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: penicillins / sulfa (sulfonamides) attending: chief complaint: peripheral diasese, here for elective stent of iliac arteries. major surgical or invasive procedure: percutaneous transluminal angioplasty/stent of left external iliac artery. percutaneous transluminal angioplasty/stent of left common iliac artery. atherectomy of left external iliac artery. atherectomy of left superficial femoral artery. atherectomy of left profunda femoris artery. percutaneous transluminal angioplasty/stent of right common iliac artery. history of present illness: 78 year old female with cad s/p nstemi, s/p lcx stent 6.03, and rca total occlusion, sefere pvd with bilateral carotid stenoses, presents for elective stent of significant le pvd. the patient has an occluded l sfa, and stenoses of the l external iliac and common femoral arteries. abi 0.27 on the r, 0.26 on the l. the patient has been having significant claudication with < 0.25 mi ambulation. past medical history: cad s/p stenting(3x18mm cypher)of prox l circumflex at copd/asthma on prednisone in past but never intubated htn pvd-severe lft subclavian stenosis with diff ue bp's hyperlipidemia glaucoma od osteoarthritis iron deficiency anemia social history: lives at home with husband. 20 pack-year smoking history, quit in . she denies alcohol or drug use. family history: noncontributory. physical exam: vs: hr 75, 130/113, rr 18, 100% on 2l nc gen: overweight caucasian female appearing well. lungs: cta b/l cor: rr, normal rate, 2/6 systolic murmur at rusb abd: nabs, soft, nt/nd vasculature: carotid bruits b/l, femoral bruits b/l, dp and pt trace palpable b/l. pertinent results: hct-36.3 hct-31.0* plt ct-232 hct-28.8* wbc-13.0* hgb-10.7* hct-31.3* mcv-86 rdw-14.3 plt ct-218 hct-28.0* wbc-11.6* hgb-11.3* hct-31.1* mcv-81* rdw-15.3 plt ct-133* wbc-13.0* hgb-12.5 hct-35.8* mcv-83 rdw-15.1 plt ct-176 pt-14.0* ptt-24.3 inr(pt)-1.2 urean-16 creat-1.0 k-4.4 glucose-103 urean-23* creat-1.2* na-143 k-4.3 cl-107 hco3-24 glucose-99 urean-21* creat-1.4* na-135 k-4.4 cl-105 hco3-23 ck(cpk)-34 ck(cpk)-39 ck(cpk)-44 ck(cpk)-49 calcium-8.7 phos-4.3 mg-1.8 urine color-straw appear-clear sp ->1.035 blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg rbc-* wbc-0-2 bacteri-none yeast-none epi-0 aerobic bottle (final ): no growth. anaerobic bottle (final ): no growth. urine culture (final ): <10,000 organisms/ml. ekg : sinus tachycardia and occasional ventricular ectopy. compared to the previous tracing of there are now more prominent q waves suggesting interim inferior myocardial infarction. in addition, the st segment depressions in leads i, ii, iii and avf are more prominent. both atrial and ventricular ectopy have appeared, the rate has increased and there is more prominent downsloping st segment depression in leads v5-v6. rule out myocardial infarction. catheterization : comments: 1. retrograde access was obtained via the right cfa using a 6 french sheath. abdominal aortic angiography demonstrated moderate distal disease with a small infrarenal saccular aneurysm. 2. nonselective angiography of the bilateral, single renal arteries demonstrated 40% proximal disease bilaterally. 3. the right cia had a 50% lesion in the origin with a 6 mmhg mean gradient after administration of ia nitroglycerin. there was diffuse disease in the rightiia with up to 50% stenoses. 4. the left cia had proximal 60% disease with a 40 mmhg peak-to-peak gradient. the iia had diffuse 40% disease. the distal eia had an eccentric 60% stenosis. the left sfa was ostially occluded and reconstituted at the adductor canal. the left pfa had a 50% lesion at its origin. no angiographically apparent, flow-limiting disease was noted in the popliteal aftery. the at had serial lesions with a total occlusion in the mid-shin. slow filling was noted of the dp. the peroneal had mild disease and terminated at the ankle. the pt was the principle vessel to the foot. 5. successful treatment of the totally occluded left sfa using adventitial dissection, an outback catheter, angioplasty, and stenting with three overlapping self-expanding stents (from distal to proximal 6.0 x 100 mm absolute, 6.0 x 100 mm dynalink, and 6.0 x 80 mm absolute) all postdilated with a 6.0 mm balloon. final angiography demonstrated no residual stenosis, a small proximal perforation, a distal perforation treated with prolonged balloon inflation and protamine, and normal flow (see ptca comments). 6. successful treatment of ostial left pfa disease with a 5.0 x 18 mm highsail balloon. final angigoraphy demonstrated a 30% residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). final diagnosis: 1. mild abdominal aorta and renal artery disease. 2. moderate disease in the right cia and iia. 3. diffuse disease in left lower extremity with totally occluded sfa. 4. successful stenting of left sfa. 5. balloon angioplasty of the left pfa. 6. perforation of the distal sfa treated with balloon inflation and protamine. arterial duplex : impression: no evidence of left leg pseudoaneurysm or av fistula. catheterization : comments: 1. initial angiography was obtained by access of the right cfa to the contralateral left sfa using a 6 french sheath. the abdominal aorta had mild distal disease. 2. the right lower extremity was significant for a right cia with a tubular 70% lesion. 