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 catheterization () history of present illness: this is a very pleasant 67-year-old blind and deaf male with past history of htn, dilated cardiomyopathy, h/o nstemi's, systolic failure (ef = 35%)cad s/p 1) left anterior descending stent in (at the ), 2) ?angioplasty in and 3) balloon angioplasty with cordis cypher stent placement in the 3rd marginal as well as balloon angioplasty of the distal circ on (at the ). he is transferred here from in the setting of recurrent chest pain for cardiac catheterization. . the patient's broader cardiac past medical history begins in , at which time he was diagnosed with hypertension. in , he began experiencing chest pain while walking and lifting heavy objects, prompting him to present to hospital. at that time, he characterized his pain as chest tightening and burning, with associated radiation to his neck, jaw and arms. echo during that admission showed concentric lvh with an ejection fraction of 55-60%, mild ai, and no regional wall motion abnormalities. a stress test performed during that hospitalization revealed exercise to 90% of his age-predicted maximum, limited by chest discomfort with radiation to both arms as well as shortness of breath, with new st depressions in ii, iii and v6. in light of these results and his recurrent pain c/w unstable angina, the patient was then transferred to for cardiac catheterization. . at the on , the patient underwent cardiac catheterization that revealed severe focal stenosis in the proximal lad. dilation was successfully opened and stented with minimal residual stenosis. some moderate focal disease in the proximal diagonal branch of the lad was noted. . he subsequently underwent angioplasty in (details are not clear in the available records) and then balloon angioplasty with cordis cypher stent placement in the 3rd marginal as well as balloon angioplasty of the distal circ on (at the ). . fast-forwarding to the present: the patient presented to his clinic on and was told that he was not supposed to recieve hd on that day. he refused to leave, complaining of abdominal pain. while there, his pressure was noted to be in the systolic 60s and 70's and he was said to be "somewhat confused". . the patient was therefore bolused and taken by ambulance to the ed, where he then complained of chest pain. per osh records, troponins were slightly elevated, peak 6.89 --> 2.52. mb rose to around 37. ecg showed left bundle branch block but no st elevations. he was givin asa, morphine and pepcid and then started on a nitro drip. the osh notes state that the nitro drip relieved the pain for a short time only, and in the context of his presenting low bp's, presumed unstable cp as well as a reported leukocytosis to 16.2, he was transferred from the ed to the icu to rule-out for mi as well as, per report, sepsis. . in the icu, he ruled-out for stemi. heparin was not started in the icu because of a reportedly supratherapeutic inr (the value is not stated in the osh notes) reportedly without any history of coumadin use, although this seems peculiar given his reported history of afib. he received vitamin k. he was transfused for hct = 25% --> 2 units --> 34% attributed to chronic blood loss anemia with external hemorrhoids noted on exam. although he had a low-grade fever while there, cultures at the osh showed no growth times three. mrsa negative. no urine culture was taken given anuria. the patient was started on augmentin after dental consultation for dental carries. he reportedly complained throughout the hospitalization of heart-burn like symptoms. dr. at arranged for cardiac catheterization with dr. , which is to take place tomorrow. . on arrival to the floor, vs: hr 74, sbp 105/59, rr 18, 95%ra. the patient complained of continuing stomach burning and chest pain, which he had great difficulty describing. he was able to say that it was worse when he lied back, requiring him to sleep with pillows on the couch at home. he admits to associated cough and nausea. he states that there is a "funny" taste in his mouth during these times. there does not seem to be a clear correlation with meals. he noted that po sucralfate makes his discomfort much better, and repeatedly asked for this medication during the interview. he admitted to non-specific arm pain in both arms, but no back or jaw pain. ros was otherwise negative in detail. . . . past medical history: as above, and: 1) hypertension. 2) speech and hearing deficit. 3) peptic ulcer disease, dyspepsia 4) gout 5) osteoarthritis. 