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: cardiac catheterization . swan placement. intra-aortic balloon pump placement. history of present illness: 79 year-old female new to with a history htn and presumed cad who presented to osh ed the morning of admission with sob, orthopnea and le edema present for the past two months but worsening over the past week. the night prior to admission her sob significantly worsened with the inability to lie flat. during the previous two days, she reports intermittent left shoulder pain that she attributed to her bursitis. she denied any chest pain at that time. given the difficulty with her breathing she presenting to the ed. initial ecg obtained in ed noted 1mm ste v1-v4. prior to transfer, she recieved lopressor 5 mg iv, plavix 600 mg, asa 81 mg x4 tabs, heparin bolus and gtt. . on further questioning she describes a "funny" sensation in her chest that she first noted 6 weeks prior. the patient was referred to a cardiologist by her pcp, she underwent a non-exercise stress test and echocardiogram. patient unclear of the results but was under the impression that the findings were unremarkable. on arrival to ccu post catherization, patient feels well and is without cp or sob. no back pain. minimal groin discomfort. states that it is the best she has felt in months. . catherization: severe 3vd as below. patient was discussed with cardiac surgery who declined possible cabg given poor distal targets. iabp inserted. ptca to mid lad with fair results. des placed mid lcx. transferred to ccu on iabp for further management. . remaining cardiac review of systems is notable for abscence of chest pain or dyspnea on exertion, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope. . on review of symptoms, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative in detail. past medical history: 1. likely cad (unknown to patient) 2. hypertension 3. hyperlipidemia 4. chornic bronchitis (non-smoker) 5. shoulder bursitis social history: patient denies alcohol or tobacco use. family history: patient denies family history of coronary disease or sudden death. physical exam: blood pressure was 118/68 lying. pulse was 83 beats/min and regular, respiratory rate was 16 breaths/min. . general: lying flat in nad. well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. heent: conjunctiva were pink with no pallor or cyanosis of the oral mucosa. neck: supple with jvp difficult to determine lying flat. the carotid waveform was normal. there was no thyromegaly. chest: no chest wall deformities, scoliosis or kyphosis. the respirations were a bit rapid but not labored and there were no use of accessory muscles. speaking in full sentences. the lungs were clear to ascultation anteriorly with normal breath sounds and no adventitial sounds or rubs. cardiac: pmi nondisplaced. there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. given sounds of iabp unable to determine presence of rubs, murmurs, clicks or gallops. abdomen: obese, soft. aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. extremities: no pallor, cyanosis, clubbing. trace non-pitting le edema. there were no abdominal, femoral or carotid bruits. left and right femoral cvl with minimal oozing. skin: inspection and/or palpation of skin and subcutaneous tissue showed multiple sub keratosis and dysplatic nevi. no stasis dermatitis, ulcers, scars. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp trace pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp trace pt 1+ pertinent results: labwork on admission: 01:44pm wbc-8.4 rbc-3.85* hgb-11.5* hct-33.5* mcv-87 mch-29.9 mchc-34.3 rdw-14.2 01:44pm plt count-274 01:44pm pt-14.3* ptt-121.2* inr(pt)-1.3* 11:40am type-art po2-90 pco2-41 ph-7.40 total co2-26 base xs-0 intubated-not intuba comments-nc 11:40am o2 sat-96 01:44pm %hba1c-6.0* -done -done 01:44pm albumin-3.8 01:44pm ck-mb-7 ctropnt-1.03* 01:44pm alt(sgpt)-10 ast(sgot)-31 ck(cpk)-114 alk phos-98 tot bili-0.8 01:44pm glucose-135* urea n-17 creat-1.2* sodium-141 potassium-3.8 chloride-105 total co2-24 anion gap-16 08:09pm ck-mb-10 mb indx-6.0 . ecg: sinus rhythm. st segment elevations in leads v1-v5 with qs deflections in leads v1-v3. q waves in lead v4. these findings are consistent with acute anterior and lateral myocardial infarction. followup and clinical correlation are suggested. no previous tracing available for comparison. . cardiac cath : comments: 1) selective coronary angiography of this right dominant system demonstrated 3 vessel coronary artery disease. the lmca was patent. the lad had 99% stenosis in the mid vessel with severe diffuse disease throughout the mid and distal vessel. the lcx had 95% mid stenosis. the ramus had 80% stenosis proximally and 70% stenosis in the mid vessel. the rca had 99% proximal disease and 100% stenosis in the mid vessel with left to right collaterals. 