3. the left lower extremity was significant for a left cia with a 90% focal lesion. the eia had an 80% lesion in the midsegment as well as a 90% distal eia lesion. the cfa had no significant disease. the previous stents in the sfa was without significant disease and normal flow. the distal perforation site was sealed. the origin of the sfa had a 70% dissection. the origin of the pfa had a 70% tubular lesion. 4. successful atherectomy using a silverhawk ls device on the left sfa, pfa, and eia. an 8.0 x 28 mm dynalink self-expanding stent was delivered to the proximal eia and postdilated with a 6.0 x 12 mm viatrack balloon at 12 atm. final angiography demonstrated a 10% residual stenosis in the pfa, no residual stenosis, in the sfa, no residual stenosis in the eia, no angiographically apparent dissection, and normal flow. 5. the left proximal cia lesion was dilated with an 8.0 x 38 mm genesis stent at 12 atm. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow. 6. the right cia was stented with an 8.0 x 29 mm genesis stent at 12 atm. a perforation was noted which was treated with multiple 5 minute balloon inflations, administration of protamine, and finally placement of an 8.0 x 30 mm wallgraft covered stent postdilated with an 8.0 mm sds balloon. final angiography demonstrated no residual stenosis, a small persistent perforation, and normal flow. final diagnosis: 1. significant disease in the right cia. 2. significant disease in the left cia, eia, sfa, and pfa. 3. successful atherectomy of the left sfa, pfa, and eia. 4. successful stenting of the left eia. 5. successful stenting of the left cia. 6. successful stenting of the right cia. 7. perforation of the right cia treated with protamine, blood pressure control, prolonged balloon inflations, and a covered stent. ekg : sinus rhythm with first degree a-v delay. probable left atrial abnormality. prominent inferior q waves - are nonspecific. modest nonspecific st-t wave abnormalities. since previous tracing of , first degree a-v delay present and st-t wave changes decreased. ct abd/pelvis 8 p.m.: impression: retroperitoneal hemorrhage worse on the left, consistent with the history of iliac artery perforation, although the exact origin of this hemorrhage is not identified on this ct. persistent nephrogram raises concern for contrast induced nephropathy. ct abd/pelvis 3 a.m.: impression: interval increase in the amount of retroperitoneal hemorrhage. persistent contrast within the renal collecting system which is concerning for contrast induced nephropathy. ekg : sinus rhythm. probable prior inferior myocardial infarction. compared to the previous tracing of the st segment depressions and t wave inversions are slightly more prominent in leads ii, iii and avf and there is new downsloping st segment depression and t wave inversion in leads v5-v6. rule out myocardial infarction. cxr : focal opacity in left retrocardiac region. it is uncertain whether this represents a recurrent acute process (pneumonia, aspiration) or a progressive abnormaltiy. followup dedicated pa and lateral radiographs of the chest are recommended for initial further characterization. followup films would also be helpful to document resolution and to fully exclude a neoplasm in this region. brief hospital course: 78 year old female with cad and severe pvd, presents for elective stent of significant biaortoiliac disease. 1) peripheral disease: on admission the patient was taken to the catheterization laboratory for planned intervention of the 100% stenosed l sfa and 50% stenosed l pfa. the l sfa was stented post angioplasty, while the l pfa was balloon dilated, without stent placement. final angiography demonstrated 30% residual pfa stenosis, no residual stenosis of the l sfa, a small proximal perforation of the l sfa, a distal perforation treated with prolonged balloon inflation and protamine, and normal flow. the l cia at this time had 60% disease, the l internal iliac artery 40% disease, and the l distal external iliac artery 60% disease. she underwent another planned catheterization 2 days after admission, for planned further intervention of her severe bilateral disease. this catheterization demonstrated l sfa 70% stenosis, l pfa 70% stenosis, l external iliac artery 90% stenosis, l common iliac artery 90% stenosis, r common iliac artery 70% stenosis. she had atherectomy of the l sfa, l pfa, l eia, with stenting of the eia. final angiography demonstrated a 10% residual stenosis of the l pfa, no residual stenosis in the sfa, no residual stenosis in the eia, no angiographically apparent dissection, and normal flow. l cia and r cia were both dilated and stented. post-stenting of the r common iliac artery there was extravasation of contrast which persisted despite balloon pressure and protamine. the patient was placed on nitroprusside drip for elevated blood pressure to 198/60 and sent to the ccu. 2) retroperitoneal hemorrhage: after her second catheterization with perforation of the r cia, she underwent ct of the abdomen/pelvis to evaluate the extent of the bleed. this demonstrated retroperitoneal hemorrhage worse on the left, consistent with the history of iliac artery perforation, although the exact origin of this hemorrhage was not identified on this ct. aproximately 8 hours after transfer to the ccu post her second catheterization, the patient complained of abdominal pain. she was noted to have hypoactive bowel sounds and a rigid tender abdomen, and was therefore sent for a repeat stat ct of the abdomen/pelvis which showed interval increase in the amount of retroperitoneal hemorrhage, however the amount of increase over the 8 hours since the previous ct scan was not considered excessive, and the patient was hemodynamically stable throughout, therefore it was decided to manage conservatively with prbc transfusion and clinical/laboratory observation. the patient remained hemodynamically stable, and her hematocrit remained stable status post 4 units of prbcs over 24 hours. her abdominal exam was benign at the time of discharge. 