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: shortness of breath major surgical or invasive procedure: carotid stenting history of present illness: 67yom o2-dependant copd, htn, dmii, ?syncopal hx admitted for coronary angiography, found to have l/r-ica disease, now s/p r-ica stenting x2, admitted to ccu for bp control. in past 2 months, outpt pcp noted carotid bruits, sent for carotid u/s , showed 70-90% r-ica stenosis, 91-99% l-ica stensosis. cta neck showed >90% post-bifurcation long segment stenosis of r-ica and near complete occlusion of post bifurcation lca. in cath lab, verbal report - 100% l-ica stenosis, r-ica 95% stenosis with multiple ulcerations and dissections of r-ica artery with collaterals from external carotid artery. two stents placed in r-ica with adequate post-placement flow. pt had 10 minute period in which he could not identify his location, which resolved. on ros per report, pt reports mult episodes of passing out that occurred about 3 years ago?. presently, feels well, denies focal numbness/weakness/visual changes, denies claudication, edema, orthopnea, pnd, cp. past medical history: 1. copd, on home oxygen 2l continuously 2. anxiety 3. depression 4. sleep apnea: cpap 5. acute renal failure 6. diabetes type ii 7. hypertension 8. appendectomy 9. tonsillectomy 10. back surgery . cad s/p ptca yrs bu 12. ? seizures 13. ? syncope 14. atrial fibrillation s/p cardioversion (? at ) 15. parasympathetic nervous system dysfunction 16. "unusual syndrome of abnormal sensation/movement in penis social history: pt retired (used to work for oxygen device company) and lives with his mother in . has 5 children ages 43 to 30 years old. previously smoked 3-4 packs/day x 45 years gradually decreasing for past 8 years to ~6 cigs/day. patient states he quit alcohol 30 years ago. prior crack/cocaine x 2 yrs. quit a few yrs ago. pt informed that he cannot drive himself to the procedure and he is going to make arrangements to have his brother bring him in and pick him up. family history: mother cabg , alive 92. father died at of pancreatic cancer at age 72. physical exam: vs: t 98, bp 98/60, hr 71, rr 16, 98%ra gen: wdwn middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate heent: ncat. sclera anicteric. perrl, eomi. conjunctiva pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ d pertinent results: 07:57pm type-art o2 flow-2.5 po2-85 pco2-52* ph-7.34* total co2-29 base xs-0 o2 sat-94 04:40pm ck(cpk)-165 ck-mb-5 wbc-6.1 rbc-3.70* hgb-11.7* hct-36.0* mcv-97 mch-31.6 mchc-32.5 rdw-15.0 neuts-53.9 lymphs-33.0 monos-6.8 eos-5.8* basos-0.5 plt count-217 c.cath study date of comments: 1. limited angiography of the left carotid artery demonstrated 99% stenosis of the left ica with fillign of the mca only. angiography of the right brachiocephalic trunk demonstrated 50% right subclavian artery stenosis, patent vertebral artery and 95% long ulcerated, dissected stenosis of the right ica. 2. successful angioplasty and stenting of the right ica with a 8.0x40mm protege stent and a 6.0x20mm acculink stent that were postdilated to 4.5mm. final angiography revealed no residual stenosis, no angiographically apparent dissection and good flow. final diagnosis: 1. 99% left ica stenosis, 95% right ica stenosis, and 50% right subclavian stenosis. 2. successful ptca and stenting of the right ica. ecg study date of 3:13:14 pm baseline artifact sinus rhythm slight st-t wave changes suggested but baseline artifact makes assessment difficult since previous tracing of , ventricular ectopy absent but otherwise baseline artifact makes comparison difficult read by: , w. intervals axes rate pr qrs qt/qtc p qrs t 76 /418 71 65 51 brief hospital course: the patient is a 67yo man with a history of o2-dependent copd, hypertension, dmii, and syncopal history who presented for carotid angiography on . # pvd/cad - the patient was admitted for carotid stenting. angiography revealed a left ica with 99% stenosis and a 95% long ulcerated, dissected stenosis of the right ica. the patient underwent angioplasty and stenting of the right ica with a 8.0x40mm protege stent and a 6.0x20mm acculink stent. there was no residual stenosis and no angiographically apparent dissection. the patient was monitored in the icu for blood pressure control and neurologic evaluation. he was felt to be stable and at his neurologic baseline. he