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: hypotension s/p cardiac cath major surgical or invasive procedure: cardiac cath plus stenting of lad history of present illness: 77 year old male with h/o htn, ef 45%, hyperlipidemia, pvd, cva, s/p right cea, stemi (st depressions in v2-v6 and 1mm ste in iii, 0.5mm ste in ii and avf; ), 3vcad s/p cagb x1 (dr. ; svg-0>om1; ) who was admitted for ccu monitoring after cardiac cath with stent placement. the patient has been symptomatic again with his typical exertional chest pain for the last few weeks (responsive to nitro). he was recently ruled out for an mi during an admission from (also found to have arf which resolved after ivf). he was scheduled for an outpatient stress test on . the exercise stress test was positive (6.75 minutes protocol, 66% max phr, stopping due progressive anginal symptoms with 9/10 arm pain radiating to the chest). the mibi showed a reversible defect in the lateral wall and he was sent for cardiac cath on the day of admission. . a cypher stent was placed into lm/lad. it was attempted to place also a stent into the mid-distal lad lesion but failed. during the catheterization, he developed intermittent cp. his sbp went up into the 220s and he received iv nitro. next, the question of a dissected lad came up based on the angiographic image of the wire. he received intracoronary nitro (200 mcg) to dilate the vessel and identify any dissection which could not be confirmed. after this administration, his sbp dropped into the 70s and he developed a vagal reaction with hr in upper 30s to lower 40s. this event lasted approx 5 minutes and he responded to iv atropin, very brief dopamine drip and ivf. there was no loc but some associated cp. there were transient ischemic changes during the procedure (st depressions in v4-v6). he was exposed to more than 350cc of dye, about one hour of fluoro and he lost a significant amount of blood. he received angiomax in the cath lab and was started on a bicarb drip. he next was transferred to the ccu for monitoring after the above mentioned events. past medical history: hypertension hyperlipidemia systolic chf (ef 45%; ) : stemi; 3vcad with subsequent cabg x 1 cva carotid artery disease, s/p right cea in pvd (known bruit over right groin) with claudication gout gerd lower back pain s/p l4-5 laminectomy nasal fractures, s/p surgical correction tonsillectomy social history: 100-pack-year history of smoking,and discontinued in . social beer drinking (about 6 beers 3x/week). married with four children. family history: brother with ??????heart problems??????, died in his 40??????s. physical exam: vs: t bp 167/59 hr 59 rr 18 o2 100% ra gen: wdwn 77 year old male in nad. alert & oriented. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. very dry mm. neck: supple without elevated jvp. right carotic bruit cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. soft, i/vi systolic murmur at apex, no rub or gallop. no thrills, lifts. no s3 or s4. chest: no chest wall deformities. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. no abdominial bruits. ext: no c/c/e. cold feet b/l (chronic per patient). no femoral bruits (but reportedly known right groin bruit pre-procedure - not audible currently with gauze/tape covering groin). skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: pre-cath ekg demonstrated normal sinus rhythm at 65 with normal axis, normal intervals, no st changes, old q in iii, old twf in avf. post-cath ekg showed transient st depressions in v4-v6 (ekg on next morning back to baseline). . 2d-echocardiogram performed on demonstrated: ef 45% pre revascularization: 1.no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. no left ventricular aneurysm is seen. there is mild regional left ventricular systolic dysfunction. resting regional wall motion abnormalities include mild hypokinesia of the mid and apical portions of the inferior wall and the inferolateral walls. 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. 6.the mitral valve leaflets are mildly thickened. mild (1+) to moderate{ 2+} mitral regurgitation is seen. there is no pericardial effusion. . post revascularization: 1. biventricular systolic function remains unchanged. 2. mild to moderate mitral regurgitation persists. . cardiac cath performed on demonstrated: 1. selective coronary angiography demonstrated two vessel coronary artery disease and branch vessel disease in this right dominant circulation. the lmca had proximal calcification with a 30% proximal stenosis. the lad had a 40% proximal stenosis, a 70% d1 stenosis, and 70% origin stenoses in the s1 and s2. the lcx had a 70% hazy origin stenosis with a 70% stenosis in the om2. the rca was diffusely diseased and tortuous with a 70% proximal stenosis, and a 95% distal stenosis that involved the origin of the pda that was occluded. 2. right heart catheterization demonstrated normal right and minimally elevated left sided filling pressures with rvedp=7 mmhg and mean pcwp=12 mmhg. pulmonary arterial pressure was normal. cardiac output and index were 7.7 l/min and 3.8 l/min/m2 respectively. 3. left ventriculogram was not performed to reduce constrast load. 4. right femoral swan ganz catheter and femoral venous introducing sheath were sutured for transport to intenstive care unit. final diagnosis: 1. two vessel coronary artery disease with branch vessel disease. 2. normal rv diastolic function. minimal lv diastolic dysfunction. . cardiac cath : 1. selective coronary angiography of this right dominant system demonstrated three vessel cad. the lmca had an 80% distal stenosis. the lad had an 80% ostial stenosis and 70% mid-distal tubular lesion at the takeoff of the d1. the d1, s1, and s2 all had 80% ostial lesions. the lcx ostium was subtotally occluded. the om1 filled via the patent svg and both were free of obstructive disease. the rca was a small vessel and had sequential 90% stenosis at mid and distal segments. the r-pda was totally occluded. 2. conduit arterial angiography revealed patent single graft (svg-om1). 