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: lisinopril attending: chief complaint: chest pain major surgical or invasive procedure: cardiac cath : urgent coronary artery bypass graft x3: left internal mammary artery to left anterior descending artery; saphenous vein grafts to diagonal and obtuse marginal arteries. 2. endoscopic harvesting of the long saphenous vein. history of present illness: mr. is a 73 m with a history of cvd s/p left carotid stent placement on , htn, hl, dm2 who presents following an episode of dizziness followed by n/v/d and associated chest pain. he reports that he has been feeling well since his prior hospitalization with no recurrence of neurologic symptoms (initially had some right hand numbness/weakness which came and went). he felt well when he went to bed last night. on awakening this morning and turning over in bed, he felt extremely dizzy and like the room was spinning around. he turned back and his symptoms resolved after about 10 seconds. he then got out of bed and walked toward his kitchen to take his medications, but felt the sudedn onset of nausea and rushed to the bathroom where he proceeded to vomit for ~ one hour. he also had several episodes of "soft stool" during this period though stool was not liquidy. no blood in emesis or stool. he was diaphoretic during this time, and after about an hour of dry heaving began to develop chest pain located just above the manubrium to a severity of ~6.5/10. he also had an exacerbation of chronic left biceps pain radiating to his hand to severity and throbbing in quality. at this time, his wife called ems. he was ultimately able to take his morning medications and reports that though he had some dry heaving afterward he did not vomit his pills. the chest pain began to resolve on its own and was down to 1/10 prior to ems arrival. en route to the ed, he received a second 325 mg of aspirin and sublingual ng spray, following which the cp fully resolved. he did have persistence of the left arm pain, though less severe. . in the ed, initial vs were t 98.0, hr 130, bp 186/102 18 100% 4l nasal cannula. his arm pain improved with one dose of 4 mg iv morphine. labwork was significant for wbc of 17.8 with neutrophilic predominance on differential. cxr was notable for possible early rll pneumonia, for which he received 1 g iv vanco and 750 mg levofloxacin for hap given his recent hospitalization. ekg was unremarkable. vitals on transfer to the floor were hr 122, bp 179/85, rr 18, o2 sat 97% on 2l. he was admitted to medicine for treatment of pneumonia. . upon transfer to the floor, he reported feeling significantly improved. he has had no further vertigo, nausea, vomiting, or diarrhea/loose stool since arriving in the ed. he does not feel sob and denies fever, chills, night sweats, shortness of breath, cough, pleuritic chest pain or sputum production. no current cp or arm pain. past medical history: - hypertension (per record of home bps, generally runs sbp 130s-140s, hr 80s-90s) - hypercholesterolemia - diabetes mellitus type ii - hypothyroidism - cerebral disease s/p stent placement to left carotid - vertigo (likely bppv) x several months (last episode > 1 month ago) - lung cancer s/p surgical excision (left sided), no chemo/radiation - left inguinal hernia repair - partial gastrectomy for ulcer ~40 years ago - multiple (~4) back surgeries for bone spurs (? additional indications), no active back problems, ? hardware in place - accidental amputation of right thumb - rotator cuff surgery social history: married (second marriage) and lives with his wife. has one stepson who lives nearby and two biological grown children who live out of state. he was previously a heavy smoker (up to 4 packs per day) but quit 40 years ago. he drinks occasional beer but keeps this to a minimum, because he continues to work as a bus driver (cross-country charter buses) and takes jobs as they come. family history: raised in an orphanage - does not know his biological family. physical exam: admission physical exam: general - well-appearing elderly gentleman in nad, comfortable, appropriate, speaking in full sentences heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear, upper and lower dentures in place, nc in place neck - supple, no thyromegaly, no jvd, soft carotid bruits appreciable bilaterally lungs - no wheeze, rales, rhonchi. however, patient has increased vocal fremitus at right base, as well as increased sound transmission on assessment for egophony. no significant dullness to percussion appreciated. heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no signifcant rashes or lesions. sebhorrheic keratoses on the back neuro - awake, a&ox3, cns ii-xii grossly intact, strength/gait not assessed pertinent results: chest (portable ap): 1. suboptimal study, as the left costophrenic angle is not fully included and a small left pleural effusion cannot be excluded. slightly increased right lower lobe opacity, early consolidation not excluded. suggest dedicated pa and lateral views for better evaluation when patient able. tte: : pre-bypass: no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is mildly depressed (lvef= 45 %). there is mild basal and mid-inferoseptal wall hypokinesis. right ventricular chamber size and free wall motion are normal. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. dr. was notified in person of the results at time of surgery. post-bypass: the patient is av paced, on no inotropes. there is moderate hypokinesis of the basal and mid-inferoseptal and inferior wall of the left ventricle. left ventricular systolic function is unchanged. right ventricular function is unchanged. mild aortic stenosis is unchanged. mild (1+) aortic regurgitation is unchanged. moderate (2+) mitral regurgitation is seen. the ascending aorta, aortic arch, and descending aorta are intact. . cardiac catheterization : 1) coronary angiography of this right-dominant system demonstrated significant left main and functional three vessel coronary artery disease. the lmca had 70% stenosis with severe damping. the lad had 60% distal stenosis with a d1 with 70% proximal stenosis. the lcx had 70% stenosis at the origin. the dominant rca had 99% proximal stenosis, 99% mid stenosis, and 99% distal stenosis with left to right collaterals. 