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: chest pain major surgical or invasive procedure: cardiac catherization and stent placement history of present illness: this is a 65 yom w/h/o cad s/p bms to lad and lcs on discharged on home and represents w/sob and cp this am. pt notes that he had had fatigue but was otherwise feeling well since his discharge w/o any sob or cp. however, this am, after his shower this am, he had sob, nausea, emesis x 2 w/gradual onset of cp that persisted >1hour. he describes cp as substernal w/o radiation same as the pain he had on when he received his first bms; this is his first episode since prior presentation. he took two w/o improvement, his daughter called ems and he was brought in to the ed. ems strips showed st elevations in v2-v5. . upon arrival, he was noted to have cp and v2-v5 st elevations no ekg; code stemi was initiated and pt went to cath lab where he had lad clot lysis and a stent placed distal to his original stent. . of note, he and his daughter report that they did not pick up his new discharge cardiac medications and the only meds he has been taking is a baby , and his psych meds. . on review of symptoms, 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. he denies sx of recent depression/anxiety; no thoughts of harming himself or si. all of the other review of systems were negative. . cardiac review of systems is notable for absence of prior chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: anxiety depression w/prior suicide attempts including on prior admission hx etoh abuse-sober x 15 years niddm cardiac risk factors: + diabetes, - dyslipidemia, - hypertension social history: social history is significant for the positive for recent tobacco use 1pack/day, reports that he quit on . there is a positive history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs: t 98, bp 142/69, hr 56, rr 18, o2 100% on 4l gen: wdwn middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple unable to assess jvp lying flat. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: sheath in place, no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: cardiac cath comments: 1. selective coronary angiography of the lmca, lad and lcx revealed totally occluded lad at mid segment with abundant thrombus burden therafter. the lcx had slow flow but otehrwise was patent. the rca was not engaged. 2. limited resting hemodynamic assessment revealed systemic arterial hypertension (143/104 mmhg). 3. left ventriculography was deferred. 4. successful pci/stent to stent thrombosis of mid lad with a 3.0x12mm vision stent deployed to 15atms. the stents were postdilated to 3.25mm at 14 atms. excellent result with normal flow down vessel and no residual stenosis. tte the left atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is severe regional left ventricular systolic dysfunction with akinesis of the mid-distal septum, anterior wall and the entire distal one-third of the left ventricle, as well as mild hypokinesis of the basal inferior wall (ef 25-30%), c/w multivessel cad. no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). 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. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. impression: severe gional left ventricular systolic dysfunction, c/w cad. compared with the prior study (images reviewed) of , regional lv wall motion abnormalities in the distribution of the lad are new. femoral vascular us right 9:27 pm right groin ultrasound: there is a 2.7 x 2.6 x 1.6 cm ovoid hypoechoic structure adjacent and superficial to the right common femoral artery, which appears to be connected to the artery with a short neck. no definite flow is demonstrable within the structure, although there does appear to be some arterial flow within the neck. the common femoral arterial waveform is normal. the common femoral venous waveform is normal. impression: findings are most suggestive of a thrombosed pseudoaneurysm arising from the right common femoral artery. flow detectable only within the neck of the pseudoaneurysm. labs 06:47am blood wbc-10.9 rbc-4.65 hgb-14.8 hct-42.8 mcv-91 mch-31.8 mchc-34.9 rdw-13.2 plt ct-261 06:47am blood plt ct-261 03:51pm blood pt-14.4* ptt-67.0* inr(pt)-1.3* 06:47am blood glucose-197* urean-19 creat-0.6 na-142 k-4.4 cl-104 hco3-22 angap-20 06:47am blood alt-69* ast-216* ld(ldh)-902* ck(cpk)-2179* alkphos-91 totbili-1.2 06:47am blood albumin-3.7 calcium-9.6 phos-3.1 mg-1.9 06:47am blood tsh-1.1 lfts 06:47am blood alt-69* ast-216* ld(ldh)-902* ck(cpk)-2179* alkphos-91 totbili-1.2 05:58am blood alt-35 ast-41* alkphos-74 totbili-0.9 cardiac enzymes 08:39pm blood ck-mb-321* mb indx-8.3* 06:47am blood ck-mb-118* mb indx-5.4 03:41am blood ck-mb-17* mb indx-3.6 ctropnt-3.5* 08:39pm potassium-5.2* 08:39pm ck(cpk)-3881* 08:39pm ck-mb-321* mb indx-8.3* 08:39pm plt count-272 09:30am blood wbc-7.2 rbc-4.07* hgb-12.7* hct-36.6* mcv-90 mch-31.2 mchc-34.6 rdw-14.0 plt ct-222 09:30am blood pt-22.0* ptt-39.1* inr(pt)-2.1* 08:00am blood pt-21.1* ptt-40.7* inr(pt)-2.0* 09:30am blood glucose-214* urean-13 creat-0.7 na-140 k-4.1 cl-105 hco3-24 angap-15 05:58am blood alt-35 ast-41* alkphos-74 totbili-0.9 09:30am blood calcium-8.9 phos-3.3 mg-1.9 07:25am blood osmolal-292 06:47am blood tsh-1.1 05:56pm urine hours-random creat-121 na-25 05:56pm urine osmolal-447 brief hospital course: this is a 65 yom w/h/o cad s/p bms to lad and lcs discharged on represents after 1 week off of cardiac medications w/stemi now s/p stent distal to initial lad stent for in-stent thrombosis off . # cad/ischemia: patient had recent admission for placement of bms to lad, lcs who represented w/stemi after 1 week of not taking any cardiac medications (including ) prior to readmission. he had st elevations in v2-v5 which