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: hypotension major surgical or invasive procedure: 1) cardiac catheterization history of present illness: 78 year old man with multiple medical problems including cad s/p recent rca taxil stent , af and sick sinus syndrome s/p pacemaker in revised in , chf with ef 45% recently admitted from for atypical chest pain (no interventions) comes in this am for elective cardiac cath to evaluate for restrictive cardiomyopathy. during the procedure his pressures dropped from the 130s/80s to sbp of 70s, he also was somnolent (?due to versed and fentanyl). he was not responsive to atropine, or to low doses of dopamine, but responded to 15mcg/kg/min of dopamine. ekg not consistent with ischemia, no other s/s. the patient was admitted to the ccu for close monitoring. given his symmetric lvh, diseases such as sarcoid and amyloid were possible but pt has not wanted a biopsy to date. an echo earlier this month showed severe symmetric lvh, inferior and septal hypokinesis, an ef 45% as above, a small pericardial effusion, and an abnormally small lv cavity (which is not reported on a repeat echo this admission). the last two findings are new since . an exercise stress test as well as a persantine stress test earlier this month were both prematurely terminated after the patient dropped his pressures. he had a normal ett in ' and an ett with elevation in his bp with exercise in . past medical history: 1. sick sinus syndrome s/p pacemaker , revised as lead was disconnected and patient p/w hr in 190s 2. afib - on coumadin chronically (held 4d prior to cath), amiodarone (dc'd 1.5 weeks ago lft abnl), av paced 3. chf - ef 45%, on coreg, altace, digoxin, lasix and asa as outpatient 4. prostate ca s/p turp c/b bleeding ; last psa 0.8 in 5. gout - on allopurinol 6. cad s/p taxil to ostial rca 7. gerd - on protonix 8. anemia - baseline hct 30-33 but data only from ; per wife in high 30s >1 year ago. 9. hematuria - after turp, therefore not on plavix for stent . cri - baseline cr 1.2-1.6 but data only from social history: lives in with wife. in visitng his daughter. tobacco, occasional etoh. no illicits. family history: brother w/ father with mi physical exam: t nr bp pre cath: 135/80l; 129/80r post cath on dopamine drip: 115-134/62-70; post cath on dopamine dc'd: 110-112/59-60. hr 70-71 post cath rr 13-23 (post cath) post cath o2 sats 92-100%3l but then nc dc'd and patient was 96%ra i/o: wt: 170# * gen: pt in nad, lying flat in bed, eyes closed; on dopamine drip (subsequently dc'd at 2:45pm) heent: perrl, eomi, no jvd, no lad neck: no jvd cv: rrr, no m/r/g; paced chest: clear on anterior exam abd: soft nt/nd; arterial and venous access in right groin, no hematoma, no bruits, non tender, no bruising of flank. ext: warm, 1+ pitting edema to knees, 1+ dp pulses bilaterally, strength 5/5, sensation intact to light touch skin: dry neuro: alert and oriented x3; easily arousable pertinent results: chemistries 09:35am glucose-113* urea n-25* creat-1.2 sodium-140 potassium-3.8 chloride-101 total co2-29 anion gap-14 lfts 09:35am alt(sgpt)-42* ast(sgot)-32 alk phos-292* tot bili-0.9 coags 07:10am inr(pt)-1.5 abg (on 3l) 09:19am type-art po2-92 pco2-40 ph-7.51* total co2-33* base xs-7 intubated-not intuba 09:19am hgb-9.5* calchct-29 o2 sat-97 cardiac cath (): comments: 1. selective coronary angiography revealed two vessel coronary disease. the lmca had mild, diffuse plaquing. the lad was moderately calcified but contained no flow-limiting disease. a d1 branch contained a modest sized, long lower pole 80% stenosis. the lad wrapped around the apex. the lcx had mild luminal irregularities throughout but was otherwise without flow-limiting disease. the rca had an ostial 40% stenosis that resulted in pressure dampening on engagement of the vessel. this was somewhat attenuated with use of a jr5 catheter. the proximal rca stent was patent with a relative 50-60% stepdown afterwards. 