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: cardiac catheterization history of present illness: mr. is an 85 yo m w/ h/o cad s/p cabg who presents w/ 1 day h/o cp. noontime on day pta pt. noted sudden onset of midsternal, dull cp & sob while seated and watching tv. cp resolved on own over next few hours and pt. was able to perform daily activities w/o additional pain/symptoms. the following day, pt. awoke w/ worsening, midsternal, dull cp and waited approx. 30 min. before calling lifeline for assistance. he denies diaphoresis, palpitations, dizziness, n/v, abd pain. . at osh pt. was found to have ecg notable for elevations in v2-v4 and positive tropinin values of 1.2 and 0.39. pt. was started on heparin gtt, asa, nitro, morphin, lopressor 2.5mg x 4 , & plavix 150mg with resolution of chest pain. ptt 150, and heparin gtt was stopped. . pt. was transferred to ed for cardiac catheterization, where found to be t: 98.2 hr:75 bp: 136/75 rr 18 & 100% 2l nc. evaluation revealed tropinin elevated to 1.27 although ecg was no longer notable for st elevations. past medical history: aortic porcine valve replacement () cabg dm chf mva requiring shoulder/knee operations. social history: lives alone in top floor of house, rents bottom floor out. tenants help with shopping, etc. only family in area is , hcp. exsmoker, 32 pack-year history - quit 10 years ago. no etoh, ivdu, herbal supplements. family history: no known h/o cardiac disease in fno known h/o cardiac disease in family. noncontributory. physical exam: vs: t 97.8, bp 87/51, hr 78, rr ,14 o2 100% on ac 500x14, peep 5, fio2 100% gen: elderly male, intubated and sedated heent: ncat. sclera anicteric. perrl, eomi. ett in place. neck: supple without appreciable jvd. cv: pmi located in 5th intercostal space, midclavicular line. distant heart sounds. rr w/ occasional early beats. normal s1, s2. sys murmur at lusb chest: rhonchorous breath sounds bilaterally anteriorly abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. groin: r groin w/ iabp and pa catheter sheath. cdi. l groin w/o hematoma or bruit. ext: cool bilat les. trace le edema bilaterally. 2+ dp, pt pulses bilat. pertinent results: cardiac cath performed on demonstrated: 90% prox and mid lad lesions s/p bms x 3 and 80% d1 s/p poba rhc: ra mean 8, rv 64/5, pa 64/36, pcw 23. co 4.06, ci 2.07 (on iabp and dopamine gtt) . cardiac cath performed on demonstrated: 1. coronary angiography of this right dominant system revealed three vessel coronary artery disease. the lmca was without angiographically evident flow limiting stenosis. the lad had a 90% proximal lesion, 90% mid lesion, diffuse distal disease, and an 80% diagonal lesion. the lcx had 70% stenosis. rca w/ 50% proximal stenosis and 80% stenosis r-pl. 2. limited resting hemodynamics revealed normal aortic systolic pressure of 116 mm hg. 3. left ventriculography was not performed. . echo : the left atrium is dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with anteroseptal/anterior hypokinesis/akinesis. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild to moderate aortic valve stenosis (area 1.1-1.2 cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion . ct chest w/o contrast; ct abdomen w/o contrast : 1. moderate bilateral pleural effusion with right lower lobe opacification and air bronchograms probably related to patient's recent history of aspiration pneumonia. bilateral linear opacities abutting both major fissures likely reflect atelectasis. 2. focal ground-glass opacities in the right upper lobe and lll 6 mm nodule just inferior to the left major fissure. no comparisons are available to assess stability - these is nonspecific and may be infectious vs inflammatory. in the absence of comparison studies to establish longitudinal stability, followup chest ct of pulmonary nodule is recommended in 12 months (assuming no risk factors for primary lung malignancy). 3. hyperdense exophytic focus arising from the left kidney. this may represent a hyperdense cyst - renal ultrasound or mri suggested for further assessment of solid vs cystic character. 4. no evidence of abscess or pancreatitis, within the limits of a ct examination. . video swallow : moderate-to-severe oropharyngeal dysphagia with aspiration noted of barium of all consistencies. . mri head : no acute intracranial pathology including no hemorrhage or infarction. . cardiac cath performed on demonstrated: 1. selective coronary angiography of this right dominant system revealed 2 vessel coronary artery disease. the lmca had moderate diffuse disease without critical lesions. the lad had a prior stent which was occluded proximally with thrombus noted. the lcx was a non-dominant vessel with 70% noted in stent restenosis. the rca was a dominant vessel and was not injected. 