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: tachycardic post op major surgical or invasive procedure: lumbar decompressive laminectomy/discectomy l3-4 cardiac cath 3v cabg history of present illness: 79 y/o russian-speaking m w/ dm, cri, htn, hyperlipidemia, lumbar stenosis s/p elective l3-s1 laminectomy and left l3-4 discectomy on . the patient was agitated and tachycardic in pacu, there were st depressions noted on telemetry monitor. a 12 lead ekg was performed and showed sr 102 2 mm ste avr st depressions in the lateral precordial leads. initial ck 282 mb 6 trop 0.01 @ 1100. ck 4918 mb 74 mbi 1.5 trop 1.05 @ . ck 4695 mb 59 mbi 1.3 trop-t 1.02 @ 0400 and ck 2716, ck0mb 21 and mb 0.8 @ 0600. given the patient's neurosurgical procedure no anticoagulation with heparin or plavix per neurosurgery. he was only started on 325mg asa. his metoprolol was also titrated up to control his tachycardia. . the patient was seen by pt today and while walking became fatigued and hypotensive to the 80's. he was given ivf bolus, but bp remained in the 70's. a repeat ecg did not show significant change from prior. he continues to have st depressions. the patient underwent an echo that showed focal basal inferior hypokinesis more apparent and the severity of mitral regurgitation and tricuspid regurgitation has increased from echo . the patient was then transferred to the ccu. . currently, the patient states he feels well. his family was in the room. pt states that his blood pressures normally run low sbp 90's. he denied fevers, but felt cold and had chills. no cp/sob/abdominal pain/ bowel or bladder complaints. he does have some discomfort in his lower back at his surgery site. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: cardiac risk factors: +diabetes (a1c 9.0% ), +dyslipidemia (total chol 110 trig 66 hdl 32 ldldirect 56 ), +hypertension . per outpatient cardiologist, last stress in showed inferior fixed defect (likely soft tissue attenuation) & last echo from showed small heart (edv 45 cc, esv 15 cc, lv mass 150, la volume 61 cc) . other past medical history: cri b/l cr ~1.6-1.8 lumbar spinal stenosis bph ventral hernia psoriasis social history: married, lives with wife. retired physician. smoker, quit at 40. no etoh. family history: brother died at 42 from complications of dm. father died at 42 from pneumonia. mother died at 83 of cvd. physical exam: vs: t=97.5 bp=91/52 hr=61 rr=19 o2 sat= 95% gen: nad, weak and fatigued appearing heent: at/nc, anicteric, perrla, eomi, mmm neck: no jvd cv: reg rate nl s1s2 no m/r/g pulm: poor inspiratory effort ctab back: midline low back dressing c/d/i abd: soft obese ntnd typamic, normoactive bs ext: warm, dry tr pedal edema neuro: aa&o3, interacting appropriately, limited english, but able to communicate pertinent results: wbc rbc hgb hct mcv mch mchc rdw plt ct 05:02am 14.4* 3.46* 10.3* 30.6* 88 29.6 33.6 17.1* 529* renal & glucose glucose urean creat na k cl hco3 angap 02:45am 88 27* 1.6* 135 4.0 95* 29 15 chemistry totprot albumin globuln calcium phos mg uricacd iron 05:02am 2.8* 2.3 source: line-r picc hematologic caltibc vitb12 folate ferritn trf 07:20am 183* 456 7.3 663* 141* fe studies added @ 13:23 diabetes monitoring %hba1c 04:15am 7.8 cardiac catheterization 1. selective coronary angiography of this right dominant system revealed three vessel coronary artery disease. the lmca has no obstructive disease. the lad had serial 90% stenoses at the proximal and mid vessel. the lcx had a 90% ostial stenosis and a 95% stenosis at the mid segment. the rca had a total occlusion at the mid segment. the distal rca was filled by right to right collaterals as well as left to right collaterals. 2. limited resting demondyamics demonstrated diastolic dysfunction with an elevated lvedp of 18 mm hg, as well as normal central arterial pressure with central aortic pressure 111/52 mm hg. carotid ultrasound 1. mild homogeneous plaque in both internal carotid arteries. 2. less than 40% stenoses in the internal carotid arteries bilaterally echo the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of septal wall . overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the descending thoracic aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. brief hospital course: mr. was admitted to the on for surgical management of his lumbar stenosis. he was taken to the operating room where he underwent a redo laminectomy. on postoperative day four, he was noted to have a myocardial infraction with hemodynamic compromise. he required resuscitation and intubation with transfer to the cardiac care unit for further care. aspirin was started however heparin and plavix were avoided given his recent back surgery. mr. otherwise stabilized from a cardiac standpoint. he self extubated himself on however his oxygen saturations and blood gases remained stable. no reitubation was required. an echo showed inferior and posterior contractile dysfunction. pulmonary edema was noted on chest x-ray and diuresis was initiated. he had two episodes of apnea and loss of consciousness which resolved spontaneously on . work-up including a head ct was negative. orthostasis was assumed. heparin was ultimately started for anticoagulation. a speech and swallow evaulation was performed which showed no significant dysphagia or aspiration. on , mr. t a cardiac catheterization which revealed severe three vessel disease. given the severity of his disease, the