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: instent thrombosis major surgical or invasive procedure: cardiac cath history of present illness: 55yo male with a history of coronary artery disease and rheumatoid arthritis was admitted from the cath lab s/p stemi with instent thrombosis. . patient initially presented to the emergency department on with left knee pain. he was treated with pain medication and sent home with percocet for pain control. his pain improved for the first 24 hours after discharge from the ed. however over the next 3-4 days, his knee pain again worsened and on the morning of admission, he developed bilateral knee pain necessitating an ed visit. he then presented to the ed for evaluation of knee pain. he describes his knee pain as localized in the bottom of his knees and behind his kenes with associated swelling. his initial vital signs upon arrival to the ed was temp 97.9, bp 143/74, hr 128, rr 20, and o2 sat 98% on room air. however, while in the waiting room of the emergency department, he developed left-sided chest pressure radiating to his left arm. he had an ecg performed which demonstrated ste in ii, iii, and avf with std in 1, avl, v1-v3, suggesting posterior-inferior infarction. he was taken immediately to the cath lab where he had 100% proximal stent thrombosis in the rca. he had thrombectomy performed wtih export of the thrombus, followed by ivus and poba to rca. his catheterization was complicated by brief episodes of afib with rvr. he was then sent to the ccu for further monitoring. . upon arrival to the floor, he reports feeling generally well. he denies chest pain, shortness of breath, light-headedness, dizziness, lower extremity swelling, nausea, or vomiting. his bilateral knee pain is somewhat improved with the fentanyl and versed he received during his cardiac catheterization and he is pain free currently. he reports taking his medications regularly, including his aspirin and plavix, and does not remember missing any doses. medication changes include the following: - lipitor: discontinuing his statin approximately 2 weeks ago as they were thought to be contributing to his joint pain - methotrexate: he was recently restarted on his methotrexate 20mg on to better control his rheumatoid arthritis . of note, he was admitted to a hospital in in for a heart attack at which time he had two stents placed. his hospital course was complicated by development of a staph infection for which he received 8 weeks of iv antibiotic therapy that he completed roughly two weeks ago. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: pmh 1. coronary artery disease s/p rca stents in ~ and 2. hypertension 3. hyperlipidemia 4. gastric ulcer 5. ruptured cyst 6. degenerative tears of the medial meniscus of the right knee, patellofemoral disease. 7. gastric ulcer. psh 1. left knee arthroscopy 20 years ago to repair a ligament. social history: social history is significant for the absence of current tobacco use. pt quit smoking on . there is no history of alcohol abuse. there is no family history of premature coronary artery disease or sudden death. he works fulltime selling medical insurance to large companies. he lives in , with his wife and 17yo step son. has three other children in their 20s. family history: - mother - died at age with rheumatoid arthritis. - father - died with nonspecified cancer. - three sisters alive and well. - two brothers, one of them with knee problems. two children alive and well. physical exam: vs - t 99 / hr 106 / bp 145/98 / rr 12 / pulse ox 99% on 2l gen: wdwn middle aged male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. blood oozing through the pressure dressing. left knee is warm, swelling with small effusions, no erythema, no tenderness; right knee with swelling and small effusions, no erythema, no warmth, no tenderness skin: no stasis dermatitis, ulcers, scars, or xanthomas. dopplerable dp / pt pulses bilaterally and symmetric. pertinent results: 12:35pm glucose-108* urea n-18 creat-1.0 sodium-134 potassium-4.3 chloride-94* total co2-25 anion gap-19 12:35pm estgfr-using this 12:35pm ck(cpk)-18* 12:35pm ctropnt-<0.01 12:35pm ck-mb-notdone 12:35pm wbc-16.6* rbc-4.54* hgb-13.7* hct-38.9* mcv-86# mch-30.1 mchc-35.1* rdw-14.4 12:35pm plt count-531*# 12:35pm pt-15.4* ptt-25.0 inr(pt)-1.4* . - 12:35pm na 134 / k 4.3 / cl 94 / co2 25 / bun 18 / cr 1 / bg 108 ck 18 / mb not done / trop t < .01 wbc 16.6 / hct 38.9 / plt 531 inr 1.4 / ptt 25 . studies: - cardiac catheterization - --> rca: 100% proximal stent thrombosis --> lad: 30% mid stenosis --> lcx: no significant disease - ecg - - nsr at ~60 bpm, normal axis, 2-3mm ste in ii, iii, avf with 2-3mm std in i, avl, v1-v3 - portable cxr - - formal read pending; poor lung volumes, enlarged heart but slightly difficult to assess on portable ap film, no infiltrates, clear diaphragmatic borders - echo - not done - stress tests - never done . brief hospital course: studies: tte : the left atrium is dilated. a left-to-right shunt across the interatrial septum is seen at rest. a small secundum atrial septal defect is present. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of the basal to mid inferior and inferolateral segments. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: mild focal lv systolic dysfunction and right ventricular dilatation and dysfunction consistent with rca ischemia/infarction. no significant valvular abnormality seen. there is a small secundum asd seen at rest (image #86). agitated saline is seen to cross the inter-atrial septum on release of the valsalva maneuver (image #89). 