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: l sided cp, "dull," no pleuritic component, no radiation major surgical or invasive procedure: cardiac catheterization peritoneal dialysis history of present illness: 68yom with esrd pckd on pd, prostate ca p/w l sided cp, "dull," no pleuritic component, no radiation. went directly to cath lab from ed due to new ste anteriorly, ? aivr, hypotension, evidence of cardiogenic shock. found to have chronically occluded rca 90% plad lesion and add'l diffuse disease and diseased lcx. bare metal stent to lad in lab. . given asa, plavix, bb, ntg; in ed bedside tte with ef = approx 15-20% . pt with acute volume o/l couple months ago treated with increased pd per renal attg. past medical history: 1. esrd pckd on pd 2. prostate ca treated with neoadjuvant hormonal therapy followed by external beam radiation therapy 3. anemia of cd 4. pvd with le claudication (on plavix) 5. ? gib, guaiac + stools social history: + tobacco hx, no etoh. lives with his wife. family history: n/c physical exam: 97.3 134/98 94 17 100% 4l pcwp 40 pad 36 ra mean 19 ci 1.74 co 3.38 gen: intubated, sedated heent: anicteric, mmm neck: jvp > 10cm cv: rrr, no apprec m/r/g chest: cta anteriorly abd: soft, + bs extr: warm, + dps neuro: sedated, responds to voice, easily arousable pertinent results: 09:06pm glucose-130* urea n-45* creat-12.7* sodium-135 potassium-5.4* chloride-99 total co2-20* anion gap-21* 09:06pm ck(cpk)-457* 09:06pm ck-mb-70* mb indx-15.3* ctropnt-2.17* 09:06pm calcium-8.1* phosphate-5.9* magnesium-1.8 09:06pm wbc-7.4 rbc-3.93* hgb-11.6* hct-34.9* mcv-89 mch-29.5 mchc-33.2 rdw-20.5* 09:06pm plt count-349 09:00pm type-mix 09:00pm type-art po2-217* pco2-34* ph-7.37 total co2-20* base xs--4 09:00pm lactate-2.2* 09:00pm o2 sat-61 09:00pm hgb-11.6* calchct-35 o2 sat-97 09:00pm freeca-1.07* 07:30pm type-art tidal vol-700 o2-100 po2-239* pco2-39 ph-7.33* total co2-21 base xs--4 aado2-442 req o2-75 -assist/con intubated-intubated 06:11pm glucose-118* urea n-46* creat-13.3* sodium-140 potassium-4.1 chloride-98 total co2-24 anion gap-22* 06:11pm ck(cpk)-87 06:11pm ck-mb-notdone 06:11pm ctropnt-0.24* 06:11pm calcium-9.3 phosphate-6.1* magnesium-1.9 06:11pm wbc-6.7 rbc-4.38* hgb-12.9* hct-39.4* mcv-90 mch-29.5 mchc-32.8 rdw-20.7* 06:11pm neuts-76.5* lymphs-17.1* monos-4.4 eos-1.7 basos-0.2 06:11pm plt count-370 06:11pm pt-12.3 ptt-22.5 inr(pt)-1.1 . labs: hct 34.2, wbc 7.7. plt 359 na 136, k 4.1, cl 91, hco3 28, bun 52, cr 10.5 ca 8.9 phos 4.7 mg 1.5 amylase 69, lipase 49 : alt 2, ast 9, alk phos 81, ldh 258, tbili 0.2 fe 38, ferritin 123, tibc 234 tsh 7.3, ft4 1.0 psa 0.4 pth 210 cks peaked at 522(110), trop 6.86. . ekg#1: new qs in v2-v4, 2mm ste v2-v4; st depressions i, avl . ekg#2: ? slow vt, rate 80 (aivr) . cxr impression: ap chest compared to and 22: intraaortic balloon pump has been removed. lung volumes remain low with persistent atelectasis at the right base, but insufficient abnormality in the lungs to explain respiratory failure. moderate cardiomegaly and a generally large and tortuous thoracic aorta are unchanged in appearance. there is no pulmonary edema or appreciable pleural effusion. tip of endotracheal tube is in standard placement at the thoracic inlet. no pneumothorax. . ct head impression: no intracranial hemorrhage . ct abd pelvis impression: 1. no evidence of intra-abdominal collection or large hematoma. 2. small amount of fluid and air and moderate amount of air in the abdomen likely related to the peritoneal dialysis. 3. multicystic kidneys. some of the cysts are complex and not well evaluated in this non-contrast study. some of the cysts are increased when compared to prior study. there is a new area of calcification in the left kidney. if indicated this cysts could be further evaluated with ultrasound or mri. 4. gallstones. 5. severe coronary artery calcifications. . cath report: comments: 1. selective coronary angiography showed a left dominant system. lmca had a 20% origin stenosis. the lad had a 90% origin stenosis involving also a d1 (90%). rest of the lad was diffusely diseased with 60-70% sequential lesions. lcx had mild itraluminal irregularities with 50% om and 60% distal lcx disease. rca was chronically occluded distally with r->l and r->r collaterals. 2. left ventriculography was deferred. 3. aortic root aortography showed markedly dilated aortic root. 4. hemodynamic assessment reaveled a depressed cardiac index 1.7-1.9 and pcwp of 35 (with large v-waves). 5. the lesion in the proximal lad was predilated with a 2.0 x 09mm maverick balloon and stented with a 2.5 x 12mm minivision stent. the final angiogram showed timi iii flow with no residual stenosis, 6. under fluoroscopic guidance, we then placed a 40cc intra aortic balloon pump just beyond the left subclavian origin. successful diastolic augmentation of blood pressure was achieved. final diagnosis: 1. three vessel coronary artery disease. 