cardiac surgical was consulted for surgical revascularization. he was worked-up in the usual preoperative manner including a carotid ultrasound which showed less than 40% stenoses in the internal carotid arteries bilaterally. on , mr. was taken to the operating room where he underwent coronary artery bypass grafting to five vessels. please see operative note for details. postoperatively he was taken to the intensive care unit for monitoring. he was transfused with packed red blood cells for postoperative anemia. epinephrine was started for a low cardiac index. within 24 hours, he awoke neurologically intact and was extubated. on postoperative day two, he was transferred to the step down unit for further recovery. he was gently diuresed towards his preoperative weight. the physical therapy service was consulted for assistance with his postoperative strength and mobility. his blood glucose was quite elevated and difficult to control with intravenous insulin. the diabetes service was consulted for assistance in his care. he developed oliguria, dyspnea and hypotension on and was transferred back to the intensive care unit for observation. flagyl was started for leukocytosis and loose stools. mr. improved and was transferred back to the step down unit on . his c-diff culture was negative and the flagyl was d/c'd. he was diuresed and started on betablockade and aspirin therapy. he was evaluated by physical therapy and rehab was recommended. at patient's insistance his foley was removed today at 10am and is dtv- it has been replaced for failure to void previously. he was discharged to rehab on . medications on admission: asa 81 mg daily neurontin 800mg tid novolin 70-30 70-30 u/ml 58 units a day lipitor 80mg daily hctz 25mg qam, 12.5 mg qpm dicyclomine hcl 20mg protonix 40mg daily tramadol hcl 50mg ambien 5mg as needed proscar 5mg daily percocet 5/325mg q6h prn pain discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. haloperidol 1 mg tablet sig: one (1) tablet po hs (at bedtime). 6. gabapentin 400 mg capsule sig: two (2) capsule po tid (3 times a day). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 10. dicyclomine 10 mg capsule sig: two (2) capsule po qidachs (4 times a day (before meals and at bedtime)). 11. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 12. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 13. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 14. picc line care and flushes per protocol 15. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po daily (daily): d/c when lasix d/c'd. 16. furosemide 40 mg iv bid decrease when edema resolved- was on hctz at home 17. lantus 100 unit/ml solution sig: twenty (20) units subcutaneous once a day: at breakfast. 18. humalog sliding scale fingerstick: breakfast lunch dinner bedtime sliding scale humalog 0-70 mg/dl 4 oz. juice and 15 gm crackers glucose breakfast lunch dinner bedtime 71-100 mg/dl 0 units 0 units 0 units 0 units 101-150 mg/dl 4 units 4 units 4 units 0 units 151-200 mg/dl 6 units 6 units 6 units 0 units 201-250 mg/dl 8 units 8 units 8 units 4 units 251-300 mg/dl 10 units 10 units 10 units 6 units 301-350 mg/dl 12 units 12 units 12 units 8 units 351-400 mg/dl 14 units 14 units 14 units 10 units instructons for npo patients: use hs scale. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary 1) non-st elevation myocardial infarction 2) lumbar spinal stenosis 3) coronary artery disease 4) hypertension secondary 1) diabetes mellitus type 2 2) chronic kidney disease stage iii 3) benign prostatic hypertrophy discharge condition: stable but deconditioned discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks from date of surgery. 6) no driving for 1 month or while taking narcotics for pain. 7) call with any questions or concerns followup instructions: please follow-up with dr. in 1 month. ( please call your primary care physician . to schedule a follow-up appointment within 1-2 weeks. you may also call at to schedule an appointment with a new primary care doctor. . please follow up with dr. on , at 1:30 pm. please call ( if you wish to reschedule. you have a follow up appointment wiiht dr. phone: date/time: 9:00 please call to schedule an appointment with dr. to be seen in 6 weeks. you will not need xrays prior to your appoinment procedure: venous catheterization, not elsewhere classified single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization insertion of endotracheal tube (aorto)coronary bypass of four or more coronary arteries excision of intervertebral disc diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified hyposmolality and/or hyponatremia cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified pulmonary collapse other and unspecified hyperlipidemia diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation paralytic ileus other constipation hypoxemia acute diastolic heart failure urinary complications, not elsewhere classified other psoriasis delirium due to conditions classified elsewhere electrolyte and fluid disorders not elsewhere classified diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy oliguria and anuria chronic total occlusion of coronary artery orthostatic hypotension displacement of lumbar intervertebral disc without myelopathy other sedatives and hypnotics causing adverse effects in therapeutic use ventral, unspecified, hernia without mention of obstruction or gangrene 

Answer: The patient is high likely exposed to