no allergies/adrs on file attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization intra-aortic balloon pump history of present illness: 57 male-to-female transgender patient on estrogen developed chest pain with diaphoresis at rest while at an aa meeting. pain described as substernal and radiating to bilateral elbows and was in severity. also had some associated nausea, no vomiting. ambulance was called, and she was given 2 sl ntg in route. no aspirin was given in field. pain when she presented to the ed. initial vitals in the ed were 97.8, 76, 111/74, 30, and 100% on 4l nc. ekg demonstrated 2-3mm st elevations in ii, iii, avf and 1-2mm st elevations in v5-v6 with st depressions in v1-v3 and avl. labs were significant for a wbc of 15.8 and a troponin of <0.01. in the ed, the patient was given plavix 600mg, aspirin 324mg, integrilin 16.2 mg bolus, then 2mg/kg/min, morphine 5 mg iv, and heparin bolus and drip. patient was taken to the cath lab. cath was significant for occlusion of the distal left circumflex, thought to be responsible for the symptoms and ekg changes. intervionalists were not able to pass a wire throught the left circ. therefore, an intra-aortic balloon pump was placed to increase perfusion to the coronary arteries and to decrease cardiac o2 demand. plan is to continue balloon pump for 48 hours, to allow completion of the infarct, and for cardiac surgery to take her for possible cabg. in the cath lab, integrilin was stopped, as was plavix and nitro. on arrival to the floor, patient had pain in the left shoulder blade. pain increased to throughout the next hour. balloon pump was on. bedside echo showed no obvious effusion. review of systems on review of systems, she 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. she denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. she has been walking miles per day. past medical history: 1. cardiac risk factors: - diabetes, - dyslipidemia, + hypertension in 30s that was initially treated with antihypertensives, but these were stopped when patient lost 30 lbs and no longer had to take antihypertensives 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: -male-to-female transgender on estrogen and spironolactone (gets them off the internet) -used to get healthcare at crossroads in , but has not been in 1.5 years due to lack of health insurance social history: -tobacco history: smokes currently - pack daily, ~30 pack-year history of smoking -etoh: none in 22 years -illicit drugs: none in 22 years -lives with her sister currently. two children are 30 and 32 years old. she used to work as a upholsterer and had her own business, which she lost after she transitioned and began living full-time as a woman 5 years ago. she does not currently have health insurance. she is being trained to be a cna and wants to work with geriatric lgbt populations. family history: father and both of mother's parents with a history of heart disease; otherwise non-contributory. physical exam: vs: 98.1, 71, 108/62, 11, 100% on 4l by nc general: wdwn m-to-f trans woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: jvp difficult to assess given large neck. cardiac: normal heart sounds difficult to assess given the loud iabp sounds. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi anteriorly. abdomen: soft, ntnd. extremities: no c/c/e. femoral bruits difficult to assess given loud iabp sounds. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ pt dopplerable left: dp dopplerable pt dopplerable pertinent results: ekg: sinus rhythm at 75 bpm. normal axis. 2-3mm ste in ii, iii, avf, 1-2mm st elevations in v5-v6; st depressions in avl, v1-v3. . cardiac cath: - coronary angiography: right dominant - lmca: large and ectatic with a 30% distal left main - lad: the lad was a diffusely diseased vessel. it had a 50% stenosis in its proximal segment, a diffuse (30 mm) 70-80% stenosis in the mid lad; and minor lumen irregularities in the distal lad. there was a large bifurcating diagonal branch. - lcx: the lcx was ectatic in its proximal segment. there was a large bifurcating omb. in the mid-distal lcx, there was an abrupt cutoff with staining of contrast consistent with an acute occlusion. no distal collaterals were seen. the area of myocardium at risk distal to the occlusion is relatively small. - rca: the was a 70% stenosis in the proximal rca followed by a large ectatic segment of mid rca. there was a 90% distal rca stenosis and diffuse disease into the lad and posterolateral branches. there was timi 3 flow into the distal vessel. - interventional details: -- the procedure was performed from the right radial artery without complications -- unfractionated heparin and eptifibatide (terminated at the end of the procedure) were used for anticoagulation. -- the ekg changes were suggestive on an interolateral stemi. there was timi 3 flow into the distal rca and an acute occlusion to the distal lcx. using a 2.5 mm balloon, multiple wires were used (bmw, prowater, pilot-50, choice pt) to attempt to cross the occlusion without success. there was distal staining consistent with dissection but no evidence of perforation. no balloon inflations were performed. after prolonged attempts, the procedure was aborted due to the small area of subtended myocardium (despite diffuse ekg changes). the rca was also a potential culprit vessel but had timi 3 flow and would not account for the ekg changes. -- an iabp was placed from the right femoral artery without complications. this resulted in an improvement of her pain. . cxr (ed): single portable view of the chest. no prior. lungs are clear of focal consolidation or large effusion. the cardiomediastinal silhouette is within normal limits. osseous and soft tissue structures are unremarkable. impression: no acute cardiopulmonary process. . laboratory data: 9:25p pt: 11.3 ptt: 119.0 inr: 1.0 . 9:12p 139 105 21 109 agap=21 4.1 17 1.0 . trop-t: <0.01 . 