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: heparinoids attending: chief complaint: transfer from osh for mi major surgical or invasive procedure: cardiac catheterization with no intervention history of present illness: mr. is a 75 y.o man with hx of cad with cabg (lima-lad, svg-plv, svg-om), lm bms in transferred to the ccu from hospital for hypotension and decreased lvef following surgery for large colon mass on . the patient was in his usoh until about 4 weeks prior to presentation when he started having constipation. he was admitted to osh on for acutely worsening abdominal pain on the background of constipation. he underwent colonoscopy which showed intussusception and fungating cecal mass with biopsies showing invasive adenoca. he underwent right hemicolectomy on friday . pathology report is pending at this time. pre-surgery he was given cardiac clearance after having a stress test that showed only inferior scarring and an echo with ef of 50%. he was extubated post operatively, but low sao2 to the 80's post extubation despite nrb led to reintubation and transfer to the pacu. per report he was extubated >1 day later. pst-operatively, on he developed hypotension requiring levophed gtt over the weekend which was weaned off the night prior to transfer. troponin i was noted to rise from 0.02 on to 2.28 on , then 1.77 on , with down trends q 8 hrs to 1.45, 1.21, and 0.55. a tte was read as reduced lvef to 25%, with mid/distal anterior wall akinesis, and inferior wall akinesis/scarring. lv apex documented as akinetic as well with mild impairment of the rv iwth free wall hypokinesis. compared to his echo, the only read was mild concentric lvh, lvef of about 54%, with inferior wall akinesis/scarring/inferolateral wall hypokinesis. he was started on aspirin 325 mg and heparin gtt on following the echo results. the following day, he was weaned off pressors and he was given another unit of prbcs with good uop. patient also noted to be somewhat confused at osh attributed to operative sedation. he was transferred to for further management of presumed peri-operative mi. on arrival to the ccu, patient is alert and interactive. he complains of severe pain in his right leg, behind the calf and in the knee. the knee is swollen and warm, which his wife notes is relatively new but has happened before. has numbness in lower extremities that is chronic. denies any chest pain, sob, nausea, vomiting, or diarrhea. has not eaten since surgery but is passing gas. no abdominal pain. no new rashes. no headaches or visual changes. denies any history of alcohol withdrawal seizures. he denies chest pain, sob. on review of systems, he denies any prior history of stroke, deep venous thrombosis, pulmonary embolism, recent fevers, chills or rigors. 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: reported mi (?nstemi) at 42 yo - cabg: :(lima-lad, svg-om, svg-rpl)c/b atelectasis and pericardial effusion, which subsequently resolved - percutaneous coronary interventions: -: rotational atherectomy and bare metal stenting of the left main into the proximal lad - angiography: no significant unbypassed coronary artery disease. lad stent widely patent. - s/dchf (lvef=30-45%) - htn - hyperlipidemia - chronic lbp spinal stenosis s/p lumbar laminectomy (, ) - sciatica - right knee osteoarthritis and associated pseudogout and chondrocalcinosis of the knee. - arthritis in his hands - peripheral neuropathy (?mixed large and small fiber polyneuropathy) - colon polyps s/p polypectomy and recent colon cancer of the cecum with laporscopic r hemicolectomy () - anemia -alcohol abuse- of alcohol/day with hx of neuropathy -mgus -presumed alcoholic cirrhosis (visualized on ct scan at osh ) social history: he is married and lives with his wife in . he is a retired salesman. tobacco: multiple ppd for several years. quit approximately 33 years ago. etoh: of alcohol daily of vodka per family (patient says "3 glasses of vodka a day"). illicit drugs: denies family history: his mother died at 86 of a stroke. father died at 54 of heart problems. one sister who is no longer alive, they believe she had heart problems. a brother with cad s/p stenting. he has one adult son who is healthy. he denies any other diseases in the family including cancers. physical exam: admission exam: general: uncomfortable appearing. affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvd of about 8 cm. cardiac: pmi located in 5th intercostal space, anterior axillarly line. faint heart sounds. tachycardia otherwise normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities. mild kyphosis. resp were unlabored, no accessory muscle use. basilar crackles up to mid back on r, basilar crackles of lower lung field on the left. no wheezes or rhonchi. abdomen: distended. surgical scar with staples and scant erythema present in the midline. laporascopic port sites on left and right side of abdomen without erythema. abdomen distended with normal bowel sounds. no rebound. no organomegaly appreciated. no abdominial bruits appreciated. extremities: 2+ edema bilaterally to mid shin. toes with scattered eschars on frontal surface (from "scraping concrete with his toes while walking") pain with manipulation of right leg. right knee appears edematous with appreciated calor without rubor. cannot manipulate knee secondary to pain. