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: allopurinol / plavix attending: chief complaint: chest pain and shortness of breath major surgical or invasive procedure: cardiac catheterization history of present illness: mrs. is a 66 y/o f with hx cad (s/p cabg with lima-->lad, svg-->dm1 in ; des to mid-proximal rca ; and bms to proximal lcx ), dhf, dm, hpl, stage iii ckd who presented to osh with cp, cough, and sob. she reports that over the last two weeks she has had increasing sob with minimal activity, weight gain, cough and fleeting cp relieved with sl nitro. she was treated prior to presentation for a pna with 7 days of clarithromycin. at baseline, she is minimally active requiring assistance with cleaning the house and grocery shopping. per her daughter, she never full bounced back from the cabg in . prior to admission on she reports that she was shaking and felt feverish and shaky, she checked her temperature and it was 99.6. she also had increasing left-sided sharp cp that radiated down her left arm, she took sl nitro x 3 but had continued cp and was taken to the osh by her daughter. at the osh, vitals were 98.6, 78, 136/62, 22, 96%ra. ekg showed nsr 72bpm lbbb unchanged from prior ekg. cxr showed cardiomegaly but was otherwise clear. she had a leukocytosis to 18.7-->10.8 which was attributed to acute gout. glucose 243, bnp was 2443-->3229, cr 1.5-->2.1 (baseline 1.3-1.5), tnt and ck were negative, no ck-mb reported. she was treated with asa, nitroglycerin paste and sl nitro, continued on and bumex. patient reports she is down 9lbs since presenting to osh. on the morning prior to transfer tnt <0.01 and ckmb 9, index 4. around 6pm she had sudden onset cp and diaphoresis. she was started on a nitro gtt and transferred to for further management. vitals on transfer were t98.1 bp94/47 rr16 hr65 o297% on arrival to the floor, patient was comfortable, in nad, speaking in full sentences and had no c/o. past medical history: htn dm2 cad cabg lima to lad, svg to small diffusely diseased diagonal, ef 40% with 2+mr ' dyslipidemia ?cri obesity gout hypothyroid social history: the patient is armenian. she lives with her husband and son, independent of adls. no history of tobacco, alcohol or illicit drug use. family history: both parents died in 70s/80s from scd. physical exam: admission exam: vs: t=98.1 bp=94/47 hr= 65 rr=18 o2 sat=97% 4l general: wdwn overweight woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of cm. cardiac: pmi located in 5th intercostal space, midclavicular line. distant heart sounds, rrr, 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. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 1+ pre-tibial edema bilaterally. no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge exam: ga: well-appearing, speaking full sentences, a&ox3 heent: perrl, eomi, mmm neck: flat jvp cv: rrr, normal s1, s2, no m/r/g pulm: ctab, no wheezes, crackles, rhonchi extremities: trace peripheral edema bilaterally skin: no rash, warm, dry neuro: cnii-xii grossly intact, alert and oriented as above, gait deferred pertinent results: admission labs: 01:31am wbc-11.9* rbc-4.11* hgb-11.0* hct-33.9* mcv-82 mch-26.8* mchc-32.5 rdw-17.1* 01:31am plt count-193 01:31am glucose-237* urea n-45* creat-1.7* sodium-140 potassium-3.9 chloride-100 total co2-30 anion gap-14 01:31am calcium-8.6 phosphate-3.9 magnesium-2.4 01:31am ck-mb-65* mb indx-14.8* ctropnt-0.58* 01:31am ck(cpk)-439* 2-d echocardiogram : the left atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. due to suboptimal technical quality, focal wall motion is difficult to assess but there appears to be apical akinesis, marked inferolateral hypokinesis, and moderate hypokinesis of the remaining walls. a left ventricular thrombus cannot be excluded. overall left ventricular systolic function is severely depressed (lvef= 25-30 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the aortic valve leaflets are mildly thickened (?#). there is mild aortic valve stenosis (valve area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. () : final diagnosis: 1. three vessel native coronary artery disease. 2. known occluded svg-d1 and patent lima-lad. 3. successful ptca and stenting of the cx with a des. 4. successful ptca and stenting of om1 with a des. 5. mild systolic heart failure. 6. elevated pulmonary capillary wedge and right ventricular filling pressures. 