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: hmg-coa reductase inhibitors / ambien attending: chief complaint: shortness of breath major surgical or invasive procedure: icd implantation coronary catheterization without intervention history of present illness: 75y/o m w/ cad s/p 5v cabg (lima-lad, svg-om1, svg-om2, svg-rpda, svg-pl) vt p mi in 92, chf w/ ef 25%, mild as, htn, hyperchol, had been admitted to for chf exacerbation one month ago for 9 days. patient re-presented again to on w/ c/o progressive sob w min exertion, lh, orthopnea and lower ext edema. no cp. he was admitted and tx for chf exacerbation, bnp 2370, started on lasix, noted to have nsvt-started on amiodarone, transiently placed on neo for hypotension which was d/c'd on , treated for ? pna w levofloxacin. pt was then tx to for eval for icd/biv pacer. past medical history: cad--s/p 5v cabg (lima-lad, svg-om1, svg-om2, svg-rpda, svg-pl) vt p mi in 92 hypercholesterolemia hypertension social history: lives in . + tobacco, quit 38 years ago. denies etoh, drug use. family history: no history of cad or sudden death physical exam: vitals: hr 84 sinus bp 94/56 sat 95% 2l g: wn, wd male, nad heent: dry mm, clear op neck: +jvd lungs: bibasilar crackles cv: rrr, s1s2, holosystolic murmur abd: soft, nt, bs+ ext: no edema. 2+ peripheral pulses neuro: appropriate. grossly intact with no focal deficits. pertinent results: admission labs: 06:39pm blood wbc-4.6 rbc-4.53* hgb-13.5* hct-38.8* mcv-86 mch-29.9 mchc-34.9 rdw-13.2 plt ct-235 06:39pm blood neuts-70.5* lymphs-18.8 monos-6.8 eos-3.8 baso-0.2 06:39pm blood plt ct-235 06:39pm blood pt-14.0* ptt-28.1 inr(pt)-1.3 06:39pm blood glucose-110* urean-19 creat-1.0 na-134 k-4.0 cl-96 hco3-29 angap-13 06:39pm blood phos-2.3* mg-2.1 03:02am blood calcium-8.4 phos-2.9 mg-2.1 iron-27* cholest-248* 03:02am blood caltibc-311 ferritn-155 trf-239 02:30pm blood triglyc-83 hdl-34 chol/hd-6.8 ldlcalc-180* 03:02am blood triglyc-91 hdl-35 chol/hd-7.1 ldlcalc-195* ldlmeas-207* 02:30pm blood tsh-2.5 ekg (admission): sinus rhythm and occasional ventricular ectopy. left atrial enlargement. low limb lead voltage. st-t wave flattening in the limb leads and t wave inversions in leads v5-v6. the st segment in lead v4 appears upward coved and t waves are biphasic. the lateral st-t wave changes may represent ischemic process. the ecg reflects ischemic cardiomyopathy. followup and clinical correlation are suggested. no previous tracing available for comparison. cath (): hemodynamics results body surface area: 2.04 m2 hemoglobin: 13.3 gms % fick post angio dobutamine **pressures right atrium {a/v/m} 11/10/6 right ventricle {s/ed} 40/10 pulmonary artery {s/d/m} 40/20/28 pulmonary wedge {a/v/m} 21/23/20 33/40/30 left ventricle {s/ed} 113/28 aorta {s/d/m} 93/60/75 98/59/76 **cardiac output heart rate {beats/min} 70 88 rhythm sinus sinus o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 47 card. op/ind fick {l/mn/m2} 5.4/2.7 6.1 **resistances systemic vasc. resistance 1022 pulmonary vasc. resistance 119 fick post angio dobutamine **valvular stenosis aortic valve gradient {mmhg} 20 aortic valve area {sq-cm} 1.7 **% saturation data (nl) svc low 64 pa main 65 ao 91 other hemodynamic data: the oxygen consumption was assumed. left ventriculography: volumetric data: lv end diastolic volume index (nl 50-90 ml/m2). 319 lv end systolic volume index (nl 15-30 ml/m2). 281 lv stroke volume index (nl 35-75 ml/m2). 38 lv ejection fraction (nl 50%-80%). 12 qualitative wall motion: : 1. antero basal - hypokinetic 2. antero lateral - hypokinetic 3. apical - akinetic 4. inferior - akinetic 5. postero basal - hypokinetic other findings: mitral valve was normal. aortic valve showed 1. calcification. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca diffusely diseased 2) mid rca discrete 100 **arteriography results morphology % stenosis collat. from **left coronary 5) left main discrete 90 6) proximal lad diffusely diseased 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 normal 10) diagonal-2 normal 12) proximal cx diffusely diseased 13) mid cx discrete 100 14) obtuse marginal-1 diffusely diseased **arteriography results to segments morphology % stenosis location **bypass graft 28) svbg #1 discrete 100 prox 29) svbg #2 discrete 100 prox 30) svbg #3 discrete 100 prox 31) svbg #4 discrete 50 prox 32) lima normal technical factors: total time (lidocaine to test complete) = 1 hour 3 minutes. arterial time = 55 minutes. fluoro time = 18.2 minutes. contrast: non-ionic low osmolar (isovue, optiray...), vol 123 ml, indications - hemodynamic premedications: asa 325 mg p.o. anesthesia: 1% lidocaine subq. anticoagulation: heparin 1000 units iv other medication: furosemide 20 mg iv tng 20 mcg/min iv dobutamine 5 mcg/kg/min iv cardiac cath supplies used: 300 cm mallincrodt, optiray 100cc comments: 1. coronary angiography of this right dominant circulation revealed severe native three vessel coronary artery disease. the lmca had a 90% narrowing at its ostium. the lad was diffusely diseased but gave rise to 4 moderate sized diagonal branches. d4 had an 80% ostial stenosis. the lcx was diffusely diseased and was totally occluded in the mid vessel after supplying a single, small and diffusely diseased om branch. the rca was diffusely diseased and totally occluded in the mid vessel. 2. arterial conduit arteriography revealed a patent lima->lad. the svg->om1, the svg->om2, and the svg->pl were all totally occluded proximally. the svg->pda had a focal 50% lesion proximally and supplied a small territory. 3. resting hemodynamics revealed markedly elevated left ventricular filling pressures with an initial lvedp of 28 mmhg and a mean pcwp of 20 mmhg that increased to 30 mmhg after angiography. the cardiac output was initially 5.4 l/min. given the high filling pressures, the patient was administered furosemide and a dobutamine drip after which his cardiac output rose to 6.1 l/min. a resting gradient of approximately 20 mmhg was measured across the aortic valve with a calculated aortic valve area of 1.7 cm2. 4. left ventriculography demonstrated profound systolic dysfunction with a calculated lvef of 12% that was also consistent with visual estimate. no significant mitral regurgitation was detected. final diagnosis: 1. severe native three vessel coronary artery disease. 2. patent lima->lad and svg->pda. 3. totally occluded svg->om1, svg->om2, and svg->pl. 4. mild aortic stenosis. 5. severe systolic and diastolic ventricular dysfunction. echo (): measurements: left atrium - long axis dimension: *5.0 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.4 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.8 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.2 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: *7.2 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 7.0 cm left ventricle - fractional shortening: *0.03 (nl >= 0.29) left ventricle - ejection fraction: 10% (nl >=55%) aorta - valve level: *4.0 cm (nl <= 3.6 cm) aorta - ascending: *4.0 cm (nl <= 3.4 cm) aorta - arch: 3.0 cm (nl <= 3.0 cm) aortic valve - peak velocity: 1.7 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.1 m/sec tr gradient (+ ra = pasp): *40 to 43 mm hg (nl <= 25 mm hg) interpretation: findings: left atrium: moderate la enlargement. right atrium/interatrial septum: no asd by 2d or color doppler. dilated ivc (>2.5 cm). left ventricle: mild symmetric lvh. severe global lv hypokinesis. no resting lvot gradient. no lv mass/thrombus. no vsd. right ventricle: normal rv wall thickness. dilated rv cavity. rv function depressed. aorta: moderately dilated aortic root. focal calcifications in aortic root. moderately dilated ascending aorta. focal calcifications in ascending aorta. normal aortic arch diameter. focal calcifications in aortic arch. no 2d or doppler evidence of distal arch coarctation. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. mild mitral annular calcification. mild thickening of mitral valve chordae. calcified tips of papillary muscles. no ms. moderate to severe (3+) mr. lv inflow pattern c/w restrictive filling abnormality, with elevated la pressure. tricuspid valve: mildly thickened tricuspid valve leaflets. normal tricuspid valve supporting structures. no ts. moderate tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. normal main pa. no doppler evidence for pda pericardium: no pericardial effusion. conclusions: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the inferior vena cava is dilated (>2.5 cm). there is mild symmetric left ventricular hypertrophy. there is profound global left ventricular hypokinesis (ejection fraction 10 percent). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. the aortic root is moderately dilated. the ascending aorta is moderately dilated. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is at least moderate pulmonary artery systolic hypertension. there is no pericardial effusion. discharge labs: significant for wbc 12.3. all others within normal limits. brief hospital course: cardiac: . a) coronaries: the patient was found to have extensive graft stenosis on cath, with 3/5 vessels completely occluded (see report). no stents were placed, and the patient was admitted to the ccu for close observation due to his low ejection fraction. in his past medical history, he reported muscle pain on statins, and so he was started on zetia for hyperlipidemia noted on labs. he was also continued on aspirin, as well as lisinopril and metoprolol as tolerated by his blood pressure. . b) pump: the patient was noted on echo to have a severely depressed ef (10%), with 3+ mr, although he was noted in the cath lab to have a cardiac output of 5.42 (ci 2.66) off of dobutamine. he was placed on dobutamine drip post-cath, which was weaned off in the ccu. he was asymptomatic throughout the hospitalization. on the floor, he was noted to consistently have blood pressures in the mid to low 80s systolic, but was completely asymptomatic and with good urine output despite this. he was slowly restarted on the acei and bb, as well as lasix as he appeared to have some degree of increased o2 requirement overnight. prior to discharge, he was seen by physical therapy, and was able to ambulate without desaturation or lightheadedness. he is discharged with plans for close follow up within 4 days for re-evaluation and/or titration of his medications. . c) rhythm: given the low ef, the patient had an icd placed. he tolerated the procedure well without complications. he was noted to have asymptomatic pvcs, as well as brief (30 - 60 min) episodes of ventricular trigeminy, which were also asymptomatic. * wbc: prior to discharge, the patient was noted on routine labs to have an increased wbc from 5.9 to 12.3. he was completely afebrile, and without any localizing symptoms of infection; in fact, he appeared quite well. he is discharged to follow up as above. medications on admission: lopressor tartrate 25mg daily, lasix 40mg daily lisinopril 10mg daily asa 325 daily otc supplement for hyperchol discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. metoprolol succinate 25 mg tablet sustained release 24hr sig: 0.5 tablet sustained release 24hr po daily (daily). disp:*15 tablet sustained release 24hr(s)* refills:*2* 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 6. keflex 500 mg tablet sig: one (1) tablet po twice a day for 1 days. disp:*2 tablet(s)* refills:*0* 7. lasix 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: congestive heart failure coronary artery disease discharge condition: stable discharge instructions: take all medications as written. if you experience shortness of breath, weight gain, chest pain, palpitations, nausea/vomiting, lightheadedness, or loss of consciousness, please call your physician or go directly to the emergency department. followup instructions: provider: clinic where: cardiac services phone: date/time: 1:30 (can also call if need to change the appointment. provider: , md where: cardiac services phone: date/time: 10:00 follow up with dr. on tuesday , at 2:45pm. md, procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension aortocoronary bypass status aortic valve disorders other specified forms of chronic ischemic heart disease old myocardial infarction knee joint replacement hip joint replacement 

Answer: The patient is high likely exposed to