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: history of present illness: the patient is an 89 year old female with a history of coronary artery disease status post remote history of mi who presented to in the a.m. of with severe substernal chest pain radiating to her back since :00 p.m. the night before. she reported shortness of breath and orthopnea overnight. she said that her symptoms were reminiscent of her prior angina several months ago. at her heart rate was 115, blood pressure 140/83. ekg showed depression in lead 1 and questionable j point elevation in v2 and v3. she also had elevation in lead 3. she was 91 to 92 percent on 4 liters nasal cannula at this time. she received 5 mg of iv lopressor, aspirin, lovenox, integrilin, nitropaste, benadryl 25 and prednisone 40. she had relief of her pain with these interventions. chest x-ray at showed no evidence of chf or infiltrate. she had a ct of the thorax and abdomen which was negative for dissection. she was pain free on arrival to . in the cath lab at she received 20 mg of iv lasix, integrilin and nitroglycerin drip. cardiac cath revealed multivessel disease including left main coronary artery with a mid 60 to 70 percent lesion, lad with a proximal 70 percent lesion, 90 percent mid-lesion, 40 percent mid-lesion. left circumflex had a 60 percent ostial lesion and 60 to 70 percent mid-lesion. she also had proximal rca subtotal occlusion. her cardiac index was 2.12. her pa pressures were 45/27 with a wedge of 33. past medical history: spinal stenosis. abdominal aortic aneurysm infra-renal approximately 4 cm. coronary artery disease with a distant history of mi in . hyperlipidemia. poor balance. borderline hypertension on no medications. social history: the patient reports that her husband died two weeks ago here in the micu at . she denies any tobacco or drug use. she reports occasional alcohol use. family history: noncontributory. allergies: bactrim, codeine, naprosyn, apples, pears, tuna, "antibiotics," fish, iodine. medications: medications on transfer included lopressor, lovenox, integrilin drip, aspirin 325, prednisone 40 mg q.d., benadryl, lipitor, nitroglycerin drip, heparin drip, mucomyst. home medications included b-12, lipitor at an unknown dose, aspirin. physical examination: on presentation the patient had a temperature of 95.5, heart rate 91, blood pressure 160/90, respirations 18, oxygen saturation 96 percent on 100 percent nonrebreather. in general, she was in no acute distress, alert and oriented times three. heent exam revealed pupils that were equally round and reactive to light. extraocular muscles were intact. oropharynx was without lesions or exudate and she had moist mucous membranes. neck exam revealed jvp approximately half way to the angle of the jaw. lungs were clear anteriorly, however, she was not able to sit up. abdomen was soft, nondistended, nontender. there were good bowel sounds. she had a palpable pulsatile mass in the mid-abdominal region consistent with abdominal aortic aneurysm. it was nontender to palpation, but pulsatile. stools were ob negative at . heart was regular and there was a 2/6 systolic ejection murmur heard best at the left upper sternal border. she had no gallop or rubs. extremities were thin without cyanosis, clubbing or edema. she had 1 to 2+ dorsalis pedis pulses bilaterally. laboratory data: laboratories at : cbc with white count 6.5, hematocrit 33.3, platelets 170. chemistries revealed sodium 138, potassium 4.7, chloride 103, bicarb 24, bun 22, creatinine 1.3, glucose 106. she had an inr of 1.2, ptt 27. alt 123, ast 85, t-bili 0.5, lipase 135, amylase 33. ck 109, mb 8.9, mbi 8.2, troponin 5.2. cardiac cath results are as mentioned above. ekg at revealed sinus tachycardia with a rate of 103 beats per minute. she had normal axis and normal intervals. she had 1 mm s elevations/j point elevations in leads v2 and v3. she had flipped t waves in v5 and v6. she had depression in lead 1. she had elevation in lead 3 and a q wave in lead 3. hospital course: 1. cardiovascular. in regard to ischemia and cad, the patient presented with unstable angina with three vessel disease by cath with lad lesion being the likely culprit of her symptoms. she was given aspirin, heparin, integrilin and subsequently started on a beta blocker after her congestive heart failure improved. she was also started on a statin. she was initially resistant to the idea of cabg and there was plan for ptca of lad the morning after admission. serial cks and troponins were followed which peaked and then began to decline. the night of admission she received 2 mg of haldol and 0.5 mg of ativan and subsequently became very lethargic and somewhat unarousable. her waxing and mental status delayed her repeat cardiac cath, however, she subsequently underwent cardiac cath on which revealed 90 percent mid-lad lesion with mild proximal om disease. she