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: ativan / seroquel attending: chief complaint: chest pain major surgical or invasive procedure: right internal jugular vein line placement coronary catheterization no aneurysm surgical repair performed per patient and family wishes. history of present illness: this is a 79 female with coronary artery disease (s/p cabg ), atrial fibrillation, chronic renal insufficiency, and known thoracic aortic aneurysm (7.5cm, previously refused intervention) who presented w/ two days of chest pain radiating to the back. upon presentation the pain was stabbing, sternal in location and radiating to the back. the patient had experienced this type of pain before but not to this degree of severity (subj. ). she initially presented to where bp150s, ekg t wave inversions in v4-6. she was given sublingual nitroglycerin w/ some relief, then metoprolol 5mg iv, morphine, ativan. hct 23, k 2.7, inr 7.5. given 2ffp, 5mg po vitk, 1u prbcs, ct (i-) revealed slt expansion of thoracic aneurysm, wet read by radiology here revealed descending dissection (but limited by lack of contrast). during , started on nipride drip, second unit prbcs given. chest pain free on arrival. hct 22.4, inr 2.1. patient has (per report) previously refused surgery for aneurysm, however, per patient was told that the surgery would not help, and is now amenable. past medical history: paroxysmal atrial fibrillation cad s/p cabg (' vessels unk) thoracic aortic aneurysm cri (baseline 1.1-1.3, ?necrotic kidney) renovascular hypertension hypothyroidism social history: lives with husband at home who has had a stroke. neighbors have been assisting. family history: non-contributory physical exam: vs: hr-80, bp 97/54, rr14 gen: nad heent: eye: right eye broken blood vessel neck supple, +jvd heart: nl rate, s1,s2 diastolic decrescendo murmur lung: cta-bilaterally, no r/r/w abdomen: flat, soft, non-tender, non-distended +bs; r femoral bruit extremities: no c/c/e pertinent results: labs on admission 09:54pm glucose-442* urea n-59* creat-1.4* sodium-131* potassium-3.1* chloride-97 total co2-23 anion gap-14 09:54pm ck-mb-notdone ctropnt-<0.01 09:54pm calcium-8.1* phosphate-3.2 magnesium-2.1 iron-185* 09:54pm wbc-5.6 rbc-2.58* hgb-7.8* hct-22.4* mcv-87 mch-30.2 mchc-34.8 rdw-14.8 . labs on discharge 05:50am blood glucose-107* urean-26* creat-1.1 na-138 k-4.1 cl-110* hco3-21* angap-11 05:50am blood calcium-8.9 phos-2.7 mg-2.0 05:50am blood wbc-7.5 rbc-3.38* hgb-10.5* hct-29.0* mcv-86 mch-31.1 mchc-36.3* rdw-13.3 plt ct-200 . radiology preliminary report . mra kidney w&w/o contrast 3:19 pm mra kidney w&w/o contrast; mr contrast gadolin reason: evaluate for renal artery stenosis contrast: magnevist medical condition: 79 year old woman with aortic anuerysm and uncontrolable hypertension on multiple anti-hypertensive medications.pt only has one kidney reason for this examination: evaluate for renal artery stenosis indication: history of aortic aneurysm and uncontrollable hypertension on multiple antihypertensive medications. technique: multiplanar t1 and t2-weighted images were performed. renal mra technique was used. pre and post-contrast axial and coronal 3-d t1-weighted images through the central abdominal vasculature were obtained. multiplanar and 3-d reformatted images were obtained along with subtraction sequences. comparison: none. renal mra: normal flow is noted in the left renal artery. there is a single left renal artery. motion artifact slightly limits evaluation of the right renal artery. however, allowing for this, there is likely focal short segment high-grade stenosis at the origin of the right renal artery. a single right renal artery is noted. diffuse irregularity is noted throughout the abdominal aorta consistent with atherosclerotic disease. there is moderate widening of the aorta at the thoracoabdominal junction. the thoracic aorta is incompletely evaluated on this study. abdomen mri: the left kidney measures 11.8 cm and the right kidney measures 8.8 cm. there is differential increased enhancement in the left kidney versus the right. both kidneys have overall delayed uptake. there is limited soft tissue detail for other intraabdominal organs due to motion artifact. multiplanar reformatted images and 3-d reformatted images were obtained on the workstation and were integral in evaluating renal artery anatomy. impression: 1. normal left renal artery flow. 2. short segment high-grade stenosis at the origin of the right renal artery. 