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: chest pain - tx to from with stemi major surgical or invasive procedure: cardiac catheterization - no intervention on totally occluded rca. history of present illness: hpi: 34 yo m no pmh but a family hx of lupus anticoagulant (mother and sister) was in usual state of health until 4d pta when he began to feel nausea in the evening. he did not take anything to resolve the discomfort and reports no associated symptoms. he then had some "heartburn" 3d pta and took tums with resolution. 2d pta he had some symptoms of malaise, though he denied any cp or sob at this point. he then had mild stomach upset 1d pta. on the day of presentation to osh () he experienced chest discomfort that awakened him from sleep at 2am. he felt his pulse was irregular. ekg there revealed stemi with st depressions in i and avl (1cm) and ste in iii and v1 (0.5-1mm). cpk 655. he was given a dose of enoxaparin and tx'd to for ptca. in the cath lab the pt was found to have a large lad and om1/om2 that were patent. rca was found to be totally occluded. attempts to revascularize were unsuccessful despite wiring through the lesion. clot was taken out of the artery. some small amt of blood flow was restored with a balloon, but no further intervention was successful. the catheter was removed. pain to balloon time was roughly 5.5-6hrs. . catheterization showed hemodynamics of: ra 19, pa 23, pcw 14, co 7.25. no lvedp was included. rca was 100% occluded with poor restoration of flow. lcx and lad were patent. . ros was otherwise negative. past medical history: pmh: none psh: kneecap reconstruction x 2 at age 5, arthroplasty 10 yrs ago (3day hospital stay - does not recall heparin sq) social history: fh: mother - lupus with sister - without lupus no history of early mi/early death ..... sh: etoh socially drinks/wk, non-smoker, no current illicits. used cocaine in past - last use in . no history of heavy use. works in carpentry. in school for archtecture. no children. physical exam: vitals: 98.1, 159/99, 80, 15, 97% ra gen: nad, lying comfortably, interactive heent: perrl, ncat, eomi, no lad, no jvd, no bruits, supple cv: rrr, no murmurs, no heave, pmi non-displaced lungs: clear laterally and anteriorly abd: soft, nt, nd, nml bs ext: groin with sheath in place on r, no hematoma, no ecchymosis, no oozing/bleeding. pulses: l 3+ dp and pt; r + pt and 2+ dp. good capillary refill bilaterally. testicular: no masses or irregularities. neuro: grossly non-focal. maew. no drift. fnf intact bilat. pertinent results: labs at osh prior to transfer: ck 655 . abg in lab: 7.39/41/140 sat 98% . ekg: pre catheterization: sinus rhythm at 79, nml axis and intervals, 1mm q in ii, v2 and v3 with 1mm ste. . ekg post catheterization: sinus rhythm at 73, nml axis and intervals, 1mm q in ii, iii with 0.5-1mm ste, v2-v4 with 1-2mm ste. . 06:22am blood wbc-10.5 rbc-4.97 hgb-15.0 hct-41.0 mcv-83 mch-30.2 mchc-36.5* rdw-12.9 plt ct-253 06:22am blood neuts-77.7* lymphs-18.4 monos-3.0 eos-0.6 baso-0.3 06:22am blood pt-13.4* ptt-30.3 inr(pt)-1.2 06:22am blood plt ct-253 06:22am blood glucose-122* urean-13 creat-1.0 na-142 k-4.5 cl-106 hco3-28 angap-13 06:22am blood ck(cpk)-573* 01:40pm blood ck(cpk)-467* 05:13pm blood ck(cpk)-450* 05:54am blood ck(cpk)-393* 06:22am blood ck-mb-41* mb indx-7.2* 06:22am blood ctropnt-1.09* 01:40pm blood ck-mb-34* mb indx-7.3* 05:13pm blood ck-mb-33* mb indx-7.3* ctropnt-0.98* 05:54am blood ck-mb-25* mb indx-6.4* 05:54am blood triglyc-98 hdl-46 chol/hd-3.6 ldlcalc-101 05:13pm blood homocys-5.5 08:46pm blood -negative . catheterization comments: 1. selective coronary angiography of this right dominant system revealed a single vessel disease. the lmca and lad were normal. the lcx had no obstructive disease with questionable mid segment thrombus. the rca had total proximal occlusion. 2. resting hemodynamics revealed mildly elevated right and left sided pressures (mean ra pressure was 12 mmhg, mean pcwp was 14 mmhg). there was no evidence of pulmonary hypertension (mean pa pressure was 23 mmhg). the cardiac index was normal at 2.9 l/min/m2. 3. treatment of totally occluded proximal rca using balloon inflations, export catheter clot removal, and intracoronary administration of medications as well as systemic enoxaparin and eptifibatide. final angigoraphy demonstrated a small channel to the small distal vessels of the rca and slow flow in the rca. (see ptca comments). 4. clot was noted on the wire and the balloon despite administration of enoxaparin and eptifibatide. final diagnosis: 1. single vessel disease. 2. mildly elevated resting hemodynamics. 3. unsuccessful treatment of proximal rca due to extensive thrombus . . arterial doppler of rle post-cath impression: 1. normal color flow and arterial venous waveforms within the right lower extremity. 