2. resting hemodynamics revealed elevated mean ra pressure of 16mmhg. pcpw tracing was difficult to acquire and actual measurements probably represented a hybrid of pcpw and pa pressure. lvedp was elevated at 20mmhg. cardiac output via the fick method was 3.4 l/min with a cardiac index of 1.8 l/min/m2. 3. left ventriculography was not performed. 4. central aortic pressure was low immediately after obtaining arterial access. pressure was approximately 80/60. the patient had no symptoms of lightheadedness or back pain. administration of atropine and flumazenil (to reverse the versed given before the case) did not improve the blood pressure. the patient did not respond to infusions of dopamine at 5 or 10 mcg/kg/min. ultimately, at 15 mcg/kg/min, the blood pressure rose to 120/80 with a pulse in the 70s. cardiac output on 7.5mcg/kg/min dopamine was 3.7 l/min. 5. a stat echocardiogram done in the cath lab revealed "bradycardic" appearing heart with ef 40% and no evidence of effusion. final diagnosis: 1. two vessel coronary artery disease. 2. diastolic dysfunction. pressures ra 16 rv 43/15 pcw 24 pa 43/22 ao 83/57 lv 85/22 * sats svc 56% pa 49-51% ao 93-98% echo (): conclusions: 1. limited focused study. 2. the left atrium is moderately dilated. the left atrium is elongated. 3.the right atrium is moderately dilated. 4.there is severe symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). resting regional wall motion abnormalities include basal and mid septal hypokinesis. 5.the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. right ventricular systolic function is normal. 6.the aortic valve leaflets (3) are mildly thickened. no color doppler study was done to assess for the presence of mr . 7. the mitral valve leaflets are mildly thickened. 8.there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. the effusion appears circumferential. 9. an echogenic density in the right ventricle is present consistent with a pacemaker lead. compared with the findings of the prior study (tape reviewed) of , the pericardial effusion is much less. the overall function is unchanged. ct abd, non contrast () r/o retroperitoneal bleed impression: 1. no evidence of retroperitoneal or groin hemorrhage. 2. moderate size bilateral pleural effusion effusions and bilateral lower lobe atelectasis. 3. innumerable punctate low-attenuation liver lesions. these are likely benign but are too small to characterize. 4. irregular thickened bladder wall. this may be partially due to incomplete distention of the bladder. there is likely a small right bladder diverticulum. further evaluation of the bladder wall with direct visualization should be considered. 5. left hydrocele. ekg (): c/w lbbb as patient is paced; no evidence of acute stemi, no change on . ct chest (): small calcifications c/w granulomas in lll and rul, as well as in liver. pulmonary nodule in lul. small mediatstinal nodes. small b/l pleural effusions. small pericardial effusion. brief hospital course: 1. cardiovascular a. rate/rhythm - the patient had underlying af, sss with pacer in place. he came in on a beta blocker. these were held the day of catheterization but were added back the following day. while here he was well controlled on this regimen. coumadin still held in anticipation of biopsy. no anticoagnulation at present. b. pump - the patient came in on an acei, lasix, and digoxin. these meds were held the day of catheterization () but reinitiated the following day. he had an episode of hypotension requiring dopamine drip during catheterization but was weaned off the drip the same evening. his ef was 45%. he also received two additional iv doses of lasix on while he received 2 units of prbcs with good uop afterwards. c. cad - s/p rca stent in , and since has had the pump problems above. his asprin 81mg was continued during this admission. d. pericardial effusion - small, but new since . stable issue during this admission. e. symmetric lvh: seen on echo, and differential includes diseases such as amyloid and sarcoid. a cardiac biopsy for tissue dx was planned while the patient was admitted. however, his inr was somewhat