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: chest pain major surgical or invasive procedure: diagnostic cardiac catheterization history of present illness: this is an 81 yo female with metastatic neuroendocrine tumor on home hospice, h/o cva, rheumatoid arthritis, diabetes, hypertension, hyperlipidemia who presented to the emergency room with chest discomfort and malaise. she began experiencing chest discomfort at 12:30 during the night, and took some nitroglycerin with partial relief, but did not tell the family because she was hoping it would resolve. by the morning, patient was becoming dyspneic and felt nauseous, and requested to come to the hospital. chest pain had resolved on arrival to emergency room, but she was noted to have st elevations in iii and avf with prominent r-wave with st depressions in v1-v2. she was given aspirin 324mg, clopidogrel 600mg, aotrvastatin 80mg, eptifibatide 5ml bolus, heparin 3100 unit bolus, metoprolol 5mg iv x 3, and transferred to for further management. . on arrival to cardiac catheterization lab at , patient was noted to be hypertensive 200/85. she was started on nitroglycerin continuous infusion. left heart catheterization demonstrated lvedp of 40mmhg, lad with diffuse disease and a 99% mlad stenosis, lcx with diffuse disease, 50% plcx stenosis, 90% mlcx lesion after om1, 70% om1, prca occlusion with large conus with 80% stenosis giving collaterals to lad and rca. given elevated lvedp, patient was given 80mg iv furosemide. she was transferred to ccu for further management of blood pressure and chf. . on review of systems, she denies any prior history deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors:: (+)diabetes, (+)dyslipidemia, (+)hypertension 2. cardiac history: ventricular tachycardia #. history of mi and ventricular tachycardia in , on amiodarone, icd declined #. ischemic cardiomyopathy with lvef 35% in at 3. other past medical history: #. h/o right-sided cva in #. h/o bell's palsy with residual deficits of facial muscles. #. history of neuroendocrine tumor with liver metastasis #. history of renal cell ca #. h/o small-bowel obstruction, s/p exploratory laparotomy #. rheumatoid arthritis #. hypertension #. diabetes mellitus - on oral metformin #. hyperlipidemia #. sp tkr x 2 in and #. s/p left total hip replacement in #. s/p right metacarpal head revision social history: widowed, formerly lived alone with hospice but now lives with son. also have 4 daughters. tobacco or alcohol use. family history: non-contributory physical exam: general: elderly heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: jvp flat. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. ii/vi systolic murmur. no thrills, lifts. + s3 lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: 10:30am blood wbc-4.2 rbc-3.24* hgb-9.3* hct-27.9* mcv-86 mch-28.7 mchc-33.4 rdw-21.9* plt ct-480*# 10:30am blood neuts-62 bands-2 lymphs-21 monos-10 eos-1 baso-0 atyps-4* metas-0 myelos-0 10:30am blood hypochr-normal anisocy-2+ poiklo-normal macrocy-normal microcy-normal polychr-2+ 10:30am blood pt-16.1* ptt-84.7* inr(pt)-1.4* 10:30am blood glucose-136* urean-30* creat-1.3* na-138 k-3.8 cl-102 hco3-24 angap-16 10:30am blood alt-17 ast-31 ck(cpk)-36 alkphos-92 amylase-39 totbili-0.9 10:30am blood ck-mb-notdone ctropnt-0.12* 06:16am blood ck-mb-notdone ctropnt-0.27* 05:25am blood ck-mb-notdone ctropnt-0.21* 06:16am blood calcium-8.8 phos-4.1 mg-2.0 10:30am blood vitb12-229* 10:30am blood %hba1c-6.0* 10:32am blood po2-94 pco2-34* ph-7.50* caltco2-27 base xs-3 intubat-not intuba 10:32am blood glucose-131* na-137 k-4.0 cl-101 10:32am blood hgb-10.8* calchct-32 o2 sat-96 . ekg - sinus rhythm. compared to the previous tracing of the rate has slowed. the previously mentioned multiple abnormalities persist without diagnostic interim change. . - echo: the left atrium is mildly dilated. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. there is moderate to severe regional left ventricular systolic dysfunction with an apical left ventricular aneurysm and an inferobasal left ventricular aneurysm. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. there is a small (~0.5 cm) mobile echodense structure adjacent to the apical anterior wall consistent with probable thrombus. . cardiac catherization - 1. selective coronary angiography of this right dominant system revealed three vessel disease. the lmca had mild disease. the lad was diffusely diseased with 99% stenosis at the mid segment. the lcx was diffusely diseased with 50% stenosis at the proximal segment, 90% stenosis at the mid segment after the first om, and there was 70% stenosis within the first om. 2. limited resting hemodynamics demonstrated elevated left sided filling pressures consistent with diastolic dysfunction, with lvedp 40 mm hg. the systemic arterial pressure was elevated with central aortic pressure 184/79 mm hg. careful pullback across the aortic valve did not reveal a significant gradient. 3. patient was symptom free, and ecg done during catheterization showed resolution of st segment changes. conservative management with blood pressure control and diuresis was elected with plan for ct surgery consult. . final diagnosis: 1. three vessel coronary artery disease. 