2) limited resting hemodynamics revealed systemic arterial hypertension (161/72/113). 3) left ventriculography was deferred. . non-contrast chest ct : 1. moderate calcifications of the ascending aorta, the aortic arch, the descending aorta and the supra-aortic branches. moderate-to-severe coronary calcifications. 2. multiple non-characteristic, partly calcified and partly non-calcified pulmonary nodules. several sub 5-mm ground-glass nodules. 3. part solid and part non-solid pulmonary nodule in the anterior aspects of the right lower lobe, with retractile behavior with regard to the major fissure. this nodule needs to be followed by ct in approximately six months from now. 4. minimal bilateral basal scarring, left more than right, with a minimal left pleural effusion. cxr : upright pa and lateral views of the chest show a decrease in the left pleural effusion. the abnormal contour is likely due to pleuralthickening seen on previous examinations. unchanged small right pleural effusion. heart size is large but unchanged. decrease in mediastinal size with no evidence for active bleeding. again seen are small calcified granulomas within the right mid lung. no pneumothorax. brief hospital course: as mentioned in the hpi, mr. presented to the ed with dizziness and chest pain. he was admitted and worked up. a repeat troponin on the evening of the day of admission () was elevated at 0.34 and ck-mb was 39. the patient was placed on oxygen and administered a second dose of aspirin 325 mg. a cardiology consult was called. he was placed on telemetry and then transferred to the cardiology floor for cardiac catheterization. catheterization on demonstrated left main and functional three vessel disease. he was continued on a heparin drip, aspirin, clopidogrel, beta blocker, and statin in preparation for cabg. he was brought to the operating room on where he underwent an urgent coronary artery bypass graft x 3. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. he was intubated on propofol and neo. he had increase bloody ct drainage required multiple blood products, he ended up returning to the or for exploration. venous bleed was found and repaired. he returned to the icu and was hemodynamically stable. he was extubated that evening and was found to be alert and oriented and breathing comfortably. the patient remained neurologically intact and hemodynamically stable he weaned from vasopressor support. beta blocker was initiated and the patient was gently diuresed. the patient was transferred to the telemetry floor on pod#1, his ct remained for continued drainage. his wires were removed in timely fashion and wihtout difficulty. the patient was evaluated by the physical therapy service for assistance with strength and mobility. patient has a history of vertigo (likely bppv), in the post-op period he was acutely dizzy and very unsteady gait as a result, he was restarted on his meclizine. he has a hx of carotid stenosis and was restarted on plavix. due to his continued dizziness, he had carotid studies done which showed 60-69% stenosis in right and patent left carotid stent. he was evaluated by the neurology service who felt that his dizziness was related his vertigo that has been aggravated by his recent surgery and that it will improve with time. he has remained hemodynamcically stable and remains in sr. the wound was healing and his pain was controlled with oral analgesics. in lgiht of his dizziness, unsteady gait and safety concerns he was discharged to neuro rehab - rehab on pod# 8. follow up instructions arranged medications on admission: ergocalciferol (vitamin d2) 50,000 unit cap po every other week simvastatin 80 mg po mouth daily losartan 100 mg by mouth daily meclizine 25 mg po up to three times per day for dizziness levoxyl 50 mcg po daily enteric coated aspirin 325 mg tab (e.c.) po daily plavix 75 mg po daily metformin 850 mg po bid discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 6. metformin 850 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 8. losartan 25 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. meclizine 12.5 mg tablet sig: two (2) tablet po qid (4 times a day). 10. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 11. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. 12. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po daily (daily) for 4 days. 13. metoprolol tartrate 50 mg tablet sig: 2.5 tablets po bid (2 times a day). 14. lasix 20 mg tablet sig: one (1) tablet po once a day for 5 days. discharge disposition: extended care facility: hospital - discharge diagnosis: coronary artery disease s/p coronary artery bypass graft x 3 past medical history: - hypertension - hypercholesterolemia - diabetes mellitus type ii - hypothyroidism - cerebral disease s/p stent placement to left carotid - vertigo (likely bppv) x several months (last episode > 1 month ago) - lung cancer s/p surgical excision (left sided), no chemo/radiation - left inguinal hernia repair - partial gastrectomy for ulcer ~40 years ago - multiple (~4) back surgeries for bone spurs (? additional indications), no active back problems, ? hardware in place - accidental amputation of right thumb - rotator cuff surgery discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: surgeon: dr. on at date/time: 1:00 cardiologist: dr. on @ 11am please call to schedule the following: primary care: , md phone: date/time: 8:30 **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries left heart cardiac catheterization reopening of recent thoracotomy site diagnoses: pneumonia, organism unspecified other and unspecified noninfectious gastroenteritis and colitis subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism personal history of malignant neoplasm of bronchus and lung personal history of tobacco use abnormality of gait other and unspecified hyperlipidemia hemorrhage complicating a procedure 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 other and unspecified coagulation defects examination of participant in clinical trial benign paroxysmal positional vertigo unspecified vitamin d deficiency unspecified cerebrovascular disease 

Answer: The patient is high likely exposed to