2) resting hemodynamics were performed. the right sided filling pressures were elevated (mean ra pressure was 30mmhg and rvedp was 30mmhg). the pulmonary artery pressures were elevated measuring 65/40mmhg. the left sided filling pressures were elevated (mean pcw pressure was 40mmhg). the systemic arterial pressures were within normal range measuring 130/80mmhg. the cardiac index was depressed measuring 1.6 l/min/m2. 3) 34 cc intraaortic balloon pump placed via the left femoral artery. 4) successful ptca of the mid lad was performed with a 2.5 mm balloon. final angiography revealed appx 30% residual stenosis and severe diffuse distal disease. stenting was not pursued do to lack of outflow. 5) successful ptca and stenting was performed of the cx with a 3.0x33 mm cypher stent which was proximally postdilated to 3.5 mm. final angiography revealed 0% residual stenosis, no dissection, and normal flow. (see ptca comments) final diagnosis: 1. three vessel coronary artery disease. 2. elevated left and right sided filling pressures. 3. depressed cardiac index. 4. iabp placement. 5. successful ptca of the mid lad with severe distal disease and poor runoff. 6. successful ptca and stenting of the cx with a drug eluting stent. . echo : conclusions: left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe regional left ventricular systolic dysfunction with akinesis of the anterior wall, septum and apex. there is hypokinesis of the inferior wall. basal inferolateral and lateral segments contract best. no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. 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. there is a trivial/physiologic pericardial effusion. . impression: dilated left ventricle with severe regional systolic dysfunction. mild mitral regurgitation (during intraaortic balloon counterpulsation). mild pulmonary hypertension . portable cxr : intra-aortic balloon pump terminates about 4.5 cm below the superior aspect of the aortic knob. swan-ganz catheter makes a slightly upward turn and may be in the proximal truncus anterior. cardiac silhouette is enlarged. mild bilateral perihilar edema is present as well as moderate bilateral partially layering pleural effusions. . portable cxr : i do not see the tip marker of an intraaortic balloon pump. heart is top normal size. thoracic aorta is generally large but not focally aneurysmal. small left pleural effusion is present. pulmonary edema has cleared . ecg : sinus rhythm. late transition with anterior q wave and st segment elevations consistent with acute or evolving infarction. non-specific lateral st-t wave changes. compared to the previous tracing no significant change. . labwork on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:05am 5.2 3.31* 9.9* 29.0* 88 30.0 34.3 14.2 189 renal & glucose glucose urean creat na k cl hco3 angap 07:05am 91 26* 1.3* 144 4.2 106 27 15 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 07:05am 18.2* 84.3* 1.7* brief hospital course: 79 year-old female with history of hypertension and presumed cad due to tte showing depressed ef , presents with progressive sob and orthopnea, found to have anterior stemi s/p pci to lad and lcx and decompensated heart failure. . 1. coronary artery disease/ischemia: the patient was noted to have st elevations in anterior leads and was transferred from an osh for cardiac catheterization, which revealed severe 3-vessel disease. she was evaluated by cardiac surgery in the cardiac cath lab, but deemed not to be a surgical candidate given her anatomy (lack of touch-down points). a drug eluding stent was placed to the left circumflex, and balloon angioplasty performed to the lad lesion. swan-ganz catheter was placed and the patient's cardiac index calculated at 1.64; therefore, an intra-aortic balloon pump was placed. she was given integrilin x 18 hours and heparin gtt. the patient was initially on aspirin 325 mg during hospitalization but this was changed to 81 mg to minimize bleeding risk as the patient will be on aspirin, plavix, and coumadin. the patient was started on plavix high-dose and atorvastatin. the iabp was discontinued after her cardiac index improved to >2.0, and low dose ace-inhibitor and beta-blocker started as tolerated by the patient's blood pressure. the patient's ck peaked at only 164; the patient's myocardial infarction likely occurred prior to hospitalization. she remained chest-pain free throughout hospitalization. the patient will follow-up with dr. from cardiology. . 