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: tetracycline analogues / atenolol / tegaderm attending: chief complaint: hypotension major surgical or invasive procedure: cvvh diagnostic coronary angiography pulmonary artery catheterization percutaneous angioplasty and stenting of svg to rca conduit and om1 hemodialysis tunneled hemodialysis line placement arterial cannulization central line placement history of present illness: ms. is a 69 yo f with sig pmh for dm, cad s/p cabg, a.fib and chf with lvef of 20-25% presents to ed feeling weak and fatigued. she started dialysis two weeks prior and since then her bp has been low, she has been dizzy, lh with nausea. she states that all of these symptoms are aggrevated with movement. she also stated that since dialysis has started her glucose levels have been low and her appetite has been decreased. she has difficulty lying flat and uses 3 pillows at night. she denies any new medications recently, she also denies fever/chills, diarrhea, abdominal pain, syncope and rash. her last dialysis treatment was yesterday. . ed course (labs, imaging, interventions, consults): - initial vitals/trigger: trigger for hypotension - ekg: st elevations but unchanged from prior - asa taken in the am - troponin elevated to 0.3 in setting of elevated cr - bps down to 80s with normal mentation -> 1 l bolus given slowly and bp increased from 80s to 100s - dr. alerted -> can scale back meds - hyperkalemia -> no ekg changes, 30 g kayelexate, 1 l fluids . on arrival to the ccu pt was mentating well, able to answer all of my questions appropriately in nad. she was denying symptoms of cp, sob, n/v, lh or dizziness. . on review of systems, she denies bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. all of the other review of systems were negative. past medical history: - cad s/p 4v cabg ' (lima to lad, svg to diag, svg to cx, svg to rca), des x3 to om1 (), bms to om1 (), bms x3 to lcx/om () - tia `97 or `98 - paroxysmal afib/flutter s/p multiple cardioversions '/'; d/c'd coumadin ~4yrs ago gib - esrd - copd on 3l home o2 (non compliant) - morbid obesity - hypertension - hyperlipidemia - pvd s/p angioplasty of anterior tibial artery (), s/p angioplasty of right dorsal pedis () - s/p l5 amp & metatarsal head resections - gib from pud ~4 yrs ago - osa - chronic anemia (baseline ~ 32) - c. diff colitis, toxin positive, in the absence of diarrhea - hypothyroidism - asthmatic bronchitis - sciatica - vertigo - mrsa hx social history: lives in , at home with her son, . she uses a wheelchair at baseline and is on 2 liters o2. she formerly worked as a homemaker and in meat wrapping. -tobacco history: quit smoking 30 years ago, smoked 2.5 ppd x 25yrs -etoh: no current alcohol use, none in past that she reports -illicit drugs: denies family history: mother died of breast cancer at age 60; sister died at 60 of glioblastoma; father died of lung cancer at 73; and sister died at 60 of heart disease; son died at , diabetic, of massive mi in physical exam: on addmission: vs: t=97.3 bp=86/51 hr=88 rr=20 o2 sat= 97% 2 l general: 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 no lymphadenopathy. jvp difficult to assess secondary to body habitus. cardiac: rr, 3/6 systolic murmur lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles present b/l at bases abdomen: soft, ntnd. no hsm or tenderness. extremities: b/l le 2+ edema to mid thigh skin: multiple scars on le from prior cabg pulses: right: carotid 2+ radial 1+ dp 1+ left: carotid 2+ radial 1+ dp 1+ . discharge general: nad.aox3, sitting in bed comfortable neck: supple jvd 15cm cardiac: rrr, 3/6 systolic murmur across precordium radiating to axilla. lungs: ctab abdomen: soft, obese extremities: b/l le 2+ edema to mid thigh skin: multiple scars on le from prior cabg pertinent results: 04:30pm pt-14.3* ptt-27.6 inr(pt)-1.2* 04:30pm neuts-69.0 lymphs-19.9 monos-7.7 eos-2.4 basos-0.9 04:30pm wbc-5.8 rbc-3.62* hgb-10.0* hct-31.0* mcv-86 mch-27.6 mchc-32.3 rdw-18.0* 04:30pm ctropnt-0.32* 04:30pm ck-mb-4 04:30pm calcium-8.8 phosphate-4.4 magnesium-1.9 04:30pm ck(cpk)-250* 04:30pm glucose-144* urea n-29* creat-4.5*# sodium-134 potassium-6.8* chloride-95* total co2-30 anion gap-16 cpk isoenzymes ck-mb ctropnt probnp 04:09 2 0.26*1 *2 pituitary tsh 05:48 1.7 thyroid t4 05:48 7.2 cortsol 03:29 22.4 ekg : rate pr qrs qt/qtc p qrs t 91 0 114 348/402 0 93 -125 baseline artifact. probably sinus rhythm with a-v nodal wenckebach. poor r wave progression. cannot exclude an old anteroseptal myocardial infarction. echo : the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is milldy dilated. there is akinesis of the septum, and moderate to severe hypokinesis of the remaining left ventricular segments. lvef (20-25%) .the right ventricular cavity is dilated and hypokinetic. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. the study is inadequate to exclude significant aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with mild cavity dilation and severe left ventricular systolic dysfunction as detailed above. dilated and hypokinetic right ventricle. mild to moderate mitral regurgitation. compared to the prior study (images reviewed) of , estimated pulmonary artery pressures are lower (may be underestimated due to poor acoustic windows). the severity of mitral regurgitation has increased. cardiac cath : 1. selective coronary angiography of this right dominant system demonstrated 3-vessel coronary artery disease. the lmca had mild non-obstructive plaquing. the lad is occluded proximally. there was severe in stent restenosis of the distal om1 and a de lesion more distal to this. the rca was not injected and is known to be occluded. 2. venous conduit angiography demonstrated an ostial/proximal 90% stenosis in the svg to rca. the rca system was free of significant disease. the svg to om was patent with new disease at the anastamosis and in the bypassed vessel. 3. arterial conduit angiography demonstrated the lima to lad to be patent. 4. resting hemodynamics revealed elevated left and right heart filling pressures (rvedp 24mmhg and lvedp 27mmhg). there was moderate pulmonary artery hypertension (52/32mmhg). the svr was low and was significantly elevated (500 dynes*sec*cm-5 and 186 dynes*sec*cm-5). the co and ci were normal in the context of anemia (5.6l/min and 2.4 l/min/m2). there was no gradient across the aortic valve on careful pullback from the lv to the ascending aorta. final diagnosis: 1. three vessel coronary artery disease. 2. occluded svg to diagonal and new stenosis of svg to rca. 3. patent lima to lad. 4. significantly elevated left and right heart filling pressures with moderate secondary pulmonary artery hypertension. 5. hypotension likely due to a combination of inappropriately low svr and lower than expected co in the context of anemia from her known systolic dysfunction. : echo: lv systolic function appears depressed. the right ventricular cavity is dilated with depressed free wall contractility. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the findings are similar. . ct abd and pelvis with contrast mpression: 1. mural wall thickening and adjacent fat stranding of the ascending colon, findings consistent with focal colitis. differential includes ischemic, inflammatory and infectious etiologies, though infectious is preferred given the clinical history of septicemia. abdominal arterial vasculature is densely calcified, though appears grossly patent. no drainable fluid collection is identified. 2. small bilateral pleural effusions with compressive atelectasis. 3. dense atherosclerotic vascular calcifications. stable subcutaneous soft tissue density posterior to the right iliac crest dating back to . the study and the report were reviewed by the staff radiologist. . cta chest: impression: 1. no evidence of pulmonary embolism. 2. moderate bilateral pleural effusions, right greater than left, increased compared to . 3. unchanged small volume perihepatic ascites with a nodular liver contour, raising concern for cirrhosis. . . cardiac cath. comments: 1. limited resting hemodynamics revealed moderate pulmonary hypertension and elevated right- and left-sided filling pressures, with mean pa pressure of 40 mm hg, mean ra pressure of 19 mm hg, and mean pcwp of 26 mm hg. final diagnosis: 1. left-sided congestive heart failure with elevated right- and left- sided filling pressures. 2. hemodialysis and crrt in the morning via a tunnelled line in the left internal jugular vein placed in the morning. 3. left cvp catheter removed, and tip sent for culture. 4. start po amiodarone load for atrial fibrillation with rvr. . . discharge labs: wbc 10.8 heme 8.6* hct 26.6* plt 180 bun 42* cr 4.5* na 131* k 4.1 cl 92* bicarb 27 brief hospital course: ms. is a 69 yo f with sig pmh for dm, cad s/p cabg, a.fib and chf with lvef of 20-25% presents to ed feeling weak and fatigued and found to be hypotensive. . # hypotension-patient's hypotension was felt to be related to cardiogenic shock, though adrenal insufficency and sepsis were ruled out. pulmonary embolism and tamponade were ruled out with cta chest and echo, respectively. echo on admission showed depressed ef of 20-25%, diffuse wma and elevated ra pressures. echo was grossly unchanged from baseline (7/). ekg was also unchanged from baseline. patient was cathed which showed new distal occlusions in the om1 and 90% stenosis of