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: acs, cardiogenic shock major surgical or invasive procedure: central line cardiac catheterization mvr possible cabg history of present illness: 77 year old female w/ a h/o , hypercholesterolemia, dm, pmr on steroids who is transferred from hospital w/ acs in cardiogenic shock. she initially presented to hospital w/ 2 days of cp and sob. family describes "chest congestion" starting at ~7 pm on the night of presentation to southshore () which was significantly worse than recently (had been complaing of chest congestion x 2 wks) now associate with sob. husband called 911 and she was brought to hospital. in the southshore ed, patient found to have st depressions in v2-v6 and isolated ste in v1. she was also found to have pulmonary edema and was managed w/ bipap and diuresis. this am, patient was evaluated by cardiology and was found to be hypotensive in cardiogenic shock. cr rising w/ poor uop despite diuresis. cardiac enzymes were found to be elevated: ck 198->431->951-> 5403, mb 37->86->192->915, trop 0.37->0.95->1.46->17.16. she was started on heparin gtt, integrillin, plavix 300mg x1. she underwent cardiac cath showing to lad, 90% circ, tortuous rca with l->l collaterals as well as r->l collaterals to septum. iabp placed and patient was intubated, patient was briefly in asystole by report but converted with cpr and was placed on levophed via a peripheral iv. 2 piv's in place. stat bedside echo showed moderate to severe mr and mr w/ apical and lateral hk. . upon arrival to the ccu, patient is intubated and sedated but moving all extremities. she continues to have a high levophed requirement to maintain her pressures. she was taken emergently to the cardiac cath lab where her lad to was confirmed as well as her 90% circ w/ l->l collaterals and rca w/ aneurysm vs. dissection and r->l collaterals. she received 2 bms->circ. the lad was crossed but given likely chronicity of her to, it was not opened. . recent events discussed with patient's family. family notes that since thr in , patient has complained of increased fatigue. has also had slow, slurred speech since that time. family notes doe w/ of a mile over the last year. she must stop after a few steps on the stairs to rest. patient also complained of "chest congestion" over the last few weeks which had recently improved. she also complained of "indigestion". associated w/ recent chest congestion, patient also had orthopnea symptoms which improved w/ pillows. past medical history: # hypertension # hypercholesterolemia # diet controlled dm (family denies) # polymyalgia rheumatica # s/p r thr # s/p appendectomy in her 30s # s/p umbilical hernia repair social history: patient lives in with husband. she has 3 daughters in the area as well as a son. she used to smoke cigs/day x 20 yrs but quit 20 yrs ago. no etoh use. family history: no significant family h/o cad or scd physical exam: vs: t 100.3, bp 84/60, hr 74, rr 17, o2 99% on ac400x16,peep5, fio2 100% gen: pale, ill appearing female, intubated and sedated heent: ncat. sclera anicteric. perrl. neck: supple with jvp of to angle of mandible. cv: rr, normal s1, s2. no s4, no s3. ii/vi sys murmur at base chest: course breath sounds bilaterally w/ basilar crackles bilaterally. abd: decreased bs. soft, ntnd, no hsm or tenderness. no abdominal bruits. groin: iabp in r groin. arterial sheath and pa catheter in l groin. ext: cool extremities. blue, cyanotic appearing l hand. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+; femoral 2+; dp dopp left: carotid 2+; femoral 2+; dp dopp pertinent results: comments: 1. successful stenting of the lcx with two bare metal stents 3.0 x 18 mm and 2.5 x 12 mm vision stents in a non-overlapping fashion with no residual stenosis (see ptca comments for detail). 2. engagement of the proximal cap of the chronic total lad occlusion with shinobi wire. 3. rca angiography showing two proximal and mid vessel 60% lesion an a distal pseudoaneurysm with possible dissection. final diagnosis: 1. three vessel coronary artery disease. 2. severe systolic and diastolic ventricular dysfunction. 3. cardiogenic shock requiring iabp support. 4. successful stenting of the lca with two bare metal stents ------- tte the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with inferolateral akinesis, as well as inferior and lateral hypokinesis (lcx distribution). the remaining segments exhibit compensatory hyperkinesis (lvef = 35-40%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. there is a partial rupture of the posterolateral papillary muscle with associated eccentric, anteriorly-directed jet of severe (4+) mitral regurgitation. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: moderate regional left ventricular systolic dysfunction, c/w cad. partial papillary muscle rupture with severe mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary hypertension ---------------- tte after surgery prebypass: moderate global lv hypokinesis (30-35%), severe mitral regurgitation with eccentric jet, partial rupture of posteromedial papillary muscle and chordae tendinae, moderate 2+ tricuspid regurgitation. right ventricular free wall appears normal. there is evidence mildly calcified aortic leaflets but no evidence of aortic stenosis. descending and ascending aorta within nl limits. postbypass: overall lv function globally depressed (30-35%). minimal improvement compared to prebypass. prosthetic mitral valve leaflets well positioned and adequate movement of the leaflets. . no appreciable mitral regurgitation. moderate tricuspid regurgitation as seen in the prebypass period.. rv free wall unchanged and normal. descending and ascending aorta within normal limits and without evidence of dissection. 09:24pm blood wbc-7.5# rbc-1.14*# hgb-3.5*# hct-10.9*# mcv-96# mch-30.7 mchc-32.2 rdw-15.7* plt ct-29*# 09:24pm blood neuts-73.2* bands-0 lymphs-16.3* monos-9.5 eos-0.2 baso-0.8 09:24pm blood plt ct-29*# 05:19am blood glucose-142* urean-51* creat-0.9 na-146* k-3.9 cl-113* hco3-24 angap-13 08:53am blood alt-57* ast-53* ld(ldh)-714* alkphos-65 amylase-264* totbili-0.8 08:53am blood lipase-99* 03:30am blood ck-mb-76* mb indx-13.9* ctropnt-8.97* 05:19am blood calcium-9.1 phos-3.0 mg-2.2 03:02am blood %hba1c-4.9 brief hospital course: summary osh and ccu course 77 y/o f with a history of type ii diabetes, , dyslipidemia, pmr with increasing fatigue since undergoing thr in 9/. patient had complaints of increasing doe and orthopnea 2 weeks prior to admission. she was only able to climb a few steps on the stairs before stopping for rest. 2 days pta patient also complained of "chest congestion" and "indigestion", on the day of admission patient c/o of worsening chest congestion and dyspnea. husband called 911 and on she presented to hospital ed, in the southshore ed patient??????s ecg showed st depressions in v2-v6 and isolated ste in avr. cardiac enzymes revealed tropt 0.37, ck 198 and mb 37. she was started on heparin gtt, integrillin, plavix 300mg x1. she was also found to have pulmonary edema and was managed w/ bipap and diuresis. next morning patient was evaluated by cardiology and found to be hypotensive, with rising creatinine, poor uop despite dieresis. cardiac enzymes rising ck 198->431->951-> 5403, mb 37->86->192->915, trop 0.37->0.95->1.46->17.16. she underwent cardiac cath at which showed a totally occluded lad, 90% occluded left circ, tortuous rca with evidence of l->l collaterals as well as r->l collaterals to septum. iabp placed and patient was intubated, patient was briefly in asystole by report but converted with cpr . levophed was started via a peripheral iv. stat echo showed moderate to severe mr and mr w/ apical and lateral hk., ef 40-45%. patient was then transferred to . upon arrival to the ccu, patient is intubated and sedated with a high levophed requirement to maintain her pressures, ecg showed st depressions in v3-4, twi v5-6. she was taken emergently to the cardiac cath lab which showed 2 sequential 90% left circ lesions which were stented with 2 non overlapping bms, no residual stenosis with timi 3 flow afterwards, pressor requirements decreased with improvement in map. her totally occluded lad was probed, were able to break the cap but the wire was not easily advanced confirming the chronicity.rca angiography showed two proximal and mid vessel 60% lesions with ? of aneurysm vs. dissection and multiple septal collaterals to lad. on return from cath lab pressor requirements were decreased and patient was diuresed, peep increased to . preload( venous return from inc. thoracic pressures) and afterload. next morning tte showed ef 35-40% with inferolateral akinesis in lcx distribution, found to have a partial rupture of the posterolateral papillary muscle with severe (4+) mitral regurgitation. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. patient taken to surgery this morning. cardiac enzymes trending down (tn 24 to 15, ck 4000 to 1500, mb 500 to 200) # cad/ischemia: ecg w/ evidence of anterolateral ischemia. ? whether due to collaterals from circ vs. rca. substantial infarct w/ ck-mb of 960. now s/p bms x 2 to lcx and no intervention on rca. decreased pressor requirements post pci. - cont asa, plavix - cont heparin gtt - high dose statin - cycling cardiac enzymes - iabp - discuss adding beta blocker . # pump: ef 40-45% w/ apical lateral hk at osh. now in cardiogenic shock. suspect worsening of ef. elevated filling pressures on rhc w/ pcw of 30. - off levophed - cont iabp 1:1. will add ace inhibitor once weaning - going for surgery this morning, held off further diuresis overnight - add beta blocker once off vasopressors - tte in am. if significant anteroapical ak or severely depressed ef will consider continuation of heparin beyond 48 hours w/ transition to coumadin . # rhythm: - atrial tachycardia likely secondary to ischemia and severe mr causing left atrial stretch, held on further diuresis - mvr this morning - on heparin gtt . # resp: significant a-a gradient on initial abg w/ po2 122 on 100% fio2. improved with peep to 10mg which decreases preload and afterload - repeat abg - weaned oxygen overnight - cont vent support on ac for now - tx for possible aspiration pna as below - diuresis as tolerated . # arf: unknown baseline but labs at osh w/ cr 0.9->1.8. likely poor forward flow in the setting of cardiogenic shock. - creatinine trending down - bun elevated, component secondary to steroids - if continues to worsen can consider urine lytes/eos . # id: leukocytosis on osh labs. potentially secondary to stress demargination in the setting of significant mi. must also consider aspiration event in the setting of cardiac arrest at osh. cxr w/ possible infiltrate in rul and rll. - check sputum and urine cx's - blood cultures if spikes, afebrile - empirically cover for aspiration w/ levo/flagyl x 7 days as wbc count and fever will be difficult to interpret in the setting of stress dose steroids and large mi . # : hypotensive currently in cardiogenic shock. - holding home dose atenolol - stress dose steroids as below . # polymyalgia rheumatica: on prednisone daily at home but unknown dose. cannot check stim. - stress dose steroids with methylpred 40 mg iv q8h, taper down - rapid taper w/ stabilization of bp . # dm: documented diet controlled dm although family denies. - hba1c <5 - iss . # fen: npo for now. once stable will start tfs - lytes once diuresis begun . # prophylaxis: heparin gtt. ppi iv. bowel regimen . # code: full. confirmed w/ hcp underwent mvr/cabg x1 with dr. on . pt. already intubated and had iabp prior to or. transferred to the cvicu in fair condition on epinephrine, nitroglycerin, insulin and propofol drips. abx continued for presumed pre-op pna. ent consulted for epistaxis. iabp removed and epinephrine drip weaned to off on pod #2. amiodarone started for afib. at 9pm on pod #3, she became acutely hypotensive and non-responsive. cpr started, and chest opened at the bedside. moderate amount of blood around the heart noted.open cardiac massage performed for asystole.unable to pace the heart. no obvious sites of bleeding identified. patient pronounced at 9:50 pm.family notified. permission for autopsy granted. medications on admission: atenolol 50 mg daily prednisone 5mg daily advil prn fosamax qwk discharge disposition: expired discharge diagnosis: cad s/p mvr/cabg x1 cardiogenic shock acute mi ruptured papillary muscle with severe 4+ mr a fib elev. lipids polymyalgia rheumatica dm discharge condition: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters (aorto)coronary bypass of one coronary artery open and other replacement of mitral valve with tissue graft transfusion of packed cells open chest cardiac massage transfusion of platelets nonoperative removal of heart assist system control of epistaxis by anterior nasal packing continuous intra-arterial blood gas monitoring transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery polymyalgia rheumatica pure hypercholesterolemia mitral valve disorders 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 chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified atrial fibrillation hemorrhage complicating a procedure cardiogenic shock acute diastolic heart failure epistaxis hip joint replacement aneurysm of coronary vessels rupture of papillary muscle 

Answer: The patient is high likely exposed to