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: crestor attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization history of present illness: 64f hx cad s/p mi in with 2 des placed to the plad, icmy ef 45-50%, htn, hlp who presented to the ed with chest burning. at 4am she awoke with substernal chest burning radiating to the back associated with nausea, no vomiting or dyspnea. . in the ed, she was found to have ekg changes with st elevations in v1-v2. she was given heparin, plavix loaded, full strength aspirin and morphine/slntg for pain. catheterization demonstrated total occlusion of the lad in the proximal portion of her previous stent. thrombectomy was performed and another des was placed. she was transferred to the ccu for further management. . upon arrival to the ccu, she was chest pain free and felt comfortable. she was on a nitroglycerin drip and was hemodynamically stable. past medical history: past medical history: 1. cardiac risk factors: -diabetes, +dyslipidemia, +hypertension 2. cardiac history: anterior stemi in with 2 des in lad 3. other past medical history: - pad - ischemic cm with ef 45% - htn - hlp social history: social history - tobacco history: never smoked - etoh: does not drink - illicit drugs: no drugs family history: family history: - strong family history of cardiac disease in her first and second degree relatives physical exam: general: nad. oriented x3. mood, affect appropriate. neck: supple, unable to appreciate jvd due to position. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. mild bibasilar rales. abdomen: soft, ntnd, obese. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: 06:30am blood wbc-5.1 rbc-3.96* hgb-10.5* hct-32.6* mcv-82 mch-26.4* mchc-32.1 rdw-13.4 plt ct-208 05:30am blood wbc-5.3 rbc-3.96* hgb-10.5* hct-32.6* mcv-82 mch-26.6* mchc-32.2 rdw-13.3 plt ct-198 01:27am blood wbc-5.0 rbc-4.04* hgb-10.8* hct-33.3* mcv-83 mch-26.6* mchc-32.3 rdw-13.4 plt ct-208 05:12am blood wbc-5.4 rbc-4.08* hgb-10.9* hct-33.7* mcv-83 mch-26.7* mchc-32.3 rdw-13.3 plt ct-210 06:55am blood wbc-8.7 rbc-4.57 hgb-12.3# hct-38.4# mcv-84 mch-26.9* mchc-32.0 rdw-13.4 plt ct-281 05:30am blood neuts-60.5 lymphs-31.7 monos-5.5 eos-1.8 baso-0.4 06:30am blood plt ct-208 06:30am blood pt-12.1 ptt-29.1 inr(pt)-1.1 06:30am blood glucose-121* urean-12 creat-0.7 na-141 k-4.6 cl-107 hco3-28 angap-11 06:55am blood glucose-179* urean-18 creat-0.8 na-137 k-7.9* cl-102 hco3-25 angap-18 06:30am blood alt-27 ast-37 ld(ldh)-486* alkphos-41 totbili-0.5 05:30am blood alt-30 ast-46* ld(ldh)-605* alkphos-46 totbili-0.5 08:58pm blood ck(cpk)-4058* 01:01pm blood alt-56* ast-346* ld(ldh)-657* ck(cpk)-3786* alkphos-50 totbili-0.3 01:01pm blood lipase-19 05:12am blood ck-mb-133* mb indx-5.1 ctropnt-3.84* 08:58pm blood ck-mb-423* mb indx-10.4* ctropnt-6.69* 06:55am blood ctropnt-<0.01 06:30am blood albumin-3.8 calcium-9.1 phos-3.5 mg-2.0 01:01pm blood mg-2.0 cholest-204* 06:30am blood %hba1c-6.6* eag-143* 05:30am blood %hba1c-6.5* eag-140* 01:01pm blood triglyc-47 hdl-64 chol/hd-3.2 ldlcalc-131* , f 64 cardiovascular report cardiac cath study date of *** not signed out *** brief history: this is a 65 year-old woman with hypertension, dyslipidemia, and coronary artery disease who presented with refractory chest pain despite aggressive early medical management. her coronary history is notable for an anterior st-elevation myocardial infarction on , at which time culotte stenting of the proximal lad and d1/s1 branches. a 2.75x16mm taxus stent was used in the septal-lad and a 3.0x12mm taxus stent was used in the diagonal-lad. rca stenosis (80-90%) was not intervened upon at that time. indications for catheterization: coronary artery disease, canadian heart class iv, unstable. prior q wave anterior mi, . prior ptca . procedure: coronary angiography via percutaneous entry of the right common femoral artery with a 6f sheath. 4fr jl4 catheter was used to engage the left coronary artery. 4fr al2 catheter was used to sub-selectively engage the right coronary artery. percutaneous coronary revascularization was performed using placement of drug-eluting stent(s). conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 1.69 m2 hemoglobin: 12.3 gms % fick **pressures left ventricle {s/ed} -/28 aorta {s/d/m} 157/86/115 **cardiac output heart rate {beats/min} 83 rhythm sinus o2 cons. ind {ml/min/m2} 125 other hemodynamic data: the oxygen consumption was assumed. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca discrete 80 2) mid rca discrete 80 2a) acute marginal normal 3) distal rca normal 4) r-pda normal 4a) r-post-lat normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad discrete 100 12) proximal cx normal 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 normal 16) obtuse marginal-3 normal **ptca results lad ptca comments: a 6fr xblad 3.5 guiding catheter was engaged into the lmca and a choice pt es guidewire was used to cross the lesion. an otw balloon was used to ensure intralumenal postion and following that an export catheter was used for manual thrombectomy for 8 passes. following thombectomy, angiography revealed a significant proximal lad stenosis. a 2.5x20mm apex balloon was used to predilate the lesion and a 2.75x28mm promus des was placed at the lesion in the proximal lad to 12atm. a 3.25x15mm nc quantum apex balloon was used to post-dilate the stent to 22 atm. timi 0 flow was present prior to the intervention and timi iii flow at the end. no complications. a 6fr angioseal device was deployed successfully in the right cfa with excellent hemostasis. technical factors: total time (lidocaine to test complete) = 1 hour 12 minutes. arterial time = 1 hour 10 minutes. fluoro time = 31.7 minutes. irp dose = 2719 mgy. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 280 ml premedications: midazolam 0.5 mg iv fentanyl 75 mcg iv asa 325 mg p.o. clopidogrel 600mg nitroglycerine gtt anesthesia: 1% lidocaine subq. anticoagulation: heparin 3000 units iv other medication: eptifibatide 13.6ml (2mg/ml) ivb f/b 11.5ml/hr (75mg/100ml) cardiac cath supplies used: - , choice pt extra support 300cm 2.0mm , apex rx 20 2.5mm , apex rx 20 2.0mm , quantum maverick 12mm 3.25mm , quantum maverick 15mm 6fr cordis, .75 6fr cordis, xblad 3.5 6fr , angioseal vip 2.75mm , promus rx 28mm 6fr , export aspiration catheter - allegiance, custom sterile pack - merit, left heart kit - , priority pack 20/30 comments: 1. selective coronary angiography of this right-dominant system demonstrated severe 2 vessel cad. the lmca was normal. the lad was totally occluded at the proximal segment of the prior stent. the lcx was normal with a large om branch. the dominant rca, which had an anomolous origin in the left coronary cusp, was only sub-selectively engaged, and had 80% stenoses in the proximal and mid-vessel segments, which were not significantly different from images during her catheterization. 2. limited resting hemodynamics revealed elevated left-sided filling pressures with a measured lvedp of approximately 28mmhg. systemic arterial pressure was elevated with a measured central aortic pressure of 157/86/115. 3. left ventriculography was deferred. 4. successful thrombectomy and pci to the plad with a 2.75x28mm promus des. 5. angioseal to the right cfa site. 6. no complications. final diagnosis: 1. severe 2 vessel cad. 2. elevated left-sided filling pressures. 3. continue asa and clopidogrel indefinitely. 4. continue integrillin for 18hr post-pci. 5. repeat echocardiography and consider elective revascularization of rca disease. 6. successful pci to the plad with promus des. 7. angioseal to the right cfa. 8. no complications tte the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with akinesis of the anterior wall, septum and apex. the remaining segments contract normally (lvef = 25%). no masses or thrombi are seen in the left ventricle. there is a distal septal post infarction ventricular septal rupture (vsr). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: severe regional left ventricular systolic dysfunction, c/w extensive anterior infarction. post-infarction distal ventricular septal rupture. compared with the prior study (images reviewed) of , regional wall motion abnormalities are significantly more extensive and the ventricular septal rupture is new. findings discussed with the ccu team including dr. . tte the left atrium is normal in size. a patent foramen ovale is present with premature appearance of saline contrast in the left atrium after intravenous injection. left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction visualized on the limited views with septal and apical near akinesis. no definite ventricular septal defect is identified, though a small systolic color flow doppler jet is seen near the apex of the right ventricle (clip #) . right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. impression: patent foramen ovale. no definite ventricular septal defect identified normal left ventricular cavity size with regional systolic dysfunction. compared with the prior study (images reviewed of ), no definite color flow signal of a vsd is seen and a pfo is now identified. cxr no acute cardiopulmonary pathology brief hospital course: 64 year old female with hypertension, hyperlipidemia, coronary artery disease, infarct-related cardiomyopathy with an ef 45%, cad s/p plad stent after stemi, hlp, htn who presents with chest pain found to have st elevations on ekg with total occlusion of the lad on cath. . # stemi/cad: on cardiac catheterization, ms. was found to have total occlusion of the lad in the proximal area of her previous stent, thrombectomy and drug eluting stent placement were performed. she remained hemodynamically stable after the procedure for the remainder of her hospital course and was free of chest pain, dyspnea or palpitations. cardiac enzymes peaked and declined appropriately. she received integrillin post-cath per protocol. she was initially on a nitroglycerin drip, which was weaned shortly after arrival to the ccu. once heart rate improved to 70s-80s, her metoprolol was restarted. aspirin 325mg, plavix 75mg were started. she was started on crestor 40 for acute mi in spite of having a past history of myalgias with statin use; throughout her hospitalization she refused her statin intermittently. ct surgery was consulted and they wil see her as an outpatient to discuss the possibility of cabg