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 known allergies / adverse drug reactions attending: chief complaint: exertional chest pain/stable angina major surgical or invasive procedure: coronary artery bypass x2: left internal mammary artery to left anterior descending, and reverse saphenous vein graft to ramus. history of present illness: mr. is a 57 year old gentleman with a pmh significant for severe hypertension, mild hyperlipidemia, and a family history of heart disease, who presented to his pcp at the end of with two months of exertional sub-sternal chest pain. his symptoms started at the end of when he noticed burning substernal pain while walking his dog briskly. symptoms were predictable in onset with exertion and always subsided with rest. the pain occassionally radiated to his left arm, but he denies nausea/vomiting or diaphoresis. never had symptoms at rest. he presented to his pcp who sent him to the ed, where he was noted to have hypertension to 244/110. his blood pressure medications were changed at that time. he has long-standing hypertension, but does not recall his prior regimen before this change. he also underwent exercise mibi at , during which he went 4 minutes 36 seconds on a protocol and developed 2mm st depressions in the inferior lateral leads. he did experience chest discomfort. imaging showed a large and severe defect involving the mid anterior wall extending to the anterior apex. in addition there was another defect involving the mid to distal septum. there was transient ischemic dilation of the left ventricle. lvef was noted at 64%. he was referred to for left heart catheterization which revealed multivessel coronary artery disease.cardiac surgery was consulted for coronary revascularization. past medical history: primary: coronary artery disease pulmonary embolism (incidental finding pre-operatively) secondary: hypertension hyperlipidemia hypothyroidism left femur fracture social history: patient is divorced with three children. he lives with girlfriend and his girlfriend's two daughters. previously worked at papa ginos as a general manager. was laid off in . tobacco: never etoh: rare recreational drugs: denies home services: denies family history: father died of early mi at age 46. mother had some type of cancer and was in remission when she died in retirement home (cause unknown). no family hx of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: physical examination on admission: vs: t=98.4 bp=135-158/77-83 hr=75 rr=18 o2 sat= 96(ra) general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. no elevated jvp. cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no m/r/g. lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, mildly obese, ntnd. no hsm or tenderness. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: labs on admission: 09:40am blood wbc-9.3 rbc-4.26* hgb-12.4* hct-34.5* mcv-81* mch-29.1 mchc-35.9* rdw-13.2 plt ct-154 09:40am blood neuts-70.9* lymphs-23.1 monos-3.8 eos-1.9 baso-0.2 09:40am blood pt-13.7* inr(pt)-1.2* 09:40am blood glucose-193* urean-20 creat-1.2 na-141 k-3.3 cl-106 hco3-24 angap-14 09:40am blood alt-22 ast-26 alkphos-65 totbili-0.6 09:40am blood albumin-3.6 iron studies/hgba1c: iron-64 09:40am blood caltibc-246* ferritn-162 trf-189* 09:40am blood %hba1c-5.5 eag-111 urinanalysis: 12:00pm urine color-yellow appear-clear sp -1.019 12:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-2* ph-6.5 leuks-neg urine metanephrines: micro: 8:34 pm staph aureus screen source: nasal swab. 12:00 pm urine source: cvs. imaging/studies: cardiac cath : 1. selective corobary angiography of this right dominant system demonstrated three vessel coronary artery disease. the lmca is a large caliber vessel with a 30% ostial stenosis. the lad has an ostial 90% stenosis prior to an ulcer, followed by a 95% stenosis. there is diffuse disease through the mid-lad to 60%. the lad is short and does not extend to the apex with timi 1 flow. the lx is a large caliber vessel with diffuse plaquing. there is a modest ramus/om1 with proximal 65% stenosis. there is a moderate om2 with moderate origin stenosis. there is a tiny om3. there is a tortuous branching om4 with mild stenosis at the origin of the lower pole. there is a large om5/lpl that is diffusely diseased to lpl2 with 60% mid-vessel stenosis. the rca has an ectatic origin with a proximal-mid tubular 50% stenosis. there is diffuse plaquing throughout with a distal 30% stenosis into rpda with 50% stenosis at the origin of its first lateral sidebranch. there are faint collaterals to the lad. 2. limited resting hemodynamics revealed mildly elevated left-sided filling pressures with lvedp averaging 13, max 21 mmhg. 3. left ventriculography revealed no mitral regurgitation, an lvef of 70%, and no regional wall motion abnormalities. 4. left radial artery hemostasis achieved with tr band. chest xray pa/lat : impression: heart is normal size. lungs are clear. fullness in the right tracheobronchial angle is explained by fat deposition in the mediastinum projecting over a transverse process of the thoracic spine. there is no good evidence for central lymph node enlargement or pleural abnormality. lungs fully expanded and clear. tte : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. 