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: history of present illness: patient is a 75-year-old woman with coronary artery disease status post coronary artery bypass graft in , diabetes mellitus type 2, gout who presented with several hours of shortness of breath and epigastric/lower sternum discomfort which developed while the patient was sleeping. denied any other associated symptoms. the discomfort was pressure like and improved with nitroglycerin spray. patient has had no chest pain since then but continued subjective shortness of breath although satting well on room air. denies edema. also, patient with upper respiratory infection over the past few days. also with right great toe pain identical to previous gout episodes. the patient is followed by numerous doctors . past medical history: 1. diabetes mellitus type 2. 2. coronary artery disease status post coronary artery bypass graft in . 3. gout. 4. chronic renal insufficiency. social history: previous tobacco smoker; quit 25 years ago. lives alone, but her daughter lives in same building and attends to her care. daughter is a nurse. allergies: no known drug allergies. home medications: 1. atenolol 50 once a day. 2. amlodipine 10 once a day. 3. enalapril 10 once a day. 4. zocor 5 once a day. 5. nephrocaps one tab once a day. 6. aspirin 325 once a day. 7. calcium supplement. 8. lasix 80 once a day. 9. epogen q. saturday. physical examination on admission: temperature 98.0, heart rate 65, pressure 140/49, satting 99% on room air. physical examination: pleasant, elderly woman in no apparent distress. heart with a soft systolic murmur. lungs with bibasilar crackles approximately one-third of the way up. remainder of physical examination within normal limits, however, notable for only trace pulses in the bilateral lower extremities as well as only trace edema in the bilateral lower extremities. diagnostic data on admission: per the patient she had a treadmill exercise stress test with imaging in which was reportedly normal. echocardiogram done at with ejection fraction of 40 to 45%, akinesis in the distal anterior septum, mild to moderate mitral regurgitation, hypokinesis in inferior and posterior walls, hypokinesis in the inferior septum. cbc on admission: white blood count 15 with 80% neutrophils, 0 bands, hematocrit 34, platelets 270. chemistries within normal limits except for bun and creatinine of 62/2.2. troponin of 0.39, ck of 84. chest x-ray with bilateral pleural effusions and prominent pulmonary vasculature consistent with left ventricular heart failure. ecg with normal sinus rhythm at 65 beats per minute, normal intervals, elevations at iii, 0. depressions in i and avl, less than 0. depressions in v4 to 6 all unchanged from the previous ecg from dated 04/. concise summary of hospital course: patient is a 75-year-old woman with coronary artery disease status post coronary artery bypass graft as well as diabetes who presented with shortness of breath and lower chest/epigastric pain which resolved. 1. coronary artery disease: patient's ecg without significant changes. patient's creatinine kinases flat and not consistent with current myocardial infarction. patient's troponins likely elevated related to her renal insufficiency but may represent older myocardial ischemia from several days prior to admission. patient was initially started on heparin drip in the emergency room, but this was discontinued after approximately six hours as the patient was entirely symptom free and patient's enzymes were largely flat. patient underwent persantine mibi stress test on which showed mild to moderate lateral reversible perfusion defect as well as moderate fixed anterior wall defect with an estimated ejection fraction of 42%. based on this information and after weighing the pros and cons of possible renal effects of catheterization and after extensive discussions with the family and medical team, decision was made for patient to undergo catheterization, which she underwent on , which showed 20% left main, 100% proximal left anterior descending, 80% left circumflex, 70% obtuse marginal 1, 100% mid right coronary artery, occluded saphenous vein graft to posterior descending artery graft, patent left internal mammary artery graft to left anterior descending graft. patient's left circumflex lesion was thought to be the likely culprit for her symptoms and was status post angioplasty with good timi 3 flow afterwards. however, this area was not able to be stented due to the anatomy. patient did not have any further episodes of chest pain throughout her hospital stay and tolerated procedure well. the patient was continued on aspirin as well as lipitor throughout hospital stay. patient was on metoprolol initially which was held peripost catheterization due to hemodynamic reasons and then restarted and titrated up to, which the patient tolerated well. patient was also started on plavix, which she should probably be on for life. patient to follow up with her outpatient cardiologist for further management. 