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: a 73-year-old man with past medical history significant for cad, status post three-vessel cabg, avr, and pacer, who presented with chest pain which started approximately 1 week prior to admission. described it as soreness which comes at rest and activity. the patient also complained of shortness of breath, beginning in or which previously is his main complaint. the patient also has neck pain with exertion, which abates at rest. last week prior to admission, the patient had increasing shortness of breath and "neck pain" which escalated and prompted his visit to his pcp. patient did lie flat and denies pnd. chest pain started over the prior week but increased shortness of breath prompted an ett, which showed a large mild reversible defect. because of this result, the patient escalating systems the primary care doctor referred the patient to dr. for possible intervention. review of systems: negative for cough and fever. negative for overindulgence in food and alcohol over the holidays. positive rash. fair appetite, which is approximately stable. no abdominal pain, nausea, vomiting or diarrhea. positive occasional monocular loss of vision in the left eye, maybe the right eye too. carotid ultrasound "okay" per the patient. past medical history: cad (cabg three-vessel and avr , reason positive ett). status post pacer placement in the context of unclear disorder ? heart block for aaa repair, . status post cardioversion or but felt return of neck pain in . hypothyroidism. aaa repair 4 to 5 years prior to admission. borderline hypertension. chronic renal insufficiency. kyphosis. allergies: nkda. medications: 1. aspirin 81 mg p.o. q.d. 2. synthroid 75 mg p.o. q.d. 3. lotrel 510 mg q.d. social history: the patient was an electric technician, retired, and lives with his wife and son who is 39 years old. the patient has 1 to 2 drinks a day. former smoker, quit in . family history: mother died at 97 of unclear causes. father died at 65 with ? cad but the father is a world war i veteran with many exposures. he has three children who are alive and well and he is the only child himself. physical examination: vital signs: the patient had a heart rate of 107, blood pressure 138/74, saturating 96 percent on room air, and respiratory rate is 21. general: he is an elderly man, alert, and mildly tachypneic in no apparent distress. heent: bilateral ear lobe creases, mottled nose, and anicteric sclerae. neck: jvp approximately 6 cm. heart: a 2/6 systolic murmur at the left sternal border and apex. regular rhythm and tachycardic. no gallops or rubs appreciated. lungs: clear bilaterally. chest: soft 3 to 4 cm mass above the left nipple. abdomen: soft, nontender, and nondistended. no hepatosplenomegaly. multiple surgical scars. extremities: same with no cce and 2 plus dp pulses bilaterally. neurologic: cranial nerves ii through xii intact. moves all extremities well. laboratory data: admission labs are notable for eosinophil percentage of 10.9 percent and creatinine of 2.9. ck on admission was 77 with a troponin of less than 0.01. the patient's recent stress spect showed a large valvular reversible defect in the inferior lateral apex, ef of 67 percent (positive for large inferolateral and inferoapical ischemia with normal ef.) echo on outside hospital showed mild lvh, ef 55 percent, mild thickened mv with trace mr, dilated ascending aorta, normal aortic valve, normal right ventricular size and function but with mild-to- moderate tricuspid regurgitation, and no pericardial effusion. chest x-ray on admission also showed no acute cardiopulmonary process or change from . brief summary of hospital course: a 73-year-old man with history significant for coronary artery disease status post three-vessel cabg, avr, and pacer, who had 6 months' history of increasing shortness of breath and neck pain. it is angina equivalent. the patient presented in the context of positive stress and escalating pain over the last 1-1/2 weeks. the patient was catheterized and found to have diffuse disease. given chronic renal insufficiency on dialysis, the patient was reassessed on the second catheterization to avoid giving him too much contrast with one procedure per his attending, dr. . however, the patient had a vagal episode and vague uti at the outside of the second catheterization with anginal chest pain. the patient had a short stay in the ccu as a result. the patient no longer considered to be a catheterization candidate and remaining options include medical management and ? of repeat cabg. the plan therefore changed to send the patient home for outpatient evaluation after carotid ultrasound read. given that the carotid ultrasound showed complete occlusion of the right ica and 40 percent of the left ica, the patient was sent home. this will be detailed below. problem list: cardiovascular rhythm, no changed tachycardiac event as before. continue beta-blocker. the patient will also have a pacemaker interrogated by ep which showed normal pacemaker function. it should be slowed only with beta blockade to control the underlying cause of sinus tachycardia, which was performed during the course of his admission. cad, the patient underwent cardiac catheterization as discussed above. he was continued on beta blockade, statin, and aspirin and thus consideration given to isordil treatment as an outpatient will be decided on followup. the patient has decreased ef to 40 percent. the patient was continued on beta blockade but never had symptoms of clinical chf on exam. renal failure. the patient had improved creatinine over the course of the admission. the patient only had a small bump in his creatinine to 3.0 from baseline in mid to high 2s with his cardiac catheterization. however given that his chronic renal insufficiency had never been adequately explained, renal ultrasound was performed. these results were as follows: normal appearance of the left kidney and urinary bladder. right kidney which appeared atrophic and 1 to 2 cm cystic stricture present in the right renal bed. functionally, the patient has unilateral kidney and ace inhibitor was therefore held. hypercholesterolemia. there is no significant increase in ldl but the patient had reduced hdl, so statin was continued given his known coronary artery disease. hypothyroidism, outpatient synthroid regimen was continued. rash, the patient developed a maculopapular rash over the face and torso, which improved with steroid cream. is to question as to whether this rash is related to metoprolol, there is a question of discontinuing this drug but cardiology input was to continue this protective drug given his coronary artery disease unless the symptoms became terribly bothersome. question tia during cardiac catheterization. the patient developed right hand numbness and weakness, speech slurring, and hypotension during cardiac catheterization. the symptoms resolved with the administration of atropine. the patient had positive amaurosis in the left eye in the past. he also has nausea and vomiting with these episodes. vascular and neurology consults were called in regards to this and as a result the patient had a ct head which showed no acute hemorrhage or infarct, chronic small vessel disease. ultrasound of the carotids were also performed, which showed complete occlusion of the right ica and 40 percent of the left ica. the vascular consults recommended mra but given that the patient has the pacemaker, he cannot have an mri. the other alternative would be ct angiograms with the carotids but given his high creatinine, this was also rejected as an option. given the patient's comorbidities and asymptomatic state, the vascular service recommended starting plavix and follow up with dr. . in light of this result, the patient was discharged to home in stable condition. discharge instructions: to return to the er. call his cardiologist for any chest or neck pain, increasing shortness of breath, dizziness or unusual sweating. diagnoses: coronary artery disease. renal insufficiency. heart failure. hypothyroidism. carotid stenosis. follow up: follow up with primary care physician 1 to 2 weeks. follow up with dr. within 1 to 2 weeks. follow up with dr. , vascular surgery, within next 4 weeks. condition on discharge: the patient was discharged home in stable condition. discharge medications: 1. synthroid 75 mcg p.o. q.d. 2. aspirin 325 mg p.o. q.d. 3. lipitor 10 mg p.o. q.d. 4. metoprolol 12.5 mg p.o. b.i.d. 5. fluocinolone cream b.i.d. p.r.n. rash. 6. plavix 75 mg p.o. q.d. , procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome acute kidney failure, unspecified unspecified acquired hypothyroidism unspecified disorder of kidney and ureter other complications due to other cardiac device, implant, and graft cardiac pacemaker in situ heart valve replaced by transplant unspecified transient cerebral ischemia 

Answer: The patient is high likely exposed to