2. no evidence of a thrombus within the right common femoral artery. . . post-cath echocardiogram conclusions: the left atrium is elongated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the basal inferior wall. the remaining left ventricular segments contract normally. right ventricular cavity size is normal with focal basal free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be quantified. there is no pericardial effusion. impression: regional left and right ventricular systolic dysfunction c/w cad (proximal rca disease). brief hospital course: brief overview: 34 yo m no cardiac risk factors with fam hx of anti-cardiolipin and distant cocaine hx presented with stemi and 100% rca occlusion that could not be opened on ptca - per cath lab, suction cath was used to remove large amounts of fresh blood clot. pt was admitted to the ccu - troponins continued to trend down from his peak at osh. he did not continue to have chest pain. heparin drip was continued for anticoagulation given the question of hypercoaguability as the cause of the patient's mi. while the possibility of hit was entertained, platelets remained stable and there was no good evidence that this episode was consistent with hit. heme service was consulted and recommended a limited hypercoagulable workup given his arterial clotting. workup was initiated. pt was tx'd to floor and continued to improve symptomatically. telemetry showed a narrow complex tachycardia that often terminated with a pause and had some internal variability - it appeared consistent with regularized afib/aflutter. given the patient's afib on presentation, prolonged presenting symptoms of mi, and propagated clot in the coronary, it was thought that he might have had asymptomatic paf with mural thrombus and embolus to the rca from this source. prior to discharge, the patient was started on coumadin and lovenox as a bridge. in addition, he was started on amiodarone therapy after a baseline pa/lateral cxr, tft's, and lft's were obtained as baseline. lft's showed only a mild hyperbilirubinemia. the goal of amiodarone therapy was for short term rhythm control (2-3 months) to be followed by ep study with likely pulmonary vein isolation. the patient was discharged with of hearts monitor with 2x daily monitoring plus event monitoring. he was set up with follow up with heme and cardiology (dr. , as well as with his primary care physician, . . he was discharged with of hearts monitor and scheduled for a cardiac mr monitor in the future. detailed course by system: ## cardiac pump: the patient had no history of chf, and his bnp at the osh was 69. wedge and ra pressures were mildly elevated (ra > wedge) in the cath lab. he remained hemodynamically stable and euvolemic throughout his hospital stay. an echo was perfomed to assess his lv function and is discussed above. in short, it showed a preserved ef with some focaly hypokinesis in the territory of his rca. vessels: the patient was admitted with a stemi and found to have a 100% rca occlusion. the occlusion was not well characterized as flow could not be adequately re-established with stenting despite the wire passing easily through the occluded region. a suction catheter returned large amounts of fresh clot. the wire was covered with blood clot when removed from the fem line after the procedure. thereafter, the flow was minimally reestablished and the pt was managed medically with asa, bb, acei, plavix, and heparin. it was thought that the patient could have had thrombus secondary to hypercoaguability or malignancy - there was no evidence of either (of note, cxr was clear and testicular exam was normal). alternatively, and perhaps more likely, he might have had paf with mural thrombus that embolized to his rca. bb and acei were started low and titrated up as bp tolerated. amiodarone was started chem 7 was monitored closely for rising creatinine or potassium given the initiation of an ace inhibitor. baseline lft's were measured prior to discharge. ecg showed resolution of st changes and pain resolved after the catheterization. the patient remained on heparin until the patient was started on lovenox and coumadin prior to discharge from the hospital. fasting lipid profile was obtained 2 days post-mi, and it showed no hypercholesterolemia, however these figures cannot be taken as baseline as mi can cause perterbations in the lipid profile. appropriate follow up was arranged (see below). in the hours following his cardiac catheterization, the patient developed a decreased dp pulse in his r leg (the side that was entered with the catheter in the lab) compared with the l. the pt remained strong. urgent doppler study of the leg showed no clot nor comprimise. capillary refill remained normal, as did warmth, color, and sensation. rhythm: the patient complained of palpitations on presentation to the osh and was found to be in afib. at post-catheterization, he was initially in sinus with pac's on tele. however, overnight two days after his mi, the patient developed a narrow complex tachycardia most consistent with afib/aflutter. it was never captured on 12 lead ekg and the patient was asymptomatic with the short spells (in contrast to his prior atrial fibrillation at the osh where he described palpitations). the patient was receiving metoprolol for cardioprotection post-mi. the patient was also receiving anticoagulation therapy for presumed hypercoaguabiltiy - see below. he was started on amiodarone therapy with the goal of a short course of therapy until and ep study could be done. the patient was thought to be a likely candidate for pulmonary vein isolation to erradicate his arrhythmia. he was scheduled for mr and in addition to the koh monitor to prepare for this possibility. ## hypercoaguability - there is a history of anticardiolipin in the patient's family. he was found to have clot in his rca on catheterization. intervention in the cath lab was unsuccessful. post-cath he remained on heparin. the hematology service was consulted and recommended a hypercoaguability workup focused on disorders that might be responsible for arterial thrombus formation. the patient was tested for lupus anticoagulant and and was negative. at the time of discharge, the patient's