was continued on aspirin, plavix, statin was discharged with instructions to follow-up with dr. as an outpatient. # rhythm - the patient had a history of afib s/p cardioversion. ekg's were difficult to interpret in the setting of baseline artifact, however it was felt that the patient may benefit from further anticoagulation. he was discharged on coumadin and instructed to follow up with his primary care physician for inr monitoring. # dm - the patient was discharged on his home regimen of glyburide and avandia # hypertension - the patient was continued on his home regimen of metoprolol, lisinopril and amlodipine. # hypercholesterolemia - the patient was continued on ezetemibe and atorvastatin. # copd/osa - the patient was continued on advair, albuterol nebs prn and cpap overnight. # tobacco abuse - the importance of smoking cessation was stressed and the patient was given information on tobacco cessation resources. # code - full medications on admission: 1. advair disc 250/50 2 puffs 2. albuterol/atrovent nebulizer 4 times daily 3. amlodipine 2.5mg daily 4. aspirin 325mg daily 5. avandia 4mg daily 6. clorezepate 7.5mg 2 pills 3 times daily 7. effexor 75mg 8. gemfibrizol 600mg daily 9. glipizide 2.5mg daily 10. lisinopril 10mg daily 11. metoprolol succinate 50mg 12. omega 3 tid 13. uroxatral 10mg daily 14. vitamin b12 1daily 15. plavix 75mg daily 16. lipitor 40mg daily 17. lidocaine 2 % solution prn 18. lidociaine 4% liquid prn 19. lidocaine 5% cream prn 20. lidocaine patch prn discharge medications: 1. advair diskus 250-50 mcg/dose disk with device sig: two (2) puffs inhalation twice a day. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 3. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. rosiglitazone 4 mg tablet sig: one (1) tablet po once a day. 6. clorazepate dipotassium 15 mg tablet sig: one (1) tablet po three times a day. 7. venlafaxine 75 mg tablet sig: one (1) tablet po bid (2 times a day). 8. gemfibrozil 600 mg tablet sig: one (1) tablet po daily (daily). 9. glipizide 2.5 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po once a day. 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po bid (2 times a day). 12. uroxatral 10 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qd (). 13. vitamin b-12 oral 14. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 15. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 16. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever, pain. 17. outpatient lab work please check inr on , and call in results to dr. , m. office number: . 18. warfarin 2 mg tablet sig: 2.5 tablets po once a day. disp:*150 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: carotid stenosis . secondary diagnoses: peripheral vascular disease coronary artery disease diabetes hypertension hypercholesterolemia chronic obstructive pulmonary disease obstructive sleep apnea discharge condition: stable discharge instructions: you were admitted for stenting of your carotid artery. this occurred without complication. we have started you on coumadin for your carotid disease. you will need to get frequent blood draws to adjust the dosage of your coumadin. you will need to coordinate this with either visiting nurses or with dr. office. his office number is . please get your coumadin level drawn early on so dr. gets the results and can tell you how much coumdadin to take on . you will need to follow up with dr. as well. dr. will contact you to make that appointment. . please continue the remainder of your medications. . please stop smoking. information regarding smoking cessation was given to you on admission. followup instructions: please follow up with dr. . he will contact you with an appointment time. his clinic number is . procedure: arteriography of cerebral arteries percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents procedure on single vessel diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pure hypercholesterolemia tobacco use disorder unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified percutaneous transluminal coronary angioplasty status occlusion and stenosis of carotid artery without mention of cerebral infarction old myocardial infarction occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction atherosclerosis of native arteries of the extremities, unspecified other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to