in the future. . # concern for vsd, now resolved: she had a post-catheterization echocardiogram, which was significant for color-flow imaging suspicious for vsd. however, the patient had no murmur, was entirely hemodynamically stable, and repeat echo with bubble study performed on clarified that there was no vsd. the patient was found to have a patent foramen ovale with valsalva. echo also demonstrated a small right ventricle which likely contributed to the colour flow imaging appearance of abnormal flow. . # schf: hx of icmy with ef 45-50% with 2+ tr. lvedp at end of case 28 suggesting fluid overload, with likely worsening ef. echocardiogram on shwoed a worse ef of 25%, but repeat echo on showed improvement of ef with improvement in septal wall motion. her oxygen saturations remained good throughout her hosptalisation, and she did not have any other evidence of fluid overload. her beta and ace inhibitor were restarted once blood pressures improved, and will require continued titration as an outpatient as we were unable to uptitrate her ace due to blood pressure concerns. . # hyperlipidemia: she as difficulty with crestor and lipitor with myalgias, appears to have been on/off statins recently. last ldl was 299. she was restarted on her home dose of crestor 20mg three times per week and will follow up with lipid clinic for further management of her hypercholesterolemia. . # hypertension: low-normal bp during this admission. as blood pressure improved, we restarted her on metoprolol and lisinopril, which will need further uptitration as an outpatient. . transitional issues: - she will followup with dr. in clinic and will need uptitration of her antihypertensive medication as tolerated. - given her history of myalgias with statin therapy, her home dose statin (crestor 20mg 3 days per week) and will need to followup in lipids clinic for optimisation of her medical management. - she will followup with cardiothoracic surgery regarding the possibility of future cabg. medications on admission: ibuprofen - 600 mg tablet - 1 tablet(s) by mouth three times a day as needed for pain lisinopril - 40 mg tablet - 1 tablet(s) by mouth once a day for blood pressure metoprolol succinate - 100 mg tablet extended release 24 hr - one tablet once a day nifedipine - 30 mg tablet extended release - 1 tablet(s) by mouth once a day rosuvastatin - 20 mg tablet - 1 tablet(s) by mouth daily acetaminophen - 500 mg tablet - 2 tablet(s) by mouth three times a day as needed for pain also called tylenol aspirin - 81 mg tablet, delayed release (e.c.) - 2 tablet(s) by mouth once a day 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. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 4. toprol xl 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 5. crestor 20 mg tablet sig: one (1) tablet po 3 days/ week. 6. ibuprofen 600 mg tablet sig: one (1) tablet po three times a day as needed for pain. discharge disposition: home discharge diagnosis: coronary artery disease ischemic cardiomyopathy (weak heart muscle, ef 45%) hypertension dyslipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you were admitted for a heart attack, which was treated with a drug-eluting stent. ultrasound imaging of the heart showed some reduction in function due to the heart attack. medication changes: increase aspirin 325mg daily indefinitely start plavix 75mg daily for minimum of one year decrease lisinopril to 10mg daily stop nifedipine *otherwise, continue your medications as usual* your cholesterol has been an issue, the numbers are very high but you are unable to tolerate many of the cholesterol medications. we scheduled you an appointment in the lipid clinc, this is to help find a medication(s) you can tolerate which will help to lower your cholesterol. *follow a low cholesterol, low fat diet if you have chest pain at home you can take nitroglycerin under your tongue as directed. if the pain does not go away, call 911. if you have pain in your right groin, fevers, chills or shortness of breath, call dr. . for your heart failure diagnosis: weigh yourself daily, md if weight goes up more than 2 lbs in 2 days or 5 lbs in 3 days, follow a low salt diet, restrict your fluid intake to 1500 ml/ day. followup instructions: department: internal medicine when: thursday at 3:15 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: cardiac surgery when: tuesday at 1:30 pm with: , md building: lm campus: west best parking: garage department: cardiac services when: wednesday at 3:40 pm with: , md building: sc clinical ctr campus: east best parking: garage dr. () fri 8:30 am lipid clinic procedure: coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel transluminal coronary atherectomy diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled percutaneous transluminal coronary angioplasty status acute myocardial infarction of anterolateral wall, initial episode of care other and unspecified hyperlipidemia ostium secundum type atrial septal defect long-term (current) use of insulin old myocardial infarction family history of ischemic heart disease acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities, unspecified 

Answer: The patient is high likely exposed to