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: erythromycin base / morphine attending: addendum: patient is a 45 yo caucasian male with history of cad s/p stent placement in , dm type 1, htn and chf, who was admitted to the hospital on for a left femoral artery to anterior tibial artery bipass. patient had surgery for bypass and recovered well postop. he was transferred to the ccu on because of chest pain and concern for acute myocardial infarction. . cad: on he began to c/o midsternal chest pain with no radiation, associated with nausea, diaphoresis and sob. says it lasted about 5 minutes (although he mentioned to someone else that it lasted an hour) and resolved with no meds. he also developed a cough with productive sputum. cardiac enzymes were drawn and showed a bump in troponin to 0.37. his ekg read: lvh with secondary st-t changes, st segment elevation in leads v2-v3 probably repolarization secondary to left ventricular hypertrophy, but cannot rule out anterior wall myocardial infarction. this appeared changed from his prior ekg on . the patient was transferred to the ccu and started on a bicarb drip,mucomyst and integrilin in anticipation of a cath. he was continued on his statin and asa and a beta blocker was started. ace inhibitors were held because he had a renal transplant. his cardiac enzymes were checked and he ruled in for mi. he had a cardiac cath on . cath showed 2 vessel disease. the lad had a proximal 80% lesion and a previous stent was patent. the d1 was a small artery with a 90% stenosis. the lcx had no flow limiting lesions. the rca was a dominant vessel with a proximal 90% stenosis. two overlapping cypher drug-eluting stents were placed in the proximal lad and a cypher drug-eluting stent was placed in the proximal rca. bicarb drip was continued after the cath and a dye load of only 100 cc was used. patient remained chest pain free post cath. he was discharged on asa, pravastatin, metoprolol and enalapril (after consulting with renal). . pump: patient had a h/o of chf. last echo on showed ef 60-65%. he developed a mild cough and some bilateral crackles during his admission and responded well to lasix. cxr showed bilateral diffuse pulmonary opacities in a perihilar distribution, which could have been secondary to pulmonary edema and was thought to be worsening chf. he was continued on lasix and improved. his cxr on read mild chf. at the time of discharge, the patient had transient desaturation to 88% with walking. after deep breaths and further ambulation, his sats were 93% on room air. after he walked again, his sats acutally increased from his baseline. he was aware to notify dr. immediately should he develop shortness of breath. . dm: patient had a long h/o diabetes type 1. he had a pancreas transplant but was on an insulin pump. he continued with his insulin pump in the hospital and fsbg were checked. . ? pna: he was started on ceftriaxone for a possible pneumonia because of his cough and what appeared to be a left lower lobe opacity in his chest x-ray. the cxr was later read as pulmonary edema or possible viral pneumonia. later chest x-rays showed no evidence for pneumonia and patient was afebrile so ceftriaxone was dc'd. . s/p renal transplant: patient had one kidney s/p renal transplant. cr was elevated at transfer. bicarb and mucomyst started prior to cath. renal was consulted and tacrolimus, cell-cept and prednisone were continued. given slightly elevated fk levels, the fk dose was decreased to 3mg po bid. ace-inhibitor was restarted at discharge, and patient was instructed to check creatinine level within one week. . orthostatic hypotension: the patient carries this diagnosis but was persistently hypertensive throughtout this hospital stay irrespective of position. as such, midodrine and florinef were discontinued. the patient tolerated this well throughout his admission and was able to walk with physical therapy without orthostasis. . abdominal wound: patient had a slowly healing wound on his abdomen that was colonized with vre. he was placed on contact precautions and followed by the wound care nurse. chief complaint: cc:chest pain major surgical or invasive procedure: left femoral to anterior tibial artery bypass graft cardiac catheterization with 2 stents placed in the proximal lad and a stent placed in the proximal rca history of present illness: hpi: patient is a 45 you caucasian male with history of cad s/p stent placement in , dm type 1, htn and chf, who was admitted to the hospital on for a left femoral artery to anterior tibial artery bipass. patient had surgery for bypass and recovered well postop. however, on he began to c/o midsternal chest pain with no radiation, associated with nausea, diaphoresis and sob. says it lasted 5 mins and resolved with no meds. he also developed a cough with productive sputum. cardiac enzymes were drawn and showed a bump in troponin to 0.37. his ekg showed ???? past medical history: pmh: dm type 1 cad s/p stent placemetn in htn chf lle angiogram demonstrated occlusive dz in left superficial femoral artery, popliteal artery and tibial artery echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is systolic anterior motion of the mitral valve leaflets. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. cath:1. two-vessel coronary artery disease. 