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: nstemi major surgical or invasive procedure: cardiac catheterization hemodialysis tunneled dialysis catheter placement history of present illness: the pt is a 72y.o m with a pmh of cad, af, cri now with nstemi. pt initally admitted to osh with complaints of increased chest discomfort at rest. found to have nstemi with ck peak 362 ckmb 12-16% per report and trop 2.33. creatinine . being transferred with plan for catheterization on friday after evaluation by renal team re: possible placement of dialysis catheter for likely need of post cath dialysis. pt previously admitted with angina however had an ecg without changes and had flat ce. since cardiac catheterization would be a high risk procedure in the setting of his chronic renal nsufficiency, he was medically managed. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. on arrival to the medical floor the patient reports chest tightness without radiation, similar to prior. denies dyspnea, nausea, diaphoresis. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: -percutaneous coronary interventions : -->lmca without disease -->lad with diffuse disease and vasospasm, reversed with tng -->d1: ulcerated 80% lesion -->lcx: distal vasospasm, reversed with tng -->rca: severe diffuse disease with serial 90% lesions in the pda and 80% stenosis in the mid-rca final diagnosis: 1. three vessel coronary artery disease. 2. acute myocardial infarction, secondary to severe lad and lcx coronary vasospasm. this was managed by intracoronary and intravenous diltiazem and nitroglycerin therapies. 3. other past medical history: -three vessel cad: see above for details -perioperative (bowel resection) vasospasm requiring cardiac cath with ntg -mild-moderate mr ef: 45% with focal inferior-posterior wall motion abnormalities -ischemic colitis: s/p sma thrombectomy, with pouch and end ileostomy. also complicated by recent diversion colitis in 2/. -peripheral disease s/p aortobifemoral bypass -raynauds -dementia -stage iv ckd: baseline creatinine appears to be around -atrial fibrillation -h/o perioperative cva: no deficits -hyperlipidemia -htn -h/o achalasia s/p esophageal dilation -h/o vre infection social history: -tobacco history: 40 pack years, quit 10 years ago -etoh: none -illicit drugs: none family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: 98.4 117/58 68 20 100,2l general: wdwn in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 6cm. bilat carotid bruits. cardiac: rrr, normal s1, s2. 2/6 systolic murmur at llsb, no rubs/gallops. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: nabs. soft, ntnd. extremities: no edema. wwp. 2+ dp pulses. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: 10:40pm blood wbc-8.3 rbc-3.38* hgb-9.2* hct-28.6* mcv-85 mch-27.3 mchc-32.3 rdw-17.0* plt ct-238 11:00am blood wbc-9.1 rbc-2.61* hgb-7.4* hct-22.1* mcv-85 mch-28.3 mchc-33.4 rdw-16.6* plt ct-260 11:22pm blood hct-33.1*# 05:25am blood wbc-14.9* rbc-4.04* hgb-11.4* hct-34.2* mcv-85 mch-28.2 mchc-33.3 rdw-17.8* plt ct-314 04:52am blood wbc-12.7* rbc-3.58* hgb-9.9* hct-31.0* mcv-87 mch-27.6 mchc-31.9 rdw-17.5* plt ct-228 10:40pm blood pt-24.2* ptt-36.3* inr(pt)-2.4* 05:20am blood pt-15.7* ptt-73.3* inr(pt)-1.4* 04:52am blood pt-21.4* ptt-35.0 inr(pt)-2.0* 10:40pm blood glucose-108* urean-89* creat-7.2*# na-139 k-4.0 cl-112* hco3-15* angap-16 04:52am blood glucose-81 urean-28* creat-4.9*# na-134 k-4.9 cl-97 hco3-28 angap-14 10:40pm blood ck(cpk)-171 12:15pm blood ck(cpk)-69 10:40pm blood ck-mb-9 ctropnt-0.26* 07:10am blood ck-mb-8 ctropnt-0.32* 02:46pm blood ck-mb-notdone ctropnt-0.45* 05:56am blood ck-mb-notdone ctropnt-0.68* 12:15pm blood ck-mb-notdone ctropnt-0.10* 05:56am blood caltibc-281 ferritn-74 trf-216 07:10am blood hbsag-negative hbsab-negative 07:10am blood hcv ab-negative 02:41pm urine color-straw appear-clear sp -1.004 02:41pm urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-tr 02:41pm urine rbc-<1 wbc-4 bacteri-few yeast-none epi-<1 tte (): the left atrium is elongated. mild regional left ventricular systolic dysfunction with mid inferolateral wall to distal inferior wall akinesis. lvef 50-55%. + mr. mild pulmonary artery systolic hypertension. carotid u/s (): 1. calcified plaque with 40-59% stenosis of the right internal carotid artery. 