6) chronic renal insufficiency, thought nephrosclerosis 7) retinitis pigmentosa 8) a fib on amio 9) h/o nstemi social history: he denies tobacco or alcohol use. he is currently unemployed on disability and lives with girlfriend. family history: mother died of mi after age 80. father died at 20's of an unspecified brain "problem". other family history is not known by patient. physical exam: vs: hr 74, sbp 105/59, rr 18, 95%%a. gen: nad, supine in bed, smiling. heent: nc/at. mmm. oropharynx clear. no oral abscess identified. poor dentition. pulm: right sided crackles limited to lower field. no wheezing or rhonchi. no a/e changes. cv: systolic murmur, decrescedo, bh@ rusb. abd: s/nt/nd. na bs ext: wwp rust pulses, strength and reflexes bl. trace bl pitting edema. pertinent results: ekg (): sinus rhythm. left atrial abnormality. borderline p-r interval prolongation. intraventricular conduction delay of left bundle-branch block type. st-t wave abnormalities. no previous tracing available for comparison. clinical correlation is suggested. cardiac catheterization (): 1. selective coronary angiography of this right dominant system demonstrated two vessel cad. the lmca was non-obstructed. the mid lad had moderate in-stent restenosis. the lcx had widely patent stents. the rca had a recanalized chronic total occlusion in the mid vessel with severe diffuse ahd heavily calcified disease in the mid to distal vessel. 2. limited resting hemodynamics demonstrated normal systemic arterial pressures. 3. unsuccessful ptca of the rca chronic total occlusion. 4. right femoral arteriotomy site was closed with a 6 french angioseal device. ekg (): baseline artifact. probable sinus rhythm. since the previous tracing limb lead voltage has diminished. otherwise, no change. cxr 2v (): large dialysis catheter in place, cardiac enlargement and evidence of moderate degree of pulmonary vascular congestion with small amounts of pleural effusions. retrocardiac left lower lobe atelectasis. followup examination recommended to monitor improvement. tte (): no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. no masses or thrombi are seen in the left ventricle. overall left ventricular systolic function is moderately depressed (lvef= 35%) with global hypokinesis and inferior/infero-lateral thinning/akinesis. there is no ventricular septal defect. with mild global free wall hypokinesis. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. compared to the report from , decreased biventricular systolic function is new. on admission (): wbc-8.8 hgb-10.7* hct-33.6* mcv-87# plt ct-215 neuts-86.1* lymphs-7.6* monos-4.5 eos-1.6 baso-0.2 glucose-159* urean-31* creat-5.2*# na-140 k-4.6 cl-102 hco3-24 calcium-8.5 phos-2.6* mg-3.2* pt-14.2* ptt-22.0 inr(pt)-1.2* ck(cpk)-24 > 21* ctropnt-2.22* > 2.36* on discharge (): wbc-8.5 hgb-9.2* hct-29.9* mcv-89 plt ct-239 glucose-72 urean-58* creat-7.5*# na-137 k-4.7 cl-98 hco3-24 calcium-8.1* phos-3.0 mg-2.9* brief hospital course: 67 year-old blind and deaf male with cad with prior nstemi and prior stent placements, hypertension, dilated cardiomyopathy admitted with recurrent chest pain. hospital course was as follows. 1. coronary artery disease: patient has significant cad history with prior stent to lad in and cordis cypher stent placement in 3rd marginal as well as balloon angioplasty of the distal circ in 5/. on admission, etiology of chest pain was unclear - differential included acs vs. gerd. on admission, ck flat, troponin not surprisingly elevated given esrd. cardiac catheterization revealed rca lesion with collaterals, unsuccessful ptca of rca, moderate instent restenosis of lad, patent left circumflex stents. patient was evaluated by ct surgery for surgery and felt not be a good surgical candidate given diffuse disease. medication managment was maximized, including starting plavix and imdur. patient was continued on aspirin, metoprolol, and statin. 2. gerd: also on the differential for this patient's burning chest pain. chest pain was initially relieved with maalox, sucralafate. given the possibility of aluminum toxicity in esrd patients, these medications were discontinued and patient was started on calcium carbonate and viscous lidocaine as needed. in addition, he was continued on a ppi and h2-blocker per his home regimen. 3. anemia: hematocrit was stable around 30. baseline unknown. patient underwent evaluation by hematology service at hospital; anemia was thought to be multifactorial and secondary to external hemorrhoids, esrd, iron deficiency. patient was continued on procrit with hemodialysis. as an outpatient, he is recommended to have a colonoscopy for further evaluation. 4. atrial fibrillation: patient was continued on amiodarone, metoprolol. coumadin therapy was discussed via email with patient's pcp; given concern for compliance with inr checks and appropriate daily dosing, risk was thought to outweigh benefit that coumadin therapy would provide. 5. systolic dysfunction, chronic: lvef= 35%. global hypokinesis and inferior/infero-lateral thinning/akinesis. patient appeared euvolemic on admission. he was continued on metoprolol and started on lisinopril, as above. 6. dental abscess/caries: patient was started on augmentin for 2 week course for dental infection while at hospital. this was continued throughout hospital course. given diarrhea without fever, leukocytosis, or abdominal pain, imodium was started. patient was asked to call his doctor or return to the emergency department if he developed any of the above. 