2. mild diastolic ventricular dysfunction. 3. successful stenting of the mid-lad. 4. successful stenting of the diagonal-2. 5. successful stenting of the distal lad. past surgical history: 1. simultaneous pancreas/kidney transplant in . 2. cadaveric pancreas transplant in . 3. phlegmon evacuation in including washout, debridement, and closure in . 4. fistula tract embolization in . . social history: soc hx:lives with mother and brother not working family history: family hx: noncontributory physical exam: pe: vs: gen: a & o x3, nad, not diaphoretic or sob heent: jvp about way up neck cardio: rrr, nl s1 s2, no murmurs, rubs, gallops pulm: crackles at lung bases b abd: soft, nt, nd, +bs ext: no edema, dp pulses difficult to palpate, l leg surgical site covered in dressing. 1 cm dry ulcer on plantar aspect of left foot, dry, non purulent. pertinent results: wbc hgb hct plts 03:52am 7.0 8.7* 26.7* 257 05:27am 4.7 3 9.9* 30.9* 251 05:30am 8.9 10.8* 34.8* 296 08:15am 10.1 12.1* 39.2* 276 12:16am 8.6 * 11.5* 36.0* 213 . diff : pmns 91.2* lymphs 3.2* monos 3.2 . inr 1.1 . na k cl hco3 bun cr gluc 136 3.8 103 25 26 1.3 194 136 4 104 20 35 1.2 271 . ck(cpk) 03:52am 80 12:00pm 45 05:27am 23* 04:14pm 231* 08:15am 300* 08:50pm 255* . cpk isoenzymes ck-mb ctropnt 04:52pm notdone1 12:00pm notdone1 1.80 05:30am 7 1.47 04:14pm 7.8* 1.35 08:15am * 8.7* 1.46 12:16am 0.76 08:50pm 8.2* 0.37 . tsh 3.8 . cxr : impression: new interstitial opacities may represent pulmonary edema or viral pneumonia. cxr : impression: worsening chf. cxr : impression: improving mild congestive heart failure. no evidence of focal consolidation to suggest pneumonia. . cardiac cath : comments: 1. selective coronary angiography of this right dominant system revealed 2 vessel coronary artery disease. there were no angiographically flow limiting lesions in the lmca. the lad had a proximal 80% lesion in the lad and previous stent was patent. the d1 was a small artery with a 90% stenosis. the lcx had no flow limiting lesions. the rca was a dominant vessel with a proximal 90% stenosis. 2. limited resting hemodynamics revealed elevated systemic pressures and severely elevated left sided pressures with no gradient upon pullback of the catherter from the ventricle to the aorta. 3. left ventriculography was deferred due to elevated filling pressures. 4. successful placement of two overlapping cypher drug-eluting stents in the proximal lad (3.0 x 8 mm proximally and 3.0 x 18 mm more distally). final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). 5. successful placement of a 2.5 x 23 mm cypher drug-eluting stent in the proximal rca postdilated with a 2.75 mm balloon. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). final diagnosis: 1. two vessel coronary artery disease. 2. elevated systemic pressures and severely elevated lvedp. 3. successful placement of drug-eluting stents in proximal lad. 4 . successful placement of drug-eluting stent in proximal rca. comments: 1. selective coronary angiography of this right dominant system revealed 2 vessel coronary artery disease. there were no angiographically flow limiting lesions in the lmca. the lad had a proximal 80% lesion in the lad and previous stent was patent. the d1 was a small artery with a 90% stenosis. the lcx had no flow limiting lesions. the rca was a dominant vessel with a proximal 90% stenosis. 2. limited resting hemodynamics revealed elevated systemic pressures and severely elevated left sided pressures with no gradient upon pullback of the catherter from the ventricle to the aorta. 3. left ventriculography was deferred due to elevated filling pressures. 4. successful placement of two overlapping cypher drug-eluting stents in the proximal lad (3.0 x 8 mm proximally and 3.0 x 18 mm more distally). final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). 5. successful placement of a 2.5 x 23 mm cypher drug-eluting stent in the proximal rca postdilated with a 2.75 mm balloon. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). final diagnosis: 1. two vessel coronary artery disease. 2. elevated systemic pressures and severely elevated lvedp. 3. successful placement of drug-eluting stents in proximal lad. 4 . successful placement of drug-eluting stent in proximal rca. brief hospital course: cad: on he began to c/o midsternal chest pain with no radiation, associated with nausea, diaphoresis and sob. says it lasted about an hour and resolved with no meds. he also developed a cough with productive sputum. cardiac enzymes were drawn and showed a bump in troponin to 0.37. ekg showed nsr and did not appear changed from his prior ekg on . the patient was transferred to the ccu and started on a bicarb drip, mucomyst and integrilin in anticipation of a cath. he was continued on his statin and asa and a beta blocker was started. ace inhibitors were held because he had a renal transplant. patient was set-up for cardiac cath on . his cath showed 2 vessel disease. the lad had a proximal 80% lesion and a previous stent was patent. the d1 was a small artery with a 90% stenosis. the lcx had no flow limiting lesions. the rca was a dominant vessel with a proximal 90% stenosis. two overlapping cypher drug-eluting stents were placed in the