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: sulfa (sulfonamide antibiotics) attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization history of present illness: outpt cardiologist: . mr. is an 80yo m with dementia, cad s/p cabg in (lima-lad, svg to om2, svg to rpda), then s/p cabg redo in , then s/p 2 caths this year with patent lima, totally occluded svg to rpda, svg to om2, s/p bms to lcx on who presented to hospital with increasing chest pain and nausea over the past few days. . per report, patient has presented several times since last cathed for recurrent angina. admitted to on with recurrent chest pain. ruled out for mi. last episode of chest pressure was the morning of transfer, associated with dry heaves and belching relieved with morphine. pt was continued on asa, plavix, statin, bbker, imdur and placed on heparin gtt. . cath last here at showed a patent bms in lcx and no new lesions. the plan in conjunction with referring dr. from was to optimize medical therapy in house. if the angina were to continue, the plan was to consider opening rca cto as well as pci of a om2 beyond prior stent. pt was transfered to for pre-hydration in anticipation of the above procedure. . on the floor, pt is agitated, and unwilling to answer questions about his symptoms. he is threatening to doctors, demanding to leave the hospital. he states, "my daughters should be yelling at you to leave me alone." he is adamantly refusing cath. past medical history: cad s/p cabg with re-do x 1 htn dyslipidemia cri (cr 1.8-2.1 at ) dementia arthritis cholecystectomy depression gerd social history: lives alone in retirement community. has 11 children who are supportive. no hx of tobacco/etoh/drugs family history: non-contributory physical exam: vitals: 98.6 140/70 73 18 97% ra gen: appears agitated but in nad. heent: perrl, eomi, conjunctiva pink. op clear. neck: no jvp, no carotid bruit lungs: well-healed scar around the left scapula. rough crackles on left lung, dullness on percussion. cv: s1, s2, pmi nondisplaced abd: soft, nt, nd, + bs's ext: 1+ pedal pulses, no edema neuro: refusing to answer orientation questions. cn ii-xii intact, strength 5/5 throughout, sensation intact to light touch throughout. pertinent results: pertinent results: labs: at osh: hct 30.1, wbc 9.7, plt 161, inr 1.1, k 4.4, na 144, cr 1.8, bun 32 cardiac enzymes 4 am ck 92 ck mb 3.6 index 3.9 trop-i 0.02 11 am ck 104 mb 4.3 index 4.1 trop-i 0.06 4 pm ck 89 mb 3.8 index 4.3 trop-i 0.14 . radiology results: at osh mild prominence of the markings at the right base. the appearance is of uncertain significance. post surgical changes are noted. . ekg: sinus at 77, old inferior infarct. <1mm st depression in i and avl which were previously noted. . osh echo: ef 55%-60%, septal wall hypertrophy. basal anterior wall scarring/hk, mild mr, mild ar, mild pr. dilated la. . echo: the left atrium is mildly dilated. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with inferior and inferolateral akinesis. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. the lumen of the descending thoracic aorta appears echodense in parasternal long-axis views compatible with probable severe atherosclerotic plaque. ef 45% . cardiac cath : 1. access via 4 f sheath in rfa. we took pictures of the native left in ap caudal, lao caudal and lao cranial. no other vessels were engaged in order to save contrast. these views showed the stent to be widely patent with no new lesions. 2. hemodynamics with bp 132/70 with hr in sinus at 74 on iv tng. 3. the plan in conjunction with referring dr. from is medical therapy in house. if he continues to have angina could have the rca cto opened as well as pci of a om2 beyond prior stent. . cardiac cath : 1. selective coronary angiography of this right dominant system demonstrated native three vessel coronary artery disease. the lmca had no obstruction. the lad was totally occluded at its mid-portion, with serial focal 80% stensoses proximally; these stenoses may impair flow to the septals which do supply flow to the distal rca. the lcx had a 80% proximal stenosis and a long tubular 70% lesion in the proximal om1 which is then occluded more distally, supplies collaterals to the rca. the rca is totally occluded in its mid-portion, with left to right and right to left collaterals. 2. selective angiography of the bypass conduits demonstrated total occlusion of the svg-rpda and svg-om2. the lima-lad was widely patent. 3. successful placement of a 2.0x12mm mini vision bare-metal stent was performed in the proximal lcx. final angiography showed normal flow, no apparent dissection, and no residual stenosis. (see ptca comments.) 4. the right femoral arteriotomy was successfully closed using a mynx device. final diagnosis: 1. three vessel coronary artery disease. 