7. hypertension: blood pressure remained in good control with beta-blocker, ace inhibitor, and imdur. 8. esrd: mwf hd regimen. as above, maalox and sucralafate were discontinued given concern for aluminium buildup/toxicity. medications on admission: allopurinol 100mg po qd amiodarone hcl 200mg po qd asa 325mg po qd simvastatin 40mg po qd vitamin b complex folic acid vitamin c vitamin e 400 units po qd iron 325mg po bid sevelamer hcl 1600mg po w, m amoxicillin/clavulanate potassium 500mg po q12hrs metoprolol tartrate 50mg po bid at 1000hrs and 2000hrs omeprazole 40mg po bidac lactobacillus po bid famotidine 20mg po q2days at 8am sucralfate 1000mg po achs nacl 10ml iv tid hydrocortisone one topical application qhs nitroglycerin paste 1 inch q 8 hours epo alfa //9000 iv at hd heparin line washes at hd acetaminophen 650mg po q4h prn aluminum hydroxide/mg hydroxide/simethicone 15ml po q6hrs prn docusate 200mg po bid prn oxycodone/acetaminophen 1-2 tabs q6hrs prn nitroglycerin .4mg sl prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. sevelamer hcl 400 mg tablet sig: four (4) tablet po tid w/meals (3 times a day with meals). 5. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for consitpation. 8. nitroglycerin 0.4 mg tablet, sublingual sig: tablet, sublinguals sublingual prn (as needed) as needed for chest pain: take every 5 minutes for total of 3 doses. 9. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 11. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for indigestion. 12. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 13. vitamin e 400 unit capsule sig: one (1) capsule po daily (daily). 14. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 15. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 16. famotidine 20 mg tablet sig: one (1) tablet po every other day. 17. imdur 30 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* 18. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 9 days. disp:*18 tablet(s)* refills:*0* 19. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 20. lidocaine hcl 2 % solution sig: twenty (20) ml mucous membrane tid (3 times a day) as needed for indigestion, reflux. disp:*1 week supply* refills:*0* **per discussion with pharmacist at on , dosing was changed to 10ml po tid prn gerd, dispense 150ml total discharge disposition: home with service facility: vna discharge diagnosis: coronary artery disease hypertension dilated cardiomyopathy gerd discharge condition: ambulatory; chest pain-free; hemodynamically stable. discharge instructions: you were transferred to on with recurrent chest pain after sustaining a heart attack recently. you were taken for cardiac catheterization, which showed some blockages in your arteries that, after discussion with our surgeons, we determined would best be managed with medications rather than surgery. we started you on a medication, imdur, which should help to control the frequency of your chest pain. new medicines: 1. plavix 2. imdur 3. viscous lidocaine (as needed for reflux) 4. tums (as needed for reflux) 5. lisinopril 6. augmentin (continue for 9 days) 7. imodium (as needed for diarrhea) stop taking: 1. sucralafate (this medication can cause aluminum buildup in patients with kidney disease) 2. maalox (this medication can also cause aluminum buildup in patients with kidney disease) please take all of your medications as prescribed. please note that you cannot take sucralfate or maalox. you must stop these medications. you must stop these medications because they contain aluminum, a toxic metal that will accumulate in your body because your kidneys do not work well enough to clear this substance. of note, hemodialysis is likewise unable to filter aluminum. in short, you must not take sucralfate or maalox. please follow-up with your physicians as suggested below. please call dr. if you have any trouble breathing, weakness, increasing chest pain, vomiting, dark stools, abdominal pain, blood in your stools, confusion (a symptom of aluminum toxicity), dizziness, fever, chills, night sweats or any other symptom that concerns you. followup instructions: please follow-up within dr. (). we phoned his office on and requested that his secretary phone you on monday to set-up an appointment to occur within two weeks of discharge. . cardiology: phone:( 15 brothers , ma date/time: at 3:20pm. md, procedure: coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization diagnoses: other primary cardiomyopathies end stage renal disease coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease unspecified hearing loss chronic systolic heart failure external hemorrhoids with other complication legal blindness, as defined in u.s.a. pigmentary retinal dystrophy periapical abscess without sinus dual sensory impairment 

Answer: The patient is high likely exposed to