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: biaxin / morphine / codeine attending: chief complaint: dyspnea major surgical or invasive procedure: right internal jugular hemodyalysis line cardiac catheterization with stents to lad and renal artery history of present illness: 82 y/o female with htn, hyperlipidemia, dm2, pvd, cad s/p cabg and ptca/stent presented to hospital with one month of worsening dyspnea on exertion with one day of acute worsening dyspnea awakening her from sleep. she denies chest pain. she had no increase in salt intake, no change in meds other than her lasix which had been increased from 80 mg to 100 mg in the last two weeks. she also reports black stools this past week, with increasing fatigue, dry cough, paroxysmal nocturnal dyspnea, and generalized weakness. on review of symptoms, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, joint pains, hemoptysis. 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 chest pain, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: diabetes dyslipidemia hypertension cad s/p cabg svg to distal rca s/p rca stent pvd s/p left popliteal artery to dorsalis pedis artery bypass using left basilic arm vein aotric stenosis s/p aortic valve replacement with 21 mm - bovine prosthesis hypothyroidism renal stones s/p right nephrectomy possible epilepsy evaluated by neurology (neurologist is dr. 1. cad s/p cabg (svg to rca) and bovine avr, s/p ptca with cypher stent to lad beyond the graft in , s/p ptca with 3 overlapping cypher stents to rca in , complicated by arf and temporal lobe seizures 2. critical as with bicuspic valve s/p bovine avr in 3. hyperlipidemia 4. hypertension 5. depression 6. diabetes since 7. gerd psh: 1) kidney stones removed 2. right nephrectomy secondary to kidney stone 3. hysterectomy 4. fibrocystic breast biopsy 5. cabg with valve replacement 6. left leg bypass 7. cath with stent 8. stent 9. multiple finger surgeries social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. daughter lives out of town; son lives in town near mother, but relationship somewhat strained. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: well appearing elderly female in no distress t 97.5 hr 70 bp 138/74 rr 12 sat 99%2l nc heent: sclera anicteric neck: no visible jvp elevation at 30 degrees elevation. hepatojugular reflex is positive with jvp elevation to about 10cm. chest: crackles at lung bases one quarter way up. heart: regular rhythm. harsh 2/6 systolic murmur without heave or gallop. abd: soft, normal active bowel sounds, non tender, no distention. ext: no piting edema. pulses: carotid pulse 2+ b/l without bruits. femoral pulses 1+b/l without bruit. pertinent results: laboratory data: bun 76/cr 2.2 hct 30 ck 494 ck-mb 19 mbi 3.8 trop-t 0.78 . ck had a second increase on up to 427 then trended down to 206 on discharge . cr was 2.2 on admission, climbed to 5.4 on , then decreased to 1.6 at time of discharge. . ekg demonstrated lateral st depressions slightly more pronounced than prior from . . 2d-echocardiogram performed in demonstrated: 1. the left atrium is mildly dilated. the left atrium is elongated. 2.there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly decreased (lvef45-50%). while not well seen there appeared to be basal and mid inferior wall hypokinesis. 3.the aortic valve is not well seen. a bioprosthetic aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. no aortic regurgitation is seen. 4.the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. 5.the estimated pulmonary artery systolic pressure is normal. 6.there is no pericardial effusion. . echo : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild global left ventricular hypokinesis (lvef = 40%). tissue doppler velocity suggests an increased lvedp (>18mmhg). right ventricular chamber size is normal with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , global left ventricular systolic function is more depressed, the ascending aorta is now moderately dilated (prior 4.2cm ascending on review), mild mitral regurgitation and pulmonary artery systolic hypertension are now identified. . renal ultrasound : the patient is status post right nephrectomy. the left kidney measures 11.4 cm. there is again seen a 1.4 cm simple cyst within the left kidney. arterial waveforms suggestive of a renal artery stenosis in the left kidney identified. . cardiac cath : 1. selective coronary angiography of this right dominant system demonstrated three vessel coronary artery disease. the mid-lad had a 95% heavily calcified stenosis, with the proximal stent patent. the lcx demonstrated diffuse distal disease as in previous studies. the distal rca had a 70% stenosis with proximal stents patent. the svg was not engaged due to known past total occlusion. the lmca did not demonstrate any angiographically apparent disease. 