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: shortness of breat major surgical or invasive procedure: intubated cardiac catheterization history of present illness: 68f with hx significant for tobacco abuse, no known medical hx, who presented to by ems today after acute onset shortness of breath and wheezing at her nephew's place this morning. per family, patient had progressive shortness of breath x 3 days with acute worsening today. at , she was noted to be short of breath, using accessory muscles of respiration, found to be tachycardic to 140s and hypertensive to 219/120 systolic with o2sat 85% on room air. she started on nitroglycerin drip. also received iv morphine 2mg to help breathing and bp. cxr showed massive bilateral pulmonary infiltrates; patient was trialed on bipap and failed for reasons. she was intubated at with versed, fentanyl, and etomidate, given 40mg iv furosemide and nitroglycerin drip was weaned off after a propofol drip was started. bnp was 1020, troponin i within normal limits at 0.05, and ekg showed subtle <1mm st elevations v2-v3 along with q waves in v1-v3, with no prior ekgs for comparison. she was given aspirin 325mg and started on a heparin drip. she was also given a dose of iv solumedrol for unknown reasons. patient was transferred from ed to for further management. per family, patient was taking no medications at home and did not receive regular medical care for >20 years. she allegedly quit smoking 4-5 months ago. upon arrival to ed, patient was intubated and sedated on propofol and with heparin drip. sbps stable in 120s. cxr improved from prior significantly and 1l of urine noted in foley bag. bnp 4531, trop-t 0.03; ekg similar to that at outside hospital. prior to transfer to ccu, patient's vitals were as follows: hr 70 bp 90/44 98%o2sat intubated on cmv- vt-450cc rr-14 peep 5 40%fio2. . review of systems was limited as patient was intubated and sedated on admission. her nephews are unaware of any additional symptoms besides shortness of breath for the last 3 days as described above. however, the patient usually remains guarded and generally adverse to seeing doctors discussing health issues. she did not complain of any chest pain. . past medical history: past medical history: tobacco abuse . past surgical history: none social history: lives alone in house independent with adls and iadls, drives, never married, no children. closest to 2 nephews and who see her once/week, but talk on phone daily. -tobacco history: +1ppd for ~50 years; quit 4-5 months ago -etoh: used to have one drink nightly when smoking, however, more recently only drinks at holidays -illicit drugs: none family history: brother died of lymphoma, father died of ?stomach cancer, nephew with diabetes mellitus. no family history of early mi or sudden cardiac death. physical exam: physical examination on admission: vs: t 98.7 hr 85 bp 133/64 16 100% on settings ac 12 tv 450 peep 5 fio2 40% general: intubated and sedated on propofol, agitated with purposeful movements intermittantly. heent: ncat. sclera anicteric. perrl. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 11 cm. 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: no chest wall deformities. crackles at bases bilaterally, right sided anterior rhonchi at apex, occasional expiratory wheezes. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no sacral edema. extremities warm and pink. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ . physical examination on discharge: pertinent results: labs on admission: 06:40pm blood wbc-25.7* rbc-4.05* hgb-11.8* hct-36.4 mcv-90 mch-29.1 mchc-32.3 rdw-14.4 plt ct-329 03:30am blood wbc-15.7* rbc-3.73* hgb-10.8* hct-32.9* mcv-88 mch-28.9 mchc-32.7 rdw-14.5 plt ct-328 06:40pm blood neuts-96.1* lymphs-2.4* monos-1.0* eos-0.2 baso-0.3 03:30am blood neuts-90.8* lymphs-6.2* monos-2.7 eos-0.1 baso-0.2 06:40pm blood pt-14.0* ptt-145.6* inr(pt)-1.2* 06:40pm blood plt ct-329 03:30am blood pt-14.8* ptt-150* inr(pt)-1.3* 03:30am blood plt ct-328 12:30pm blood ptt-35.8* 02:33pm blood ptt-32.2 06:40pm blood fibrino-290 06:40pm blood glucose-141* urean-18 creat-1.1 na-143 k-3.8 cl-102 hco3-28 angap-17 03:30am blood glucose-147* urean-17 creat-0.9 na-141 k-4.1 cl-103 hco3-30 angap-12 02:33pm blood na-139 k-4.2 cl-100 03:30am blood ck(cpk)-120 06:40pm blood lipase-30 06:40pm blood ck-mb-6 ctropnt-0.04* probnp-4531* 06:40pm blood ctropnt-0.03* 03:30am blood ck-mb-5 ctropnt-0.03* 03:30am blood calcium-8.9 phos-4.6* mg-1.9 cholest-185 02:33pm blood calcium-9.2 phos-3.6 mg-2.0 03:30am blood triglyc-52 hdl-91 chol/hd-2.0 ldlcalc-84 ldlmeas-91 06:40pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:43pm blood type-art tidal v-450 peep-5 fio2-100 po2-314* pco2-57* ph-7.34* caltco2-32* base xs-3 aado2-365 req o2-63 -assist/con intubat-intubated 11:45pm blood type-art po2-117* pco2-46* ph-7.42 caltco2-31* base xs-5 06:48pm blood glucose-137* lactate-2.0 na-143 k-3.7 cl-100 calhco3-31* . labs upon discharge: . 