2. resting hemodynamics revealed normal right sided filling pressures with lvedp 10 mmhg. the pulmonary artery systolic blood pressure is mildly elevated at 31 mmhg. the cardiac index is elevated at 5.42 l/min/m2. there is evidence of systemic arterial systolic and diastolic hypotension with sbp 91 mmhg and dbp 52 mmhg. 3. successful ptca, thrombectomy and stenting of the mid lad with a 2.75 x 18 mm vision bms which was post dilated to 2.75 at high pressure. final angiography revealed no residual stenosis in the stent, no dissection and timi ii flow (see ptca comments) 4. successful ptca of the diagonal with a 2.0 x 15 mm voyager balloon. final angiography revealed a 20% residual stenosis in the diagonal, no dissection and timi ii flow. (see ptca comments) 5. successful iabp placement in right groin. . echo : the left atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with akinesis of the anteroseptum and anterior walls. there is no ventricular septal defect. right ventricular chamber size is normal. with borderline normal free wall function. a bioprosthetic aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , the left ventricular function is slightly worse. mild pulmonary artery systolic hypertension is now present cxr : in comparison with the study of , the patient has taken a somewhat better inspiration. there is persistent enlargement of the cardiac silhouette, though the pulmonary vascularity is essentially within normal limits. the blunting of the costophrenic angles has decreased and the hemidiaphragms are more sharply seen. pertinent discharge labs peak troponin t at 4.4 pituitary tsh 2.2, free t4 0.60 () discharge weight: 86.5 kg discharge cr 1.0, wbc 10.2, hct 33.6 brief hospital course: summary of long hospital course: 85 yom w/ as s/p porcine avr, dm, htn presented with stemi that was intitially interpreted at osh as nstemi (but upon further review was stemi), cath here demonstrated 3vd with plan for cabg but same evening developed chest pain, stemi --> bms to lad and poba to d1 w/ aspirated on table requiring intubation and complicated subsequent course including aspiration pneumonia, sepsis, influenza type a, pseudomonas uti, in-stent thrombosis in setting of holding plavix for peg placement, followed by re-bms of lad, angioplasty of diagonal branch c/b peri-cath vt requiring 2 shocks, hypotension --> iabp placement, pressors, and re-intubation with good recovery coming off pressors, extubated and hd stable. patient stable for discharge to rehab placement. . hospital course by problem: 85 yom w/ as s/p porcine avr, dm, htn presented with stemi . # cad/ischemia presented with stemi that was intitially interpreted at osh as nstemi (but upon further review was stemi), cath here demonstrated 3vd (lmca was without angiographically evident flow limiting stenosis. the lad had a 90% proximal lesion, 90% mid lesion, diffuse distal disease, and an 80% diagonal lesion. the lcx had 70% stenosis. rca w/ 50% proximal stenosis and 80% stenosis r-pl). plan was for cabg but same evening developed chest pain, stemi --> bmsx3 to lad and poba to d1. had in-stent thrombosis in setting of holding plavix for peg placement, followed by re-bms of lad, angioplasty of diagonal branch. pt was kept on aspirin 325mg, atorvastatin 80mg. an intervention to the lcx may be considered once stabilized after a stress test if pt wishes to do so. patient was restarted on metoprolol 12.5mg po bid on , with hr 60s, sbp 90-100s. continue metoprolol on discharge, and can follow up with cardiologist about addition of acei as tolerated after discharge. . # pump/acute systolic heart failure pt was initially in cardiogenic shock (as well as septic shock), and needed iabp, pressors, then recovered with echo showing ef 45-55% and moderate regional left ventricular systolic dysfunction with anteroseptal/anterior hypokinesis/akinesis. came off iabp and pressors after a few days and diuresed, started on bb and acei as bp tolerated, then low dose po lasix started to keep i/os even. after in-stent restenosis again had cardiogenic shock requiring iabp and pressors, this time needing pressors for an extended period. patient was restarted on metoprolol 12.5mg po bid on , with