2. calcified plaque with less than 40% stenosis of the left internal carotid artery. cardiac cath (): 1. selective coronary angiography of this co-dominant system demonstrated severe three vessel coronary artery disease. the lmca had no angiographically apparent disease. the lad had a 70% very distal to apical disease. there was an 80% diffuse stenosis in a small to medium 1st diagonal branch. the lcx had a second om with a 90% stenosis and a to in the om3. there was insignificant plaquing in the large l posterolateral branch. the rca had an 80% distal stenosis and a diffuse 60-70% stenosis in a small pda. 2. resting hemodynamics revealed elevated right and left ventricular enddiastolic filling pressures at 13 and 16 mmhg. the mean pa pressure was 23 mmhg (phasic 35/13 mmhg). the pcwp was 16 mmhg. the cardiac index was 3.5 l/min/m2. the mean systemic arterial pressure was 91 (161/56 mmhg). 4. successful ptca and stenting of the rca with a 3.0x18mm vision stent. final angiography revealed no residual stenosis, no angiographically apparent dissection and timi iii flow (see ptca comments). 4. successful ptca and stenting of the om2 with a 2.0x23mm mini vision stent. fianl angiography revealed no residual stenosis, no angiographically apparent dissection and timi iii flow (see ptca comments). 5. unsuccessful attempt to ptca of the small 1st diagonal branch. brief hospital course: 1. nstemi: his cardiac markers trended down at . he was initially started on heparin and nitroglycerin drips, and continued on asa, clopidogrel, carvedilol, and statin. echo showed new akinesis of inferior/inferolateral walls, although preserved ef. he went to cardiac cath, where he had stenting of rca and om2. he was transferred to the ccu afterwards for htn. he was initially controlled with nitroprusside and nitroglycerin gtt. upon arrival to ccu patient was only on nitroglycerin gtt and this was quickly weaned off. he had slightly higher bps in the morning and was started on captopril, later changed to lisinopril. ck and ckmb were followed and trended down. he was subsequently asymptomatic except for an episode of cp with dynamic st depressions after an hd session, resolved with ntg sl, cardiac markers flat. his isosorbide dose was increased from 10mg tid to 30mg tid and he had no further symptoms. 2. end-stage renal disease: patient's outpatient nephrologist felt he was ready to begin hd. he received acetylcysteine 1200mg po bid x4 doses as well as bicarb hydration prior to/after cardiac cath for renal protection, but hd was still deemed necessary. he received hd initially in the ccu via a temporary catheter. he later had a right chest tunneled catheter placed and underwent tu/th/sat hd via this. he noted some intermittent extremity cramping, associated with fasciculations on exam, felt related to his newly started dialysis. these improved during the admission. he was also continued on ca acetate, started on sevelamer, and received iron at hd. hepatitis serology and ppd were negative. 3. atrial fibrillation: remained in sinus rhythm during this admission. initially on heparin alone with warfarin held for his tunneled catheter placement. after this, warfarin was restarted and bridged with heparin until his inr was therapeutic. his warfarin dose was increased from 2.5mg to 5mg daily to achieve this, and will be checked at his outpatient lab 2 days after discharge. 4. hypertension: bp was intially elevated and managed in the ccu as above. on the floor, he had further htn that improved with his hd sessions. he was discharged normotensive on lisinopril and carvedilol. 5. anemia: early in admission, his hematocrit trended down to 22.1 with no evidence of active bleeding. he was transfused two units prbcs with ~10 point improvement in hematocrit, which remained stable. 