evevated after having stopped coumadin and was 1.7 on . therefore he was given vitamin k with a decrease in his inr to 1.5 on . the interventional cardiologist felt that the inr should be lower, and that the patient should be placed on lovenox and return for the biopsy next week. this was scheduled for tuesday, . he was given another dose of vitamin k on and will get his inr checked on saturday. * 2. pulmonary - the patient maintained good sats with 2l nc. he had calcifications c/w granulomatous dz in liver and lung, possible sarcoid or tuberculosis. - ace level pending on discharge - ppd placed () - negative on * 3. renal - the patient had chronic renal insufficiency of unclear etiology. his creatinine was stable over the past one month, and during his hospitalization. * 4. id - during admission the patient remained afebrile, without a white count. * 5. gi - after his procedure, the patient was advanced to a cardiac diet. lft abnormalities on admission were lower than earlier this month. * 6. gu - s/p turp c/b hematuria in the past so was not on plavix for his stent. foley dc'd am. * 7. heme/onc - hct 36.7 after 2 units (), up from 28.6. inr 1.5 on after vitamin k given on , he was given another dose on . previously on coumadin - held on friday for procedure. the coumadin was held, and the patient was sent home on lovenox until procedure tuesday. * 8. endo - glucose stable in low 100s. hiss with qid fs. earlier this month ft4 was mildly elevated at 1.9 with normal tsh at 3.8. * 9. psych - no issues, wife supportive. * 10. proph - ppi, heparin sq, bowel regimen, tylenol. c/o constipation so increased bowel regimen. * 11. drains/tubes/lines - right groin arterial and venous access - dc'd at 2:45pm on ; now with l piv. * 12. dispo - sent home on to return for biopsy next tuesday . medications on admission: coreg 6.25mg altace 1.25mg digoxin 0.125mg lasix 40mg coumadin ld, held protonix 40mg allopurinol 100mg k dur 10meq mvi recently dc'd amiodarone lft abnl discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. allopurinol 100 mg tablet sig: one (1) tablet po qd (once a day). 3. multivitamin capsule sig: one (1) cap po qd (once a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po qd (once a day). 5. carvedilol 3.125 mg tablet sig: two (2) tablet po bid (2 times a day). 6. ramipril 1.25 mg capsule sig: one (1) capsule po qd (once a day). 7. outpatient lab work please come to the emergency department on saturday to have your inr drawn. you do not have to stay for the results. ordering physician . 8. medication vitamin k - take 10mg by mouth tomorrow 9. zocor 40 mg tablet sig: one (1) tablet po once a day. 10. lasix 20 mg tablet sig: one (1) tablet po every other day. discharge disposition: home discharge diagnosis: 1. hypotensive episodes since 2. sick sinus syndrome s/p pacemaker , revised as lead was disconnected and patient p/w hr in 190s 3. afib - on coumadin chronically (held 4d prior to cath), amiodarone (dc'd 1.5 weeks ago lft abnl), av paced 4. chf - ef 45%, on coreg, altace, digoxin, lasix and asa as outpatient 5. prostate ca s/p turp c/b bleeding ; last psa 0.8 in 6. gout - on allopurinol 7. cad s/p taxil to ostial rca 8. gerd - on protonix 9. anemia - baseline hct 30-33 but data only from ; per wife in high 30s >1 year ago. 10. hematuria - after turp, therefore not on plavix for stent . cri - baseline cr 1.2-1.6 but data only from discharge condition: stable, tolerating an oral diet, ambulatory, afebrile. discharge instructions: take all your regular medications take vitamin k 10mg tomorrow have your inr checked in the ed on sat am please return next week for your cardiac biopsy. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet followup instructions: dr for biopsy next week dr per your routine procedure: injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation personal history of malignant neoplasm of prostate long-term (current) use of anticoagulants cardiac pacemaker in situ sinoatrial node dysfunction 

Answer: The patient is high likely exposed to