other hypercoaguability workup was pending. included in these labs were anti-cardiolipin antibodies (igg and igm), anti-platelet factor 4, homocysteine and factor v leiden. the patient was maintained on heparin and changed to lovenox prior to discharge. warfarin was also started prior to discharge with the plan to anticoagulate pending return of the hypercoaguability labs. disposition: the patient was told to follow up with dr. on the monday following discharge - dr. was contatcted to this effect. the patient was also told to follow up with hematology and with dr. in cardiology. coumadin was to be managed through dr. office. it was planned that he would remain on lovenox until he reached therapeutic levels of coumadin (inr 3-3.5 given hypercoaguable state). because his hypercoag w/u was pending when he was discharged, the labs were to be followed after his discharge (anticardiolipin, factor v leidin, homocysteine). if the hypercoag w/u was negative, coumadin therapy might not be necessary long-term (his lone afib was planned for ablation, and might be managed with chronic asa therapy in this young man if ablation were not to be successful). many of these decisions will require detailed follow-up as an outpatient with hematology and cardiology. in preparation for his follow-up with dr. , the patient was scheduled for a cardiac mri and a 24hr as pre-ablation evaluation. medications on admission: meds at home: none . meds on tx cardizem asa nitro drip lovenox x 1 discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): take as directed to reduce blood clotting. :*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily): take as directed to reduce cholesterol. :*30 tablet(s)* refills:*2* 4. lisinopril 10 mg tablet sig: two (2) tablet po once a day: take as directed for cardioprotection and hypertension. :*60 tablet(s)* refills:*2* 5. enoxaparin 100 mg/ml syringe sig: one (1) syringe subcutaneous q12h (every 12 hours): use as directed to prevent clotting until directed to stop by your physician. :*14 syringe* refills:*2* 6. coumadin 1 mg tablet sig: five (5) tablet po at bedtime: take as instructed and adjust as directed based on inr testing. :*120 tablet(s)* refills:*0* 7. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): take 2 tablets twice daily for one week. thereafter, take 2 tablets once daily. :*120 tablet(s)* refills:*2* 8. toprol xl 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day: take as directed for heart protection and blood pressure control. :*30 tablet sustained release 24hr(s)* refills:*2* discharge disposition: home discharge diagnosis: myocardial infarction paroxysmal atrial fibrillation discharge condition: stable. discharge instructions: you were admitted to the hospital after you had a myocardial infarction (also called "mi" or "heart attack.") your heart attack seems to have been associated with clotting of blood in the arteries of your heart. you will need to take blood thinners to try to prevent this from happening again. you will have a list of medications when you leave the hospital. you will have of hearts monitor when you leave the hospital. you will be given this monitor and instructions on how to use it prior to leaving the hospital. you should follow up with dr. next week for basic blood tests and exam. please call dr. for an appointment on monday (. she is expecting your call and knows of your hospitalization. you will need to have your blood drawn weekly for the next 1-2 months and -weekly thereafter to monitor your coumadin levels. you have an appointment with dr. in cardiology at on at 3pm, as well. he will assist your pmd in further managment of your heart disease and arrhythmia. you may need an ablation procedure in the future. you will likely be enrolled in cardiac rehabilitation to strengthen your heart - your cardiologist will set this up for you. dr. number is: (. his office is at . before you see him you will need to have two tests: 1) 24 hour monitor - this monitors your heart continuously for a 24 hour period. you have an appointment to pick it up at on monday, at 11am. 2) cardiac mri - this will give a clear picture of your heart. you will need to have this done prior to your appointment with dr. on . you can call at to confirm your appointment date. she has your information and has already been notified that you need an appointment. you should see a physician in the hematology department, as well. you can call to schedule an appointment: (. you can see any of the physicians in the department - they will work with dr. in determining how long you will need to take coumadin. you should be sure to eat a low cholesterol and low salt diet and take your medications as prescribed to reduce the chance of having another heart attack in the future. if you develop pain or bleeding in your groin at the site of the catheterization, chest pain/tightness, lightheadedness/dizziness, or other worrisome symptoms, seek immediate medical attention. followup instructions: koh monitor on hospital discharge. dr. within 1 week for chem 7 and f/u care. will also need pt monitoring on coumadin. dr. in cardiology at on at 3pm, hematology - pt to call for appt. - at 11am cardiac mri - before - notified - pt being scheduled. procedure: coronary arteriography using two catheters left heart cardiac catheterization excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery atrial fibrillation acute myocardial infarction of other inferior wall, initial episode of care 

Answer: The patient is high likely exposed to