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: tylenol-codeine #3 / bactrim ds attending: chief complaint: st elevation mi major surgical or invasive procedure: coronary catheterization and angioplasty history of present illness: yof with h/o bioprosthetic valve replacement unclear as to which one at present time, htn who was transferred from out of concern for and inferior stemi. . she began having malaise/lethargy, anorexia, insomnia, indigestionfor the past week. last tuesday, there was initial concern for uti after she went to her pcp's and reportedly had a floridly positive ua, for which she was given a ten day course of ciprofloxacin started on . earlier in the week she started otc prilosec for gerd sx as well as frequent belching. . monday night while sitting in a chair she began having pressure-like tightness radiating to l arm; she has never had this pressure before and it was non-exertional. she thought it was related to her gerd sx and tried to go to sleep. the pressure never went away and the following day around noon the cp became worse and it was associated with nausea / vomiting and diaphoresis. her daughter-in-law called her cardiologist about the chest pressure and she was referred to . . at , ekg showed inferior ste and std in v2-3, new compared to 18 mos ago. she was noted to be hypertensive as well. labs there showed tropi 1.58 (normal 0-0.39), no ck's, cr 1.5, and wbc 17, hct 37. she received 325 asa, 600 mg po plavix, 5 mg iv metoprolol x2, bolus then gtt heparin, 80 mg atorvastatin. she was transferred to for further evaluation. . in the ed, initial vs: 150/76, p87 18. sbp's also noted to be 170. she was continued on heparin gtt. labs showed a subtherapeutic ptt, wbc 18.3, trop 0.35, and normal renal function. ekg showed improvement, but not full resolution, of the above noted st segment deviations. importantly, she was no longer having any pressure; because of this and resolving ekg changes, she was not taken to the cath, but admitted to ccu for medical management and close observation. . vitals before transfer: 91 151/77 23 97%ra . on arrival to the ccu she was denying cp, sob, n/v, diaphoresis. she was just tired and was requesting a sleeping pill to help her relax. on review of systems, she denies any prior history of stroke, tia, bleeding at the time of surgery. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: htn 2. cardiac history: - bioprosthetic valve replacement - pulmonary unclear the time frame, family unaware of this and pt cannot remember when it happened - cabg: none - percutaneous coronary interventions: states she had a prior cath at in , no records available at this time - pacing/icd: none 3. other past medical history: - h/o breast ca s/p l radical mastectomy - hip fx s/p fall - migraines - arthritis social history: widow, lives alone, takes care of self. has a chair that goes up her stairs, cooks her own dinner. - tobacco history: denies - etoh: 1 drink / month - illicit drugs: denies family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - mother: pt states passed away of "old age" unknown etiology - father: pt states passed away of "old age" unknown etiology physical exam: on admission: vs: bp= 156/58 hr= 90s rr=20 o2 sat=96% ra general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp not elevated, trachea midline cardiac: rrr, normal s1, s2. mechanical mr murmur appreciated best at axilla no thrills, lifts. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ left: carotid 2+ dp 2+ on discharge pertinent results: admission labs: 11:47pm ck(cpk)-326* 11:47pm ck-mb-60* mb indx-18.4* ctropnt-0.57* 11:47pm pt-12.9 ptt-42.1* inr(pt)-1.1 07:40pm glucose-128* urea n-19 creat-0.8 sodium-133 potassium-4.4 chloride-97 total co2-23 anion gap-17 07:40pm ck(cpk)-258* 07:40pm ctropnt-0.35* 07:40pm triglycer-52 hdl chol-58 chol/hdl-2.9 ldl(calc)-100 07:40pm %hba1c-5.9 eag-123 07:40pm wbc-18.3* rbc-4.80 hgb-14.6 hct-41.8 mcv-87 mch-30.5 mchc-35.0 rdw-13.3 admission ekg: moderate baseline artifact. normal sinus rhythm. st segment elevation in leads ii, iii, avf and v6. no previous tracing available for comparison. consider acute inferolateral ischemia. admission echo: due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. a bioprosthetic aortic valve prosthesis is present. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: limited emergency study. grossly preserved biventricular systolic function. coronary cath: , f 91 cardiology report cardiac cath study date of *** not signed out *** brief history: this year old female with history of hypertension, hyperlipidemia and bioprosthetic aortic valve replacement is referred for cardiac catheterization secondary to ruling in for a myocardial infarcation. indications for catheterization: 1. mi 2. stemi procedure: percutaneous coronary revascularization was performed using balloon angioplasty. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 1.6 m2 hemoglobin: 14 gms % fick **pressures right atrium {a/v/m} 8/7/4 right ventricle {s/ed} 31/9 pulmonary artery {s/d/m} 31/10/19 pulmonary wedge {a/v/m} 10/9/8 aorta {s/d/m} 152/70/66 **cardiac output heart rate {beats/min} 84 rhythm nsr o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 50 card. op/ind fick {l/mn/m2} 4.0/2.5 **resistances systemic vasc. resistance 1240 pulmonary vasc. resistance 220 **% saturation data (nl) svc low 72 pa main 72 ao 98 other hemodynamic data: the oxygen consumption was assumed. **ptca results ptca comments: initial angiography revealed a complete occlusion in the distal r-pl branch of the rca which filled via right to right collaterals. we planned to treat this stenosis with ptca. bivalirudin was started prophylactically. a 5 french jr4 guiding catheter provided adequate support for the procedure. a prowater wire was used, however the wire was unable to cross the lesion despite multiple attempts at crossing. just proximal to the complete occlusion there was a point in the r-pl with a hazy appearance that suggested plaque rupture (likely cause of downstream embolization). we dilated this area with a a 1.5x15mm sprinter otw balloon at 8 atms. repeat angiography at this point showed minimal improvement in blood flow after the complete occlusion of the r-pl. due to the small size of the r-pl and the difficulty in corssing the lesion there was no further attempt made at intervention as the risks outweighed the benefits of opening up this small vessel which appeared to give blood supply to a small area of myocardium. final angiography showed the complete occlusion was still present, but no angiographically apparent dissection was noted. the patient left the lab free on angina and in stable condition. technical factors: total time (lidocaine to test complete) = 41 minutes. arterial time = 28 minutes. fluoro time = 8.7 minutes. irp dose = 400 mgy. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 65 ml premedications: midazolam 0.25 mg iv fentanyl 12.5 mcg iv asa 325 mg p.o. anesthesia: 1% lidocaine subq. other medication: bivalirudin 40 mg bolus via iv bivalirudin 96 mg/ hr via iv cardiac cath supplies used: - , prowater 300cm 1.5mm , sprinter 15mm 5fr cordis, jr 4 sh - allegiance, custom sterile pack - merit, left heart kit - merit, right heart kit - , priority pack 20/30 5fr arrow, balloon wedge pressure catheter 110cm comments: 1. selective coronary asngiography demonstrated one vessel disease. the lmca had no angiographically apparent disease. the lad had no angiographically apparent disease. the cx had no angiographically apparent disease. the rca had a complete occlusion in a distal small (1.5mm in diameter) r-pl. prior to the complete occlusion there is point in the distal r-pl which appears to have a hazy area consistent with plaque. 2. limited resting hemodynamics revealed normal left and right sided filling pressures with an rvedp of 9 mmhg and a mean pcwp of 8 mmhg. the pulmonary pressures were 31/10 mmhg with a mean of 19 mmhg. the cardiac index was preserved at 2.5 l/min/m2. 3. unsuccessful attempt at crossing the distal r-pl. ptca of the point just proximal to the complete occlusion in the distal r-pl where there appeared to be a hazy area consistent with possible plaque rupture. final angiography revealed no apparent dissection and timi iii flow up to the level of the complete occlusion.' cxr: patient is status post median sternotomy with intact sternotomy sutures. both lungs are clear without lung consolidation. pleural effusion, if any, is minimal on the left side. heart size, mediastinal and hilar contours are normal. mild atherosclerotic calcification seen in the aortic arch. discharge labs: 04:12am blood wbc-10.1 rbc-3.94* hgb-11.9* hct-35.4* mcv-90 mch-30.3 mchc-33.7 rdw-12.7 plt ct-440 04:12am blood glucose-106* urean-12 creat-0.8 na-137 k-4.4 cl-106 hco3-26 angap-9 04:12am blood calcium-8.1* phos-3.3 mg-2.0 brief hospital course: assessment and plan yof with h/o bioprosthetic mitral valve replacement, htn who presented to found to have a inferior stemi and was transferred to for further evaluation