2. pump: the patient had an echocardiogram in revealing an lvef of 35%. she presented with decompensated heart failure, and was diuresed with iv lasix. after the cardiac cath, an iabp was placed for low cardiac index (1.64) as noted above. this was weaned once her c.i. rose to >2.0. her breathing and orthopnea improved (the patient could again lie flat), and she was placed on maintenance lasix (40 mg po daily). the patient was started on ace-inhibitor, then beta-blocker after her decompensated heart failure resolved as her blood pressure tolerated. repeat echocardiogram revealed worsened lvef of 20%, akinesis of the anterior wall, septum and apex, and hypokinesis of the inferior wall. because of these wall motion abnormalities, the patient was started on coumadin and bridged with heparin and then lovenox until inr became therapeutic. lovenox should be discontinued once inr at goal . she will follow up with dr. from cardiology. . 3. rhythm: the patient was in normal sinus rhythm throughout hospitalization without events on telemetry. due to her low ef, she should be considered for an icd for primary prevention of sudden cardiac death. she will need a repeat echocardiogram after four weeks and outpatient evaluation for an icd. . 4. hypertension: her outpatient regimen was discontinued. systolic blood pressure 90-110s during her hospitalization. she was started on low dose ace-inhibitor and then beta-blocker as tolerated by her blood pressures. doses were occasionally held as holding parameters were for systolic < 100. . 5. hyperlipidemia: the patient was continued on statin therapy. . 6. chronic bronchitis: the patient was continued on advair and given nebulizer treatments as needed. . 7. renal failure: the patient's baseline creatinine appears to be approximately 1.3, with creatinine clearance 25. this is likely secondary to long-standing hypertension. the patient's medications were renally dosed. . 8. anemia: patient's hematocrit on discharge was 29 and normocytic. further work-up and management deferred to her primary care physician. . 9. code: full . 10. disposition: rehabilitation for deconditioning medications on admission: advair hctz 12.5 norvasc 5 atenolol 50 imdur 30 asa 325 lovastatin 40 discharge disposition: extended care facility: landing discharge diagnosis: primary: 1. anterior st-elevation myocardial infarction 2. congestive heart failure, ef 20% 3. akinesis of the cardiac apex . secondary: 1. hypertension 2. hyperlipidemia 3. chornic bronchitis (non-smoker) 4. shoulder bursitis discharge condition: afebrile, vital signs stable. discharge instructions: you were admitted with shortness of breath and found to have a heart attack resulting in congestive heart failure. you underwent cardiac catheterization with interventions to improve the blood flow to your coronary arteries. you were started on a number of medications for your heart. you were also started on a blood thinner, coumadin, to prevent clots. this medication will need frequent monitoring and adjustment of your dose. . your medications have changed. please review the list carefully. you should stop taking atenolol, norvasc, hydrochlorothiazine, and imdur. you were started on plavix, coumadin, carvedilol, lisinopril, and lasix. you should continue taking aspirin 81 mg daily. you should continue taking advair. . call your doctor or return to the hospital if you have chest pain, shortness of breath, palpitations, or any other symptom that concerns you. . please keep your follow-up appointments as below. please call the office of your new cardiologist, dr. , at prior to your appointment to provide your insurance information. followup instructions: follow-up with your new cardiologist: provider: , .d. phone: date/time: 9:00. please call the office prior to your appointment to provide your insurance information. . please call to make a follow-up appointment with your primary care physician, . , at within two weeks of discharge from the rehab facility. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor implant of pulsation balloon 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] procedure on two vessels diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension unspecified chronic bronchitis 

Answer: The patient is high likely exposed to