2. selective renal angiography of the left renal artery demonstrated a 90% heavily calcified stenosis. 3. limited resting hemodynamic measurement revealed an elevated systemic arterial pressure of 167/65 mmhg. 4. successful stenting of the mid lad with 3.0 x 8 and 2.5 x 8 overlapping bare metal mini vision stents without residual stenosis (see ptca comments for detail). 5. successful stenting of the left renal artery with a 5.0 x 18 mm genesis stent postdilated to 7.0 without residual stenosis of embolization, performed with distal protection device. brief hospital course: 82 y/o female with htn, hyperlipidemia, dm2, pvd, cad admitted with nstemi. . 1. nstemi: this was initially medically managed in the setting of a slow upper gi bleed. later, she developed acute renal failure, and catheterization was again delayed out of concern that the dye load would further injure her kidney. echo demonstrated an ef of 40% and global hypokinesis as described in the results section above. once it was felt that her renal function was not improving and she was likely to end up on dialysis, a cardiac catheterization was performed. she had bare metal stents placed to her lad as described in the cath report included. she should be continued on aspirin 325mg ongoing, plavix 75mg for at least one month, and simvastatin 40. once her renal function has been followed for a couple of weeks and remains stable, it would be recommended to start an ace inhibitor. . 2. upper gi bleed: gi was consulted and did not feel that the patient was a candidate for an egd given her slow bleed. she was transfused packed red cells and monitored; eventually her hematocrit stabilized and she was no longer having dark, guaiac positive bowel movements. by her report, the patient had a colonoscopy in that was negative. it is advised that her primary care physician follow her hematocrit to make sure that it is stable. gi did not feel that she would require an upper endoscopy as an outpatient. patient should have follow-up with her pcp to ensure that the colonoscopy was indeed negative. . in addition, h. pylori serology was sent and was found to be positive. although it was unclear whether the gi bleed was secondary to an ulcer or simple gastritis, the team felt it appropriate to begin therapy for h pylori given the recent bleed. she had an bad reaction to clarithromycin in the past that she was not able to describe, so therapy with pantoprazole , amoxicillin , and levofloxacin was started for a total of a 10 day course. the dosage of these meds was adjusted for her renal function. . 3. acute renal failure: the patient is s/p right nephrectomy for renal stones many years ago. her cr on admission was 2.2, and continued to worsen until it peaked at 5.4 on and she developed oliguria. renal was consulted, and it was thought that her renal failure was most likely secondary to hypoperfusion following her nstemi. a renal artery ultrasound was suggestive of renal artery stenosis; however, we could not perform confirmatory ct or mri in the setting of her elevated cr. a hemodialysis catheter was placed and the patient was receiving ultrafiltration and then hemodialysis. when her urine output remained very poor, it was felt that she was unlikely to recover renal function. she was then taken to cardiac catheterization, at which time her left renal artery was found to have a significant proximal stenosis and was stented. she had rapid improvement of her renal function with almost 1l of urine out the night following her catheterization. her cr returned to baseline and she had significantly decreased need for her antihypertensives. hemodialysis catheter was removed the day prior to discharge. . 4. htn: patient had difficult-to-control blood pressure requiring multiple medications. at the time of discharge, her blood pressure medications had been decreased until she was only on norvasc 2.5 and metoprolol 12.5 . given her recent improvement in renal function, the team was careful to avoid low blood pressures that might hypoperfuse her kidneys. at the time of discharge, this regimen maintained blood pressures between 120 and 140 systolic. she may need to have bp meds titrated in the next several weeks. . 