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: cardic catheterization with percutaneous angioplasty history of present illness: 84 yo m with htn, hyperlipidemia, pvd, cad s/p mi 's, h/o l nephrectomy admitted with inferior stemi s/p cath and bms x2 to rca. pt reports that he awoke at 4 am on the morning of admission and noted that he had substernal aching in his chest. in addition he noted that he had l sided jaw ache, diaphoresis, nausea and vomiting. he took ntg x3 with no relief in pain. the aching in his chest continued until 7 am when he called his son and was taken to . he reports that he was told that he lost consciousness several times since coming to the hospital. nothing relieved his pain, which was finally relieved during cardiac cath. chest pain free on arrival to the ccu. . in ed given asa 325, ntg gtt, plavix 600mg po x1, heparin gtt, integrilin gtt and transferred to ed. he was noted to be bradycardic and vomiting with hr in 30's , hypotensive sbp 70's. transferred to cath lab. . cardiac cath with mid occlusion of rca with no collaterals, s/p bms x2 to rca. . he had been in his usual state of health prior to this am. he has had no chest pain in the past, even with his prior mi and has never had to use his ntg prior to this am. he has been taking all of his medications except for his asa which he stopped 1 1/2 weeks ago as he ran out of his pills. he has not had any decrease in exercise tolerance and has been able to go up 13 steps and walk around his neighborhood without any shortness of breath. he denies orthopnea, pnd, lower extremity edema, palpitations, dyspnea on exertion. he does report occasional left buttock pain with exercise relieved with rest. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. past medical history: past medical history: 1. coronary artery disease; a myocardial infarction in . a normal stress echocardiogram in with left ventricular ejection fraction of 55% and trace aortic regurgitation. cardiac cath, stress: negative, lv normal wall motion ,small fixed distal anterior wall defect per omr. 2. history of hypertension. 3. peptic ulcer disease. 4. abdominal aortic aneurysm; status post repair. 5. renal cell carcinoma; status post left nephrectomy. 6. hyperlipdemia 7. syncope in attributed to vasovagal reaction vs orthostatic hypotension * past surgical history 1) poplitial aneurym excised/bypass 2) left iliac aa 3) aaa repair w bilat iliac aa repair , 4) lt. thorocoabdominal nephrectomy , 5) angio with embolization of left hypogastric artery 6) left inguinal hernia repari 7) vasectomy social history: retired, worked in chemical compnay mixing compounds. widowed 9 years ago, but has 5 children, 4 of whom live locally, and 16 grandchildren. pt was a smoker, but quit in . never drank much alcohol and currently drinks none. was a singer/son in his freetime. family history: non contributary physical exam: vs: t 97.8 bp 142/86 hr 72 rr 17 96%2l gen: alert, lying flat, appears comfortable, answers questions appropriately heent: jvp around 7-8cm cv: distant heart sounds, rrr no murmur auscultated lungs: unable to assess posterior lung fields as he is lying flat with sheaths still in place, anterior lung fields ctab abd: obese, soft, nontender bs+ ext: no pedal edema, dp's 2+ bilaterally, sheaths in place in r femoral a and v, oozing around site . pertinent results: procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through an 8 french introducing sheath. cardiac output was measured by the fick method. left heart catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 french left catheter, advanced to the ascending aorta through a 6 french introducing sheath. coronary angiography: was performed in multiple projections using a 6 french jl4 and a 6 french jr4 guide catheter, with manual contrast injections. percutaneous coronary revascularization was performed using placement of bare-metal stent(s). hemodynamics results body surface area: 2 m2 hemoglobin: 16 gms % fick **pressures right atrium {a/v/m} 10/11/8 right ventricle {s/ed} 34/10 pulmonary artery {s/d/m} 34/17/23 pulmonary wedge {a/v/m} 19/25/16 aorta {s/d/m} 144/82/104 **cardiac output heart rate {beats/min} 85 o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 56 card. op/ind fick {l/mn/m2} 4.5/2.2 **resistances systemic vasc. resistance 1707 pulmonary vasc. resistance 124 **% saturation data (nl) pa main 73 ao 100 **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca diffusely diseased 2) mid rca discrete 2 2a) acute marginal diffusely diseased 3) distal rca diffusely diseased 4) r-pda diffusely diseased 4a) r-post-lat diffusely diseased 4b) r-lv discrete 60 **arteriography results morphology % stenosis collat. from **left coronary 5) left main diffusely diseased 6) proximal lad diffusely diseased 10 6a) septal-1 diffusely diseased 7) mid-lad diffusely diseased 10 8) distal lad diffusely diseased 10 9) diagonal-1 diffusely diseased 10 10) diagonal-2 diffusely diseased 10 12) proximal cx diffusely diseased 10 13) mid cx diffusely diseased 10 13a) distal cx diffusely diseased 10 14) obtuse marginal-1 diffusely diseased 10 15) obtuse marginal-2 diffusely diseased 10 **ptca results rca **baseline stenosis pre-ptca 100 collateral grade (0-2) 0 **technique ptca sequence 1 guiding cath jr4 guid guidewires choice p initial balloon (mm) 2.0 final balloon (mm) 4.0 # inflations 5 max pressure (psi) 270 **result stenosis post-ptca 0 dissection (0-4) 0 success? (y/n) y ptca comments: the initial angiography revealed a total occlusion of the large mid rca with some chronic component to it and calcifications but no collaterals and with large thrombus burden. heparin and integrilin were administered for anticoagulation. the initial stragegy was to predilate the lesion to reestablish flow and perform thrombectomy given large thrombus burden and risk of no-reflow. jr4 guide provided good support. choice pt xs wire crossed the lesion with some difficulty. 