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: sulfa (sulfonamide antibiotics) / nitrofurantoin mono-macro / cortisone / levoxyl attending: chief complaint: elective pci for three-vessel disease complicated by dissection of left main major surgical or invasive procedure: cardiac catheterization x2 with stents to the right coronary artery, left main artery, left anterior descending artery, obtuse marginal artery. history of present illness: this 75 year old woman has a history of obesity, hypertension, dyslipidemia, cad and syndrome with longstanding steroid use and subsequent development of dm. on she underwent cardiac catheterization at anginal sx and an abnormal ett. angiography revealed three vessel disease with a 50%stenosis of the rca, 40% lm, 80-90% stenosis of her om1 and om2, and a 90% stenosis of distal lad. lvef was noted at 60%. . she has since been evaluated by dr. from cardiac surgery. studies have revealed no usable lower extremity veins for cabg. in addition, it is felt that mrs. is quite high risk for sternal complications. plans were for pci of the rca, om1 and om2 by dr. with possible lima to lad by ctsurg at a later date. . during her catherization today her rca was stented and while trying to stent the om's the left main was dissected then stented. she denies any chest pain, and her ekg was not concerning for evolving mi. biomarkers were negative int he immediate post-procedure period. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: -pacing/icd: 3. other past medical history: - disease s/p ablation of pituitary adenoma at . - hip replacement for osteoarthritis. - obesity. - lower back pain. - status post right knee patella removal after motor vehicle accident. - history of left lower leg hematoma after a fall 3 years ago. - depression. - hypothyroidism. - deep vein thrombosis in left calf 3 years ago. - cataract in both eyes status post extraction. social history: she lives with her husband and daughter in a house. she has 4 children. she does not use any services currently. she is independent in her adl's but is known to have a gait disorder and a history of falls in the past. -tobacco history: never -etoh: none -illicit drugs: none family history: brother died from an mi at 50. daughter had a stent at age 36. physical exam: admission exam: general: obese elderly white woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple and obese. jvd not able to be assesed secondary to body habitus cardiac: s1 s2 faint sem lungs: obese distant breath sounds. cta bl abdomen: obese nt +bs extremities: le wwp venous stasis dermatitis bl with exfoliative scar on left anterior tibia. left ue is without erythema but mild non pitting edema. right ue has large resolving hematoma with pressure dressing in place. pulses: right: dp 2+ r not assesed pressure dressing left: dp 2+ r 2+ pertinent results: admission labs: 02:32pm wbc-9.4 rbc-3.67* hgb-8.9* hct-29.0* mcv-79* mch-24.3* mchc-30.7* rdw-15.7* 02:32pm pt-23.8* ptt-55.5* inr(pt)-2.3* 02:32pm calcium-8.8 phosphate-4.2 magnesium-2.4 02:32pm ck(cpk)-169 02:32pm ck-mb-13* mb indx-7.7 02:32pm glucose-263* urea n-45* creat-1.3* sodium-138 potassium-5.1 chloride-103 total co2-28 anion gap-12 11:25pm ck-mb-62* mb indx-8.4* ctropnt-2.74* 11:25pm lipase-26 11:25pm ck(cpk)-741* amylase-31 . cardiac catheterization : final diagnosis: 1. three vessel coronary artery disease. 2. patent lmca, lad, lcx and rca stents. 3. significant om1 lesion with flow. 4. stemi lateral. 5. moderate biventricular diastolic dysfunction. 6. normal cardiac index. 7. successful pci of om1 with bmsx2. . echo: left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction with hypokinesis of the basal inferior and inferolateral walls and akinesis of the distal inferior, septal, and anterior walls. the apex is mildly dyskinetic. the remaining segments contract normally (lvef = 30%). right ventricular chamber size and free wall motion are normal. mild (1+) mitral regurgitation is seen. there is an anterior space which most likely represents a prominent fat pad. compared with the prior study (images reviewed) of , the basal inferolateral and inferior walls are now hypokinetic. the anterior wall function and global systolic function are slightly improved. . labs on discharge: 07:45am blood wbc-11.0 rbc-3.70* hgb-9.7* hct-30.2* mcv-82 mch-26.1* mchc-31.9 rdw-17.0* plt ct-159 07:45am blood glucose-83 urean-34* creat-1.2* na-147* k-3.6 cl-108 hco3-34* angap-9 05:55am blood ck(cpk)-542* 05:50am blood ck(cpk)-843* 07:45am blood calcium-8.5 phos-2.6* mg-2.3 brief hospital course: 75 yo woman with cad sp pci of rca and om's complicated by dissection of left main with subsequent stenting and right radial hematoma. . # cad: no angina or st elevations immediately following first catheterization. ckmb is mildly elevated which could be evidence of evolving mi. will obtain echo and trend biomarkers. the patient had to return to the cath lab for revision of original procedure. on , the patient's sedation was lifted and she was extubated. she almost immediately to complain of chest pain. ecg showed st elevations, and she was brought to cath lab again. selective coronary angiography of her right dominant system revealed three-vessel cad. the lmca had patent stents with persistent dissection outside stents. the