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: hydrocodone attending: chief complaint: chest pain major surgical or invasive procedure: cardiac cath with pci to svg-rca history of present illness: 75yo man with h/o cad s/p several nstemis and cabg x 4 in , hyperlipidemia, chronic afib, chf, transferred from for pci of instent restenosis of svg-rca graft. pt was admitted to with complaints of sscp radiating to bilateral fifth fingers, assoc with slight sensation of nausea and dyspnea, not relieved by one tab slntg but then relieved in ed by second tab slntg. noted to have inferior depressions on admission ekg. pt was treated at mwmc with heparin for rising troponin and with lasix 40mg iv x once for evidence of chf. pt then went for diagnostic cardiac cath today which revealed instent restenosis of svg-rca, which may have been worse then stenosis known to exist (see pmh below for details). was transferred to for pci of graft by dr. . . in cath lab, the prowater guide passed through the diseased artery with some difficulty. the lesions were then pre-dilated with a 3.0mm cutting balloon, which was noted to cause immediate no-reflow. subsequently, three 3.5mm taxus stents were placed in overlapping fashion (28, 24, 20 mm distal to proximal), and the vein graft was infused with adenosine and nipride. it was felt that there was likely thrombus in the stents thereafter, a complication of the no-reflow phenomenon. therefore, a temporary pacer was inserted, filter wire placed, angiojet amd export thrombectomyc caths were used with good result. eventually timi flow was restored, st elevation improved, chest pain resolved. at the intended end of the procedure, however, the patient had a sudden vf arrest, was defibrillated, though the vf recurred two more times requiring one shock per episode to revert to sinus. he was given an amio bolus, rhythm remained sinus. relook angio revealed return of no-reflow, again treated with intracoronary vasodilators with some improvement. st elevations in inferior leads returned. patient's bp dropped transiently, necessitating dopamine, but this was rapidly weaned off. no residual stenosis seen on relook. patient was noted to be in nsr leaving cath, had been in afib prior to procedure. was transferred to ccu for continued management of stemi, close observation given vfib arrest. past medical history: -cad s/p cabg at in with lima-lad, svg-lcx, svg-pda(r dom), svg-d1, several nstemis (, , , - angio and stent at ), cath at , showing 80% lmca stenosis, to of lcx, severe stenosis of lad, to of rca; to of svg-lcx, svg-pda with severe instent stenosis (80-90%), lima-lad patent; cypher stent x3 were placed to svg-pda with severe no-reflow that resolved with ic ntg and ic nitroprusside, timi 3 flow thereafter -chronic atrial fibrillation -chf with mod mvr, stage ii-iii lvef 38% on cath, date unknown -diabetes mellitus, type ii -hypercholesterolemia -copd, last exacerbation -hiatal hernia -depression -lumbar laminectomy -prostate ca s/p prostatectomy -pvd s/p l fem- bypass -osteoarthritis -pud, duodenal, s/p gi bleed while on celebrex, coumdain, asa -cri (unknown bl cr) social history: active smoker (1ppd x 60y), drinks etoh occassionally; retired tool and dye maker. family history: unknown physical exam: vitals: hr 72 bp 109/59 rr 22 sat 100% on ra gen: caucasian man, lying in bed flat, no apparent distress heent: perrl, eomi, mmm, op clear neck: no jvd, supple cv: rrr, distant hs, syst murmur at lusb without rads lungs: rales at bases bilaterally, otherwise cta abd: soft, obese, nt, nd, decreased bs groin: r side with sheath in place, slight ooze, no bruit ext: no le edema, dopplerable pulses bilaterally neuro: a+ox3, no gross deficits pertinent results: labs: admission: chem10: na 132, k 4.6, cl 101, co2 23, bun 28, cr 1.1, gluc 211, ca 7.5, mg 1.6, phos 3.4 cbc: wbc-8.2 rbc-4.32* hgb-12.8* hct-37.6* plt count-101* coags: pt-13.8* ptt-60.9* inr(pt)-1.3 cardiac enzymes: ck(cpk)-61, mb not done discharge: chem10: na 139, k 4.2, cl 106, co2 25, bun 20, cr 1.4, gluc 154*, ca 8.0*, mg 2.2*, phos 2.0 cbc: wbc-5.9 rbc-3.47* hgb-10.8* hct-30.3* plt count-74* coags: pt-15.4* inr-1.6 cardiac enzymes: ck-493, mb 59, mbi 12.0, trop 4.66 peak cardiac enzymes (): ck-637* mb-122* mbi-19.2* trop-1.66* ----------------- catheterization: ptca comments: the angiogram at the facility showed critical diffuse, lengthy, eccentric narrowing in the svg to the rca. we planned to predilate and stent the lesion which was within the previously stented segments. the arterial and venous sheaths which were in situ from the transferring hospital were changed to new