2. severe systolic ventricular dysfunction. 3. acute anterior myocardial infarction, managed by acute ptca and iabp. ptca of vessel. 4. successful stenting of the proximal lad lesion with a bare metal stent. 5. successful placement of a 40cc intra aortic balloon pump. . tte: conclusions: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with moderate cavity dilation and severe global hypokinesis. the basal inferior and inferolateral walls contract best with the more distal left ventricular segments near akinetic. there is an apical left ventricular aneurysm. no intraventricular thrombus is identified. tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is moderately dilated. the aortic valve leaflets (3) are mildly thickened but with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is at least mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior report (images reviewed) of , the left ventricular findings are new and c/w multivessel cad. mild-moderate mitral regurgitation and pulmonary artery systolic hypertension are now present. ......................................... abdomen (supine & erect) 6:15 pm abdomen (supine & erect) . comparison: ct abdomen and pelvis and portable abdomen . . abdomen, upright and supine: only one of these radiographs includes the right hemidiaphragm. there are small ovoid-shaped collections of free intra- abdominal air layering above the liver and stomach. large and small bowel are of normal caliber. there is no evidence of obstruction. extensive stool is noted within the right colon. a peritoneal dialysis catheter coils over the left abdomen into the pelvis. surrounding osseous and soft tissue structures are unchanged. . impression: small collections of free intra-abdominal air above the liver and stomach which is expected given presence of peritoneal dialysis catheter. brief hospital course: assessment: 68yo m with esrd on pd, prostate ca p/w acs and severe 2vd presented with cp and taken to cath lab and found to have 2vd with stent to lad and subsequent mental status changes that have steadily improved. . #. cv: a. pt went directly to the cath lab on admission where he was found to have significant 2vd, s/p bare metal stent to proximal lad. patient was s/p acs with unclear culprit lesion, developed cardiogenic shock and was intubated in ccu for several days. per ct , was determined not to be a cabg candidate due to poor touchdowns and severe r sided lesions. his course was complicated by a groin bleed (see below). continued asa, plavix and high dose statin, and titrated bb to metoprolol xl 200 mg po daily. due to known residual coronary lesions, isordil 10mg tid was initially added for better cp control, but was ultimately d/c'ed due to low bps, with the addition of sl ntg prn for chest pain. was initially on lisinopril 30 mg po daily, which was also ultimately decreased to 10mg po qd due to low bp. beta blockade will be the most important factor in the medical management of his cad, and should not be decreased if at all possible. he was discharged on toprol xl 150 mg qd. he should have f/u with cardiology within the next 6-8 weeks, and see his pcp soon after discharge from rehabilitation facility. . b. pump - cardiogenic shock, newly depressed ef. he had significant volume o/l and lv dysfunction. an iabp was in place (1:1) with hep gtt after cath. the balloon was subsequently removed and we titrated up inotropes/pressors to map > 60, ci > 2 a pcwp > 40 determined that he needed aggressive diuresis which he underwent via pd with renal service following. several liters of fluid were removed by pd and was maintained at relatively even volume exchanges for several days prior to discharge. . c. rhythm- aivr in ed, nsr since. qtc was monitored in setting of haldol administration, and was consistently in normal range. . #. esrd on pd x several years -- volume o/l by elev pcwp on admission, s/p fluid removal by pd for several days, now euvolemic on exam with even volume exchanges. renal following and maintaining even is/os. he should continue with daily peritoneal dialysis. he should follow-up with his nephrologist dr. on discharge from rehab facility. . #. groin hematoma- pt had rapidly expanding groin hematoma of his right groin in setting of heparin s/p cath. he was reintubated in setting of pain when he was uncontrollable and thrashing in bed. hematoma was tamponaded with a pressure dressing and external fixture and was controlled by the following day. he had a hct drop in setting of bleed. peripheral pulses were still dopplerable (baseline) throughout. this has now resolved, with persistent ecchymosis, but stable hct x 5 