proximal lad and a cypher drug-eluting stent was placed in the proximal rca. bicarb drip was continued after the cath and a dye load of only 100 cc was used. patient remained chest pain free post cath. he was discharged on asa, plavix, pravastatin, metoprolol and enalapril (after consulting with renal). . pump: patient had a h/o of chf but appeared possible pneumonia: he was started on ceftriaxone for a possible pneumonia because of his cough and what appeared to be a left lower lobe opacity in his chest x-ray. the cxr was later read as pulmonary edema or possible viral pneumonia. later chest x-rays showed no evidence for pneumonia and patient was afebrile so ceftriaxone was dc'd. renal: cr was elevated at transfer. bicarb and mucomyst started prior to cath. renal was consulted and tacrolimus, cell-cept and prednisone were continued. renal: ace-inhibitor was restarted at discharge, and patient was instructed to check creatinine level within one week. orthostatic hypotension: the patient carries this diagnosis but was persistently hypertensive throughout this hospital stay irrespective of position. as such midodrine and florinef were discontinued. the patient tolerated this well throughout his admission and was able to walk with physical therapy without orthostasis. s/p transplant: given slightly elevated fk levels, the fk dose was decreased to 3mg po bid hypoxia without shortness of breath: at the time of discharge, the patient had transient desaturation to 88% with walking. after deep breaths and further ambulation, his sats were 93% on room air. after he walked again, his sats acutally increased from his baseline. he was aware to notify dr. immediately should he develop shortness of breath. s/p vascular surgery: vascular followed the patient and noted he was stable from their point of view. medications on admission: medications: 1. prograf 5 mg b.i.d. 2. prednisone 5 mg daily. 3. cellcept mg b.i.d. 4. aspirin 325 mg daily. 5. celexa 40 mg daily. 6. midodrine 10 mg daily. 7. florinef 0.4 mg daily. 8. pravachol 80 mg daily. 9. folic acid 1 tablet daily. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. citalopram hydrobromide 20 mg tablet sig: two (2) tablet po daily (daily). 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 4. pravastatin sodium 20 mg tablet sig: four (4) tablet po daily (daily). 5. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 6. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 7. insulin pump ir1250 miscell. 8. tacrolimus 1 mg capsule sig: three (3) capsule po bid (2 times a day). disp:*200 capsule(s)* refills:*2* 9. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 10. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*1* 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*1 tablet(s)* refills:*1* 12. vitamin a 10,000 unit capsule sig: two (2) capsule po daily (daily) for 14 days. disp:*28 capsule(s)* refills:*0* 13. keflex 500 mg capsule sig: one (1) capsule po four times a day for 7 days. disp:*28 capsule(s)* refills:*0* 14. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po four times a day as needed for pain. disp:*21 tablet(s)* refills:*0* 15. outpatient lab work fk level. chem-7. this week 16. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day: you need to have your kidney function checked while on this medication. disp:*30 tablet(s)* refills:*2* 17. aquacel-ag 1.2-3/4 x 18 %- bandage sig: one (1) bandage topical twice a day. disp:*qs 2 weeks* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: 1) s/p left femoral to anterior tibial artery bypass graft 2) difficult airway 3) s/p renal and kidney transplants 4) acute mi s/p cardiac catheterization with stent placement discharge condition: stable at 92% on room air, with transient desaturation to 88% with walking. discharge instructions: 1) place a dry dressing over abdominal wound. change daily. you may cleanse the area with a gauze soaked with normal saline. 2) call dr. office or return to er if you notice increased drainage or redness around your leg or abdominal wounds. 3) you may shower. 4) you will need to check labwork this week and discuss the results with your tranplant or primary doctor. 5) call you doctor , pain, chest discomfort, shortness of breath, palpitations, bleeding or any other concerns. followup instructions: 1) follow up in 1 week with dr. . call for appt. 2) please follow-up with your primary care doctor: , f. this week for labwork check. 3) provider: , . appointment should be in days provider: , m.d. where: cardiac services phone: date/time: 9:30 4) provider: , md where: lm center phone: date/time: 9:20 md procedure: coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization other (peripheral) vascular shunt or bypass transfusion of packed cells percutaneous angioscopy insertion of drug-eluting coronary artery stent(s) diagnoses: pneumonia, organism unspecified nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified percutaneous transluminal coronary angioplasty status ulcer of other part of foot diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled atherosclerosis of native arteries of the extremities with ulceration kidney replaced by transplant complications of transplanted pancreas 

Answer: The patient is high likely exposed to