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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: cardiac catheterization internal cardiac defibrillator placement history of present illness: this is a 49 year-old male with a history of hbv hepatitis on entecavir , hypercholesterolemia, family history of premature cad who presents with leg swelling and progressive sob. . worked up in late for week or so of cough, told he had pneumonia by cxr, received 5 days of azyhtromycin w/o any improvement in his cough. got second cxr around findings had not cleared got another course of 5 days azithromycin which he finished 7 days prior to presentation again w/o improvement in cough. during this period except for cough complained of exertional dyspnea which has progressed rapidly over the past week from 20 stairs to dyspnea at rest. admits to orthopnea two or more pillows, describes paroxysmal cough at night but not pnd. noticed 11 lb weight gain over past two months. no nocturia. denies chest pain. two days prior to admission had ct chest which showed diffuse bilateral ground-glass infiltrates consistent with infectious process, most likely atypical or viral pneumonia as well as bilateral pleural effusions. on day prior to admission noticed swelling on right foot followed later by left foot swelling. saw his pcp who sent him to the er. . does not recall recent febrile illness. believes all his symptoms started after "overworked" himself in the gym around thanks giving and had to spend a day in bed because of general muscle soarness and chest pain. patient has no history of hf or coronary disease. denies any recent travels. no contacts with animals. no bites or stings. no contact with people. was vaccinated for flu in early novemebr. . in the ed, admission vitals were: 99.9 121 134/91 20 100% on 4l o2. he triggered for tachypnea 30-40 and dested to high 80's in ra. found to have right leg swelling, leni was negative for dvt as was cta for pe. cta did show multifocal ground glass opacities and bil mod pleural effusions r>l essentially unchanged from ct of 2 days prior. labs showed unremarkable cbc, chemistry remarkable for hco3 = 21 with normal anion gap. d-dimer was 3019. trop x 1 was negative. patient was given 1 dose of ceftriaxone + levoflox in the ed (1900). his transfer vitals were hr 112 bp 123/88 rr 34 sat 95%4l . ros: + nausea over past few days - denies any fevers, nausea, vomiting, abdominal pain, diarrhea, constipation, melena, urinary frequency, urgency, dysuria, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash. . past medical history: - hbv hepatitis: biopsy grade 2 inflammation and stage i fibrosis on entecavir with good response and normalized lft's. - hypercholesterolemia - bil varicocele surgery social history: allergies: nkda . social history: born in , emmigrated to us at age 1y. accountant. married + 1 daughter aged 15. adl independent. no etoh. no tobacco, no illicit. monogamous sexuall relations with wife. family history: family medical history: mother - cad after age 55, cabg, dm type 2, htn father - died at age 72, esrd 3 brothers, 1 sister: sister with type 2 dm. brother underwent cabg at 50y. physical exam: admission physical: . vitals: t: 97.5 bp: 136/95 hr: 107 rr: 37 o2sat: 95% or 5l gen: tachypnic but not dyspnic, not in distress, completes full sentenses, a+o x3, cooperative heent: eomi, perrla, sclera anicteric, mmm, op clear neck: no jvd but hjr is positive, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: limited by breath sounds but essentiall rapid rrr, no m/g/r, normal s1 s2. radial pulses +1 pulm: lungs bil wet crackles to hight of chest, no wheezing, reduced breath sounds and fremitus on bilateral bases, precussion is symetrical and hypotympanic at bases abd: soft, nt, nd, +bs, no hsm, no masses ext: no clubbing or cyanosis. right calf > left calf, no calf tenderness, neg sign, bil trace pre-tibial edema. neuro: grossly intact skin: no stigmata of chronic liver disease . discharge physical: . vs: tm 98.4, 104/73-107/75, hr 89, rr 18, 96% ra general: well-appearing man. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. neck: supple with elevated jvp, at angle of jaw cardiac: rr, normal s1, s2. no m/r/g. s3 audible at rusb. icd pocket in upper l chest, no tenderness or hematoma lungs: no chest wall deformities, scoliosis or kyphosis. decreased breath sounds at bases, faint rales bibasilarly, improved from yesterday abdomen: soft, ntnd. no hsm or tenderness. extremities: no pedal edema, no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. small 1cm raised erythematous lesion above sternum, appears like hive pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs: 05:20pm blood wbc-7.0 rbc-4.51* hgb-14.4 hct-42.1 mcv-93 mch-32.0 mchc-34.3 rdw-13.2 plt ct-234 05:20pm blood neuts-61.3 lymphs-32.3 monos-4.4 eos-1.5 baso-0.5 04:20pm blood esr-2 05:20pm blood glucose-121* urean-21* creat-1.1 na-137 k-4.4 cl-105 hco3-21* angap-15 05:20pm blood alt-149* ast-72* alkphos-89 totbili-0.5 05:20pm blood lipase-44 05:20pm blood ctropnt-<0.01 03:30am blood ck-mb-4 ctropnt-<0.01 05:20pm blood probnp-4767* 03:30am blood calcium-8.2* phos-3.1 mg-2.1 cholest-144 04:20pm blood d-dimer-3019* 05:05am blood %hba1c-5.8 eag-120 03:30am blood triglyc-74 hdl-36 chol/hd-4.0 ldlcalc-93 04:20pm blood tsh-3.5 03:43am blood type-art po2-94 pco2-30* ph-7.44 caltco2-21 base xs--1 07:19pm blood lactate-1.9 . discharge labs: . 07:10am blood wbc-7.5 rbc-4.76 hgb-15.5 hct-46.1 mcv-97 mch-32.7* mchc-33.8 rdw-14.5 plt ct-176 07:10am blood glucose-97 urean-23* creat-1.2 na-142 k-3.9 cl-102 hco3-28 angap-16 07:10am blood alt-128* ast-48* alkphos-91 totbili-0.7 07:10am blood calcium-9.0 phos-3.6 mg-2.6 05:05am blood %hba1c-5.8 eag-120 06:45am blood triglyc-61 hdl-46 chol/hd-3.0 ldlcalc-81 ldlmeas-96 ecg : sinus tachycardia. right superior axis. low voltage. right bundle-branch block with prominent precordial q waves in leads v1-v4 with mild st segment elevations. consider pulmonary disease, right ventricular hypertrophy, anterior wall myocardial infarction. low limb lead voltage. . chest cta : 1. no evidence of pulmonary embolism. 2. multilobar ground-glass opacities, similar in distribution to the prior examination with possible small increase in consolidation. findings compatible with infectious process. 3. moderate bilateral pleural effusions again seen. 4. reflux of contrast into the ivc suggestive of right heart failure which can be further evaluated on echocardiogram. non-specific left ventricular apex wall thickening can also be further evaluated on echocardiogram. . cardiac echo : normal left ventricular cavity size with extensive regioanl systolic dysfunction suggestive of multivessel cad or other diffuse process. apical mural left ventricular thrombus. right ventricular cavity enlargement with free wall hypokinesis. pulmonary artery systolic hypertension. mild-moderate mitral regurgitation. lvef < 20% . cardiac mri : impression: 1. mildly enlarged left ventricular cavity size with severely depressed left ventricular systolic function with hypokinesis of the basal inferoseptum and basal to mid inferior and lateral walls. the remaining walls are akinetic. the lvef was severely depressed at 21%. the effective forward lvef was severely depressed at 14%. late gadolinium contrast-enhanced cmr images demonstrating areas of hyperenhancement as described above. the findings are consistent with a high likelihood of functional recovery of the mid to basal inferoseptum, inferior and lateral walls. there is a low likelihood of functional recovery of all remaining segments. 2. large laminated thrombus at left ventricular apex. 3. focal apical aneurysm. 4. normal right ventricular cavity size. the rvef was severely depressed at 17%. 5. cardiac index is depressed at 1.8 l/min/m.2 6. mild aortic regurgitation. moderate to severe mitral regurgitation. mild pulmonic regurgitation. 7. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was normal. 8. mild biatrial enlargement. 9. normal coronary artery origins with no evidence of anomalous coronary arteries. in the setting of suboptimal image quality, there is a proximal lad severe stenosis and diffuse disease of the rca. the lmca and proximal lcx are patent. 10. a note is made of a large right pleural effusion and moderate left pleural effusion. . cardiac cath : 1. selective coronary angigoraphy in this left dominant system demonstrated two vessel disease. the lmca had no angiographically apparent disease. the lad has a proximal total occlusion. the very distal portion of the lad filled via left to left collaterals. the cx had a 60% stenosis in the proximal portion of the l-pda. the rca was a small non-dominant vessel with no angiographically apparent disease. 