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: no known allergies / adverse drug reactions attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization history of present illness: 62 yo m h/o achalasia s/p laparoscopic myotomy , hyperlipidemia, bph who presented to the ed with chest pain. for the past few days he has complained of flu-like symptoms with right sided chest pain and was taking dayquil/nyquil for relief. yesterday, he developed different left sided chest pressure that was substernal without relief, he took nyquil and went to bed, and awoke with the continued pain. he took a russian medication for angina without relief (some type of valerian derivative). he went to work today with persistent chest pain and his daughter was called, who commented that he was very pale with weak pulses and appeared quite ill. she called 911, ems arrived and provided 325 asa. of note, he recently had an echo for lower extremity edema on which showed preserved ef of 55% and no wall motion abnormality (normal). . upon arrival to the ed, initial vs: 96.4 88 110/60 16 100% 2l nasal cannula. ekg showed st elevations in i/avl and v4-v5 with st depressions in the inferior leads. . in the cath lab a occluded lad which was stented with 2 overlapping des. he also had a tight diagonal lesion that was angioplastied. during the procedure he had some hypotension and a hct was drawn showing a crit of 19.9 from 26.7 prior to cath. his baseline after his myotomy was 40 in . . on arrival to the ccu, vs: 98.7 93 92/61 95% on 2l. he complained of chest pressure that had decreased from previously. denied sob, nausea, vomiting. also, specifically denied any melena or brbpr since his discharge after myotomy. he had one episode of melena during his last admission that resolved, with a hct of 40 at discharge. past medical history: 1. cardiac risk factors: + dyslipidemia 2. cardiac history: none 3. other past medical history: - achalasia s/p laparoscopic myotomy, flexible esophagoscopy in - balloon dilatation in of his esophagus - gerd - dyslipidemia - hyperplastic polyps on colonoscopy five years ago. social history: he is not a smoker. he is a rare social drinker. he does not use any drugs. he owns a business. he is divorced. he works in . he has several members of his family including his daughter whose phone number is . family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - mother: cva and - father: - brother: congenital heart disease family history is notable for a daughter with achalasia, mother who had myocardial infarction and mother and father who reportedly had blood clots and deep venous thromboses. physical exam: vs: t= 99.1 p 96 bp 108/64 94% 2lnc general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: decreased breath sounds with minor rales at the right base, rhonchi over the left middle lung field. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c. no femoral bruits. + bilateral pitting edema to the shin. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs 04:10pm blood wbc-12.7* rbc-3.27*# hgb-7.8*# hct-26.7*# mcv-82# mch-24.0*# mchc-29.4*# rdw-14.8 plt ct-495*# 04:10pm blood neuts-92.4* lymphs-5.8* monos-1.5* eos-0.1 baso-0.2 04:10pm blood hypochr-3+ anisocy-1+ poiklo-1+ macrocy-normal microcy-1+ polychr-normal ovalocy-1+ 06:30pm blood pt-12.2 ptt-104.1* inr(pt)-1.1 04:10pm blood glucose-266* urean-18 creat-0.7 na-136 k-3.6 cl-104 hco3-19* angap-17 04:10pm blood ld(ldh)-265* ck(cpk)-195 totbili-0.3 04:10pm blood calcium-8.4 phos-2.1* mg-2.1 iron-13* discharge labs 07:20am blood wbc-7.5 rbc-3.76* hgb-9.5* hct-30.7* mcv-82 mch-25.2* mchc-30.8* rdw-15.4 plt ct-438 07:20am blood plt ct-438 07:20am blood pt-11.3 ptt-55.8* inr(pt)-1.0 07:20am blood glucose-110* urean-14 creat-0.8 na-141 k-4.6 cl-107 hco3-26 angap-13 07:43am blood ck(cpk)-1109* 02:51am blood ck(cpk)-1359* 11:21pm blood ck(cpk)-1358* 06:30pm blood ck(cpk)-484* 04:10pm blood ld(ldh)-265* ck(cpk)-195 totbili-0.3 07:43am blood ck-mb-163* mb indx-14.7* ctropnt-2.45* 02:51am blood ck-mb-217* mb indx-16.0* ctropnt-3.06* 11:21pm blood ck-mb-208* mb indx-15.3* ctropnt-2.98* 06:30pm blood ck-mb-62* mb indx-12.8* ctropnt-0.76* 04:10pm blood ctropnt-0.09* 04:10pm blood ck-mb-15* mb indx-7.7* 06:45am blood calcium-8.2* phos-3.7 mg-2.2 pertinent studies cardiac catheterization 1. selective coronary angiography of this right-dominant system demonstrated severe single-vessel cad. the lmca was normal. the lad had a 99% thrombotic lesion in the mid-vessel segment. this extended into the ostium of a large d1 branch causing total occlusion of the d1. the lcx had mild luminal disease throughout. the dominant rca was a large-caliber vessel with ulcerations in the mid-vessel segment. 