7. pulmonary hypertension. . () cxr: impression: severe cardiomegaly, in particular dilatation of the pulmonary arteries are longstanding. pulmonary edema is mild. there is no appreciable pleural effusion. . () cxr: again, the heart is grossly enlarged. the left pleural effusion likely is stable. right lung appears grossly clear. bilateral pulmonary opacities are consistent with pulmonary edema which is slightly improved since the prior study. the patient is status post median sternotomy. . discharge: 06:20am blood wbc-12.9* rbc-4.55 hgb-12.2 hct-37.1 mcv-82 mch-26.8* mchc-32.8 rdw-17.5* plt ct-266 06:20am blood pt-20.2* ptt-75.0* inr(pt)-1.9* 06:20am blood glucose-180* urean-51* creat-1.9* na-136 k-4.6 cl-95* hco3-32 angap-14 06:20am blood calcium-9.5 phos-2.9 mg-2.6 05:20pm blood %hba1c-7.6* eag-171* brief hospital course: 66 y/o f with hx cad (s/p cabg with lima-->lad, svg-->dm1 in ; des to mid-proximal rca ; and bms to proximal lcx ), dm, hpl, stage iii ckd who presented to osh with cp, cough, and sob, likely unstable angina now with elevated tnt and ck-mb without ekg changes which is c/w nstemi. likely that she was having ua prior to presentation to osh and her event occurred around 10pm on prior to transfer to . . # nstemi: initially at osh patient did not have troponin or ck-mb leak, but in setting of acutely worsening cp prior to transfer requiring nitro gtt and then found to have significantly elevated cm with no ekg changes, she has likely suffered a nstemi. she was taken for cardiac catheterization, which showed occluded lad (old), 90% proximal instent restenosis of lcx, 70% mid lcx stenosis, 50% mid rca in prior stent, and patent lima to lad. successful ptca and stenting of the cx with a des and succssful ptca and stenting of om1 with a des. after the cardiac catheterization, she continued to complain of less intense chest pain. she was medically optimized with the following medications: asa 81, prasugrel 10 mg , atorva 80, metop 12.5mg . post chest pain would improve after starting ranolazine 500mg . in subsequent days, the patient's functional status and chest pain symptoms resolved and no longer would she complain of this pain. on day of discharge the patient was pain free. post echo showed lvef 25-30% with probable apical akinesis and severe inferolateral hypokinesis. the remaining walls are moderately hypokinetic. severe pulmonary artery systolic hypertension. mild aortic stenosis. mild-to-moderate mitral regurgitation. likely elevated pcwp. the patient should be considered for icd after 40 days post pci. . # acute on chronic systolic and diastolic chf: hx of diastolic hf with preserved ef. however, post- echo here showed lvef 25-30%. given her sxs, likely nyh class iii-iv. we aggressively diuresed the patient, first with lasix drip at 25mg/hour and then with oral torsemide. the patient had an acute episode of hypotension after undergoing cardioversion, and at that time responded to 2l ns ivf. we suspect that the oral torsemide was started too soon after the lasix gtt. patient home regimen was bumex 4mg . admission weight was 117kg. discharge weight was 238lb (approx 20lb down). please consider restarting losartan and starting spironolactone once kidney function improves. . # atrial fibrillation: on , patient developed new atrial fibrillation with rvr rate 120s-130s. first episode was accompanied by 10/10 chest pain, which resolved when she was treated with iv metoprolol and iv diltiazem, which controlled her rate (to 90s-110s). was increased from 12.5mg daily to 25mg daily. regarding anticoagulation, chads2 score was 3. she was put on heparin gtt with a bridge to warfarin. patient was cardioverted on . post cardioversion pt was hypotensive, in sinus rhythm, required transfer back to ccu for 24 hours where her blood pressures normalized. etiology likely over diuresis. she remained in sinus rhythm for the remainder of her admission. she remained normotensive for the remainder of her admission. she was discharged home on warfarin after heparin gtt, pt was not candidate for lovenox bridge poor renal function. on discharge, inr was 1.9. . # htn: at home, bp was controlled with , losartan, and bumetanide. was switched to metoprolol 12.5mg , losartan was held given her low bps, and torsemide 40 daily was initiated instead of bometanide. pt remained normotensive after a hypotensive episode as described above. . # aockd: thought to be acute on chronic kidney disease in the setting nstemi with possible worsening ef. cr 1.7 on admission, peaked at 2.7 and was 1.9 on discharge. . # dm: we continued home lantus qhs, but the dose had to be adjusted frequently due to hyperglycemia at different points during her hospitalization. she was