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/dyspnea on exertion major surgical or invasive procedure: - off pump cabg x 2 (internal mammary to left anterior descending artery, vein graft to obtuse marginal). - cardiac catheterization history of present illness: this 75 year old female with a history of hypertension, smoking and hyperlipidemia was recently referred to dr. for evaluation of new onset chest pain. two weeks ago, she awoke from sleep with chest pain that lasted for an hour. since then, she has had one further episode of chest pain, occuring at rest. she took mylanta at that time with relief of her symptoms. she has also been experiencing new onset dyspnea with exertion. she has dyspnea after walking about 2 blocks. she denies claudication, orthopnea, pnd, and lightheadedness. she has left ankle edema. she was referred for a stress test, done at the on . she exercised for 6?????? protocol. negative for chest pain. positive for 3mm downsloping st segment depressions in leads ii, iii, avf and v4-v6. nuclear imaging was significant for a severe reversible anterior defect involving the mid and apical segments of the anterior wall, mid and apical segments of the upper septum and apical segment of the apex. ef 87%. past medical history: hypertension hyperlipidemia glaucoma hysterectomy cyst removed from ovary d&c cataract surgery to the right eye with a lens implant social history: social: lives alone, works for the mass highway dept as an administrative assistant. she has no children. has a 40-80 pack year history of smoking quitting 9 days ago. occassional alcohol consumption. family history: father died of mi at age 56 physical exam: 57 sb 16 145/77 62" 148lbs gen: nad heent: ncat, perrl, anicteric sclera, op benign neck: supple, from lungs: mildly diminished breath sounds at left base heart: rrr, , no m/r/g abd: soft, nt, nd, nabs ext: warm, well perfused without edema. no varicosities noted on standing neuro: nonfocal pertinent results: 09:00am pt-11.9 ptt-29.9 inr(pt)-1.0 09:00am wbc-8.8 rbc-4.24 hgb-12.0 hct-35.4* mcv-84 mch-28.2 mchc-33.8 rdw-13.6 09:00am %hba1c-6.3* -done -done 09:00am alt(sgpt)-27 ast(sgot)-23 ck(cpk)-86 alk phos-54 amylase-30 tot bili-0.2 dir bili-0.1 indir bil-0.1 09:00am glucose-217* urea n-18 creat-0.9 sodium-135 potassium-3.3 chloride-97 total co2-31 anion gap-10 11:27am urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-9.0* leuk-neg cardiac catheterization 1. coronary angiography of this right dominant system demonstrated 3 vessel coronary artery disease. the lmca had no angiographically apparent flow-limiting disease. the lad had a 90% proximal stenosis and a 70% mid-vessel stenosis. the diagonal-1 branch was small and had a 40% distal stenosis. the lcx had a 70% mid-vessel stenosis. the om1 had diffuse disease with a 40% stenosis. the om2 was occluded. the rca had a proximal total occlusion. there were left to right collaterals. 2. limited resting hemodynamics revealed elevated left sided filling pressure with a lvedp of 16 mmhg. the systemic arterial pressure was normal with a bp of 136/65 mmhg. there was no transaortic valve gradient on pullback of the catheter from the lv to the aorta. 3. left ventriculography demonstrated no mitral regurgitation. the calculated lvef was 67%. there was normal lv systolic wall motion. echo the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 11-15mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. there is no ventricular septal defect. the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trace to mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. carotid ultrasound less than 40% stenosis of the proximal internal carotid arteries bilaterally. this is a baseline examination at the . brief hospital course: ms. was admitted to the on for a cardiac catheterization. this revealed three vessel coronary artery disease and given the severity of it, the cardiac surgical service was consulted. ms. was worked-up in the usual preoperative manner including a carotid duplex ultrasound which showed less then a 40% stenosis of the bilateral internal carotid arteries. given that her preoperative chest x-ray and echocardiogram showed an atherosclerotic aorta, it was planned to do her surgery off pump. on , ms. was taken to the operating room where she underwent off pump coronary artery bypass grafting to vessels. postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. by postoperative day one, ms. had awoke neurologically intact and was extubated. gentle diuresis was initiated. the physical therapy service was consulted for assistance with her postoperative strength and mobility. on postoperative day four, she was transferred to the step down unit for further recovery. she developed atrial fibrillation which converted to normal sinus rhythm with an increase in her beta blockade. as she continued to have paroxysmal rate controlled atrial fibrillation, coumadin was started for anticoagulation. her white blood cell count was mildly elevated however slowly trended back towards normal. no evidence of infection was found and a repeat white cell count will be checked . she continued to make steady progress and was discharged to rehab on . she will follow-up with dr. , her cardiologist and her primary care physician as an outpatient. her coumadin will be managed by dr. or dr. upon discharge from rehab for a goal inr of 2.0-2.5 for atrial fibrillation. medications on admission: hctz 25mg daily atenolol 25mg daily simvastatin 20mg daily timolol eye gtts one drop both eyes aspirin 325mg daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 4. zocor 20 mg tablet sig: one (1) tablet po at bedtime. 5. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 6. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily) for 1 months. 8. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 1 months. 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 10. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) for 1 months. 11. lasix 40 mg tablet sig: one (1) tablet po once a day for 5 days: take for five days with potassium and then stop. 12. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 5 days: take with lasix and stop when lasix stopped. . 13. coumadin 1 mg tablet sig: dose for goal inr of 2.0-2.5 tablets po once a day: dose for goal inr of 2.0-2.5 for atrial fibrillation. monitor daily pt/inr and dose accordingly. . discharge disposition: extended care facility: rehab & nursing center - discharge diagnosis: cad htn glaucoma af discharge condition: stable discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5)no lifting greater then 10 pounds for 10 weeksfroom date of surgery. 6)no driving for 1 month. 7)take lasix 40mg once daily with potassium 20meq once daily for five days and then stop. please monitor electrolytes and replete as needed. 8)take coumadin daily for goal inr of 2.0-2.5 for atrial fibrillation. please monitor daily pt/inr for appropriate dosing. dr. (pcp) or dr. (cardiologist) ( will manage her coumadin as an outpatient. please call to arrange follow-up appointment prior to discharge from rehab. she received her coumadin dose (4mg) for . 9)please check white blood cell count on monday . 10)please call wih any questions or concerns. followup instructions: with dr. (pcp) in weeks with dr. (cardiologist) in weeks with dr. in weeks (cardiac surgeon) ( please call all providers for appointments. needs coumadin follow-up upon discharge from rehab. likely dr. (pcp) or if patient prefers dr. cardiologist . please call to arrange when patient discharged from rehab. goal inr is 2.0-2.5 for af. procedure: single internal mammary-coronary artery bypass angiocardiography of left heart structures left heart cardiac catheterization coronary arteriography using a single catheter (aorto)coronary bypass of one coronary artery diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome tobacco use disorder unspecified essential hypertension atherosclerosis of aorta atrial fibrillation other and unspecified hyperlipidemia 

Answer: The patient is high likely exposed to