05:58am blood wbc-15.8* rbc-3.60* hgb-10.5* hct-30.5* mcv-85 mch-29.1 mchc-34.2 rdw-14.9 plt ct-275 05:58am blood pt-12.5 ptt-27.7 inr(pt)-1.1 05:58am blood glucose-107* urean-21* creat-0.7 na-138 k-4.0 cl-99 hco3-32 angap-11 08:44pm blood ck(cpk)-134 05:58am blood calcium-9.0 phos-2.7 mg-2.0 03:30am blood %hba1c-5.9 eag-123 03:30am blood triglyc-52 hdl-91 chol/hd-2.0 ldlcalc-84 ldlmeas-91 03:30am blood tsh-0.43 . cxr : there is interval improvement in interstitial prominence, in particular in the left lung. there is still present right interstitial engorgement as well as right parahilar opacity which is currently better demonstrated than on the prior studies and might represent either sequela of pulmonary edema or an unrelated process such as focal area of infection in the right lower or right middle lobe or aspiration. . portable tte (complete) done at 8:40:00 am the left atrium is normal in size. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is mild to moderate global left ventricular hypokinesis with anterolateral wall contracting the best and the septum contracting the worst (lvef = 40 %). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . impression: global left ventricular systolic dysfunction with some regionality which could be consistent with multivessel coronary artery disease. . cardiac catheterization: final diagnosis: 1. two vessel coronary artery disease. 2. mild to moderate biventricular diastolic dysfunction. 3. moderate pulmonary hypertension. 4. moderate systemic arterial hypertension. 5. successful ptca/stenting of the ostial rca with a promus otw 3.0x12mm drug-eluting stent (des) post-dilated with a 3.0mm balloon. (see ptca comments) 6. r 6fr femoral artery angioseal closure device deployed without complications 7. asa indefinitely 8. plavix (clopidogrel) 75 mg daily for at least 12 months brief hospital course: is a 68 year old woman without prior regular medical care and a history of tobacco abuse who presented to an outside hospital with acutely worsening shortness of breath, found to be hypertensive with flash pulmonary edema. she was temporarily started on a nitroglycerin drip, given morphine, failed a trial of bipap and was intubated. the nitroglycerin drip was stopped after intubation and her blood pressure was well controlled while on propofol for sedation. after initiation of diuresis, she was transferred to for further management and anticipated cardiac catheterization. . flash pulmonary edema: the patient's flash pulmonary edema was addressed with continued diuresis with iv furosemide upon admission to the ccu. repeat chest x-rays at demonstrated improving pulmonary edema. her flash pulmonary edema was thought to have been caused by her acutely worsening hypertension in the setting of chronic diastolic dysfunction. the morning after admission she was extubated successfully and her breathing continued to improve. . coronary artery disease and cardiac function: intial ecg upon admission showed q waves in v1-v2 along with early repolarization changes in v2-v3, no concerning st/t changes, most consistent with an old anteroseptal infarct. an echocardiogram was completed and showed global left ventricular systolic dysfunction (lvef 40%) with some regionality which could be consistent with multivessel coronary artery disease and mild mr. she then received a cardiac catheterization that showed two vessel coronary disease (ostial rca 80% and lad with 95% mid vessel stenosis involving the major diagonal but with a small distal vessel, lcx has a 30% mid vessel stenosis) along with moderate pulmonary hypertension and biventricular diastolic dysfunction. she received a successful des to the rca. the lad was not stented to due prediction of poor benefit secondary to the thought that her small distal lad vessel did not cover much perfusion territory. she was continued on a heparin drip (started at outside hospital) for a total of 48 hours. additionally, she was started on a full dose aspirin daily, atorvastatin, metoprolol, and was initially loaded on admission with plavix 300mg and transitioned to plavix 75mg daily. she was not started on an ace-i secondary