sheaths under sterile conditions with iv antibiotic cover. we used heparin and integrillin prphylactically. a 6f sideholed jr 4 guide provided adequate support. an asahi prowater wire crossed the lesion without difficulty and was placed in the distal vessel. we then placed a 3.0 x 15 cutting balloon in the distal most portion of the lesion, and inflated it to 10 atm thrice, from distal to proximal. the subsequent angiogram showed timi 1 flow upto the mid and timi 0 from there onward suggesting no reflow phenominon. the patient also developed chest pain and inferior st elevation. we then delivered 3 taxus stents from the distal to the proximal part of the lesion in an ovelapping manner, measuring 3.5 x 28, 3.5 x 24 and 3.5 x 20 with no diffculty and deployed them at 18, 20 and 18 atm respectively. the second stent balloon was used to post dilate the overlap between the first and the second stents once to 20 atm. the timi 0 reflow progressed to the proximal rca. we then used an ultrafuse catheter to deliver ic medications, particularly given the jr4 catheter had side holes in it and administered ic adenosine and nitruprusside in varying amounts with no success. we then placed a ez 300 cm filter wire in the distal vessel and an angiojet catheter proximal to it, with no difficulty. we then placed a 5f pacing wire in the floor of the rv for demand pacing. we then performed 4 passes with the angiojet with flow improving up to timi i - ii and the chest pain subsiding. the angiogram showed some underexpansion of the proximally placed stent, which was post dilated using a nc ranger 3.5 x 18 balloon at 20, 22 and 22 atm with satisfactory result. how ever the flow still remained to be timi ii and we then advanced an export catheter in the the distal vessel and aspirated the contents. after multiple injections of the above medications and the procedures the flow remained to be timi ii. at this point the patient developed coarse vf three times one after the other and necessitated 3 shocks at 200, 300 and 360 j with successful cardioversion each time. the subsequent angiogram showed worsening flow of the rca and the patient became hypotensive. we then commenced a dopamine infusion which was turned off with improvement in blood pressure soon after. the ecg was unchanged and the patient continued to have some chest dyscomfort though to a lesser degeree. after consensus opinion, we elected not to intervene any further at this stage, given the hemodynamic stability of the patient. the patient left the lab in a hemodynamically stable condition. 1. critical instent restonisis of the svg to the rca. 2. predilation using 3.0 x 15 cutting balloon,placement of three cypher stents in the svg instent restenosis using 3.0 x 28, 3.0 x 24 and 3.0 x 20 stents and post dilatation using nc ranger balloon with lesion reduction from 80% to 0%. the procedure was complicated by no reflow with timi 0 flow with subsequent extensive pharmacological and mechanical manupulation using adenosine ic, nitruprusside ic, angiojet rheolytic thrombectomy and export catheter aspiration with flow improving to timi ii. the procudure was subsequently complicated by three episodes of vf, successfully cardioverted. the final angiogram showed timi i flow with no dissection or no macrovascular embolus or thormbus or residual stenosis. (see ptca comments) final diagnosis: 1. stenting of the svg to rca using three cypher stents with no residual lesion. 2. procedure complicated by no reflow with timi 0 flow improving to timi ii transisently. 3. vf arrest x 3 with successful prompt cardioversion and subsequent deterioration of flow to timi i. brief hospital course: a/p: 75yo man with h/o cad s/p several nstemis and cabg with svg-rca graft, chronic afib, chf, transferred from for pci of instent restenosis of svg-rca graft, complicated by no-reflow, inferior stemi, and vfib arrest. . 1. cad - as described in the hpi, the patient was taken to for catheterization for his instent restenosis and had multiple stents placed with eventual improvement of blood flow through the graft. during the hospitalization, he remained chest pain free. he was placed on asa and plavix, with asa decreased to 81mg on discharge secondary to concomittent coumadin use. he was initially started on a nitroglycerin drip, which was changed to imdur prior to admission. he was also started on a betablocker. lipitor was increased to 80mg in the setting of his acute stemi, but decreased to his home regimen of 20mg at discharge. . 