6. bruits: had carotid and abdominal bruits on exam. carotid u/s obtained showed noncritical ica stenosis. review of ct abdomen from last year showed significant aortic calcifications, stable from prior study, which was felt to be the cause of his abdominal bruit. medications on admission: isosorbide mononitrate 60mg omeprazole 20mg daily asa 81mg daily carvedilol 12.5mg loperarime 2mg warfarin 2.5mg daily lovastatin 20mg daily phoslo 667mg tidwm ferrous sulfate 325mg tid ntg prn epogen q other week prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. loperamide 2 mg tablet sig: one (1) tablet po twice a day as needed. 4. lovastatin 20 mg tablet sig: one (1) tablet po once a day. 5. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). disp:*180 capsule(s)* refills:*2* 6. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) sublingual as needed. 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily) for 30 days. disp:*30 tablet(s)* refills:*0* 9. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. sevelamer hcl 800 mg tablet sig: one (1) tablet po three times a day: with meals. disp:*90 tablet(s)* refills:*2* 11. warfarin 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 13. isosorbide dinitrate 30 mg tablet sig: one (1) tablet po three times a day: on dialysis days, give after hd. disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: primary: non st-elevation myocardial infarction end stage renal disease secondary: hypertension chronic systolic heart failure atrial fibrillation discharge condition: stable discharge instructions: you were admitted to after having a small heart attack. you had two stents placed in your coronary arteries (that supply the heart muscle) and your heart pumping function remains good. you were also started on dialysis for your kidney failure and received 2 units of blood for anemia (low red blood cells). please go to all follow up appointments and take all medications as prescribed. we have made the following medication changes: 1. increase aspirin to 325mg daily for one month, then you may resume the 81mg daily dose. 2. take clopdiogrel daily for one month to prevent clots in your stents. 3. decreased your isosorbide mononitrate to isosorbide dinitrate 30mg three times daily. 4. decreased your carvedilol to 6.25mg twice daily. 5. increased your calcium acetate (phoslo) to 2 tabs three times daily. 6. started sevelamer, which helps prevent phosphate from becoming too high. 7. stopped your oral iron (you will get this at dialysis). 8. started nephrocaps, a vitamin for patients with kidney damage. 9. started lisinopril, a blood pressure medicine that also helps the heart. 10. changed omeprazole to pantoprazole, as this is less likely to interact with your heart medications. 11. increased warfarin to 5mg daily as your blood test (inr) was not high enough on 2.5mg daily. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. if you experience chest pain or pressure, trouble breathing, fevers, chills, palpitations, lightheadedness, dizziness, or any other concerning symptoms, please seek medical attention or come to the er immediately. followup instructions: please go to your regular laboratory on tuesday to have an inr drawn to check if your warfarin dose is appropriate. have the results faxed to dr. at . if this can be done at dialysis instead, that would be acceptable. you will have dialysis on tuesday, thursday, and saturday at dialysis center. provider: , md phone: date/time: 11:00 please follow up with your primary care doctor, , on thursday at 10:00 am. phone: . please follow up with your cardiologist, , on at 9:00 am. phone: procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters hemodialysis venous catheterization for renal dialysis transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] destruction of cranial and peripheral nerves procedure on three vessels diagnoses: end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation occlusion and stenosis of carotid artery without mention of cerebral infarction hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia disorders of phosphorus metabolism chronic systolic heart failure leukocytosis, unspecified achalasia and cardiospasm other symptoms involving cardiovascular system 

Answer: The patient is high likely exposed to