2.0 x 20 mm voyager baloon was used to predilate the lesion reestablishing flow. x-sizer device could not advance past the lesion and despite another predilation with a 2.5 x 30 mm maverick baloon at 10 atms. therefore an angiojet device was used for thrombectomy with good result. pacer was placed in the rv and 1 mg of atropine was administered for transient bradycardia and hypotension during the angiojet. 3.5 x 28 mm bare metal vision stent was placed in the distal rca and deployed at 18 atms. subsequently a 4.0 x 16 mm liberte baremetal stent was placed proximally in an overlapping fashion and deployed at 18 atms. the overlap was postdilated as was the proximal edge of the stent. there was no residual stenosis in the stented segment. timi flow was iii and there was no dissection or distal embolization. the patient left the cath lab pain free and in stable condition to the coronary care unit. technical factors: total time (lidocaine to test complete) = 1 hour 23 minutes. arterial time = 1 hour 23 minutes. fluoro time = 28 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 320 ml, indications - renal premedications: integrilin 8.5 ml bolus and 14.9 ml/hr drip heparin 1000 1% lidocaine subq. anticoagulation: heparin 1000 units iv other medication: nicardipine 400 mcg ic nitroglycerine 200 mcg ic atropine 1 mg iv cardiac cath supplies used: 3.5 , vision 08mm .014 , choice pt xs, 300cm .014 , choice pt xs, 300cm 2.0 , maverick 20mm 2.5 , maverick 30mm 6f cordis, jr 4 sh - ev3, x-sizer - possis, angiojet xmi 135cm 5f bard, pacing wire 4.0 , liberte 08mm - allegiance, custom sterile pack - possis, angiojet pumpset - guidant, priority pack 20/30 comments: 1. selective coronary angiography revealed a right dominant system with mild disease in the lmca. lad and lcx had mild non-critical disease throughout. rca was totally occluded in the mid vessel without collaterals and large thrombus burden, as well as proximal calcifications. 2. left ventriculography was deferred given renal insufficiency. 3. hemodynamic assessment showed no evidence of right heart failure with normal rvedp and pcwp. cardiac index was preserved at 2.2 l/min/m2. 4. successful stenting of the mid to distal totally occluded rca with two overlapping baremetal stents 4.0 x 16 liberte and 3.5 x 28 vision without residual stenosis. thrombectomy was also performed with resultant timi iii flow and no evidence of embolization (see ptca commenst for detail). final diagnosis: 1. one vessel coronary artery disease. 2. normal ventricular function. 3. acute inferior myocardial infarction, managed by acute ptca. 4. successful ptca of rca vessel with thrombectomy and baremetal stent placement. brief hospital course: # cad - imi stemi s/p bms x2 to rca most likely to acute thrombosis. he has not had any prior angina or decreased activity tolerance making progressive occlusion less likely. in addition, he stopped taking his asa for the past 1.5 weeks which may have played a role in acute mi. patient had a peaked at 1450, and has been trending downward. he will be discharged on plavix, aspirin, statin, metoprolol. patient has not been hypertensive, so home hctz was stopped. a follow up echo after catherization showed mild inferior-basal hypokenesis with an ef of 50%. . #chronic renal insufficiency - s/p left nephrectomy for rcc, baseline cr 1.8-2. recieved 320ml contrast during cardiac cath so he is at high risk of contrast nephropathy. patient given continued hydration after cath, and cr at d/c is 2.0. . #guiac positive emesis - became transiently hypotensive and vomited with sheath pull, coffee ground vomitus, guiac positive, no bright red blood. concerning as he was on integrilin gtt and heparin gtt during cath and will be continued on asa and plavix post cath. patient started on protonix 40mg . hct has held steady, and patient scheduled for outpatient gi follow up. . #bph - takes saw and two other herbal medications at home. patient with poor urinary output, and some concerns of urinary retention. started on fosamax. medications on admission: lopressor 50mg zocor 40mg daily asa 325mg daily (hasn't taken for past 1.5wks) hctz 25mg daily ntg (took for first time on morning of admission) saw (and two other herbals for bph) coenzyme q-10 omega 3 discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. zocor 40 mg tablet sig: one (1) tablet po once a day. 4. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 6. protonix 40mg po bid discharge disposition: home discharge diagnosis: stemi upper gi bleed discharge condition: stable discharge instructions: you are being discharged from the hospital after an admission for continued chest pain. evaluation showed that you were having a heart attack, and you underwent a cardiac catheterization to open up your blocked coronary artery. you had two bare-metal stents placed in one of your coronary arteries. the stent will keep you artery open. please follow theese instructions as you recover: - you must take aspirin 325mg every day and plavix 75mg every day. you should not stop taking plavix uncless your doctor tells you to stop. stopping too early can cause a new clot to form. - you should continued to take your already prescribed medication - you will follow up w/ your doctor in 2 weeks. - if you develop chest discomfort that does not go away with nitroglycerin, sweling ,redness, or bleding at the puncture site, a fever of 101 deg or higher, call your doctor. - you were also noted to have bloody vomit while in the hospital. you will need to follow up with a gastroenterologist as an out patient to evaluate for source of bleed. if you develop light headedness, you faint, or shortness of breath, call your doctor. followup instructions: provider: , apg (sb) phone: date/time: 10:10 gastroenterology: provider: , md phone: date/time: 5:00 procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures intraoperative cardiac pacemaker injection or infusion of platelet inhibitor transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified cardiac dysrhythmias acute myocardial infarction of other inferior wall, initial episode of care old myocardial infarction cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hematemesis personal history of malignant neoplasm of kidney 

Answer: The patient is high likely exposed to