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: aaox3, although needed to be reoriented regarding year. cnii-xii intact, with reorientation during testing of eom. grip strength, biceps, triceps, wrist. lower extremity strength difficult to assess secondary to right knee pain. difficult moving toes bilaterally with stocking distribution of paresthesias to midshin. cannot elicit dtr's. positive asterixis. pulses: right: carotid 2+ fdp 2+ pt 1+ left: carotid 2+ dp 2+ pt 1+ . pertinent results: admission labs: 07:43pm blood wbc-9.9 rbc-3.52* hgb-11.0* hct-32.7* mcv-93 mch-31.1# mchc-33.5 rdw-16.1* plt ct-170 03:57am blood neuts-87.8* lymphs-8.5* monos-3.4 eos-0 baso-0.3 07:43pm blood pt-15.0* ptt-49.4* inr(pt)-1.4* 07:43pm blood glucose-116* urean-5* creat-0.5 na-136 k-3.6 cl-104 hco3-24 angap-12 07:43pm blood alt-9 ast-13 ld(ldh)-242 alkphos-54 totbili-1.0 07:43pm blood ck-mb-1 ctropnt-0.19* 07:43pm blood albumin-2.8* calcium-8.2* phos-2.6* mg-2.0 discharge labs: imaging: ultrasound right leg : limited assessment of the right posterior tibial and peroneal calf veins. otherwise no deep venous thrombosis noted in the right lower extremity. cxr : findings: as compared to the previous radiograph, the patient has received a new right internal jugular vein catheter. the tip of the catheter projects over the lower svc. there is no evidence of complications, notably no pneumothorax. an increase in density of the right lung base is likely caused by patient rotation. moderate cardiomegaly. sternal wires are unchanged and intact. cardiac cath : comments: 1. selective native coronary angiography in this right dominant system demonstrated 3 vessel coroanry artery disease. the lmca had a patent stent into the proximal lad. the lad had a 60% lesion in the mid segment. the lcx had an 80% lesion in the proximal segment, and the distal lcx was supplied by a patent svg graft. the rca was totally occluded. 2. selective venous conduit angiography demonstrated patent svg to om and svg to rca grafts. 3. selective arterial conduit angiography demonstrated a patent lima to lad graft. 4. left heart catheterization revealed a severely elevated lvedp of 28 mmhg. there was normal systemic arterial blood pressure with a central aortic blood pressure of 101/55 mmhg. there was no gradient across the aortic valve with carefull pullback. 5. right heart catheterization revealed severely elevated right and left sided filling pressures. the mean ra pressure was moderately elevated at 14 mmhg, and the rvedp was severely elevated at 18 mmhg. there was moderate pulmonary hypertension with a pa pressure of 47/22 mmhg and a mean pa pressure of 32 mmhg. it was not possible to obtain a good wedge tracing, and furthur attempts at obtaining a wedge tracing were deferred given that a lvedp had also been obtained. the cardiac output and index were normal at 5.2 l/min and 2.7 l/min/m2. the svr was mildly reduced at 585 dyne-sec/cm5. the pvr could not be calculated due to the lack of a wedge pressure tracing. 6. due to severely elevated filling pressures, the patient was given 80 mg iv lasix. 7. selective renal angiography demonstrated patent bilateral renal arteries final diagnosis: 1. three vessel native coronary artery disease. 2. patent lima to lad. 3. patent svg to om and svg to rca. 4. severely elevated right and left sided filling pressures treated with 80 mg iv lasix. 5. moderate pulmonary hypertension. 6. preserved cardiac output. 7. mildly reduced svr. 8. patent bilateral renal arteries. 9. continue with medical management of cad and chf. . discharge labs: 07:35am blood wbc-5.7 rbc-3.51* hgb-10.5* hct-32.5* mcv-93 mch-29.9 mchc-32.3 rdw-14.7 plt ct-246 07:35am blood glucose-87 urean-9 creat-0.6 na-139 k-3.4 cl-103 hco3-24 angap-15 06:05am blood calcium-8.1* phos-3.8 mg-2.0 brief hospital course: mr. is a 75 year old man with history of coronary artery disease (cad) with left main (lm) stent in and prior cabg in who is transferred to the ccu from hospital for concern for nstemi given hypotension and decreased lvef following surgery for large colon mass. he underwent cardiac cath with no interventions, thought to have a autolysed thrombosis from heparin gtt > 48 hours before cath. # cad: patient has significant cad s/p cabg and recent pci in 2/. prior to surgery his ef was 45% by echo and then after the surgery he was hypotensive and developed new focal wall motion abnormalities with depressed ef to 25%, concerning for new ischemia. his troponin peaked at osh at 2.5 and he was transferred here for evaluation via cath of his coronaries. he was restarted on a heparin drip to cover for an acute plaque ruputure and admitted to the ccu. cardiac cath showed chronic disease with