also put on insulin sc. discharged on following regimen: glargine 10 units bedtime humalog 4 units lunch humalog 8 units dinner insulin sc sliding scale using hum insulin . . # hypothyroidism: we continued home synthroid 150mcg. pt discharged with this. . # gout: complained of pain in her right toe c/w prior episodes of gout. she was treated with colchicine and prednisone 200mg x 5 days. . transitional issues: - evaluate for icd >40 days out from acs - consider outpatient sleep study - will discuss as outpt to restart losartan - will consider spironolactone as outpatient to optimize chf regimen) - home telemonitoring medications on admission: preadmission medications listed are correct and complete. information was obtained from osh. 1. aspirin 81 mg po daily 2. 12.5 mg po bid 3. rosuvastatin calcium 5 mg po daily 4. losartan potassium 100 mg po daily 5. novolog *nf* (insulin aspart) 4 units subcutaneous daily with lunch 6. levothyroxine sodium 150 mcg po daily 7. vitamin d unit po daily 8. bumetanide 4 mg po bid 9. zolpidem tartrate 10 mg po hs 10. prasugrel 10 mg po daily 11. nitroglycerin sl 0.3 mg sl prn chest pain 12. lantus *nf* (insulin glargine) 50 units subcutaneous qhs 13. novolog *nf* (insulin aspart) 8 units subcutaneous daily with dinner discharge medications: 1. atorvastatin 80 mg po daily rx *atorvastatin 80 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 2. aspirin 81 mg po daily 3. levothyroxine sodium 150 mcg po daily 4. prasugrel 10 mg po daily 5. zolpidem tartrate 10 mg po hs 6. colchicine 0.3 mg po daily rx *colchicine 0.6 mg 0.5 (one half) tablet(s) by mouth daily disp #*3 tablet refills:*0 7. glargine 10 units bedtime humalog 4 units lunch humalog 8 units dinner insulin sc sliding scale using hum insulin 8. metoprolol succinate xl 25 mg po daily hold for sbp<90, hr,60 rx *metoprolol succinate 25 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 9. ranolazine *nf* 500 mg oral reason for ordering: starting while inpatient rx *ranolazine 500 mg one tablet(s) by mouth twice a day disp #*60 tablet refills:*2 10. torsemide 40 mg po daily hold for bp <90 rx *torsemide 20 mg 2 tablet(s) by mouth daily disp #*60 tablet refills:*2 11. warfarin 7 mg po daily16 rx *warfarin 2 mg 3.5 tablet(s) by mouth daily disp #*120 tablet refills:*2 12. nitroglycerin sl 0.3 mg sl prn chest pain 13. vitamin d unit po daily 14. outpatient lab work check chem-7 and inr on thursday with results to dr. at phone: fax: icd9 427.3 discharge disposition: home with service facility: homecare discharge diagnosis: non st elevation myocardial infarction acute on chronic systolic chf exacerbation (ef 25%-30%) new onset atrial fibrillation and atrial flutter hypertension diabetes mellitus coronary artery disease 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 with a heart attack and an exacerbation of your congestive heart failure. you were taken to the cardiac cathterization lab and 2 drug leuting stents were placed in your heart arteries. you had some chest pain after the procedure and you were started on ranexa which has eliminated the pain. your weight was increased from excess fluid in your lungs and your belly. you were on a furosemide intravenous drip and are now on a new pill, torsemide, to help keep the fluid off. weigh yourself every morning morning before breakfast, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. your weight at discharge is 238 pounds. we are holding your losartan right now because your kidney function is improving, but not normal yet. you will need to have this restarted by dr. . you also developed atrial fibrillation and atrial flutter and needed a cardioversion to shock you out of this rhythm. you are in a normal sinus rhythm now and should monitor your pulse to make sure it remains regular. having the atrial fibrillation puts you at increased risk for a stroke so you are now on warfarin to prevent blood clots and strokes. dr. office will let you know how much warfarin to take every day. followup instructions: cardiology appointment: thursday, at 3:15pm with: ,md location: cardiology associates, inc. .,, phone: department: cardiac services when: friday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor other electric countershock of heart insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status other chronic pulmonary heart diseases atrial flutter other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) obesity, unspecified acute gouty arthropathy volume depletion, unspecified acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to