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 allergies/adrs on file attending: chief complaint: fall and loss of consciousness major surgical or invasive procedure: lumbar puncture history of present illness: this is a 22 year old male with past medical history significant for anxiety and a previous cardiac work-up at the age of 16 for "conduction abnormalities" presenting with an episode of chest pain followed by loss of consciousness and s/p a fall down a steep flight of stairs in his apartment building. he states that he was in his usual state of health when he suddenly felt a sharp, substernal chest pain that radiated across his chest bilaterally, and felt unwell. he was walking down the toward his roommate's room and he can not remember anything further. he recalls being told that he fell down a flight of stairs but has no recollection of this. his roommates heard him call for help and then fall down the stairs. when he was found, he woke up confused, unable to follow commands, and lethargic. glucose was 132 in the field. . he does not describe any palpitations, diaphoresis, warmth, or lightheadedness prior to the event. denies any new medications other than citalopram, which he has been taking for the past few months. he does describe occasional "regurgitation" of food and he report being diagnosed with a hiatal hernia in the past. no report of past esophageal studies. he has been getting 5-6 hours of sleep per night and does not drink any caffeine, limited alcohol as of late, and denies any illicit drug use. per his pediatric cardiologist from previous notes in , tte showed a structurally normal heart with good contractility, without cardiomyopathy, mvp, or pulmonary hypertension, and normal stress test. double contrast esophogram in shows hiatal hernia, no evidence of dysmotility. positive gliadin antibody, but no evidence of celiac sprue. . in the ed, initial vs were: t97.9 p108 bp160/d r44 o2 sat 100% on nrb. rectal temp 99. at times noted to be tremulous but per ed was also alert. per the ed, they did not think he was seizing. labs notable for lactate 4.6, anion gap 18. tox screen negative. they describe his mental status as "waxing and "; at one point more awake and following commands. the decision was made to intubate and sedate in order to get ct studies done. ct were negative for traumatic pathology, but he required paralytics to get through ct. lp unremarkable, with normal protein/glucose/wbcs. . on arrival to the micu, patient quite sedate, not responding to painful stimuli initially. neuro was consulted and report intact brainstem reflexes, limited ability to follow midline and appendicular commands, symmetric, purposeful movements of the extremities, and quite brisk reflexes at the patella. they recommended mri of the brain as well as an eeg. lactate has resolved from 4.6 to 2.2 within hours. abg was completely normal. d-dimer sent and returned elevated at 551. he was extubated without incident and deemed safe for transfer to the floor. psychiatry has been consulted and will see him on the floor. . on the floor, he complains of bouts of shortness of breath, described as like being under water. he is otherwise hemodynamically stable and asking when he might be able to get back to school to study for his finals. past medical history: anxiety ?cardiac conduction abnormalities hiatal hernia social history: mba student at . reports only social etoh, no ivdu, and has never smoked. denies supplements family history: mother - thyroid ca. maternal grandfather - htn. seizure disorders in the family physical exam: vs: t 99.0, bp 124/84, hr 68, rr 18 and 100%ra ga: aox3, nad heent: perrla. eomi. mmm. no lad, no jvd, neck supple. cards: rrr, nl s1/s2, no murmurs/gallops/rubs. pulm: ctab, no crackles or wheezes abd: soft, nt/nd, +bs. no guarding/rebound extremities: wwp, no edema. dps, pts 2+. skin: no rashes/lesions neuro/psych: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl (biceps, patellar). sensation intact to lt throughout. cerebellar fxn intact (, ). steady on his feet. pertinent results: admission labs: . 07:50pm blood wbc-5.9 rbc-4.81 hgb-15.5 hct-44.0 mcv-91 mch-32.3* mchc-35.3* rdw-12.2 plt ct-269 07:50pm blood pt-13.0 ptt-27.3 inr(pt)-1.1 01:32am blood glucose-91 urean-7 creat-0.9 na-141 k-3.6 cl-107 hco3-24 angap-14 01:25pm blood d-dimer-551* 07:50pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 07:52pm blood glucose-117* lactate-4.6* na-142 k-3.9 cl-99* calhco3-25 . discharge labs (not indicated while on floor) . microbiology: blood cultures x2: no growth to date urine culture: final - no growth csf culture: final - no growth . imaging / other studies: cxr (): impression: no acute traumatic injury is seen within the chest. . ct head (): impression: no evidence of acute intracranial process. . ct chest/abdomen/pelvis (): impression: no acute traumatic findings within the chest, abdomen, and pelvis. . mri head w/ and w/o contrast (): impression: no evidence of intracranial abnormalities. . eeg (): no epileptiform changes, unremarkable . echocardiogram (): the left atrium is normal in size. the right atrial pressure is indeterminate. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is mild global left ventricular hypokinesis (lvef = 45 %) consistent with a cardiomyopathy. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). the right ventricular cavity is mildly dilated with mild global 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 pericardial effusion. . ekg (): sinus rhythm. vertical axis. otherwise, normal tracing. compared to the previous tracing of the findings are similar. brief hospital course: 22 year old male with history of anxiety and ?cardiac conduction abnormalities of unknown significance presents s/p fall and loc after an episode of profound, non-exertional chest pain and tightness. on echo, he was found to have a depressed ef of 45% and global ventricular dilatation. . #. fall with loss of consciousness: from the history, it is still unclear as to how long he was unconscious for. he received a full trauma work-up upon admission, with full body ct scan. from the negative trauma work-up, it is probably safe to say the cause of his loc was biological rather than mechanical. patient has been taking citalopram for a number of months, which can both lower the seizure threshold and prolong the qt interval leading to torsades, but neither of these etiologies seemed applicable in this case. neurology and electrophysiology were both involved in his case. eeg over 24 hours did not show any epileptiform changes. . #. chest pain: his pain did recur once during admission, but did not result in loss of consciousness. it was not associated with any shortness of breath or diaphoresis. he did explain a previous history of "regurgitation" when eating, with an esophageal study in the past, only showing a hiatal hernia and no apparent dysmotility. he is somewhat anxious at baseline and a psychiatry consult was called to help assess any pscyhiatric causes of his chest pain (i.e. panic attack), but they did not indicate any. an echocardiogram was recommended by the cardiology team and it showed an ejection fraction of 45% and global dilatation of the ventricles. he will be followed closely by the electrophysiology team as an outpatient with cardiac mri and follow-up appointments to further explore this structural abnormality and work-up this apparent dilated cardiomyopathy. we also recommended following up with gastroenterology to investigate his regurgitation symptoms and have set up an appointment for him at . . #. follow-up: will be establishing care here at after his hospitalization with a number of new physicians. he understands that we are still not sure as to why he lost consciousness and knows that it will be important to continue seeing the cardiologists to manage and work up his suspected cardiomyopathy and visit gastroenterology to address his regurgitation symptoms. he was instructed to continue on citalopram and omeprazole. his pcp and gi appointments are in , and cardiac mri and ep appointments are in . medications on admission: citalopram 40mg daily discharge medications: 1. citalopram 40 mg tablet sig: one (1) tablet po once a day. 2. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: cardiomyopathy, based on echocardiogram results vasovagal syncope secondary diagnosis: anxiety hiatal hernia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure to take care of you at the . you were admitted after you felt chest pain, fainted, and fell down a flight of stairs. you received ct scans of your head, chest, and abdomen to make sure you were not bleeding anywhere from your fall. there was none. the emergency room physicians placed a breathing tube and you were admitted to the intensive care unit. . you were evaluated by the neurology service. an mri of your brain was done and it was normal without evidence of stroke or focus of seizure. an eeg was performed and there was no evidence of seizures. . you were evaluted by the cardiology (electrophysiology) service. we performed an echocardiogram, which showed an abnormal reduction in the heart's pumping ability, which will require further evaluation with the cardiologists. they would like to you get a cardiac mri before you see them for a follow-up appointment. . it is very important that you do not exercise before you see them. it is dangerous to continue training for your race and you need to be cleared by the cardiologists before you do any more strenuous exercise. . medication changes: 1) you should start omeprazole 40mg daily to help with your reflux symptoms. 2) continue taking your citalopram as prescribed. followup instructions: we have scheduled two follow-up appointments for you. the first one is with a new primary care physician, our records indicated that you did not have one. the second appointment is with a gastroenterologist to help you with your regurgitation symptoms. . the cardiology service (and dr. will be contacting you with your appointment and with the information about where and when to get your cardiac mri as an outpatient. if you do not hear from dr. office in a week or so, please call them at . the cardiac mri office will e-mail with your appointment information. if you do not receive a date and time from them in the next week, you should call . these are your upcoming appointments: department: when: tuesday at 2:35 pm with: , md building: sc clinical ctr campus: east best parking: garage department: gastroenterology when: wednesday at 10:30 am with: , md building: lm campus: west best parking: garage md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: other primary cardiomyopathies acidosis esophageal reflux diaphragmatic hernia without mention of obstruction or gangrene anxiety state, unspecified acute respiratory failure accidental fall on or from other stairs or steps other chest pain syncope and collapse generalized pain 

Answer: The patient is high likely exposed to