2. congestive heart failure/pump: patient with significant shortness of breath and chest x-ray and clinical findings consistent with congestive heart failure at admission. patient was diuresed gently on the floor. at catheterization hemodynamics revealed an elevated right and left pressure including pa pressure of 60/25, mean wedge of 32, lvedp of 35, and cardiac index of 2.2. echocardiogram on showed an ejection fraction of 30 to 35% with 3+ mitral regurgitation and left ventricular hypertrophy. patient continued low-sodium diet and weighed daily with close ins and outs. patient's angiotensin-converting enzyme inhibitor was held and instead hydralazine and isordil were used for after load reduction. this was due to the patient's high creatinine, which was at her baseline, and pericath with the dye load. due to the elevated filling pressures seen on catheterization, the patient had an intra-aortic balloon pump placed. patient was also started on dobutamine drip. patient was admitted to the coronary care unit overnight due to these interventions and she was stable throughout her coronary care unit time. the intra-aortic balloon pump was removed and the patient was off of dobutamine within 12 hours of those being started. patient remained hemodynamically stable throughout this time. at the time of discharge the patient was satting very well on room air, as well as ambulating. was restarted on her home lasix dose of 80 once a day. close outpatient follow up for this. 3. rhythm: patient in sinus rhythm obtained on telemetry throughout her hospital stay. 4. diabetes: patient maintained with regular insulin sliding scale throughout her hospital stay. 5. renal: patient's baseline creatinine in the low to mid 2 range per outpatient cardiologist. patient also has an outpatient nephrologist who presumably has done some workup for the patient's renal insufficiency. patient was given mucomyst peri cardiac catheterization. patient's spep and upep were also sent, and at the time of discharge the upep came back normal and spep was still pending. plan outpatient follow up. 6. anemia: patient received one unit packed red blood cells on for a hematocrit of 27. patient was asymptomatic at this time with no signs or symptoms of active bleed. patient's hematocrit increased appropriately once stable throughout the end of her hospital stay. 7. gout: patient was initially placed on colchicine for likely gouty flare in her right great toe. however, this was discontinued and patient was given three days of prednisone 20 q.d. for this flare. patient also given percocet p.r.n. 8. previous diarrhea/hematochezia: patient did not have either of these in house. patient's daughter reports that patient underwent virtual colonoscopy at just prior to presenting to . as the patient was entirely asymptomatic, planned outpatient follow up for this. 9. fluid, electrolytes, nutrition: patient begun on low salt diet with fluid restriction. 10. prophylaxis: patient begun on subcutaneous heparin and proton pump inhibitor throughout hospital stay. 11. code status: patient is a full code, which was confirmed with the patient as well as her family at admission. discharge condition: stable. disposition: to home with physical therapy visiting. discharge diagnoses: 1. coronary artery disease status post angioplasty to the left circumflex coronary artery. 2. congestive heart failure. 3. diabetes mellitus. 4. chronic renal insufficiency. 5. gout. medications on discharge: 1. nephrocaps one once a day. 2. aspirin 325 once a day. 3. plavix 75 once a day. 4. trazodone 25 mg q. h.s. p.r.n. 5. lipitor 80 once a day. 6. toprol xl 75 mg once a day. 7. famvir 60 once a day. 8. hydralazine 20 q. 6 hours. 9. lasix 80 once a day. discharge instructions: 1. patient to follow up with her outpatient primary care physician. 2. patient to follow up with cardiologist, dr. (). 3. patient to follow up with dr. (). patient to call to make her own appointments, however, was instructed to see her doctors within one to two weeks. , m.d. dictated by: medquist36 d: 16:18 t: 09:09 job#: procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor implant of pulsation balloon removal of external heart assist system(s) or device(s) diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of autologous vein bypass graft gout, unspecified unspecified disorder of kidney and ureter 

Answer: The patient is high likely exposed to