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 appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. no pathologic valvular abnormality seen. mildly dilated aortic root and ascending aorta. renal artery ultrasound : impression: 1. normal kidneys and bladder. 2. segmental arterial resistive indices within normal limits, ranging from 0.58 to 0.67. no evidence of renal artery stenosis. cta coronaries : impression: 1.extensive involvement of the coronary arteries by diffuse and focal abnormalities as described in details in the body of the report. those findngs in conjunction with focal areas of coronary arteries dilataions ca raise the suspicion of vasculitis with some degree of atherosclerosis as well. given the lack of coronary calcifications in the presence of such an extensive unvolvement of coronary arteries, vasculitis might first diagnostic consideration. 2.segmental and subsegmental pulmonary embolism. 3. persistent left svc findings were discussed with dr. over the phone by dr on monday, at 10 am. dr. approved: mon 2:11 pm imaging lab intra-op tee conclusions pre-bypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the descending thoracic aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. dr. was notified in person of the results at time of surgery. post-bypass: the patient is in sinus rhythm. the patient is on no inotropes. biventricular function is unchanged. mitral regurgitation is unchanged. the aorta is intact post-decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 16:24 ?????? caregroup is. all rights reserved. 05:50am blood wbc-12.4* rbc-3.34* hgb-9.9* hct-28.8* mcv-86 mch-29.7 mchc-34.5 rdw-14.1 plt ct-139* 06:10am blood wbc-14.6* rbc-3.54* hgb-10.5* hct-29.8* mcv-84 mch-29.5 mchc-35.1* rdw-14.7 plt ct-125* 06:40am blood pt-17.5* inr(pt)-1.6* 05:50am blood pt-14.4* inr(pt)-1.3* 06:10am blood pt-14.0* inr(pt)-1.3* 05:06pm blood pt-14.5* ptt-35.3* inr(pt)-1.3* 03:38pm blood pt-14.9* ptt-30.0 inr(pt)-1.3* 09:40am blood pt-13.7* inr(pt)-1.2* 06:40am blood urean-18 creat-1.0 na-140 k-3.6 cl-102 05:50am blood glucose-116* urean-18 creat-1.1 na-140 k-3.6 cl-105 hco3-30 angap-9 brief hospital course: mr. is a 57 year old gentleman with a history of hypertension, hyperlipidemia, and strong family hx of heart disease who presented for scheduled cardiac catherization after a positive stress mibi at osh, found to have severe cad requiring admission for heparin drip and evaluation for cardiac bypass surgery. after conclusion of preoperative work up, mr. was taken to the operating room on and underwent coronary artery bypass x2(left internal mammary artery to left anterior descending, and reverse saphenous vein graft to ramus) with dr.. please see operative report for further surgical details. cardiopulmonary bypass time: 54 minutes. cross-clamp time: 45 minutes. he tolerated the procedure well and was transferred to the cvicu intubated and sedated. he awoke neurologically intact and was extubated without incident. he weaned off pressor support and was started on beta-blocker/statin/aspirin and diuresis. all lines and drains were discontinued per protocol. pod#1 he was transferred to the step down unit for further monitoring. physical therapy was consulted for evaluation of strength and mobility. anticoagulation with coumadin was initiated for pulmonary embolism seen on mra on . he continued to progress and on pod 4 he was cleared for discharge to home with vna. all follow up appointments were advised. medications on admission: carvedilol - 25 mg po bid hydralazine - 20 mg po tid hydrochlorothiazide - 25 mg po qam levothyroxine - 112 mcg po qam lisinopril - 40 mg po qam simvastatin - 40 mg po qpm aspirin - 81 mg po qd discharge medications: 1. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 2. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 3. outpatient lab work labs: pt/inr for coumadin ?????? indication, pulmonary emboli goal inr first draw , then monday, wednesday, friday for 2 weeks. results to phone , dr. (confirmed ) 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 11. warfarin 5 mg tablet sig: one (1) tablet po once a day: dr. to dose for goal inr . dx: pe. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: allcare vna discharge diagnosis: primary: coronary artery disease secondary: hypertension hyperlipidemia hypothyroidism left femur fracture discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage leg left - healing well, no erythema or drainage. edema 1+ discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. on at 1:00pm dr on at 11:00am wound check on at 10:45am please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication, pulmonary emboli goal inr first draw , then monday, wednesday, friday for 2 weeks. results to phone , dr. (confirmed ) procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of one coronary artery diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder unspecified essential hypertension unspecified acquired hypothyroidism paroxysmal ventricular tachycardia other and unspecified hyperlipidemia other and unspecified angina pectoris family history of ischemic heart disease other pulmonary embolism and infarction personal history of traumatic fracture 

Answer: The patient is high likely exposed to