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: history of present illness: patient is an 83-year-old female with a history of coronary artery disease status post mi and cabg in , hypertension, hyperlipidemia, who was transferred from an outside hospital after she was found to have markedly elevated cardiac enzymes consistent with a non-st segment elevation mi. ekg showed st depressions in the lateral leads. according to the patient, she was in her usual state of health until two days prior to admission at which time she had onset of severe diaphoresis. there were no chest pains, but she does report palpitations and increasing dyspnea on exertion. she also notes that she has had increasing orthopnea over the last several weeks. patient denies nausea, vomiting, or worsening lower extremity edema. she notes that she has been fatigued also lately. past medical history: 1. coronary artery disease status post myocardial infarction in and subsequent cabg x4 at in . 2. hypertension. 3. hyperlipidemia. 4. status post left carotid endarterectomy in . 5. history of paroxysmal atrial fibrillation. 6. history of a pancreatic cyst and left renal cyst. allergies: no known drug allergies. medications on admission: 1. aspirin 81 mg p.o. q.d. 2. lisinopril 10 mg p.o. q.d. 3. lopressor 50 mg p.o. b.i.d. 4. lipitor 20 mg p.o. q.d. 5. multivitamin q.d. 6. celebrex. 7. potassium chloride. 8. lasix 40 mg p.o. q.d. social history: the patient has a 20 pack year smoking history, but she quit after her cabg. the patient recently resumed smoking half a pack per day for the past month. the patient denies alcohol use. she lives alone. she is widowed with two children. physical exam on admission: afebrile with a blood pressure of 145/50 and a heart rate of 79. she was satting 99% on 3 liters of o2 by nasal cannula. physical exam is notable for a flat jugular venous pressure. her heart is regular, rate, and rhythm with a 3/6 systolic murmur heard at the left sternal border radiating to the apex and the axilla. there are crackles at the left lung base, but is otherwise clear to auscultation. abdominal exam is benign. there is no lower extremity edema. she is alert and oriented times three. laboratories: are notable for a white count of 11.5 and a hematocrit of 34.0. her creatinine is 1.5. cardiac enzymes are elevated. ekg shows sinus rhythm at a rate of 72 with a q wave in lead iii and downsloping st depressions in leads i, avl, and v4 through v6. she has a t-wave inversion in lead ii. these findings are new since her previous ekg performed in . ct performed at the outside hospital shows no evidence of aortic dissection. hospital course: 1. cardiovascular: the patient was transferred from an outside hospital with a non-st segment elevation mi. she ruled in by elevated cardiac enzymes. she was initially admitted to the service. the patient had not received lasix for three days prior to admission and again her lasix dose was held on the day of admission. the patient was taken to cardiac catheterization and in the holding area she was found to be hypertensive with a blood pressure of 200/100. in addition due to her elevated creatinine of 1.5 on admission, the patient had been started on iv fluid for prehydration prior to cardiac catheterization. in the holding area, the patient was found to be in flash pulmonary edema. an ekg was obtained, which showed no changes from the previous ekg performed prior to the event. the patient was started on a nitroglycerin and nitroprusside drip with good resolution of her symptoms as her blood pressure decreased. she was also given lasix 200 mg iv to which she diuresed well. the patient was transferred to the ccu for further monitoring. the patient was eventually able to be weaned off her face mask down to 3 liters nasal cannula. she was monitored overnight in the ccu with good blood pressure control as she was transitioned from nitroglycerin and nitroprusside drip to metoprolol and captopril p.o. the patient was taken to cardiac catheterization the following day. the patient was found to have severe three vessel disease in the native coronary arteries. vein graft angio revealed a patent svg to om graft supplying the distal left circumflex. she was noted to have severe diastolic dysfunction as well as right renal artery stenosis. the patient underwent successful stenting of the distal lmca/proximal ra with a cypher stent. the patient was placed on integrilin and plavix and sent back to the ccu for further monitoring. the patient had no further episodes of shortness of breath or chest pain. pt consult was obtained prior to discharge, and she was found to have very good functional status. the patient will be discharged on aspirin, plavix, lipitor, atenolol, and lisinopril. an echocardiogram was performed prior to discharge. she was noted to have an ejection fraction of greater than 55%. there was mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion was normal. there was mild aortic valve stenosis as well as moderate mitral regurgitation. the left atrium was mildly dilated. there was also mild pulmonary artery systolic hypertension. 