lad had patent stents with diffuse distal disease. the lcx had patent stents; the om1 had reopened since prior cath had had a 95% proximal stenosis with associated limited dissection from prior. the rca had patent stents with a 95% pda stenosis present on prior films. successful ptca and stenting of large om1 with two overlapping 2.25x12 minivision bare metal stents postdilated to 2.5mm. the medical management included aspirin, plavix, simvastatin, metoprolol and ezetimibe. she will be on plavix for the rest of her life. do not stop plavix without first speaking to dr. at . her peak ck was 4332 in the setting of extensive chest pain and manipulation of coronary arteries. her creatinine increased to 1.3 after contrast load, currently at 1.2. . # acute systolic dysfunction: the echocardiogram of showed reduced lvef of 30% in the setting of stemi. although cardiac catheterization showed high filling pressures, she has appeared euvolemic with no signs of fluid overload and has not required standing diuretics. her lisinopril was decreased to 5 mg daily. she should have daily weights and close monitoring of her fluid status. . # atrial fibrillation: noted in the setting of mi. currently in af with frequent bradycardia at night, she is asymptomatic with these episodes. she is on very low dose metoprolol for mi prevention but this can be discontinued if hr cont to be an issue. extensive discussion regarding coumadin. decision made to treat with asa and plavix only given hx of falls and likelihood that ef will increase in the long term. . # radial hematoma: resolving. no symptoms of compartment syndrome (pain, cap refill, pulses) were noted. . # disease: patient was cotinued on her home dose of 25mg of cortisef in the am and 5mg in pm. given the stressors, however, of her cardiac events, dosing was increased to 100mg. the endocrine team was consulted, and the patient was placed on 100mg hydrocortisone iv three times a day. as her condition stabilized, a taper was started and she is now currently back on her home cortisone . she will need to have stress dose steriods for any medical procedures. her endocrinologist at should be contact. . # dm: the patient was kept on an insulin sliding scale. her blood sugars were quite high with stress dose steriods but are now normalizing on a slightly decreased lantus dose. # depression: continued home escitalopram. . # hypothyroidism: patient was started on home dosing of synthroid. given that she was intubated on multiple occasions, however, she instead received iv levothyroxine at the same approximate dose for several days, now back on po dosing. . # hypertension: sbp was somewhat low so her imdur and norvasc was not restarted and her lisinopril was decreased to 5 mg daily. . # dyslipidemia: continued home dosing of simvastatin and ezetimibe. . # neuropathy: continue neurontin but dose to 300 mg daily. pcp would like to d/c entirely if possible. vicodin was restarted at discharge at home dose per family. this medicine is the only one that seems to alleviate pain. . # delerium: noted after extubation and thought to be related to sedation, icu stay and uti. her memory is mildly impaired at baseline. currently improving on scheduled seroquel dosing in the evening. would recommend freq reorientation, avoidance of benzos (tiny home dose of aprazolam d/c'ed) and night time interruptions. assume that pt will return to her home where she lives with her daughter and husband. . # papillomatous rash of groin: dermatology consulted and rec miconazole powder. currently improving. medications on admission: alprazolam - (prescribed by other provider) - 0.5 mg tablet - tablet(s) by mouth once a day amlodipine - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth once a day bumetanide - (prescribed by other provider) - 2 mg tablet - 3 tablet(s) by mouth once a day clopidogrel - 75 mg tablet - 8 tablet(s) by mouth x 1 on , then 75mg qd ergocalciferol (vitamin d2) - (prescribed by other provider) - 50,000 unit capsule - 1 capsule(s) by mouth weekly escitalopram - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth once a day ezetimibe-simvastatin ] - (prescribed by other provider) - 10 mg-80 mg tablet - 1 tablet(s) by mouth qpm gabapentin - (prescribed by other provider; dose adjustment - no new rx) - 300 mg capsule - 2 capsule(s) by mouth twice a day hydrocodone-acetaminophen - (prescribed by other provider) - 5 mg-500 mg tablet - 2 tablet(s) by mouth three times a day hydrocortisone - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth 20mg in am and 5mg in am and 5mg pm insulin glargine - (prescribed by other provider) - 100 unit/ml solution - 48 units am 15 units in pm insulin lispro - (prescribed by other provider) - 100 unit/ml solution - per sliding scale under 100 22 24 20 101-150 26 26 22 151-200 28 28 24 201-51-300 34 32 28 301-350 35 34 30 351-400 37 36 32 isosorbide mononitrate - (prescribed by other provider) - 30 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day levothyroxine - (prescribed by other provider) - 150 mcg tablet - 1 tablet(s) by mouth once a day lisinopril - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day pantoprazole - (prescribed by other provider) - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth twice a day pioglitazone - (prescribed by other provider) - 30 mg tablet - 1 tablet(s) by mouth once a day aspirin - (prescribed by other provider) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day senna - (prescribed by other provider) - 8.6 mg capsule - 1 capsule(s) by mouth at bedtime as needed hold if diarrhea discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): do not stop taking this medicine unless dr. tells you to. . 2. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for angina. 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 5. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 6. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 7. bumetanide 2 mg tablet sig: three (3) tablet po daily (daily). 8. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a week. 9. gabapentin 300 mg capsule sig: one (1) capsule po q 24h (every 24 hours). 10. hydrocodone-acetaminophen 7.5-650 mg tablet sig: one (1) tablet po three times a day: home dose that works well per family. 11. cortef 20 mg tablet sig: one (1) tablet po qam (). 12. cortef 5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)): take with 20 mg tablet for total of 25 mg in the morning. 13. cortef 5 mg tablet sig: one (1) tablet po qpm (). 14. miconazole nitrate 2 % powder sig: one (1) appl topical three times a day as needed for . 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 16. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for diarrhea. 17. synthroid 150 mcg tablet sig: one (1) tablet po daily (). 18. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily): hold sbp < 100. 19. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 20. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po daily (daily). 21. quetiapine 25 mg tablet sig: one (1) tablet po q4pm (). 22. quetiapine 25 mg tablet sig: one (1) tablet po q10pm (). 23. insulin glargine 100 unit/ml solution sig: twenty six (26) units subcutaneous once a day: give before breakfast. 24. humalog 100 unit/ml solution sig: per fixed dose and sliding scale units subcutaneous four times a day: see attached scale. 25. pioglitazone 30 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: northeast - discharge diagnosis: coronary artery disease hypertension diabetes syndrome hypernatremia delerium acute systolic dysfunction discharge condition: level of consciousness: alert and interactive. mental status: confused - sometimes. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had chest pain and a heart attack. there were multiple arteries that were blocked and over the course of 3 cardiac catheterizations, we were able to open them. you will need to take plavix every day for the rest of your life. do no stop taking plavix or miss unless dr. tells you it is ok. we also changed some of your heart medicines to help your heart pump better. you were seen by doctors were here to manage your diabetes and cushings disorder. medication changes: 1. stop taking aprazolam, norvasc and imdur 2. start taking miconazole powder in your groin area to treat a yeast infection 3. start taking metoprolol to help your heart recover from the heart attack 4. start taking quetiapine to help keep you calm in the evening 5. increase aspirin to 325 mg daily for at least one month 6. decrease gabapentin to 300 mg daily because of your kidney function 7. decrease lisinopril to 5mg daily because of your kidney function 8. decrease your glargine and humalog per the sliding scale. . weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. followup instructions: department: , md when: wednesday at 1:45 pm with: , md building: (, ma) campus: off campus best parking: none department: cardiac services when: wednesday at 1:20 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , n. md location: diabetes center address: one place, , phone: appt: we are working on a follow up appt for you within the next two weeks. the office will call you at home with an appt. if you dont hear from them in 48 hours, please call office directly to book. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters coronary arteriography using two catheters left heart cardiac catheterization insertion of endotracheal tube insertion of endotracheal tube insertion of drug-eluting coronary artery stent(s) insertion of drug-eluting coronary artery stent(s) removal of other device from thorax transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on single vessel procedure on single vessel insertion of three vascular stents insertion of three vascular stents central venous catheter placement with guidance diagnoses: abnormal coagulation profile coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia unspecified acquired hypothyroidism cardiac complications, not elsewhere classified atrial fibrillation hematoma complicating a procedure other and unspecified hyperlipidemia acute respiratory failure cardiogenic shock cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft rash and other nonspecific skin eruption acute systolic heart failure hyperosmolality and/or hypernatremia accidents occurring in residential institution acute myocardial infarction of other specified sites, initial episode of care delirium due to conditions classified elsewhere mononeuritis of unspecified site cushing's syndrome dissection of coronary artery secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to