3) cad: the patient did have a number of episodes of chest pain between the first and second catheterizations. these episodes were accompanied by ekg changes consisting of st depressions in the lateral leads (v3-v6) of up to 3 mm. they consistently resolved with sl nitroglycerin. she was continued on asa, plavix, and a statin (atorvastatin 10 mg daily). 4) complete heart block: 1 day after her second catheterization she was noted to have a 6 second period of complete heart block during which time she had an atrial rate of approximately 75 beats per minute. she was also noted to have had several alarms for bradycardia down to 39 post her first catheterization. of note, her pr interval was prolonged to 220 msec surrounding the episode. the electrophysiology team saw the patient, and felt that this chb episode may have been consistent with a vagal episode, given the prolonged pr interval around the time of her block, as well as her known rp bleed. however, given the significant duration of her pause, it was recommended that she have a pacemaker placed should she have another one. after extensive discussions with the patient, she persistently refused pacemaker placement should the event recurr. she did indicate understanding of the possible consequences of not having the pacer placed. fortunately, she did not have any further episodes of chb, though she did continue to have transiet bradycardia to the 30s. she had no syncopal or pre-syncopal episodes, nor was she ever symptomatic or unstable during her episodes of bradycardia. av nodal blockers were avoided, and should continue to be avoided in the future given this history. 5) contrast nephropathy: the patient's creatinine transiently rose from 1.1 to 1.4 post her second catheterization. she was also noted to have persistent nephrograms on ct scan (performed for her rp bleed, as above), which raised concern for contrast induced nephropathy. her creatinine peaked at 1.4 and came down to 1.2 on the day of discharge, however, and the patient was producing adequate urine output. her lisinopril and lasix were held for the 2 days prior to discharge, but restarted on discharge. the patient was to follow up with dr. in weeks, at which time a chem 7 was to be drawn. 6) htn: the patient was on a nipride drip for 24 hours post catheterization, for blood pressure goal of 100-140. subsequently she was transitioned back to her home blood pressure medications: norvasc 10 mg daily, lisinopril 10 mg daily, and clonidine 0.3 mg tid. 7) copd: continued inhalers. 8) fever: the patient had a fever on the day before discharge. blood and urine cultures were negative. a cxr revealed a retrocardiac opacity which had been seen on previous cxrs. treatment was therefore not initiated, and the patient did not have any further fevers. she should have a repeat cxr at some point to assess for interval change in this opacity. medications on admission: lasix 20 mg daily norvasc 10 mg daily lipitor 10 mg daily lisinopril 40 daily asa 325 daily clonidine 0.03 tid combivent discharge medications: 1. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 2. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual q5min () as needed for chest pain. 3. amlodipine besylate 5 mg tablet sig: two (2) tablet po daily (daily). 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. clonidine hcl 0.1 mg tablet sig: three (3) tablet po tid (3 times a day). 8. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation tid (3 times a day). 9. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 10. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*8* discharge disposition: home discharge diagnosis: retroperitoneal hemorrhage coronary artery disease peripheral disease hypertension chronic obstructive pulmonary disease hypercholesterolemia discharge condition: stable and improved. having bowel movements, urinating, walking without assistance. discharge instructions: you will need to schedule a follow up appointment with dr. for within the next 10-14 days. his number is listed below. weigh yourself every morning, md if your weight increases by more than 3 pounds. adhere to 2 gm sodium diet. seek medical help if you experience worsening abdominal pain or lightheadedness. followup instructions: please call dr. office at to schedule an appointment for 10-14 days from now. you also have the following appointments already scheduled: provider: study where: cc clinical center radiology phone: date/time: 2:00 provider: , m.d. where: cardiac services phone: date/time: 4:30 f/u with dr. in weeks procedure: angioplasty of other non-coronary vessel(s) angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries aortography insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) transfusion of packed cells diagnoses: unspecified essential hypertension atherosclerosis of native arteries of the extremities with intermittent claudication accidental puncture or laceration during a procedure, not elsewhere classified hemorrhage complicating a procedure atrioventricular block, complete accidental cut, puncture, perforation or hemorrhage during other specified medical care iron deficiency anemia, unspecified other chest pain chronic obstructive asthma, unspecified 

Answer: The patient is high likely exposed to