to systolic blood pressures (in the 90s) upon discharge. she will have close follow-up with cardiology and will likely be started on an ace-i as an outpatient as her blood pressures tolerates. . pulmonary function: due to long smoking history and presence of hyperinflated lungs on chest x-ray, there is concern for underlying copd. she was intermittently treated during admission with ipratropium nebulizers for wheezing. she received iv solumedrol once at the outside hospital which caused a transient leukocytosis that resolved, but did not receive any further steroids at . upon discharge, she is scheduled to establish care with a new pulmonologist and obtain pulmonary function testing. . the patient wished to find and schedule an appointment with a pcp in her area on her own. she will need outpatient screening (colonoscopy, mammogram and bone density) and routine health care as she has not seen a doctor in greater than 20 years. . the patient was full code for this admission. medications on admission: none discharge medications: 1. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*0* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): you must continue this medication every day, please do not stop taking this medication without talking to your cardiologist. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: and hospice discharge diagnosis: acute exacerbation of systolic congestive heart failure coronary artery disease: partial occulsion of the rca and lad (blood vessels in your heart) pulmonary edema hypertension 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 because of shortness of breath. your symptoms became severe and you required temporary intubation. your shortness of breath was related to excess fluid in your lungs secondary to decreased heart function and high blood pressure. you received medications to help decrease the fluid in your lungs and your breathing improved. you also received a cardiac catheterization and a stent was placed in one of the arteries in your heart. you were started on new medications to help protect your heart and lower your blood pressure. you may have emphysema or copd secondary to your smoking, and you will need to see a pulmonologist to determine if you need medications for your breathing. we applaud you for stopping smoking and recommend you do not start smoking again due to significant risks of progressive lung and heart disease. . we have started you on the following new medications: - start metoprolol tartrate (toprol xl) 25mg 1 tab by mouth daily - start aspirin 325mg 1 tab by mouth daily - start atorvastatin (lipitor) 80mg 1 tab by mouth daily - start clopidogrel (plavix) 75mg 1 tab by mouth daily - start albuterol inhaler 1-2 puffs up to every 6 hours as needed for shortness of breath of wheezing - you were not started on a medication called an ace-inhibitor such as lisinopril because your blood pressure was low. your cardiologist may start you on a similar medication in the future. . it is extremely important that you continue taking the above medicines as perscribed. please continue taking your clopidogrel (plavix) every day unless instructed otherwise by your cardiologist. clopidogrel is especially important in preventing a future heart attack and death now that you have new stents placed in the arteries of your heart. . please follow up with your new cardiologist and pulmonologist. your cardiologist may start you on additional blood pressure medications as an outpatient. you will also need to make an appointment with a primary care doctor in your area. you should aim for an appointment within the next 2-3 weeks with a primary care doctor. . it was a pleasure taking care of you. we wish you a speedy recovery. followup instructions: please follow up with your new physicians: . cardiology: provider: , md phone: date/time: 2:40 building . pulmonology provider: , m.d. phone: date/time: 10:00 . you will need to have pulmonary function testing (spirometry) to test your breathing right before your pulmonology appointment as listed above. please proceed to the building and they will guide you towards your testing. . please make an appointment with a new primary care physician in your area to establish care within the next 2-3 weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: congestive heart failure, unspecified unspecified essential hypertension other chronic pulmonary heart diseases personal history of tobacco use acute combined systolic and diastolic heart failure gross hematuria 

Answer: The patient is high likely exposed to