5. chf, systolic dysfunction: echo demonstrated ef 40% as described above. patient initially had difficult to control pulmonary edema with associated respiratory distress. following renal artery stent placement, her pulmonary edema improved and she was sat'ing well on room air. of note, she was admitted to the hospital on a home dose of lasix 100mg po bid. by the time of discharge, she was not taking lasix, and it was felt that she should not yet be restarted out of concern it might dehydrate her and damage her kidney. in addition, it was not clear that she would still need such high doses of lasix. over the next weeks, it will be important to monitor her fluid status and consider restarting lasix. . 6. hyperlipidemia: patient not taking simvastatin because of chronic pain in legs. she was put on simvastatin 10 and then 40, and appeared to tolerate these doses. . 7. dm2: her oral glucose agents were held during admission. she was advised to return to her home regimen upon discharge. . 8. shoulder pain--apparently, patient has a rotator cuff injury in the past. her pain responded to tylenol. . she had no other active issues during this hospitalization. her daughter () can be contact with questions at: cell . home: . medications on admission: asa 325 mg daily plavix 75 mg dialy simvastatin 10 mg qhs (not taking) lopressor 50 mg lasix 100 mg norvasc 2.5 mg daily synthroid 50 mcg daily gluctrol 10 mg imdur 120 mg daily trileptal 150 mg qhs allopurinol 100 vitamin d insulin- lantus 7 units qpm with humolog sliding scale celexa 20 mg discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. oxcarbazepine 150 mg tablet sig: one (1) tablet po at bedtime. 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for shoulder pain. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day for 9 days: last day to give twice a day is , then continue medication once daily. 9. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). 10. amoxicillin 250 mg capsule sig: one (1) capsule po twice a day for 9 days: please give last dose on . 11. levofloxacin 250 mg tablet sig: one (1) tablet po once a day for 9 days: please give last dose on . 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 13. glucotrol xl 10 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po twice a day. 14. lantus 100 unit/ml solution sig: number of units needed units subcutaneous at bedtime: please return to using the dose of evening lantus you were on before coming to the hospital. 15. humalog 100 unit/ml solution sig: number of units needed units subcutaneous with meals: please return to using the sliding scale you were on before coming to the hospital. 16. allopurinol 100 mg tablet sig: one (1) tablet po once a day. 17. vitamin d 400 unit tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: house discharge diagnosis: primary diagnosis: nstemi secondary diagnoses: upper gi bleed, acute renal failure, diabetes, hypertension discharge condition: patient was improved. she had no chest pain or shortness of breath, and she was no longer having dark bowel movements, hematocrit was stable. her renal function had returned to a baseline cr of 1.6 with good urine output. her vital signs were stable. discharge instructions: you were admitted with a heart attack. initially, we could not perform a cardiac catheterization because you also were bleeding slowly from your stomach. you then developed worsening kidney function. when we eventually were able to perform a cardiac catheterization, you received stents to keep the arteries to your heart open as well as a stent to keep the artery to your kidney open. your kidney function improved. 1. please take all medications as prescribed. 2. please attend all follow-up appointments listed below. 3. please call your doctor or return to the hospital if you develop chest pain, shortness of breath, blood in your stool, or black, sticky bowel movements, or you develop any other concerning symptom. followup instructions: please see the following doctors within the next month: 1. dr. , your kidney doctor , ma 2. dr. , your heart doctor 3. your primary care physician procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters hemodialysis angioplasty of other non-coronary vessel(s) venous catheterization for renal dialysis insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) arteriography of renal arteries excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] insertion of three vascular stents procedure on two vessels diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia atherosclerosis of renal artery epilepsy, unspecified, without mention of intractable epilepsy heart valve replaced by transplant hemorrhage of gastrointestinal tract, unspecified acquired absence of kidney helicobacter pylori [h. pylori] disorders of bursae and tendons in shoulder region, unspecified 

Answer: The patient is high likely exposed to