3. right kidney atrophy with delayed enhancement. dr. dr. . radiology final report carotid series complete port 12:48 pm carotid series complete port; dup extext bil (map/dvt) p reason: preop thoracic aneurysm repair medical condition: 79 year old woman with cad who presented with cp secondary to thoracic aortic aneurysm reason for this examination: evaluation of carotids study: 1. carotid series complete preop for aneurysm repair. 2. venous duplex. patient in need of venous conduit. findings: duplex evaluation was performed of both carotid arteries. moderate to significant plaque was identified on the left. on the right, peak systolic velocities are 87, 108, 172 in the ica, cca, eca respectively. the ica to cca ratio is 0.8. this is consistent with less than 40% stenosis. on the left, peak systolic velocities are 262, 50, 41 in the ica, cca, eca respectively. the ica to cca ratio is 5.2. this is consistent with a 70-79% stenosis. there is antegrade flow in both vertebral arteries. impression: moderate to significant left-sided plaque with a 70-79% stenosis. on the right, there is a less than 40% carotid stenosis. venous duplex: both greater saphenous veins have been harvested. right lesser saphenous vein is patent with diameters ranging from 0.28-0.42 cm. on the left, the lesser saphenous vein is patent with diameters ranging from 0.30-0.31. of note, more proximally the vein forms multiple branches. impression: patent bilateral lsv with diameters as noted dr. approved: sat 11:45 am . echo conclusions: the left atrium is mildly elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size.there is mild global left ventricular hypokinesis with focal inferior akinesis. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic arch is markedly dilated/aneurysmal. the descending thoracic aorta is moderately dilated. no discrete dissection is seen (best excluded /ct/mri). the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: markedly dilated aortic arch and moderately dilated descending thoracic aorta. mild-moderate aortic regurgitation. mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w cad. if clinically indicated, a , mri, or thoracic ct would be better able to characterize the aortic aneurysm/presence of a dissection. based on aha endocarditis prophylaxis recommendations, the echo findings indicate a moderate risk (prophylaxis recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. electronically signed by , md on 13:58. physician: . cath comments: 1. coronary angiography revealed native 3 vessel disease and savenous vein graft disease in one of the three grafts. the lmca had a 99% ostial stenosis. the lad was occluded proximally. the lcx was a nondominant vessel with a moderate size ramus intermedius patent. the lcx was occluded in the proximal segment. the rca was a dominant vessel with diffuse disease throughout its course up to 50%. the pda was occluded at its origin. 2. graft angiography revealed a subtotally occluded svg-->rca/pda with origin and mid segment lesions of 99%. the svg--> om1/d1 is patent without lesions. the lima--> lad is patent and does not cross the midline. 2. thoracic angiography revealed an ascending aneurysm of 4 cm with transverse aneurysm of 8.0 cm in a type ii arch. the descending aorta has ectasia with bicoronate aneurysm of teh diaphragm. 3. limited hemodynamics revealed elavated systemic pressures. 4. left ventriculography was deferred due to high contrast administration. final diagnosis: 1. three vessel native coronary artery disease. 2. occluded svg->rca. 3. severe systemic htn. 4. ascending thoracic aneurysm. attending physician: , brief hospital course: 79 y/o female with cad s/p cabg, who presented with chest pain radiating to the back in the setting of a known 7.5 cm thoracic aortic aneurysm and no elevation in cardiac enzymes. . 