96 15.8 14.4 297 42.8 n:69.2 l:24.7 m:3.7 e:1.8 bas:0.4 . echo : the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior and inferolateral segments. the remaining segments contract normally (lvef = 45%). right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. brief hospital course: 57 yo f (male to female transgender) on hormone therapy who presented w/ cp and was found to have stemi. # stemi: infero-posterior stemi based on ekg and cath findings w/ total occlusion of distal left cx. unfortunately, the cardiac interventionalists were unable to pass a wire through the occlusion, so pt was allowed to complete infarct prior to definitive revascularization, which will take place during the next hospitalization. cath showed 3vd (lcx as above, lad w/ 50% proximal stenosis, 70-80% stenosis in the mid lad, rca w/ 70% proximal and 90% distal stenosis). to increase coronary perfusion and decrease o2 demand, an intra-aortic balloon pump was placed in the cath lab. the patient did well on the balloon pump, and her symptoms of chest pain resolved the following day. she was treated with heparin while on the pump. the pump was weaned and finally removed on . regarding medical management, the patient was treated with aspirin 325mg daily, atorvastatin 80mg daily, and metoprolol tartrate 12.5 tid (switched to 37.5mg of metoprolol succinate daily on discharge). smoking cessation was encouraged, and the patient was prescribed the nicotine patch. we held off on starting an acei during this admission. we also held the patient's home spironolactone (in favor of metoprolol) and estrogen (due to the increased risk of mi). troponin peaked at 3.44, and ck-mb peaked at 132. cardiac surgery was consulted, and they advised cabg, which is scheduled to be performed to days following discharge. # nicotine dependence: currently smokes 0.5-0.75 packs per day. transdermal nicotine 14mg daily was prescribed, and it was decreased to 7mg daily prior to discharge. we encouraged continued smoking cessation and stressed the importance of smoking cessation, especially with concurrent estrogen use. transitional issues: # hormone therapy: the patient is a pre-operative male-to-female transgender woman and was taking estrogen and spironolactone. she understands that estrogen may have increased her mi risk and has agreed to stop taking this medication at least until after ther cabg. she has also agreed to stop taking the spironolactone while we add and adjust other medications that affect her blood pressure. future providers should consider restarting both of these medications because they are important priorities for the patient. # follow up: after the admission for the cabg, the patient should be discharged with cardiology follow up and pcp follow up. a referral to might be especially useful for this patient, given their experience with transgender health and hormone therapy. # insurance: the patient does not currently have health insurance. she met with social work about this, who have started the process of trying to get her health insurance. this should be followed up during the next admission. # code: confirmed full # emergency contact: sister medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. estrogens conjugated 2 mg po daily 2. spironolactone 200 mg po daily discharge medications: 1. nicotine patch 7 mg td daily rx *nicotine 7 mg/24 hour please apply 1 patch daily daily disp #*14 unit refills:*0 2. atorvastatin 80 mg po daily rx *atorvastatin 80 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*2 3. mupirocin nasal ointment 2% 1 appl nu duration: 5 days please start after collecting staph screen 4. aspirin ec 325 mg po daily rx *aspirin 325 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*2 5. chlorhexidine gluconate *nf* 2 % topical daily duration: 3 days 6. metoprolol succinate xl 37.5 mg po daily rx *metoprolol succinate 25 mg 1.5 tablet(s) by mouth daily disp #*45 tablet refills:*2 discharge disposition: home discharge diagnosis: st-elevation myocardial infarction (heart attack) coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital for a heart attack. you were taken to the catheterization lab, and a blockage was found in your left circumflex coronary artery. however, we were unable to clear this blockage. you had an intra-aortic balloon pump placed in order to help your heart function during and immediately after the heart attack. the pump was removed, and you remained stable without complications following the heart attack. you were evaluated by cardiac surgery. they plan to do "bypass" surgery on tuesday, , to help your heart muscle get blood because you have blockages in your arteries. please come to the admissions department in the clinical center building on tuesday at 6am for the surgery. do not eat after midnight the night before. please shower daily using the chlorhexidine soap that we will give you. also please use the mupirocin ointment that we will give you in your nostrils twice a day. the estrogen that you were taking may have contributed to your risk of a heart attack. therefore, please stop taking the estrogen at least until after the bypass surgery. also, stop taking the spironolactone at least until after the bypass surgery, as this medication can affect your blood pressure. cigarette smoking increases your risk of heart disease. please continue to stay quit from smoking. you can use nicotine patches at least until your next hospitalization. stop: - spironolactone - estrogen start: - metoprolol 12.5 mg twice a day - atorvastatin 80 mg daily - aspirin ec 325 mg daily - nicotine patch 7 mg daily - mupirocin 2% ointment to the nostrils twice daily - chlorhexidine soap daily if you need to speak with a physician, contact dr. through the cardiology clinic at (. followup instructions: - the cardiac surgery team plans to do 'bypass' surgery on tuesday, ; please come to the admissions department on tuesday at 6am for the surgery - after the surgery, the cardiac surgery team should help you get set up with a cardiologist and a primary care doctor; you might consider going to for a primary care doctor, as their doctors have experience with hormone therapy and transgender health more generally procedure: coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization implant of pulsation balloon diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder acute myocardial infarction of inferoposterior wall, initial episode of care chronic total occlusion of coronary artery procedure not carried out for other reasons gender identity disorder in adolescents or adults 

Answer: The patient is high likely exposed to