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: shortness of breath. transfer for nstemi/gib/pna major surgical or invasive procedure: cardiac cath history of present illness: 85yom with no primary care for 25+ years presenting from hospital with nstemi, pna, and gi bleed. . the patient reports acute onset shortness of breath which began last night which has been progressively worsening. he denies chest pain, lightheadedness, dizziness, or pedal edema, orthopnea, pnd. he also reports 2-3 weeks of increasing dyspnea on exertion and cough. he presented to and was found to have an nstemi. he was given asa 325 but reported intermittent bloody bowel movements and was found to have gross blood on rectal exam, and was not started on heparin gtt. when asked, the patient reported he has intermittent brbpr for the past 2 weeks. d-dimer was elevated. he underwent a cta at which showed a question of b/l pna and was given levofloxacin, negative for pe. he was transferred to for further management. . in the ed, initial vitals were: 97.9 105 133/74 18 97% 2l nc ecg was significant for anterolateral st depressions. cardiology was made aware. troponin was 0.31. wbc was 21.9 and portable cxr showed bilateral infiltrates. the patient had another rectal exam which showed frank blood in the rectal vault. ng lavage was negative. gi was made aware, and agreed the source of bleed is likely lower source. hct was 28.0. he was given pantoprazole 80mg iv and type and screened. he was admitted for further management. past medical history: none per patient social history: 35 pack years, recently less. 1 drink/week. retired. family history: non-contributory physical exam: on admission: vs: 98, 111/58, 84, 20, 97%ra general: alert, interactive, lying supine, nad heent: sclerae anicteric. perrl, eomi. mmm. neck: supple. jvp 3 cm above sternal angle at 30deg cardiac: rrr, ii/vi hsm heard best at apex. no s3 or s4. no thrills, lifts. lungs: clear abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. extremities warm and well perfused. skin: no ulcers, scars, or xanthomas. mild hyperpigmentation of anterior shins pulses: right: femoral 2+ carotid 2+ dopplerable dp/pt : femoral 2+ carotid 2+ dopplerable dp/pt on discharge: unchanged pertinent results: on admission: 08:10pm blood wbc-21.9* rbc-2.91* hgb-9.6* hct-28.0* mcv-96 mch-33.1* mchc-34.4 rdw-14.2 plt ct-349 08:10pm blood neuts-88.6* lymphs-6.0* monos-5.2 eos-0.1 baso-0.1 08:10pm blood pt-14.0* ptt-24.4 inr(pt)-1.2* 08:10pm blood glucose-137* urean-40* creat-1.3* na-135 k-4.1 cl-101 hco3-21* angap-17 08:10pm blood ck(cpk)-330* 06:30am blood alt-19 ast-39 ck(cpk)-230 alkphos-70 totbili-0.8 06:30am blood albumin-3.9 calcium-8.8 phos-4.0 mg-1.9 cholest-203* 06:30am blood triglyc-66 hdl-77 chol/hd-2.6 ldlcalc-113 07:08am blood %hba1c-6.1* eag-128* 03:04am blood lactate-2.5* hematocrit and wbcs 08:10pm blood wbc-21.9* hct-28.0* 03:45pm blood wbc-17.8* hct-28.0* 07:00pm blood hct-23.0* 07:00am blood wbc-13.0* hct-26.5* 07:50am blood wbc-11.4* hct-28.8* creatinine 08:10pm blood creat-1.3* 03:45pm blood creat-1.4* 08:36pm blood creat-1.6* 05:53pm blood creat-1.7* 09:30am blood creat-1.2 07:50am blood creat-1.3* cardiac enzymes 08:10pm blood ck-mb-32* mb indx-9.7* 08:10pm blood ctropnt-0.31* 08:10pm blood ck(cpk)-330* 02:11am blood ck-mb-21* mb indx-8.0* ctropnt-0.36* 02:11am blood ck(cpk)-262 06:30am blood ck-mb-16* mb indx-7.0* ctropnt-0.44* 06:30am blood ck(cpk)-230 03:43am blood ck-mb-4 ctropnt-0.54* 03:43am blood ck(cpk)-107 microbiology blood, urine, sputum cultures - no growth imaging tte (): impression: extensive inferior-posterior myocardial infarct with secondary moderate-to-severe mitral regurgitation; "severe" aortic stenosis (most likely with a component of low flow/low gradient physiology); reduced stroke volume and cardiac output cxr: impression: acute pulmonary edema with underlying centrilobular emphysema, an extensive pneumonia is a less likely possibility. cardiac cath: 1. selective coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had a 40-50% eccentric and calcified stenosis. the lad had an 80% calcified mid lad stenosis with 100% distal occlusion. the lcx had a 100% ramus branch occlusion, an 80% tubular omb1 stenosis. there was an occluded small omb2. the rca had a 60% diffuse stenosis which was calcified and leading to a pda. 2. resting hemodynamics demonstrated mildly elevated left sided filling pressures with mean pcwp 21 mmhg. there is mild pulmonary artery systolic hypertension with pasp of 42 mmhg. the cardiac index is preserved at 2.52 l/min/m2 (using an assumed oxygen consumption). there was moderate aortic stenosis with a calculated aortic valve area of 1.19 cm2 (based on an assumed vo2). final diagnosis: 1. severe three vessel coronary artery disease. 2. moderate to severe mitral regurgitation. 3. moderate aortic stenosis. 4. moderate pulmonary artery hypertension. 5. mildly elevated pulmonary capillary wedge pressure. carotid u/s: right ica 60-69% stenosis. a more severe stenosis cannot be excluded due to the presence of calcifiedplaque. left ica 40-59% stenosis. right verterbral artery appears occluded. l vertebral open. spirometry: impression: severe obstructive ventilatory defect with a moderate gas exchange defect. there are no prior studies available for comparison. tee: impression: regional left ventricular systolic dysfunction. mild to moderate mitral regurgitation. moderate thickened aortic valve with significant aortic stenosis present (though not quantified). brief hospital course: 85yom with no primary care for 25+ years presenting from hospital with posterior/inferior nstemi, pna, and gi bleed. . active issues . # coronaries: the patient presented with acute onset dyspnea and was found to have an nstemi with elevated ce's. he was started on asa 325, atorvastatin 80mg, and metoprolol. he was not originally started on heparin or plavix given gib (see below) and was trasnfused 1u prbcs to minimize cardiac demand ischemia. after undergoing a flex sig, a cath was performed and showed "lad disease, with ramus occluded, diseased circ, 60% rca, and aortic valve area 1.1 without