1. thoracic aneurysm / hypertension . surgical management: although initially agreeable to the possibility of surgical intervention, after thorough discussion of the risks and benefits of the procedure, the patient declined what is described as a high-risk intervention. her family was in agreement with her decision, which remained durable during the length of stay. her goals were to minimize all medications, and "no procedures!" . medical management keeping with this philosophy, it was felt that strict blood pressure control, using multiple anti-hypertensive agents, would give her the best chance of prolonging life, and keeping high quality of living. initially managed with a nitroprusside drip, multiple agents were added in sequence. . agents used included iv nitroprusside (d/c'd), iv nitroglycerin, diltiazem (max), hctz 25, lisinopril 40, labetolol (switched to metoprolol), amlodipine (max), clonidine, lasix 20, toprol 200 qd, and minoxidil 5 . maximal doses of the antihypertensive agents were attained before starting additional agents. the patient requried use of all of these to maintain goal sbp 120-140 mm hg. . by , the patient was weaned off all iv drips (nitroprusside -> nitroglycerin -> off), and transferred to the floor for further management. her sbp on the discharge regimen (see attached) was 130-140 mm hg, at her goal range. . hospital course was complicated on - with a period of hypotension, low urine output, increasing creatinine and numbness in the right arm. pt also had guaic positive stools. hematocrit at this time was 27.2. at this point the decision was made to stop all anti-hypertensive medications, give fluid boluses and to transfuse the patient one unit. the patient's blood pressures and urine output improved. hematocrit improved to 29.2. the numbness in her right arm resolved. . thereafter the patient was slowly restarted on anti-hypertensives. on the day of discharge the patient was sent home with the following anti- hypertensives: toprol 100, imdur 120, clonidine patch, norvasc 10. sbp on discharge was stable at 130. . 2. guaic positive stools patient had guaic positive stools intermittently throughout her hospital course. cultures were sent and were negative. pt has been afebrile and there has been no increase in wbc. pt's hematocrit was monitored and she was transfused as needed. pt reports that she has had a colonoscopy within the past 5 years. she recalls it being normal. while a colonoscopy would be needed to rule out a malignancy, patient's gi bleed may be a reflection of ischemia secondary to her worsening thoracic aneurysm. . 3. dnr/dni: comfort measures only as previously stated, the patient has decided that would not want any type of surgical intervention to repair the thoracic aneurysm. she has decided that she would like to go home and spend her remaining days with her family. the patient is aware that it is not possible to pinpoint when her aneurysm will rupture. she understands that it can occur at any time and that she will be sent home on anti-htn, morphine and nitrates to keep her as comfortable as possible. . patient is not a candidate for hospice, but she will be receiving home vna services. she also has homemaker services in place. the patient has identified her neighbors as a strong support network. medications on admission: atenolol labetalol lipitor levothyroxine coumadin discharge medications: 1. levothyroxine sodium 25 mcg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. clonidine 0.3 mg/24 hr patch weekly sig: two (2) patch weekly transdermal qfri (every friday). disp:*8 patch weekly(s)* refills:*2* 5. atorvastatin calcium 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 7. imdur 120 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. disp:*30 tablet sustained release 24hr(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: thoracic aortic aneurysm discharge condition: good discharge instructions: you are being discharged with new anti-hypertensive medications to medically manage your thoracic aneurysm. please adhere to these medications. a visiting nurse will be coming by to check in on you. followup instructions: you should make an appointment to see your pcp 1 week of being discharged from the hospital. if you are unable to control your pain at home go to the emergency room. bring discharge summary with you if you do need to come back to the hospital. procedure: venous catheterization, not elsewhere classified left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures transfusion of packed cells transfusion of other serum diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome pure hypercholesterolemia acute kidney failure, unspecified unspecified acquired hypothyroidism thoracic aneurysm without mention of rupture atrial fibrillation aortocoronary bypass status atherosclerosis of renal artery other complications due to other cardiac device, implant, and graft unspecified renovascular hypertension 

Answer: The patient is high likely exposed to