3. limited hemodynamic assessment demonstrated initial severe hypertension (up to map of 130 mmhg) that was successfully treated with intravenous nitroglycerine and a brief episode of hypotension followed by bradycardia following the administration of 200 mcg of ic nitro. this resolved shortly with treatment. 4. left ventriculography was deferred. 5. the lesion in the ostial lad was predilated with a 2.5mm balloon, stented with a 3.0 mm cypher stent and post dilated with a 3.5 mm balloon with lesion reduction to 0%. the final angiogram showed timi iii flow with no residual stenosis, no dissection, no perforation and no embolisation. the patient left the lab in a stable condition. 6. the ostium of the d2 was treated with poba using a 2.5 mm balloon. final angiogarm showed normal flow, minimal residual stenoses, no dissection, no perforation and no angiographic evidence of distal embolisation. the patient left the lab in a stable condition. 7. the mid lad lesion was treated with poba alone using a 2.5 mm and a 3.0 mm balloon, as no stent could be delivered. the final angiogram showed timi iii flow with <50% residual stenosis, no dissection, no perforation and no embolisation. the patient left the lab in a stable condition. . cxr : comparison with . slight improvement in the cardiac shadow size. left ventricular configuration still remains. aortic mural calcifications again noted. tiny pleural effusion. lower lobe atelectasis. no evidence of failure. osseous structures unchanged. changes of cabg. . le abi??????s: right 0.75, left 0.71. impression: bilateral tibial disease. . exercise mibi : 1. new moderate, reversible defect involving the entire lateral wall, at the level of exercise achieved. 2. normal left ventricular cavity size and function. calculated ef 49%. . laboratory data (see attached): normal chem7 (cr of 1.3 pre-cath came down to 1.0 when arrived in the ccu). wbc 5.7, hct 35.8 (baseline 35-40), plt 190 brief hospital course: this is a 77 year old male with h/o htn, hyperlipidemia, pvd, cva, s/p right cea, stemi (), 3vcad s/p cagb x1 (dr. ; svg-0>om1; ) who was admitted for ccu monitoring after cardiac cath with stent placement into lm/lad, c/b hypertensive urgency followed by hypotension and vagal reaction with hr in high 30s after iv and intracoronary nitro administration. . 1) hypotensive episode: this was likely due to a vagal reaction after intracoronary nitro administration. resolved after brief dopamine drip, ivf and atropine for bradycardia. . 2) cad: s/p cabg x1 (dr. ; svg-0>om1; ), now s/p cypher stent to lm/lad and failed attempt to stent mid-distal lad. he had intermittent cp during cath with transient ischemic changes on ekg. a post-cath check at midnight was without significant hematoma or changes in pulses. midnight hct was stable. pt was continued on asa, plavix. integrilin drip for continued for 18 hours after the sheath was pulled. nitro sl prn cp was not needed b/o abscence of cp. cardiac enzymes were stable. he was monitored for significant blood loss after cath but his hct remained stable. . 3) rhythm: bradycardic event resolved after atropine administration in cath lab. nsr on ekg. . 4) pump: ef of 45% and mild regional lv dysfunction on tte from . systolic chf likely secondary to htn. he will need to follow up with his primary care physician, may need a follow up tte as an outpatient. he should follow a salt restricted diet. . 5) arf: cr of 1.3 prior to arrival in ccu. recent arf also during last admission in resolving after ivf. cr was 1.0 when arrived in ccu. pt received about 400cc of dye load during cath. bicarb drip was started in cath lab. he received post-cath hydration with hco3 drip for 1.5l at 100cc/h followed by d5 1/2ns at 100cc/h to prevent contrast-induced nephropathy. he will have outpatient lab work on to check his creatinine. . 6) hyperlipidemia: continue statin . 7) htn: pt was hypertensive during stenting followed by hypotensive episode after iv and intracoronary nitro administration. normotensive when arrived in ccu. on discharge he was continued on his outpatient blood pressure meds (lopressor and amlodipine). . 8) pvd: known bruit over right groin. s/p right cea. claudication on history but palpable le pulses. outpatient management recommended. . 9) gerd: cont ppi. . 10) fen: cardiac diet. . 11) code: presumed full medications on admission: aspirin 325mg daily every morning plavix 75mg daily every morning metoprolol 50mg twice a day zocor 40mg daily every evening prilosec 20mg every morning norvasc 5mg daily every morning discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily) for 3 months. :*30 tablet(s)* refills:*3* 3. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 4. prilosec 20mg qday 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 7. outpatient lab work chem 7 on , . discharge disposition: home discharge diagnosis: primary diagnosis: 1. 3 vessel cad, s/p cagb and stenting 2. htn 3. bradycardic, hypotensive episode responsive to fluids, dopamine and atropine . secondary diagnosis: 1. s/p cva discharge condition: hemodynamically stable, no chest pain, tolerating pos, no groin bleeding. discharge instructions: you have been admitted for a cardiac catheterization. a stent has been placed in one of your coronary arteries. you have experienced prolonged radiation from the procedure. if you experience any skin changes on your back, please go to your pcp to have them evaluated. . please call your pcp for any chest pain, shortness of breath, fever, bleeding or any other concerning symptoms. followup instructions: please have your kidney function checked by a blood test on at your pcp's office. , j. you will also need to see dr. within 1-2 weeks for a full follow up appointment. procedure: coronary arteriography using two catheters 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] destruction of cranial and peripheral nerves procedure on three vessels diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified cardiac complications, not elsewhere classified systolic heart failure, unspecified other specified cardiac dysrhythmias other and unspecified angina pectoris 

Answer: The patient is high likely exposed to