1. coronary artery disease patient developed chest pain in the ed waiting room with ecg changes suggestive of a stemi in the posterior-inferior distribution. he was found to have an instent thrombosis of stent in the rca. patient has remained hemodynamically stable with this event and is currently chest pain free. unclear what may have precipitated this event given that the patient reports taking his plavix and aspirin regularly. possible explanations include recent statin discontinuation in the setting of recent stent placement or inflammatory / procoagulable state in the setting of ra flare. since patient failed aspirin and plavix therapy we continued aspirin and, for additional platelet inhibition, increased plavix to 150mg daily and added cilostazol 100mg po bid. he was maintained on integrillin for 18hours post-cath. statin was re-started and beta blocker was increased given tachycardia post-cath. he was also re-started on his ace inhibitor. tte showed mildly depressed ef as well as an asd (secundum) defect. he will follow up with cardiology clinic here in a few weeks. 2. knee pain patient's knee pain appeared most likely related to his rheumatoid arthritis. no previous history of gout or pseudogout. bilateral septic arthritis would also be very atypical. rheumatology was consulted and increased his prednisone to 20mg daily and restarted him on his methotrexate (20mg weekly). he was continued on folate. once bps were stable he was given morphine for pain control as well as round-the-clock tylenol. 3. atrial fibrillation patient had short episodes of atrial fibrillation in the cath lab. afterward remained in sinus, although at times tachycardic to 100s. as bps were stable, increased beta blocker dose for better control. 4. pump: patient had moderately depressed lv systolic function on tte after his stemi. he remained euvolemic throughout his hospital course. he was continued on ace-i, beta blocker, statin, asa as above. #. ppx: ppi, fall precautions, bowel regimen prn, heparin sc in the am #. code: full code #. communication: , medications on admission: 1. plavix 75mg po daily 2. enalapril 2.5mg po daily 3. aspirin 325mg po daily 4. metoprolol tartrate 12.5mg po bid 5. methotrexate 20mg po q weekly 6. folate 1mg po daily 7. omeprazole 20mg po daily 8. prednisone 10mg po daily 9. zyrtec 10. oxycodone 5-325mg q4-5hour prn discharge medications: 1. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 2. cilostazol 100 mg tablet sig: one (1) tablet po bid (). disp:*60 tablet(s)* refills:*2* 3. enalapril maleate 5 mg tablet sig: 0.5 tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. simvastatin 80 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 8. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 11. atenolol 100 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. aspirin 325 mg tablet sig: one (1) tablet po once a day. 13. methotrexate sodium 2.5 mg tablet sig: eight (8) tablet po once a week. discharge disposition: home discharge diagnosis: stemi asd-secundum type rheumatoid arthritis flare history of congestive heart failure discharge condition: the patient was afebrile, hemodynamically stable, and chest pain free prior to discharge. discharge instructions: you were admitted to the hospital with a rheumatoid arthritis flare and a heart attack. for your heart attack you received medications and a clot was removed from one of the stents in your heart. for your arthritis your rheumatologist saw you and recommended re-starting on methotrexate and given extra doses of prednisone. you had an ultrasound of your heart that showed a small hole between the top two of your heart. this is usually something you are born with and should not cause you any health problems. a vitamin d level was sent to check to see if you have a deficiency. dr. can check the result at your next appt. . medication changes: start: cilostazol - to keep your stents open by making platelets less sticky. you should take this every day change: plavix to 150mg daily - to keep your stents open. you should take this medication every day change: prednisone to 20mg daily- for your rheumatoid arthritis flare change: calcium and vitamin d, to prevent thinning of the bones because of prednisone. to be taken twice daily. change: discontinue metoprolol and start atenolol, a beta blocker that you only take once a day. . please call your pcp or come back to the hospital if you have fainting or near-fainting, dizziness, chest pain, jaw pain, arm pain, shortness of breath, nausea, abdominal pain, vomiting, blood in your stools or black tarry stools, leg swelling, weight gain of more than 3lbs in 1 day, rash, or any other concerning symptoms. . please weigh yourwself every day in the am before breakfast. call dr. if you notice more than 3 pounds weight gain in 1 day or 6 pounds in 3 days. please also call dr. if you notice trouble breathing with activity, trouble lying flat to sleep, swelling in your legs or feet. followup instructions: rheumatology: provider: , md phone: date/time: at 12:00pm. provider: , md phone: date/time: 2:30 . orthopedics: provider: , m.d. phone: date/time: 10:15 provider: xray (scc 2) phone: date/time: 9:55 cardiology: provider: , md phone: date/time: 10:20 clinical center, primary care: dr. phone: date/time: office will call you with an appt. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of temporary transvenous pacemaker system excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel intravascular imaging of coronary vessels diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation other and unspecified hyperlipidemia ostium secundum type atrial septal defect old myocardial infarction cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft rheumatoid arthritis acute myocardial infarction of inferoposterior wall, initial episode of care 

Answer: The patient is high likely exposed to