2. severe diastolic ventricular dysfunction. brief hospital course: 81 yo female with history of ischemic cardiomyopathy, apical aneurysm, cva, chf, presents with chest pain in setting of uncontrolled hypertension now s/p cardiac catherization. as patient was pain free with resolution of st changes elected to pursue conservative management with bp control and diuresis and would consider pci if recurrent symptoms. . # chest pain: st-elevations may have been secondary to aneurysmal changes noted on echocardiogram and confirmed on echocardiography today at . lack of significant biomarker elevation suggests against significant ischemic territorial stemi, and angiography suggests chronic rca given collateralization. patient may have had symptoms secondary to uncontrolled hypertension. patient was continued on aspirin, statin. patient was continued on atorvastatin, metoprolol, enalapril. started patient on imdur 30 mg po daily for both blood pressure and anginal control. increased beta blocker dose. decided against starting patient on plavix. . # hypertension - patient maintained as outpatient on bb, acei. initially started on nitroglycerin drip which was discontinued and oral imdur started. increased bb dose as above, continued same dose of enalapril. . # chronic systolic congestive heart failure: euvolemic with ischemic cardiomyopathy. echocardiogram with aneurysmal changes, possible thrombus in lv. patient was continued on outpatient furosemide dose, enalapril. increased beta blocker dose. patient already on acei, lasix, aspirin, statin. . # chronic renal failure - baseline unknown, cr currently 1.5 and stable, potassium stable, continue to monitor. medications were renally dosed, nephrotoxins avoided. . # rhythm - history of ventricular tachycardia, continued amiodarone and bb, repleted electrolytes as needed. . # diabetes - insulin sliding scale in house, cahnged back to metformin on discharge. . # neuroendocrine carcinoma - continue fentanyl patch, senna, docusate, lorazepam, acetaminophen. patient in hospice care for this. . # rheumatoid arthritis - restart methotrexate and prednisone on discharge. . # b12 deficiency- patient with low b12 on admission. patient got b12 injection once and discharged on po vitamin b12. needs outpatient follow up and may require monthly b12 injections. . fen: regular diet, mvi , folate, b12 . access: piv's . prophylaxis: heparin sc, regular diet, ppi, bowel regimen . code: dnr/dni confirmed with healthcare proxy (daughter), medications on admission: #. aspirin 81mg daily #. atorvastatin 20mg daily #. enalapril 5mg daily #. metoprolol succinate 25mg daily #. nitroglycerin sublingual prn #. amiodarone 200mg daily #. furosemide 20mg daily #. metformin 500mg po daily #. fentanyl patch 25mg q72h #. prednisone 1mg daily #. methotrexate 10mg qtuesday #. docusate 100mg #. folate 1mg daily #. pantoprazole 40mg daily #. multivitamin daily #. acetaminophen 650mg po q6h prn #. lorazepam 0.5mg po q4h prn discharge medications: 1. aspirin 81 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). disp:*60 tablet, chewable(s)* refills:*2* 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). 4. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual as needed as needed for chest pain: please hold for bp < 100. 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 7. metformin 500 mg tablet sig: one (1) tablet po once a day: please do not start until . 8. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 9. prednisone 1 mg tablet sig: one (1) tablet po daily (daily). 10. methotrexate (anti-rheumatic) 2.5 mg tablets, dose pack sig: four (4) tablets, dose pack po every tuesday: 10mg every tuesday. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. multivitamin tablet sig: one (1) tablet po daily (daily). 15. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*5* 16. ativan 0.5 mg tablet sig: one (1) tablet po every four (4) hours as needed for nausea. 17. tylenol 325 mg tablet sig: two (2) tablet po every six (6) hours. 18. cyanocobalamin 250 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 19. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): please hold for bp < 100, hr < 55. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: hospice of and greater discharge diagnosis: primary: acute coronary syndrome . secondary: rheumatoid arthritis, cad, neuroendocrine tumor discharge condition: afebrile, vital signs stable, chest pain free discharge instructions: you were admitted for chest pain. . we did a catheterization which showed chronic heart disease but no clear signs of an acute heart attack. we also did blood tests which showed that you did not have a heart attack. we optimized your heart medications. . please continue to take your medications as prescribed. we have made the following changes: 1. please take aspirin 162mg every day 2. please take imdur (isosorbide mononitrate) 30mg every day 3. your beta blocker dose was increased, you are being a prescription for this 4. you were started on oral b12 supplements as you were noted to be b12 deficient on admission . please attend your follow up appointments. . please call your doctor or come to the nearest emergency room if you experience chest pain, palpitations, shortness of breath, bleeding, or other concerning symptoms. followup instructions: we have made you a follow up appointment with your primary care physicin for wednesday, at 11:00am with , t. , f. . . in addition, you should follow up with your outpatient cardiologist with 2-4 weeks. please schedule an appointment at your convenience. procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome malignant neoplasm of liver, secondary congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other b-complex deficiencies other and unspecified hyperlipidemia old myocardial infarction chronic systolic heart failure rheumatoid arthritis malignant essential hypertension personal history of malignant neoplasm of kidney knee joint replacement other late effects of cerebrovascular disease, facial weakness malignant carcinoid tumor of unknown primary site 

Answer: The patient is high likely exposed to