2. vfib/afib - as per the hpi, the patient was defibrillated out of ventricular fibrillation three times in the cath lab. he was given an amiodarone bolus, and was stable throughout the rest of the hospitalization. his electrolytes were repleted prn. this episode may have been secondary to ischemia or revascularization. in addition, he was found to be in chronic afib, which was converted to nsr with the defibrillation. during the hospitalization, he did not convert back into atrial fibrillation, though this was expected given his long history of afib. he was restarted on coumadin 2.5mg qd until his inr was therapeutic, and he had an outpatient follow-up appointment made to adjust his coumadin as necessary. . 3. heart failure - initially the patient was thought to be fluid overloaded by report. he was not given lasix on admission due to his renal failure and the concern of an acute insult to his kidneys from the dye during catheterization. however, clinically the patient was not in heart failure. he does, however, have significant cardiac disease and a low ef is expected. would recommend outpatient echo. lasix and lisinopril were both restarted prior to the patient's discharge. . 4. hyponatremia - a sodium level of 132 on admission was likely secondary to fluid shifts with revascularization, though it could have been complicated by either chf or dehydration. he did well with fluids overnight, and the na level resolved. it was within normal limits on discharge. . 5. thrombocytopenia - per osh reports, he has had low platelets with recent value of 124 on . his platelet count on discharge was 74. recommend outpatient follow-up. his platelet count was monitored throughout hospitalization. he had no signs of bleeding, no hct drop, and so he was not transfused. . 6. arf on cri - while the patient's baseline renal function was unknown; it was thought that he was likely to have an acute renal failure on his chronic renal insufficiency given the >400cc contrast dye used in his multiple catheterizations. he was restarted on lisinopril and lasix after his creatinine was determined to be stable at 1.4. . 7. pud - given his peptic ulcer disease and anticoagulation, he was placed on a proton pump inhibitor, all stools were guaiac'ed, and his hct was monitored (and remained stable throughout the hospitalization). . 8. dm, type ii - he was maintained on diet with insulin sliding scale for hyperglycemia. . 9. copd - there were no acute issues during this hospitalization, so his outpatient medical management was continued. . 10. apnea with bradycardia - recommend an outpatient sleep study as the patient had an episode of apnea associated with bradycardia, most likely obstructive sleep apnea. . 11. depression - the patient was initially started on his home regimen of celexa, but he reported that he had stopped taking it previously, so it was stopped. medications on admission: -lasix 40mg qd -coreg 6.25 -coumadin 1mg four times per week, alternating with 0.5mg three times per week; held pre-cath -asa 81mg qd -lisinopril 20mg qd -imdur 60mg qd -lipitor 20mg qd -celexa 20mg qd -xalatan eye drops qd -cosopt eye drops discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily) for 3 months. disp:*30 tablet(s)* refills:*2* 2. atorvastatin 20 mg tablet sig: one (1) tablet po once a day. 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. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 5. 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* 6. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. lisinopril 20 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 9. furosemide 40 mg tablet sig: one (1) tablet po once (once) for 1 doses. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: coronary artery disease discharge condition: good discharge instructions: pt should contact pcp or go to if pt: chest pain feels new shortness of breath experiences increased pain or bleeding/swelling at his groin cath site. followup instructions: pt's pcp (dr. ) will contact him with appointment. pt's cardiologist (dr. ) will contact him with appointment. addendum - these appointments were made in the next several days after discharge. md, procedure: injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter other electric countershock of heart insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of three vascular stents diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified coronary atherosclerosis of autologous vein bypass graft cardiac complications, not elsewhere classified atrial fibrillation old myocardial infarction long-term (current) use of anticoagulants other complications due to other cardiac device, implant, and graft ventricular fibrillation 

Answer: The patient is high likely exposed to