2. totally occluded svg-rpda and svg-om2. 3. patent lima-lad. 4. successful bms placement in the lcx. . 1- selecive coronary angiography of this right-dominant system showed severe diffuse three vessel disease. the lmca had mild plaquing. the lad was diffusely diseased with serial 80% lesions throughout its course and total occlusion at the mid vessel. the klad gave collaterals to the rca via its septal branches. the lcx was diffusely diseased with a long 80% lesion that starts proximal to the stent and continues as isrs. the lcx gave rise to a major branching om with long 90% stenosis at the origin of the upper pole of the om. the lcx gave numerous collaterals to the distal rca system. the rca was chronically occluded proximally with essentially no contguous flow channel. tghe vessel was difusely diseased throughout. 2- limited resting hemodynamic assessment showed moderately elevated (171/60 mmhg). 3- successful poba of the origin/proximal upper pole of a branching om2. final angiography showed a nonflow-limiting (timi iii) stable dissection at the angioplasty site with 30-40% residual stenosis and no distal emboli. 4- successful ptca and stenting of the proximal lcx with a 2.5x18 mm cypher des. final angiography showed no residual stenosis with timi iii flow and no dissection or distal emboli. rigorous flow into the lcx-->rca collaterals was noted. 5- successful revascularization of a totally occluded rca with poba of the entire rca proper (ostium to bifurcation). final angiography showed 30-40% residual stenosis with stable nonflow-limiting (timi iii) dissection (proximal third) and no distal emboli. 6- successful deployment of a perclose proglide closure device to the rcfa. final diagnosis: 1. three vessel coronary artery disease. 2. modearts systemic hypertension. 3. successful poba of the distal om. 4. successful ptca and stening of the proximal lcx with a cypher des. 5. successful poba of the entire rca proper with re-establishment of timi iii flow to chronically-occluded vessel. 6- successful deployment of a perclose proglide closure device to the rcfa. . echo: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is moderately-to-severely depressed (lvef= 30%) secondary to severe hypokinesis/akinesis of the inferior and posterior walls. the basal inferior septum and inferior free wall are dyskinetic. the anterior septum is also hypokinetic. right ventricular chamber size and free wall motion are normal. 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. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . labs on discharge: brief hospital course: patient was initially cared for on the cardiac floor while awaiting cath. he had an uneventful night except for extreme aggitations, however when he went to the cath lab in the morning he was agitated and refused cardiac cath. he was then transferred to the ccu for better monitoring until he could undergo cath. he did have chest pain and hypoxia on the floor while aggitated. his ekg had finidngs of ischemia during his aggitation that resolved when calmer. he was transferred for the cath and had the interventions. see below for ccu course. ccu course: # ams: patient was transferred to ccu after refusing cardiac cath in the setting of ams in cath lab. he had a ua which was positive and thus was started on antibiotics as it was thought he had ams in setting of baseline slight dementia with infection. he also was initially treated with haldol and zyprexa without change in his ams and eventually had clearing of his ms with seroquel and a few days of abx. still has nighttime delerium but no longer has the aggitation that he had previously. he will continue venlafaxine for now. he can take seroquel at night as needed. . # angina: refractory to medical management. had cardiac cath that showed severe three vessel cad but as patient not deemed good cardiac surgery patient he had poba of rca and om2 and des in lcx. was continued on asa, plavix, statin, imdur, , beta blocker. from home meds, his imdur was decreased, and losartan decreased. his coreg was also increased. after intervention he remained chest pain free and was feeling well even with the mild amount of exercise he was doing. . # cri: (cr 1.8-2.1 in ). pre- and post-cath hydration and mucomyst per protocol and , hctz and nsaids were held in anticipation of cath. creatinine was stable post cath at baseline except that two days after cath it went up to 2.3 and then plateaued, is likely contrast nephropathy and will continue to monitor. the day of discharge cr was 2.1. . # htn: was continued on imdur and bbker and was added post-cath. see med list for complete list. was mostly normotensive except for some hypertension while aggitated early in his admission. . # dyslipidemia: was continued on high dose atorvastatin. . # uti: patient with dirty ua and was treated with cipro x 7 days first dose . cipro was stopped due to interaction with psych meds and he was switched to cefpodoxime and he will finish his 7 day course with that abx. he has one more day left of treatment after discharge. . # anemia: patient had hct<30 post-cath and was transfused total of 2uits while in ccu. hcts after the second transfusion were stable. he required lasix with the transfusions (40mg iv) with good effect. his hct remained stable after discharge from the ccu. . # fluid overload: had crackles on exam and still had a 3l o2 requirement so was given lasix 40 mg iv daily. for discharge he was transitioned to 40 mg po daily which can be reevaluated as an outpatient. . return to floor course: once back to team, patient was doing well. he was continued to be diuresed and his o2 was weaned slowly. he was briefly satting well on room air but with movement required about 1-2l. he worked with pt/ot. he still had some confusion but was much improved previously. . his family agreed to a short rehab stay where his fluid status will continue to be monitored and he can continue to work with pt and have nursing care at night in the case of delerium. medications on admission: medications at home: 1) asa 325 qday 2) clopidogrel 75 qday 3) coreg 12.5 4) imdur 60 qday 5) atorvastatin 80 qhs 6) losartan 100 qday 7) ranitidine 150 8) effexor 75 qday 9) nitro sl prn . medications on transfer: imdur, plavix, aspirin 325mg, nexium, coreg, cozaar, lipitor, norvasc, effexor discharge medications: 1. venlafaxine 75 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 4. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 5. ranitidine hcl 150 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. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 9. cefpodoxime 100 mg tablet sig: two (2) tablet po q24h (every 24 hours): please continue for one more day. last dose should be . 10. lasix 40 mg tablet sig: one (1) tablet po once a day. 11. seroquel 25 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. discharge disposition: extended care facility: rehabilitation and nursing center - discharge diagnosis: primary diagnosis: 1. coronary artery disease 2. nstemi 3. delerium 4. congestive heart failure discharge condition: stable, walking around, breathing well on room air discharge instructions: you were admitted to the hospital for chest pain. it was due to blockages in your heart. it was not well controlled on oral medicines and you were starting to get worsening shortness of breath. we did a cardiac catheterization and did two balloon angioplasties on your vessels and put in one stent. you felt better and your symptoms improved after the catheterization. . you also had some delerium while you were in the hospital. we treated you with some medicines to help you calm down. you should not need to continue seroquel at home. . please take the medicines as described in the attached sheet. we made some changes including increasing your imdur from 60 mg daily to 120 mg daily, decreasing your losartan from 100 mg daily to 25 mg daily, increasing your coreg from 12.5 twice daily to 25 twice daily. we added lasix 40 mg daily. we also added venlafaxine 75 mg daily. you should continue the antibiotic cefpodoxime for one more day. . please call your doctor or return to the hospital for worsening chest pain, shortness of breath, palpitations, fainting, sweating, nausea, vomitting, fevers, chills, or any other concerns. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. followup instructions: please follow up with your primary care doctor dr. in one to two weeks after being discharged from rehab so she can check your blood pressure and increase your medicines in needed. dr. phone number is . . please follow up with your cardiologist dr. within two to three weeks after discharge. your family can call and make an appointment which fits into their schedule. his number is . md procedure: coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] destruction of cranial and peripheral nerves procedure on three vessels diagnoses: anemia in chronic kidney disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status other persistent mental disorders due to conditions classified elsewhere accidental puncture or laceration during a procedure, not elsewhere classified chronic kidney disease, unspecified other and unspecified hyperlipidemia cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft pulmonary congestion and hypostasis delirium due to conditions classified elsewhere chronic total occlusion of coronary artery arthropathy, unspecified, site unspecified dissection of coronary artery 

Answer: The patient is high likely exposed to