resolved after being taken emergently to cath lab and receiving distal stent to lad for in-stent thrombosis off . he received integrillin after the procedure and was optimized on regimen of , , statin, acei, and beta blocker. patient was cp free after the procedure. the importance of taking and other cardiac medications has been reemphasized to the pt multiple times. they deny financial or social reasons for not picking up the medications. he has follow-up next week with dr. . his bblocker was decreased upon discharge for sbp ranging from 90s to 120s. it should be titrated appropriately. cath was complicated by a pseudocyst, which thrombosed spontaneously. distal pulses were intact. # pump: ef on prior tte 45% w/inferoapical and lateral akinesis, he also has diastolic dysfunction noted on prior tte. repeat echo on showed worsened ef of 25-30% and global lv systolic dysfunction. he was euvolemic and started on ace inhibitor for afterload reduction. # rhythm: rhythm: patient was nsr until am of when he had acute episode of afib with rvr and hypotension to sbp 70s. he was given iv boluses of metoprolol and started on amiodarone bolus and gtt. ep was consulted, but intermittent afib thought to be recent ischemia and no need for amiodarone unless recurrent episodes. patient had question of transaminitis with amiodarone so po amiodarone was never started. he was titrated up on his metoprolol and he had no additional episodes of afib and maintained nsr with beta blocker. he was started on coumadin 5mg po daily given high risk of thromboembolic event (both afib and severe lv dysfunction). his dose was titrated as high as 10mg/day to get therapeutic, though his dose was decreased upon discharge as there would be 4 days until he could get his inr drawn. he was discharged on coumadin with followup with pcp and lab draws for inr to follow coumadin dosing with goal inr . he has a prescription for lab draws and an appointment to follow-up with his pcp, , np. phone: . fax: . # orthostatic hypotension: pt was symptomatic on with lightheadedness upon standing. his vitals showed orthostatic hypotension. he was given a fluid bolus with improvement in symptoms. urine lytes fena consistent with prerenal. he continued to be orthostatic by vitals through the rest of his stay, though he was asymptomatic. he was encouraged to take po fluids. his bblocker was decreased to 100mg toprol qday upon discharge and may need to be further titrated down. # dm: had been off of diabetes meds prior to admission. covered w/ssi while in house and he was started on metformin 500mg with improved control. his regimen should continue to be titrated for blood glucose. # depression/anxiety: s/p recent suicide attempt. patient was continued on venlafaxine and clonazepam. no si/hi and was seen by outpatient psychiatrist in hospital. # prophylaxis: heparin, ppi, bowel regimen # code: full medications on admission: *** unclear if patient taking these medications. these were his discharge medications from last admission 1. aspirin 325 mg po daily 2. clopidogrel 75 mg tablet po daily 3. atorvastatin 80 mg tablet po daily 4. venlafaxine sr 150 mg capsule, po daily 5. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 6. pantoprazole 40 mg po daily 7. lisinopril 5 mg tablet po daily discharge medications: 1. outpatient lab work inr check on . please fax to at . phone: . 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). disp:*80 tablet(s)* refills:*2* 5. venlafaxine 150 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 6. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 7. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 8. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. warfarin 5 mg tablet sig: one (1) tablet po daily16 (once daily at 16). disp:*30 tablet(s)* refills:*2* 10. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary: stemi from instent thrombosis acute on chronic systolic heart failure . secondary: anxiety depression w/prior suicide attempts including on prior admission hx etoh abuse-sober x 15 years niddm discharge condition: good discharge instructions: you were seen at for thrombosis in your coronary stents. it is imperative that you take all of your medications, especially your aspirin and , to avoid future complications. all of your medications are important. . you have been started on a medication called coumadin. the level of this medication is important to maintain. you will need close follow-up for this. please go to office on monday (in addition to the appointments below) to get your blood drawn. you have a prescription for this. . you were also lightheaded during your stay, which improved with fluid. you should stay hydrated by drinking plenty of fluid daily. you should discuss this lightheadedness with your pcp as well as further monitoring of your blood pressure, which was occasionally low especially when standing (orthostasis). . please take your medications as prescribed. . please follow-up as below. you should discuss your blood pressure, orthostatic symptoms, coumadin, and blood sugar (titration of metformin or other diabetic medications) with . . you should call your primary care provider or return to the emergency department if you experience chest pain, shortness of breath, lightheadedness, loss of consciousness, lower extremity swelling, or any other symptoms that concern you. followup instructions: provider: , np. health center. wednesday, at 1:15pm. phone: . provider: , m.d. phone: date/time: 1:40 procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters injection or infusion of platelet inhibitor cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation other complications due to other cardiac device, implant, and graft acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to