days. . #. s/p intubation- done for agitation purposes at first in the cath lab. he was successfully weaned by hd #3 but reintubated the next day s/p groin bleed and uncontrolled behavior, including trying to get out of bed and resisting pressure on his bleeding groin. he was successfully weaned a second time and as his ms has improved, he has not required further intubation. . #. acute ms changes: pt has been agitated at times, generally in the setting of pain, and seemed to have no clear understanding of what was going on. he has been on several sedatives and could have been experiencing medication effects s/p extubation. his mental status started to clear. he passed speech and swallow, now on regular renal/cardiac diet. ct head ruled out bleed/new process but did show old lacunar infarct. continued haldol hs and prn haldol as needed, with input from psychiatry service. his ms improved daily and was near baseline at time of discharge, with minimal need for haldol. his haldol was discontinued several days before discharge. his mental status is approaching baseline, however, he still has some difficulty performing his own peritoneal dialysis. he will need ongoing education in this process while at rehab. . #. abdominal discomfort: developed on . there were initial concerns for peritoneal fluid infection in setting of ongoing pd, and dialysate was pink-tinged. pain may have been due to hematoma from subcutaneous heparin, which was d/c'ed prior to d/c, as patient was ambulating well ct abdomen ruled out bleed, or other pathology that could explain his symptoms. peritoneal fluid analysis from showed gram positive cocci in pairs, not yet speciated. his cell count from his peritoneal fluid was low, with a very low number of pmns. he received vancomycin 2 gm ip x 1; he should have a second dose on . he had guaiac negative stool on day of discomfort. lfts were normal, as were amylase and lipase. a plain film of the abdomen on demonstrates a small amount of intra-abdominal free air, which is likely secondary to a pd cath that was uncapped for too long. repeat analysis of peritoneal fluid showed on 33 wbc, 14% pmns. abdominal pain had significantly improved on day of discharge. . #. guaiac + stools: pt has documented history of this before and during this admission, but not for last several days. outpatient colonoscopy should be arranged. hct remained stable. . #. prostate ca- not acute issue while in-house. psa 0.4. has f/u appt with oncology. medications on admission: asa 81mg daily flomax neurontin labetalol 400mg daily iron norvasc 10mg daily cac03 discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). 5. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. epoetin alfa 10,000 unit/ml solution sig: 8000 (8000) units injection qmowefr (monday -wednesday-friday). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 8. lanthanum 250 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 11. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 12. dolasetron mesylate 12.5 mg iv q8h:prn 13. metoprolol succinate 100 mg tablet sustained release 24hr sig: 1.5 tablet sustained release 24hrs po once a day. 14. vancomycin 1,000 mg recon soln sig: two (2) gm intravenous once for 1 days: please administer vancomycin 2 gm x 1 intraperitoneally on . discharge disposition: extended care facility: - discharge diagnosis: myocardial infarction congestive heart failure end-stage renal disease discharge condition: stable, cardiac medication regimen optimized. discharge instructions: you had a blockage in your coronary artery with evidence of damage to your heart; the blockage was stented. you also had a bleed from the cateterization site, as well as some post-operative confusion that has been improving. your heart medicines were optimized prior to discharge. * your fluid status should be kept even with peritoneal dialysis. * call your doctor or return to the emergency room if you develop cehst pain, shortness of breath, nausea/vomting, you are unable to continue with your peritoneal dialysis or you develop any other symptoms that are concerning to you. followup instructions: provider: , md phone: date/time: 11:00 . you should follow with dr. soon after being discharged from the rehabilitation center. you can call for an appointment. . you have an appointment with dr. on at 3pm on the of the building. . you should also follow-up with your nephrologist dr. after you are discharged from your rehab program. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube implant of pulsation balloon peritoneal dialysis cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute myocardial infarction of other anterior wall, initial episode of care hematoma complicating a procedure cardiogenic shock 

Answer: The patient is high likely exposed to