and medical management. . # inferior stemi: patient presented with symptoms of chest pressure and abdominal discomfort which were felt to be anginal equivalents. the time frame of symptoms was unclear as patient was a poor historian, but likely occurred 24 hours prior to admission. right sided ekg and posterior ekg were performed and no rv infarct was noted. she was started on atorvastatin 80mg, aspirin 325mg, plavix 75mg, heparin gtt, metoprolol tartrate 12.5mg and lisinopril 5 mg. patient subsequently underwent cardiac cath which showed wedge of 8 ra of 6, rv:32/5 pa:31/10 ci=2.5 co=4, complete occlusion in the distal r-pl branch of the rca s/p balloon angioplasty with minimal improvement in flow. echo prior to cath showed a preserved ef and right ventricular chamber size and free wall motion that were normal. a bioprosthetic aortic valve prosthesis was present consistent with her pmh. the mitral valve leaflets were mildly thickened. trivial mitral regurgitation was seen. there was no pericardial effusion. she was discharged on aspirin 325mg, plavix 75mg, atorvastatin 80mg, metoprolol succinate 50mg and lisinopril 5mg. . # pt has chronic htn. she continued on her home metoprolol succinate 50mg and we stopped amlodipine and started lisinopril 5 mg daily. her blood pressures remained well controlled during admission. . # leukocytosis: patient had an elevated wbc at the time of presentation, likely as stress response to her mi. her leukocytosis had resolved prior to discharge. of note she was on ceftriaxone on admission due to a diagnosed uti as an out patient. her wbc trended down and she finished her 10 day course of ceftriaxone without incident. . # uti: patient was under treatment for a uti at the time of presentation and in the middle of a 10 day course of ceftriaxone. patient completed her course of antibiotics while in patient. she remained a symptomatic throughout this admission . # h/o breast ca s/p l radical mastectomy: stable, no change in treatment while inpatient. . #hip fx s/p fall: stable no change in treatment while inpatient. . # migraines: stable no change in treatment while inpatient. . # arthritis: table no change in treatment while inpatient. . transitional issues: pt has a follow up appointment with her cardiologist dr. on . medications on admission: metoprolol succinate 50mg simvastatin 40mg aspirin 81mg calcium 600mg vitamin d3 1000u daily tylenol 650mg q4hr prn pain amlodipine 2.5 mg daily ciprofloxacin 500mg daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. 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* 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. calcium oral 7. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 8. trazodone 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. disp:*5 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: myocardial infarcation hypertension urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mrs. , . it was a pleasure taking care of you. you were admitted to the hospital because you had a heart attack. this means that one of the arteries that supplies your heart with blood became occluded. we treated you with medication to thin your blood and performed a procedure call a cardiac catheterization. during the procedure we dilated a small artery in your heart with a balloon to allow the blood to flow to your heart effeciently. we believe that the occlusion in your blood vessel has resolved. we have made some changes to your medication regimen to optimally protect your heart. . we made the following changes to your medications: - increased aspirin from 81mg to 325mg daily - started clopidogrel (plavix) 75mg daily. **do not stop taking this medication unless instructed to by your cardiologist** - stopped simvastatin and started atorvastatin 80mg daily - stopped amlodipine and started lisinopril 5mg daily - stopped ciprofloxacin since you finished the course of antibiotics for your urinary tract infection followup instructions: name: , b. location: internal medicine associates address: , , , phone: appt: at 11:15am procedure: coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor left heart cardiac catheterization excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension personal history of malignant neoplasm of breast other and unspecified hyperlipidemia acute myocardial infarction of other inferior wall, initial episode of care heart valve replaced by transplant chronic total occlusion of coronary artery 

Answer: The patient is high likely exposed to