2. limited resting hemodynamics revealed severely elevated left-sided filling pressures with an lvedp of 31mmhg. systemic arterial pressures were low-normal with a measured central aortic pressure of 99/54/64. 3. left ventriculography was deferred. 4. successful pci of the lad with overlapping 2.5x28mm and 2.5x12mm -dilated to 3.0mm (see ptca comments). 5. successful thrombectomy and ptca rescue of a large diagonal branch (see ptca comments). 6. successful rfa groin closure with 6f angioseal device. echocardiogram normal left ventricular cavity size and wall thickness with moderately depressed left ventricular systolic function and regional wall motion abnormalities consistent with coronary artery disease involving a proximal lesion in a likely wrap-around left anterior descending coronary artery. mild pulmonary artery systolic hypertension. compared to the previous study of (images reviewed), the regional left ventricular systolic dysfunction and depression in left ventricular systolic ejection fraction are new. mild pulmonary artery systolic hypertension is now appreciated; it's presence/absence was not commented upon on the prior study. ct chest/abdomen/pelvis without contrast 1. moderate pulmonary edema and central vascular congestion, with moderate size bilateral pleural effusions, compatible with cardiac decompensation, given current stemi. 2. dilated esophagus filled with food products and fluid, compatible with achalasia. status post myotomy. no secondary signs of perforation. 3. global decrease in blood density, suggestive of chronic anemia. 4. no acute intra-abdominal or intrapelvic process. specifically, no retroperitoneal bleed detected. cxr 1. bibasilar opacities, worse on the left, with possible new left effusion. 2. limited assessment of superior mediastinum due to lordotic positioning. 3. probable right humeral diaphysis enchondroma. when the patient is stable, recommend clinical correlation to exclude any right humeral atypical pain and baseline right humerus radiographs to include the entire lesion. brief hospital course: 62m hx hlp, achalasia s/p myotomy , bph, gerd who presented with one day of chest pain found to have ste in the anterolateral leads. cath complicated by acute bleeding from unknown source. . # stemi: risk factors include hypercholesterolemia but otherwise no smoking history, no htn, no dm, no fhx. found with large thrombus burden in the diagonal branch and a tight proximal lad lesion, no s/p desx2 to the lad and angioplasty with clot retrieval of the diagonal. he was started on atorvastatin 80, aspirin 325, plavix 75. tte showed ef 35% with depressed left ventricular systolic function. he was placed on a heparin drip and will transition to warfarin on a lovenox bridge. he will be followed in . he did have some ventricular ectopy and an episode on vtach lasting about 40 seconds, and was started on metoprolol. he will go home with a life vest for defibrillation in the acute setting, and will follow up with cardiology for potential icd placement in the future. . # bleed: acute hct drop from 26.7 in ed to 20 in cath lab. baseline hct 40 most recently in after his myotomy. one episode of melena after his surgery, however his hct was stable and there were no further episodes of melena or brbpr. etiologies include gi (lgib from unknown source, ugib from ?recent surgery) vs rp bleed. due to his drop from 40 to 26.7 over the past 1.5 months, gi bleeding from either his procedure or lgi source is more likely. currently hemodynamically stable. ct chest/ abdomen/ pelvis showed no evidence of rt bleed and his hematocrits remained stable despite starting heparin. he was seen by gastroenterology who did not recommend endoscopy. . # chf: no hx of chf, last echo with preserved ef of 55% and no wall motion abnormalities. tte showed new depressed left ventricular ef, lvedp high at end of cath suggestive of poor forward flow. we monitored his fluid status and diuresed him gently given risk of gi bleed. . # rhythm: sinus on presentation, but with ventricular ectopy, with nsvt, pvcs and one run of sustained v tach lasting 40s, following catheterisation. however, his ventricular ectopy improved over his hospitalization. he was started on metoprolol, and will go home with a life vest. he will followup with cardiology for potential icd placement. . # bronchitis: patient had an elevated wbc count, dyspnea, non-specific cxr findings, had a fever on one night. although these findings could be explained by post-mi inflammation and chf, pneumonia or bronchitis could not be excluded. he was started on empiric levofloxacin and azithromycin. levofloxacin was subsequently discontinued and he was continued on azithromycin. . # hld - started atorvastatin 80. medications on admission: simvastatin - 40 mg tablet - 1 tablet(s) by mouth at bedtime tamsulosin - 0.4 mg capsule, ext release 24 hr - 1 capsule(s) by mouth at bedtime omeprazole magnesium - (prescribed by other provider) - 20 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth twice a day saw - (prescribed by other provider) - dosage uncertain discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. azithromycin 250 mg tablet sig: two (2) tablet po q24h (every 24 hours): end date . disp:*2 tablet(s)* refills:*0* 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. flomax 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 6. saw 80 mg capsule sig: one (1) capsule po once a day. 