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: codeine attending: chief complaint: altered mental status, respiratory distress, mitral regurgitation major surgical or invasive procedure: intubation history of present illness: 86 yo female with history of paroxysmal atrial fibrillation, moderately severe mitral regurgitation, moderate pulmonary hypertension, diastolic dysfunction and mild aortic stenosis presented to on for palpitations. according to the patient's family she complained of fatigue, worsening dyspnea on exertion and cough for the three days prior to admission. she denied fevers, chills, orthopnea, pnd, and chest pain. . at , she was found to be in a fib with rapid ventricular response. in the ed, she was treated with dc cardioversion and iv amiodarone. following dc cardioversion, the patient developed respiratory arrest requiring intubation. she was found to have questionable infiltrate on cxr that was present from admission. subsequently she developed sinus bradycardia and hypotension, and was started on dopamine for pressor support. on , she developed a junctional rhythm and the amiodarone was discontinued. at that time she was weaned off propofol, however failed sbt. multiple attempts at weaning were tried from that point on, but were unsuccessful. she was digoxin loaded on the 11th. on the 12th, she went back into a fib however without rapid ventricular response. she was extubated this am and started on po amiodarone. she is being transferred here for surgical evaluation of severe symptomatic mitral regurgitation. . on review of systems, according to the patient's family she has a prior history of stroke, she denies any prior history of tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, syncope or presyncope. . on presentation, the patient is in atrial fibrillation with rapid ventricular response, hypotensive to the 60s systolic, and unresponsive to verbal commands. past medical history: 1. cardiac risk factors: none . 2. cardiac history: -cabg: quadruple bypass in -percutaneous coronary interventions: none -pacing/icd: none . atrial fibrillation moderate severe mitral regurgitation mild aortic stenosis - peak gradient 28mmhg moderate pulmonary hypertension - pressure of 46mmhg diastolic heart failure . 3. other past medical history: crohn's disease, s/p partial colectomy in , gastroesophageal reflux disease, right hemispheric stroke in with negative head mra and temporal artery biopsies, s/p right carotid endarterectomy in wet macular degeneration hypothyroidism copd social history: she was very active, independent at baseline. supportive husband and sons. previously lived in , now resides in fl, visiting the area recently. -tobacco history: she smoked in the distant past quitting 60 years ago -etoh: she drinks two glasses of wine with supper -illicit drugs: denies family history: no cardiac hx physical exam: gen: nad, alert, interactive, disoriented heent: bleeding at ij site resolved cv: rrr, giii/vi murmur at rusb and apex, dynamic precordium with rv heave pulm: ctab anteriorly abd: soft, nt/nd extr: no pedal edema, no breakdown pertinent results: on admission: 05:40pm blood neuts-67.1 lymphs-17.2* monos-9.8 eos-5.5* baso-0.4 04:18am blood pt-12.9 ptt-55.7* inr(pt)-1.1 05:40pm blood alt-50* ast-41* ck(cpk)-75 alkphos-305* totbili-0.8 04:18am blood ggt-291* 05:40pm blood ck-mb-notdone ctropnt-0.20* 04:18am blood ck-mb-5 01:33pm blood ck-mb-9 05:40pm blood albumin-3.1* calcium-9.1 phos-4.2 mg-1.8 05:40pm blood type-art po2-306* pco2-40 ph-7.46* caltco2-29 base xs-5 cxr heart is mildly enlarged. pulmonary interstitium is abnormal, which could be due to residual edema. followup advised. no pleural effusion or pneumothorax. et tube and left internal jugular line are in standard placements. a nasogastric tube passes into the stomach and out of view. no pneumothorax. upper most two sternal wires are fractured, but not widely displaced. i suggest the clinical inspection of the sternotomy to exclude instability or other complication. head ct 1. no acute hemorrhage, mass effect, or territorial vascular infarction. 2. region of encephalomalacia within the right occipital lobe consistent with prior infarct. 3. scattered punctate calcifications throughout the right hemisphere consistent with prior granulomatous disease. 4. scattered calcifications within the basal ganglia bilaterally. cardiac echo the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. the right atrium is dilated. mild spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is mildly depressed (lvef= 40 %). the right ventricular cavity is dilated with moderate global free wall hypokinesis. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve. there is mild to moderate aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. moderate to severe (3+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate-severe mitral regurgitation. mild-moderate tricuspid regurgitation. probably mild/moderate aortic stenosis ( 1.2 cm2). depressed left and right ventricular function (ef 40%). complex atheroma in the descending aorta. abd us limited study. tiny right-sided pleural effusion. otherwise, unremarkable abdominal ultrasound. unilateral ue us small nonocclusive thrombus seen within the right ij at the level of the recent puncture. there is no pseudoaneurysm. no av fistula and no hematoma identified. cxr: ng tube tip is out of view below the diaphragm. mild cardiomegaly is stable. the sternal wires are aligned with rupture of the first two wires as before, right peripheral catheter tip is in unchanged position. there is no pneumothorax. bilateral increased interstitial marking is unchanged. no evidence of new lung abnormalities. brief hospital course: 86 yo female with severe mitral regurgitation, severe tricuspid regurgitation, diastolic heart failure, atrial fibrillation transferred from for evaluation of respiratory arrest and severe mitral regurg. she was treated during this hospitalization for her arrhythmia, respiratory failure and mental status changes. . # respiratory distress: pt was admitted with respiratory distress thought to be secondary to over-sedation and also had sputum growing gnr and cxr shows evidence of lll pna. on arrival, her blood gas was wnl however she was unable to maintain her airway due to her mental status changes, therefore she was urgently intubated, and successfully extubated on day 5 of the admission. she was treated with 7-day course of vanc-zosyn (completed on ) out of concern for pneumonia, and provided with nebs and chest pt for supportive care. she was also diuresed out of concern for fluid overload. she will need baseline pft's now that she is on amiodarone. . # altered mental status: likely oversedation given 5+ day course of propofol at the outside hospital. with discontinuation of the propofol, her mental status significantly improved and she was alert and interactive currently. head ct was performed and showed no acute changes. there may also have been a component of icu/infecious delerium and pt continued to have some confusion on discharge, however was oriented to person and time. . # atrial fibrillation: the patient has history of rapid a fib at the outside hospital s/p dc/cv and amiodarone/digoxin loading with subsequent bradycardia and junctional rhythm. on arrival, patient was in a fib with rvr and hypotensive. after cardioversion on arrival to this hospital, she remained in nsr until when patient went back into a fib with rvr. she was continued on amiodarone for rate control and was in atrial fibrillation on discharge. she was also treated with warfarin (decreased from home dose because of amiodarone) with a heparin drip bridge. her inr at discharge was 1.3. please check inr on monday , heparin can be discontinued with inr > 2.0. . # mitral regurgitation/tricuspid regurgitation: mod-severe mr/mild-moderate tr on tte in-house. blood pressure was kept at systolic <120 with lisinopril for afterload reduction to prevent flash pulmonary edema with mr. valve replacement surgery was deferred given her tenuous state. . # acute kidney injury: patient??????s baseline cr 1.1. initially this was presumed to be pre-renal however feurea was elevated suggesting intrinsic renal disease, likely ain lisinopril given elevated urine eosinophils. her creatinine and uop were monitored, additional fluids held given her heart failure and mr and concern for inducing pulmonary edema. creatinine at discharge is 1.2. . # leukocytosis: on admission, there was concern for pna, therefore she was treated with a 7 day course of vanc/zosyn. she was then afebrile, negative c. diff, s/p 7 day abx course, blood cxs negative, therefore low concern for infectious etiology at discharge. patient has increasing leukocytosis, but normal pmns with elevated relative eosinophils, therefore may have leukocytosis secondary to ain. completed vancomycin course for pna so this should not be contributing to leukocytosis; all cultures negative to date except rare yeast on sputum culture. her wbc had decreased on discharge to 16. . # acute on chronic diastolic congestive heart failure: the patient has diastolic heart failure on most recent echo, but preserved systolic function, tte in-house showed ef 40%. lisinopril continues at increased dose. she was treated with blood-pressure control. metoprolol was discontinued because of av block on amiodarone iv initially. pt has been well rate controlled on current dose of amiodarone. lasix was decreased to 20 mg daily, currently appears euvolemic with weight 49 kg today. . # coronary artery disease: history of quadruple cabg in , has not been reevaluated since. no evidence of acute ischemia. no asa given history of pud. she was continued on plavix, pravastatin and captopril. . # decreased hct/bleeding