the rca-acg bypass, des were placed in both. patient's pcwp was elevated, ci was depressed and surprisingly, svr was noted to be 500 during the procedure. despite depressed svr, hemodynamics were felt to be from fluid overload and increased preload. she was diuresed with cvvh requring additonal pressure support with phenylephrine. phenylephrine was difficult to wean but ultimately pt was started on midodrine, sudafed and fludrocortisone to assist in raising svr. additionally, 20 l were removed with cvvh and phenylephrine was and pt maintained pressures with maps of 60-80. dialysis was reinitiated and after two sessions, pt was able to tolerate dialysis without any drops in pressure. a new tunneled dialysis catheter was placed and she will continue dialysis in rehab and ultimately resume outpatient hd. . #leukocytosis/infection- the patient developed a leukocytosis during this admission. her wbc rose to 18. she also became febrile at that time as well. her tunneled dialysis line on the right was noted to be erythematous. cultures were sent from the line and 1 of 2 bottles grew gram positive rods, gram negative rods and gram postive cocci in pairs and chains. she was started on empiric vancomycin and zosyn antibiotic therapy. also her tunneled line was pulled as well as her left ij central line. on antibiotics her leukocytosis resolved. during her antibotic course she developed diarrhea. she was then also started on flagyl as well and her stool was sent for c.difficile toxin as well as pcr which was negative. she completed a 10 day course of vancomycin and zosyn. a temporary dialysis line was re-inserted into her right ij for continued cvvh while in the ccu. she was restarted on hd and a new tunneled line was placed. . # pt has documented ef 20-25% on echo from with severe regional left ventricular systolic dysfunction and severe hypo to akinesis of the entire septum, anterior wall, and distal of the left ventricle. cath showed new distal occlusions in the om1 and 90% stenosis of the rca-acg bypass, des were placed in both. patient was aggressively diuressed with cvvh requiring pressors as outlined above. at time of discharge pt's weight had decreased from 143kilos to 119 kilos. . # a. pt had chads score of 4 and not anticoagulated given history of recurrent gi bleeds, patient was monitored on telemetry while in the icu. she was ultimately loaded with amiodorone. afib converted to sinus after first day of amiodorone loading. she was discharged on 400mg tid of amiodarone for an additional 3 days of loading and will transition to 200mg daily after loading. . # cad- patient had documented 4 vessel disease status post cabg, underwent cath and stenting of the acg-rca bypass and the om1 while in the icu. she was continued on asprin, statin and plavix. . # pt was not wheezing on admission but developed cough and wheezing approximately one week prior to discharge. she was started on advair, ipratropium and albuterol nebs and given short course of solumedrol, and a prednisone taper. o2 sats were in low to mid 90's on ra at time of discharge. . # pt on insulin at home. pt was managed on iss. she was discharge on home insulin regimen. gabapentin was continued for peripheral neuropathy. . # hypothyroidism- tsh and free t4 were wnl. pt was continued on levothyroxine 100mcg. . transitional: - tolerate bps in 80-90 systolic. - needs hd on mwf medications on admission: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. metolazone 5 mg tablet sig: one (1) tablet po bid (2 times a day). 5. torsemide 100 mg tablet sig: one (1) tablet po bid (2 times a day). 6. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 7. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 8. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 9. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 10. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 11. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qam (once a day (in the morning)). 12. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 13. multivitamin tablet sig: one (1) tablet po daily (daily). 14. docusate sodium 100 mg capsule sig: one (1) capsule po daily (daily) as needed for constipation. 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 16. sevelamer carbonate 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 17. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 18. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 19. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 20. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 21. insulin nph & regular human 100 unit/ml (70-30) suspension sig: thirty (30) units subcutaneous every am. 22. insulin nph & regular human 100 unit/ml (70-30) suspension sig: twenty (20) units subcutaneous every pm. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 4. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 5. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qam (once a day (in the morning)). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. fludrocortisone 0.1 mg tablet sig: two (2) tablet po daily (daily). 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 9. midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 12. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 13. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: mls po q6h (every 6 hours) as needed for cough. 14. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 15. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 16. tramadol 50 mg tablet sig: one (1) tablet po q8hr: prn. 17. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6hr prn as needed for cough. 18. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) neb inhalation once a day. 19. insulin nph & regular human 100 unit/ml (70-30) suspension sig: thirty (30) units subcutaneous qam. 20. insulin nph & regular human 100 unit/ml (70-30) suspension sig: twenty (20) units subcutaneous qhs. 21. insulin lispro 100 unit/ml solution sig: 2-12 units subcutaneous qachs: prn as needed for hyperglycemia. bg>150: as per insulin sliding scale regimen. 22. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q4h (every 4 hours) as needed for cough. 23. amiodarone 200 mg tablet sig: two (2) tablet po tid (3 times a day) for 4 days: please stop after . 24. amiodarone 200 mg tablet sig: one (1) tablet po once a day: to be started on . 25. prednisone 20 mg tablet sig: one (1) tablet po once (once) for 1 doses. 26. prednisone 5 mg tablet sig: two (2) tablet po once (once) for 1 doses. 27. pseudoephedrine hcl 30 mg tablet sig: one (1) tablet po every twelve (12) hours for 1 days: . 28. pseudoephedrine hcl 30 mg tablet sig: one (1) tablet po once a day for 1 days: . discharge disposition: extended care facility: discharge diagnosis: cardiogenic shock chf exacerbation esrd atrial fibrillation sepsis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mrs. , it was a pleasure taking care of you. you were admitted to the hospital for a congestive heart failure exacerbation and hypotension. this resulted in a condition called cardiogenic shock. you were treated with iv medications to increase your blood pressure and we used a type of dialysis called cvvh to remove excess fluid from your body. your blood pressures improved and we restarted you on hemodialysis. you tolerated the hemodialysis well and will continue with your -wednesday-friday dialysis routine. your hospital course was complicated by an infection in your blood. we treated you with antibiotics and changed your dialysis catheter and you improved. . we have made the following changes to your home medications: start: amiodorone 400mg tab by mouth three times daily until . on start amiodorone 200mg tab by mouth once daily start: midodrine 10 mg by mouth three times daily start: fludricortisone acetate 0.2mg tab by mouth once daily continue pseudoephedrine taper: on take 30mg by mouth every 12 hrs, on take 30mg by mouth once and then discontinue this medication. start: albuterol 0.083% neb solution 1 neb ih q6hr:prn for cough start: fluticasone-solumedrol inh 250/50mcg/dose: one puf by mouth twice daily start: nephrocaps, one cap daily decrease: atorvastatin from 80mg to 40mg daily continue: prednisone taper: take 20mg by mouth on and 10mg by mouth on and then stop this medication stop: metolazone, torsemide, metoprolol, lisinopril and isosorbide mononitrate. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: name: , location: bldg, address: , , phone: appointment: wednesday 2:30pm . you will be contact by nephrology to schedule outpatient dialysis after you leave rehab. procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters angiocardiography of left heart structures other and unspecified coronary arteriography other and unspecified coronary arteriography hemodialysis venous catheterization for renal dialysis pulmonary artery wedge monitoring diagnoses: hyperpotassemia sciatica anemia in chronic kidney disease end stage renal disease obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis unspecified acquired hypothyroidism coronary atherosclerosis of autologous vein bypass graft atrial fibrillation other chronic pulmonary heart diseases peripheral vascular disease, unspecified atrial flutter hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia cardiogenic shock chronic obstructive asthma, unspecified acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to