2. limited resting hemodynamics revealed elevated left and right sided filling pressures with an lvedp of 27 mmhg and an rvedp of 16 mmhg. there was moderate pulmonary artery hypertension with a pasp of 58 mmhg. the cardiac index was depressed at 1.5 l/min/m2. the central aortic pressure was 113/87 mmhg. final diagnosis: 1. two vessel coronary artery disease. 2. moderate diastolic ventricular dysfunction. . cxr : impression: ap chest compared to : mild interstitial edema has improved, and small bilateral pleural effusions and mild cardiomegaly are stable. new transvenous right ventricular defibrillator lead is continuous from the left axillary pacemaker terminating along the floor of the right ventricle. no pneumothorax. . brief hospital course: 49 year-old with pmh of hbv hepatitis on entecavir and hypercholesterolemia who presented with 2 months history of cough and sob and recent progressive dyspnea and found to have severe heart failure likely due to ischemic cardiomyopathy. . active issues: -------------- . # ischemic cardiomyopathy / chf: patient had 2 month history of cough and sob, these were initially attributed to respiratory infection and treated with two courses of azythromycin, without improvement. on admission pnt appeared clinically and radiographically fluid overloaded, was tachycardic, tachypneic to 30-40 and desaturated to the high 80's on ra. he had elevated bnp and neg trops x2. ecg showed right axis deviation, rbbb, lafb, and anteroseptal q waves of unknown age. pe was ruled out with negative leni's and cta. echo showed severe lv hypokinesis with ef < 20% and a mural thrombus as well as rv hypokinesis. pt was admitted to the icu, treated with lasix and improvement of symptoms. he was also initially started on captopril, metoprolol, asa 325mg, and heparin gtt (for lv thrombus). pt was transferred to the cardiology floor for further management of chf. cardiac mr was done and showed hypokinesis of the basal inferoseptum and basal to mid inferior and lateral walls, which were thought to be viable. there was copmlete akinesis of all other walls, which were non-viable. cardiac catheterization was done and showed 2 vessel disease with total occlusion of proximal lad and 60% of lcx in proximal region of l-pda. no stents were placed given distribution of stenosed coronaries to non-viable areas of the myocardium. pt has strong family history of cad and personal history of hypercholeterolemia, which are the likely etiologies of his ischemic disease; it is also possible that hepatitis b may be contributing though this is rare. pt was started on heparin gtt bridge to coumadin for the lv thrombus and medical management of his chf with lisinopril 5mg, metoprolol 25mg daily, asa 325mg, statin 40mg, lasix 40mg daily. he was diuresed with iv lasix during hospitalization, but still slightly overloaded at time of discharge with elevated jvp and faint rales bilaterally. an icd was placed successfully and pocket appeared intact without hematoma prior to discharge. pt will follow-up in device clinic 1 week after discharge. he will have his inr and chem 7 checked with pcp this week, and has f/u with dr. . pt will be referred for ett and outpatient cardiac rehabilitation. . # lv thrombus - seen on echo; pt was bridged to coumadin with heparin drip. inr at time of discharge was 2.5 (goal ), coumadin dose on discharge was 2mg qhs. as above, will have inr monitored and coumadin adjusted accordingly by his pcp, . . . # hyperlipidemia: home pravastatin was increased to 40 mg qhs. goal ldl <70. . inactive issues: ---------------- # hepatitis, hbv: pnt has known hbv infection with history of hepatitis treated with entecavir for the past 6 months. ast/alt on this admission were up to 72/149 from 24/26 at baseline in then trended down to alt/ast 128/48 on discharge. pt was started on pravastatin 40mg qhs regardless of baseline transaminitis, and will follow up with hepatology as an outpatient (dr. ). . transition of care: ------------------ # pcp : - check inr, goal - check chem 7 given discharged on lasix . # cardiology follow-up: - icd device check - medical management of heart failure and titration of lasix - ett (non-imaging) scheduled as outpatient as part of rehab work-up . # hepatology follow-up: - lfts; discharged on pravastatin 40mg qhs medications on admission: multivitamin qd pravastatin 10mg qd entecavir 0.5 mg tablet daily. aspirin daily was recommended but is not taking it discharge medications: 1. entecavir 0.5 mg tablet sig: one (1) tablet po daily (daily). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 5. pravastatin 20 mg tablet sig: two (2) tablet po at bedtime. disp:*60 tablet(s)* refills:*2* 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*0* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. outpatient lab work please have your chem 7 panel and inr checked at dr. office at your follow-up visit 2 days after discharge. discharge disposition: home discharge diagnosis: primary: ishemic cardiomyopathy acute chf . secondary: hepatitis b discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to with heart failure. we did an echocardiogram which showed decreased function of your heart and an mri which showed that some of areas of muscle in your heart are not contracting the way they should. we did a cardiac catheterization which showed that some of the arteries supplying your heart have blockages. you did not have any stents placed because the clogged arteries are supplying areas of the heart that would not improve with stents. the blockages are likely what caused your progressive heart failure. you had an internal cardiac defibrillator placed in your chest which will help stop irregular rhtyhms if they occur. your heart failure will be managed with medications (listed below). you were started on a blood thinning medication for a thrombus (clot) found in one of the in your heart. you wlll have many follow-up appointments in the next months, which are listed below and very important to attend. if your symptoms worsen, you gain water weight, have continued worsening of your breathing, or have any shocks by your icd, you should come back to the hospital. we have made the following changes to your medications: - start lisinopril 5mg daily - start pravastatin 40mg at nighttime - start metoprolol xl 25mg daily - start coumadin 2mg daily at 4pm - start lasix 40mg daily - start aspirin 325mg daily - continue your entecavir 0.5mg daily you will need to have your inr (level of blood thinner in your blood) checked by your pcp few days after you leave the hospital. your goal level is and your inr should be checked regularly and coumadin dose adjusted accordingly. weigh yourself every morning, md if weight goes up more than 3 lbs. you should avoid driving until your icd device has been tested at device clinic. they will advise you when it will be safe for you to resume. after your discharge, you should return to work part-time for 1 week and afterwards as tolerated. it was a pleasure taking care of you at the hospital. we wish you a speedy recovery! followup instructions: name: , md specialty: internal medicine location: healthcare - address: , , , phone: we are working on a follow up appointment within the next days with dr. to have your inr checked. you will be called at home with the appointment. if you have not heard or have questions, please call the above number. department: cardiac services when: thursday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 2:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage name: , md specialty: cardiology location: - cardiac services address: , 7, , phone: we are working on a follow up appointment within the next 3 weeks with dr. . you will be called at home with the appointment. if you have not heard or have questions, please call the above number. department: liver center when: wednesday at 4:00 pm with: , md building: lm bldg () campus: west best parking: garage you should also have an exercise stress test done after you are discharged, this has been ordered and you will be called with the date/time for the test. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia alkalosis family history of ischemic heart disease viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta chronic total occlusion of coronary artery other ill-defined heart diseases 

Answer: The patient is high likely exposed to