occluded rca, lad 60% occluded but prior stent patent, and left circumflex 80% occluded. we felt that the new wall motion abnormality and troponin elevation represented a true ischemic event, brought on by massive surgery, but that his prolonged heparin gtt was effective in lysing the clot prior to cath. his medical regimen was optimized to: aspirin 81 mg, clopidogrel 75 mg, lisinopril 2.5 mg daily, metoprolol succinate 50 mg daily, simvastatin 40 mg daily, furosemide 40 mg daily. # systolic congestive heart failure: patient has history of decreased ef however his preop tte showed ef of 50% and postop showed ef of 25% with focal wall motion abnormality concerning for ischemic heart failure due to mi perioperatively. managed as above with beta blocker, acei, diuresis. weight at discharge is 80.1 kg. # delerium- patient became delirious in the evenings, and required haldol 0.25mg x2. he later was determined to be waxing and , with worse confusion and hallucinations in the early morning hours. this was also exacerbated by sedating medications used for cath, etc. his mental status resolved to normal after 48 hours. # colon cancer status post right hemicolectomy at osh: his wound healed well and he was able to pass stool and eat during this admission. the pathology from the outside hospital was not final at time of discharge. #liver cirrhosis: he had a ct abdomen at the osh for staging which showed nodular liver and the intraoperative report noted a nodular, cirrhotic liver. he did have a significant drinking history. his lfts were normal, platelets were greater than 200, and inr was 1.4. albumin was 3.2 social work was consulted to help with his alcohol abuse and he should have further work-up and follow-up for chronic cirrhosis. transitional issues: - new diagnosis of cirrhosis need outpatient fu - has f/u appt with surgeon on , wife has appt details. - will need appt with oncologist depending on pathology results. - is on furosemide dose from admission. increase furosemide if pt shows signs of fluid retention. medications on admission: preadmission medications listed are correct and complete. information was obtained from family/caregiver. 1. atenolol 25 mg po daily 2. furosemide 80 mg po daily 3. simvastatin 40 mg po daily 4. aspirin 325 mg po daily 5. cyanocobalamin 1000 mcg po daily 6. nitroglycerin sl 0.4 mg sl prn chest pain discharge medications: 1. aspirin 325 mg po daily 2. cyanocobalamin 1000 mcg po daily 3. furosemide 40 mg po daily hold for sbp<90 4. simvastatin 40 mg po daily 5. acetaminophen mg po q6h:prn pain do not exceed 2g in 24 hour period 6. clopidogrel 75 mg po daily 7. lisinopril 2.5 mg po daily hold for sbp<90 8. metoprolol succinate xl 50 mg po daily hold for sbp<90 or hr<60 9. tramadol (ultram) 50 mg po q4h:prn pain 10. nitroglycerin sl 0.4 mg sl prn chest pain discharge disposition: extended care facility: for living discharge diagnosis: non st elevation myocardial infarction acute systolic congestive heart failure hypertension hyperlipidemia cecum mass s/p hemicolectomy 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: you had a heart attack around the time of your operation and was transferred to for a cardiac catheterization. this showed that the blockages are the same and no intervention was done. you will continue on the aspirin, plavix (clopidogrel) and simvastatin to prevent the blockages from getting worse. at this time, we do not have results of the biopsy that was done at hospital. the surgeon from should be contact early next week for results. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. followup instructions: please keep the follow up appt with your surgeon on . . department: cardiac services when: monday at 11:00 am with: , md building: campus: east best parking: garage **dr. has nothing available in the office where you are usually seen until the end of , your doctors to be seen in a months time. please keep the above appointment unless you can call the office and get a cancelation appt. sooner. pcp : pending with: ,md location: healthcare - address: 1000 , , phone: **we are working on a follow up appointment with dr. in the next week. you will be called at home with the appointment. if you have not heard within 2 business days or have questions, please call the number above. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures other and unspecified coronary arteriography diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension alcoholic cirrhosis of liver cardiac complications, not elsewhere classified aortocoronary bypass status percutaneous transluminal coronary angioplasty status alcohol abuse, unspecified other and unspecified hyperlipidemia surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation lumbago unspecified hereditary and idiopathic peripheral neuropathy acute on chronic systolic heart failure osteoarthrosis, unspecified whether generalized or localized, lower leg malignant neoplasm of colon, unspecified site dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to