2. gastrointestinal: the day following cardiac catheterization, the patient was found to have a bloody bowel movement. in the early morning hours of , she passed dark maroon colored stools and also possibly melena. a gi consult was obtained and there was a prolapsed internal hemorrhoid that was mildly excoriated, but not thrombosed found on physical exam. her hematocrit dropped from a precath level of 35.2 down to 27.1 on the morning of the bleed. the patient was resuscitated with iv fluids as well as 2 units of packed red blood cells. an upper endoscopy was performed, which showed a small hiatal hernia, schatzki's ring, blood in the stomach, but an otherwise normal egd. gi consult felt that her stools were most likely due to a lower gi bleed. they recommended following her hematocrit. there was no indication for urgent colonoscopy. patient's hematocrit was followed throughout the remainder of the hospitalization and it remained stable. she had another brownish bowel movement with streaks of blood prior to discharge. the patient stated, however, that this is her normal bowel movement and she normally has streaks of blood due to her internal hemorrhoids. gi recommended following up for a colonoscopy in months following discharge. the patient remained hemodynamically stable during the gi bleed event on and throughout the remainder of her hospitalization. 3. pulmonary: on the morning of cardiac catheterization, the patient was found to have to be in flash pulmonary edema. cardiac enzymes and ekgs were followed, but there was no evidence to suggest a re-infarction as the cause of her flash pulmonary edema. the cause of the pulmonary edema was most likely severe diastolic dysfunction with an elevated blood pressure of 200/100 as well as the holding of her lasix dose for the four days prior to cardiac catheterization. the patient was initially hypoxic to 80% on room air. patient was placed on face mask and given a lasix dose of 200 mg iv with good diuresis. her o2 saturations quickly improved to the high 90s on face mask and she was eventually able to be weaned off down to nasal cannula. the patient had no further episodes of pulmonary edema, and she was restarted on a dose of lasix of 20 mg p.o. q.d. prior to hospital discharge. patient was found to have good ambulating o2 saturations also prior to discharge. condition on discharge: stable, ambulating without assistance, breathing on room air, chest pain free with no evidence of orthostasis. discharge status: patient is discharged to home without any services. discharge diagnoses: 1. non-st segment elevation myocardial infarction status post stent of the distal left main coronary artery/proximal ri. 2. diastolic dysfunction. 3. flash pulmonary edema. 4. anticoagulation related adverse events leading to blood loss. 5. lower gastrointestinal bleed. 6. internal hemorrhoids. discharge medications: 1. aspirin 325 mg p.o. q.d. 2. atorvastatin 40 mg p.o. q.d. 3. plavix 75 mg p.o. q.d. x3 months. 4. lisinopril 20 mg p.o. q.d. 5. pantoprazole 40 mg p.o. q.d. 6. lasix 20 mg p.o. q.d. 7. multivitamin p.o. q.d. 8. atenolol 37.5 mg p.o. q.d. followup: 1. patient is asked to followup with her primary care physician, . on wednesday, at 3:15 p.m. 2. patient is asked to followup with her cardiologist, dr. on at 9:20 a.m. 3. patient has a previously scheduled follow-up appointment with her general surgeon, who performed her left carotid endarterectomy. he has also been following her for her pancreatic cyst. 4. patient should follow up with a gastroenterologist to obtain a colonoscopy in months. a letter has been written by the gi consult service to her primary care physician, . detailing the events surrounding her gi bleed as well as need for colonoscopy. gi consult asked dr. in a letter to arrange a follow-up appointment with a gastroenterologist. , m.d.12.222 dictated by: medquist36 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters other endoscopy of small intestine transfusion of packed cells arteriography of renal arteries insertion of drug-eluting coronary artery stent(s) diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation hemorrhage of gastrointestinal tract, unspecified coronary atherosclerosis of artery bypass graft 

Answer: The patient is high likely exposed to