from r neck: pt had continuous oozing from her ij site which did not cease with compression. her anticoagulation goals were slightly decreased and an us was obtained to evaluate for hematoma, however only a small non-obstructive thrombus was visualized. she was given one unit of prbcs and her hematocrit stabilized. the line was pulled and oozing ceased. . # hypotension: she temporarily required pressures on admission however improved with tx of infection and stabilization of cardiac rhythm. . # cool lue: dopplers of lue showed normal flow, warmth improved with heating pad and decreased discoloration. she has no numbness and good cappillary refill. . # hypothyroidism: tsh wnl, continue levothyroxine at home doses. monitor thyroid function, given now on amiodarone. . # crohn's disease: no acute issues, continue to monitor. pt will need assistance with frequent feeding to ensure adequate caloric intake. . # diarrhea: c.diff negative x2, no abdominal pain; believed most likely to be due to tube feeds, now d/c'ed. . # macular degeneration: continue brimonidine eye drops and preservision vitamin supplementation. . # history of cva: affected her right eye and is s/p left sided cea. continue plavix and pravastatin. no aspirin secondary to pud. . # pud: continue home ppi . # osteoporosis: continue actonel weekly medications on admission: coumadin 4-mg/day furosemide 40-mg/day lisinopril 1.25-mg/ plavix 75-mg/day levothyroxine 0.05-mg/day pravastatin 40-mg/day metoprolol 12.5-mg omega 3 fatty acids actonel 35-mg/week brimonidine eye drops preservision one tab daily omeprazole 20mg calcium 500mg one tab daily discharge medications: 1. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 2. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 3. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q8h (every 8 hours). 4. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 9. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 10. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 11. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. 12. preservision 226-200-5 mg-unit-mg capsule sig: one (1) capsule po once a day. 13. calcium 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po twice a day. 14. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 15. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 16. actonel 35 mg tablet sig: one (1) tablet po once a week. 17. outpatient lab work please check cbc, chem-7, and inr on monday . omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 19. omega-3 fatty acids 1,000 mg capsule sig: one (1) capsule po twice a day. 20. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day: hold for k > 4.0. 21. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: per sliding scale units intravenous continuous. discharge disposition: extended care facility: - discharge diagnosis: atrial fibrillation with rapid ventricular response acute on chronic systolic and diastolic congestive heart failure pneumonia hypoactive delerium mitral regurgitation leukocytosis coronary artery disease discharge condition: stable blood culture x2 and urine cxo n pnd foley was d/c'ed on discharge instructions: you had atrial fibrillation with rapid ventricular response. you were started on amiodarone to control your heart rhythm and rate. you also had trouble breathing and required a breathing tube. you were slow to wake up from sedatives and will need a lot of physical therapy before you return home. . weigh yourself every morning, call provider if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days adhere to 2 gm sodium diet fluid restriction: 1500cc . medication changes: 1. start amiodarone to control your heart rate and rhythm. 2. increase your lisinopril to 20 mg. 3. stop metoprolol, you cannot continue this with amiodarone because of low heart rates. 4. start heparin iv until your inr is > 2.0. . please call your doctor or return to the hospital if you develop fever, chest pain, shortness of breath, palpitations, confusion, or other symptoms that concern you. followup instructions: cardiology: , phone: date/time: at 10:40 am. . primary care: , r. phone: please call after you leave rehabilitation to make an appt procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart arterial catheterization insertion of other (naso-)gastric tube transfusion of packed cells diagnoses: pneumonia, organism unspecified mitral valve disorders acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other chronic pulmonary heart diseases acute respiratory failure osteoporosis, unspecified macular degeneration (senile), unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea diseases of tricuspid valve delirium due to conditions classified elsewhere acute on chronic combined systolic and diastolic heart failure personal history of other diseases of digestive system 

Answer: The patient is high likely exposed to