hr 60s, sbp 90-100s. continue metoprolol on discharge, and can follow up with cardiologist about addition of acei as tolerated after discharge. . # rhythm pt had new onset afib developing when septic after first intervention. this was treated with dccv and was amio loaded, heparin gtt started with transition to coumadin intially. coumadin was held in anticipation for peg and not restarted since pt did not have recurrence of afib (monitored closely on tele). amio was kept at 200mg daily at the time of d/c as it was felt that perhaps it was keeeping the pt in nsr. at the time of the in-stent thrombosis pt had peri-cath vt, but was monitored closely on tele and did not have any recurrence. given this was peri-cath it likely is not scar related (rather ischemia). patient discharged on amiodarone 200mg po daily to continue for 1 month after discharge from hospital . # arf pt developed acute renal failure hypotension during sepsis and cardiogenic shock with creatinine peakeing at 1.8. pt recovered renal function while holding diuresis and acei briefly and creatinine prior to d/c was 1.0. patient's weight at discharge was 86.5kg. patient was discharged on po lasix which should be titrated to keep patient euvolemic to negative 500ml out daily. . # id pt aspirated on the table at the time of the first intervention and developed aspiration pneumonia and levo, flagyl were started at that time (). ct torso demonstarted moderate bilateral pleural effusions with right lower lobe opacification and air bronchograms. pt developed sepsis subsequently by hd numbers and so on d/c'd levo and vanco, flagyl, cefepime were started. on spiked a fever to 103.4 and at this time id were consulted and found to be positive for influenza type a with id recommending supportive care (no tamiflu) and resp precautions for 7 days per infection control. on d/c'd vanco since afebrile and on d/c cefepime, flagyl. pt remained afebrile. given ms changes (see below) was urine cultured with pan-sensitive pseudomonas aeroginosa growing --> started cipro. when had in-stent thrombosis restarted broad spectrum abx given shock but was pan-cx negative --> d/c'd vanco, flagyl after 3 days empiric therapy aside from cipro which was continued for a 14 day course for complicated uti. cipro was discontinued on day 9 due to development of drug rash which improved with discontinuation. repeat ucx was equivocal. foley discontinued prior to discharge. pt continues to be at great risk for aspiration given abnormal swallowing and should be kept on aspiration precautions and should have aggressive chest pt for upper secretions. . # focal ground-glass opacities in the right upper lobe and lll 6 mm nodule inferior to the left major fissure. no comparisons were available; nonspecific and infectious vs inflammatory per rads --> followup chest ct of pulmonary nodule is recommended in 12 months. . # hyperdense exophytic focus arising from the left kidney. likely a hyperdense cyst per rads. recommend renal ultrasound or mri suggested for further assessment of solid vs cystic character as an outpatient. . # valves: s/p porcine avr miniminally elevated gradient . # ms changes on was found to be unresponsive and therefore had head ct and mri negative for acute hemorrhage. tsh nl, b12/folate nl, rpr neg ekg and cxr without change. neuro were consulted who thought this was toxic/metabolic. pt was then found to have pseudomonas uti and after rx with copro the ms changes improved. per hcp pt was very independant at home and able to perform adls. also per hcp very jumpy when depressed/anxious. w/u revelaed tsh nl, b12/folate nl, rpr neg ekg and cxr without change. patient at baseline mental status . # gi failed s+s , and s/p extubation and again video swallow . held coaumdin and plavix for 5 days given that gi, surgery and ir were consulted and all declined peg placement on plavix and given that bms was 3 weeks out (so thought to have had epithelialized and healed stent). after recovering from in-stent thrombosis had peg placed by surgery. pt had no complication and tf's were started and advanced afterwards and tolerated well. medications on admission: glipizide er 5mg po daily lasix 20mg po daily ibuprofen prn pain discharge medications: 1. aspirin 325 mg tablet : one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). 3. senna 8.8 mg/5 ml syrup : five (5) ml po bid (2 times a day). 4. lactulose 10 gram/15 ml syrup : thirty (30) ml po q8h (every 8 hours) as needed for constipation. 