had successful ptca and stenting of the lad. final diagnosis was three vessel coronary artery disease with successful stenting of the mid-lad. as mentioned above, she was continued on aspirin, a beta blocker, a statin and ace inhibitor was held due to elevated creatinine, however, it was restarted on the day of discharge. in regard to her pump function, she had evidence of elevated filling pressures in the cath lab here. she was diuresed with lasix overnight the first night of admission to desaturate her wedge to 15 to 20. she was continued on nitro drip which was stopped the following morning. she had a chest film the day after admission which revealed evidence of congestive heart failure. she had an echo on which revealed severe global left ventricular hypertrophy consistent with multivessel cad or another diffuse process. she had mild aortic regurgitation. her pulmonary artery systolic pressures were elevated. she had mild mitral regurgitation. she had an ejection fraction of 20 percent. she was subsequently diuresed for several days until she became euvolemic. at this time she experienced an elevation in her creatinine to 2.2, which was felt to be a combination of diuresis in the setting of two exposures to contrast. she was started on lisinopril 2.5 mg q.d. on the day of discharge. rhythm. the patient had no rhythm issues throughout admission. 2. renal. as mentioned above, the patient experienced some renal failure during her admission with peak creatinine of 2.2. it was felt this was most likely secondary to diuresis in the setting of exposure to dye in someone with a known iodine allergy. she was premedicated prior to both catheterizations with benadryl and steroids as well as mucomyst. her creatinine continued to decline prior to discharge as she began to auto-diurese. it was felt safe to start an ace inhibitor with lisinopril 2.5 mg p.o. q.day on the day of discharge. 3. neurologic. as mentioned above, the patient was given haldol and ativan the night of admission for agitation and combativeness. she was given a very small dose, however, in the setting of likely renal failure, she became extremely sedated and unresponsive on these medications. a neurology consult was obtained and it was felt that her mental status changes were most likely multifactorial in the setting of underlying dementia and poor substrate. she had a cat scan of her head which was negative. she had tsh which was slightly elevated with normal free t4. she had normal b-12 and folate. it was not felt necessary to perform an lp, given her improving mental status and lack of fever and white cell count. it was felt most likely that her mental status changes were due to medication effect and sedating meds were thereon avoided. on the day of discharge she was awake, alert and oriented times three intermittently with some waxing and confusion. 4. musculoskeletal. the patient became extremely weak throughout admission and was seen by physical therapy the day prior to discharge. it was felt that she would most likely benefit from subacute rehabilitation. 5. hypernatremia. it was noted the day before discharge that the patient was hypernatremic to 152. it was felt that this was most likely secondary to aggressive diuresis in the setting of lack of access to free water. her free water dose was adjusted and she was replaced with d5w with half of her deficit being replaced in the first 24 hours. it was also felt that her hypernatremia was possibly responsible for some of her mental status changes. 6. endocrine. in the workup of the patient's mental status changes, it was noted that she had an elevated tsh with a normal free t4, possibly reflecting subclinical hypothyroidism. it was recommended that this be followed up as an outpatient. discharge diagnoses: 1. coronary artery disease status post stent to lad. 2. dementia. 3. hypernatremia. discharge medications: 1. lisinopril 2.5 mg q.d. 2. toprol xl 100 mg q.d. 3. plavix 75 mg q.d. 4. lipitor 10 mg q.d. 5. aspirin 325 mg q.d. 6. multivitamin. condition on discharge: at the time of discharge the patient was with improved spirits, was denying chest pain or shortness of breath. she was having waxing and mental status changes with intermittently being confused and disoriented to place. however, she was in good spirits and felt ready to go to rehab and then subsequently home following rehab. followup: the patient will be discharged to rehab and will require followup with a cardiologist and with her pcp at the time of discharge. dr., 12-426 dictated by: medquist36 d: 13:19 t: 13:32 job#: procedure: combined right and left heart cardiac catheterization combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of drug-eluting coronary artery stent(s) diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere hyperosmolality and/or hypernatremia diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to