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tab sublingual q 5 minutes x3 as needed for chest pain: take as directed. disp:*25 tablets* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 10. warfarin 2 mg tablet sig: 2.5 tablets po once a day. disp:*75 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: st elevation myocardial infarction ventricular tachycardia acute systolic dysfunction acute blood loss anemia dyslipidemia gerd achalsia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after having a heart attack. you had 2 drug eluting stents placed in your left anterior descending (lad) artery and an angioplasty of your diagonal artery. you should take aspirin 325mg daily indefinitely. you should take plavix 75mg daily for a minimum of one year. these medications have antiplatelet effects, which helps to prevent blood clots from forming inside your stents. do not stop either of these medications unless instructed to do so by dr. . stopping either of these medications early could result in a blockage inside your stents and another heart attack. if you have chest pain, take nitroglycerin under your tongue as directed. if the pain does not go away, call 911. since you had a heart attack you should switch your simvastatin to atorvastatin 80mg (stronger cholesterol medication). you will need your cholesterol and liver function tests repeated in 6 weeks. you are starting a new medication called metoprolol succinate, this medication will help to take some of the work load off of your heart. it will lower your heart rate and blood pressure as well. while you were in the hospital you were losing blood, no source was identified of where the blood was coming from. you received 3 units of blood while you were here. your blood counts are stable at this time. we changed your omeprazole (prilosec) to pantoprazole because it does not interfere with the clopidogrel. during your hospitalization you had ventricular tachycardia which can be a life threatening heart rhythm. you are going home with a lifevest which is worn externally and will shock you if you have this dangerous rhythm again. while you were in the hospital you developed a fever. you were started on antibiotics for a suspected pneumonia. you should continue to take azithromycin 500mg daily until friday. you are starting on a blood thinner called coumadin to prevent a clot from forming in your left ventricle. this medication requires close monitoring and frequent blood draws. the clinic at will manage your coumadin dosing and blood draws. medication changes: stop simvastatin add aspirin 325mg daily add plavix 75mg daily add atorvastatin 80mg daily add azithromycin 500mg daily add toprol 50mg daily add coumadin 5mg daily (the dosing of this medication may change) add nitroglycerin under your tongue if you need for chest pain add pantroprazole to prevent bleeding your heart is weak after the heart attack and you need to watch yourself carefully for signs of fluid retention. weigh yourself every morning, md if weight goes up more than 3 lbs in 3 days or 5 lbs in 3 days. . it is not safe for you to drive until after you see dr. or dr. . you can discuss driving with them during the appointment. followup instructions: department: when: thursday at 1:45 pm with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 8:40 am with: , md building: campus: east best parking: garage department: cardiac services when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , g. md location: -division of gastroenterology/gi east address: , rose 423, , phone: ***the office is working on an appt for you in the next weeks and will call you at home with the appt. if you dont hear from them by friday afternoon, please call them directly to book. procedure: coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified acute posthemorrhagic anemia hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) acute myocardial infarction of anterolateral wall, initial episode of care paroxysmal ventricular tachycardia other and unspecified hyperlipidemia acute systolic heart failure bronchitis, not specified as acute or chronic chronic total occlusion of coronary artery achalasia and cardiospasm essential thrombocythemia 

Answer: The patient is high likely exposed to