gradient". given the extent of his disease, the option of a cabg and valvular repair was offered. however, cardiac surgery evaluated him and determined that he would not be a good surgical candidate and should be medically managed at this point. his valvular disease was not significant enough to warrant mitral and aortic valve replacements, but should be monitored. on discharge, he will begin taking the follow medications for optimal medical management: aspirin 325 mg daily, atorvastatin (lipitor) 80mg daily, metoprolol 75mg daily, and lisinopril 5mg. . # pump: on admission, he appeared euvolemic without evidence of volume overload. an echo on showed 3+ mr and severe aortic stenosis with depressed ef35%. however after medical treatment and diuresis, a repeat echo showed 2+ mr and a tee confirmed these findings. he will follow-up with dr. as an outpatient for repeat tte and management of his heart failure with the likely initiation of diuretic therapy. . # gi bleed: the patient reported intermittent bloody bowel movements in the past, brbpr with stool. likely lower source, diverticulosis vs polyp vs avm. gi was consulted. he was made npo and underwent a flexible sigmoidoscopy on which showed a polyp and bleeding hemorroids. his polyp was not removed given the bleeding risk and recent mi and should be followed as an outpatient with gi for this issue. he required 1 u prbcs on but then stopped bleeding with stable hematocrit. he will need a colonoscopy as an outpatient. his plavix was held on discharge and he should receive his colonoscopy before restarting this. he will also be continued on omeprazole for gastric protection while taking asa. . # community-acquired pneumonia: the patient reported cough and shortness of breath for the past 2-3 weeks, and underwent cta at osh which showed evidence of b/l pna, and was given a dose of levofloxacin. he denied fevers and b/l lower lobe opacities are more likely chf exacerbation in the setting of nstemi given infiltrates are bilateral and patient is not an aspiration risk. however, given his elevated white count of 21.9, which may be all or partially due to his nstemi and gi bleed, his levofloxacin was continued for 5 days. . transitional issues . # follow-up care: mr. will be seeing dr. for outpatient cardiology appointments. at this point, he will be assisted in setting up an appointment with a primary care physician, will then be coordinating his care. since he has not been watched by the medical system for a while, he should be encouraged to follow-up closely, given that he is on many new medications and will new follow-up imaging to monitor his valvular function. . # health screening: he will likely need routine health maintenance, most notably a colonoscopy, especially given his gi bleeding and anemia. follow-up with a new pcp will be essential for him to follow his routine health care maintenance. medications on admission: no home medications discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). capsule, delayed release(e.c.)(s) 4. metoprolol succinate 50 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day. disp:*45 tablet extended release 24 hr(s)* refills:*2* 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. outpatient lab work please check chem-7 on friday with results to dr. at discharge disposition: home with service facility: discharge diagnosis: non st elevation myocardial infarction aortic stenosis, valve area 1.2 moderate mitral valve regurgitation acute systolic congestive heart failure acute kidney injury lower gi bleed carotid stenosis hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a heart attack and had a cardiac catheterization that revealed many blockages in your heart arteries. you have been started on many medicines to help your heart function better and recover from the heart attack. you were also found to have blockages in the arteries in your neck that could lead to a stroke if these blockages worsen. you had some bleeding from your rectum that appeared to be due to internal hemorrhoids but you absolutely need to have a colonoscopy to look at your whole colon to make sure there are no other areas of bleeding or polyps. you also were found to have emphysema or copd due to your smoking. it is extremely important that you do not start smoking again. your kidneys were not working well due to your heart problems but now have almost returned to function. your heart is weak after the heart attack and you had some fluid retention that was treated with diuretics. we are not sending you home on diuretics now but you need to weigh yourself every day in the morning and call dr. if your weight increases more than 3 pounds in 1 day or 5 pounds in 3 days. . we started you on the following medicines: 1. start taking aspirin 325 mg daily to prevent another heart attack 2. start taking atorvastatin (lipitor) to prevent further blockages in your arteries from cholesterol buildup 3. start taking metoprolol to prevent another heart attack and lower your heart rate 4. start taking lisinopril to lower your blood pressure and help your heart pump better. 5. start taking omeprazole to protect your stomach from the aspirin. . it is extremely important that you take all of your medicines and follow up with your doctors. followup instructions: department: cvi , when: wednesday at 2:00 pm with: building: (, ma) campus: off campus best parking: free parking on site **please call dr. office on monday to ask for names of primary care physicians in the area that he would recommend.** md, procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnostic ultrasound of heart flexible sigmoidoscopy diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified personal history of tobacco use occlusion and stenosis of carotid artery without mention of cerebral infarction other emphysema mitral valve insufficiency and aortic valve stenosis acute systolic heart failure internal hemorrhoids with other complication benign neoplasm of colon occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction unspecified gingival and periodontal disease 

Answer: The patient is high likely exposed to