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. insulin glargine 100 unit/ml solution : twenty (20) units subcutaneous qhs at bedtime. 7. insulin aspart 100 unit/ml solution : variable doses subcutaneously subcutaneous as indicated by insulin sliding scale. 8. acetaminophen 500 mg tablet : one (1) tablet po q6h (every 6 hours) as needed. 9. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 10. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 11. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 12. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 13. amiodarone 200 mg tablet : one (1) tablet po daily (daily). 14. ipratropium bromide 0.02 % solution : one (1) nebulizer inhalation q6h (every 6 hours). 15. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical qid (4 times a day) as needed. 16. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day): hold for sbp<80, hr<50. 17. furosemide 40 mg tablet : three (3) tablet po bid (2 times a day): hold for sbp<80. discharge disposition: extended care facility: northeast - discharge diagnosis: # st elevation myocardial infarction with bms to lad and poba to d1 - 3vd on cath # aspiration pneumonia # sepsis # influenza type a # acute renal failure # new onset afib s/p dccv - remained in sr after dccv # focal ground-glass opacities in the right upper lobe and lll 6 mm nodule inferior to the left major fissure - followup chest ct of pulmonary nodule is recommended in 12 months # hyperdense exophytic focus arising from the left kidney - recommend renal ultrasound or mri suggested for further assessment of solid vs cystic character as an outpatient # acute systolic heart failure - lvef 45-55% # dm # hypertension . secondary diagnosis: # as s/p porcine avr # s/p mva requiring shoulder/knee operations. discharge condition: stable discharge instructions: - you were admitted to with an st elevation myocardial infarction. - please take your previous medications as prescribed including aspirin to prevent another heart attack, atorvastatin 80mg daily for your heart and for your cholesterol, lisinopril for your heart and blood pressure (prevents remodelling of the heart), metoprolol for your heart and blood pressure (prevents remodelling of the heart), and clopidogrel (plavix) 75 mg daily to keep your cardiac stents open. you will need to take amiodarone for 1 month after discharge, also will continue on lasix for removal of fluid. - if you develop chest pain, jaw pain, or chest pressure with pain radiating into arm, or if you for any reason become concerned about your medical condition please call 911 or present to nearest ed. - we also gave you nitroglycerin tablets to take if you experience chest pain, please call 911 or your doctor if chest pain recurs even if it dissapears with nitroglycerine. **do not stop taking the aspirin or plavix unless instructed to do so by your cardiologist even if another doctor tells you to** - please make all of you appointments as outlined below. followup instructions: you have a follow up appointment with dr. , your cardiologist, on monday at 4:40pm. please also make an appointment to see your primary care provider 2 weeks of discharge from the hospital. at this appointment, please follow up on the following issues: started amiodarone for atrial fibrillation; lfts were mildly elevated, likely venous congestion, and tsh was normal; cxr at that time showed resolving aspiration pna. will need lfts q3months, tsh annually, and pfts within one month of discharge as well as complete eye exam within one month of discharge for amiodarone safety monitoring. procedure: venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] implant of pulsation balloon implant of pulsation balloon cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] insertion of three vascular stents procedure on two vessels destruction of cranial and peripheral nerves procedure on three vessels diagnoses: coronary atherosclerosis of native coronary artery other postoperative infection congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis acute myocardial infarction of other anterior wall, initial episode of care cardiac complications, not elsewhere classified atrial fibrillation paroxysmal ventricular tachycardia pneumonitis due to inhalation of food or vomitus cardiogenic shock other complications due to other cardiac device, implant, and graft acute systolic heart failure heart valve replaced by transplant influenza with pneumonia 

Answer: The patient is high likely exposed to