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: pericardial effusion major surgical or invasive procedure: pericardiocentesis history of present illness: 80 year old man with a history of cad s/p stent to lad in with recent admission for in-stent rethrombosis (stemi) with successful ptca who is sent from an outside hospital with new pericardial effusion and acute anemia. . the patient was recently discharged on for revascularization and thrombectomy after in-stent rethrombosis of lad cypher stent placed in in setting of holding plavix for a knee replacement. . he was discharged on aspirin, plavix, metoprolol, captopril, atorvastatin, and warfarin with a lovenox bridge (the patient was found to have apical akinesis and was at high risk of clot formation). he had been doing well until when he noted the onset of sharp left sided pleuritic chest pain and shortness of breath. this improved after administration of aspirin. he was subsequently admitted to , where echocardiogram revealed pericardial effusion with concern for hemopericardium. he was given 1mg of vitamin k, asa and plavix were continued. there was concern for acute blood loss given a hematocrit of 22.8, and he was subsequently transfused 1u prbc. vitals on transfer: 97.6, 18, 67, 92/61, 96% 3l . of note, the patient was noted to have an acute anemia prior to his stemi while at rehab for his knee replacement. he had an endoscopy showing gastritis at that time, with eventual stabilization of his hematocrit. . on arrival to the floor, patient reports feeling continued pleuritic chest pain, but otherwise has no complaints including no pre-syncope, syncope, shortness of breath. he also has no f/c/s, cough, or swelling. he has not noticed any blood in his stool. . cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: (-) diabetes, (+) dyslipidemia, (+) hypertension 2. cardiac history: -percutaneous coronary interventions: *lad cypher stent in at *in stent restenosis (off of plavix for knee surgery), with ptca and aspiration thrombectomy with restoration of timi 3 flow distally 3. other past medical history: roator cuff tear left wrist fracture osteoarthritis s/p left total knee replacement and left continuous femoral nerve block gout pseudophakia social history: retired electrical engineer for in . he lives in with his wife-- . 2 children- mark and - tobacco history: never family history: history of cad (brother also has stents). physical exam: admission: vs: 98.5 113/72 69 97% 2l general: nad, laying in bed speaking in full sentences heent: perrl, eomi, jvd. cardiac: distant heart sounds with rrr. lungs: clear anteriorly abdomen: soft, ntnd. no hsm or tenderness. extremities: warm and well perfused. no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. discharge: vs: 98.5, 109/69, 88, 18, 96% on ra i/o 2540/965 in 24hrs, 100/300+inc general: nad, laying in bed speaking in full sentences, aaox3 heent: no jvd. cardiac: rrr. lungs: few bibasilar crackles abdomen: soft, ntnd. no hsm or tenderness. extremities: warm and well perfused. no c/c/e. no femoral bruits. +healing tkr scar. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission- 08:07pm blood wbc-11.0# rbc-2.83* hgb-8.1* hct-25.0* mcv-89 mch-28.6 mchc-32.4 rdw-14.0 plt ct-464* 08:07pm blood pt-34.1* ptt-35.9 inr(pt)-3.3* 08:07pm blood glucose-113* urean-23* creat-1.0 na-130* k-3.9 cl-93* hco3-24 angap-17 08:07pm blood alt-69* ast-42* alkphos-141* totbili-1.3 08:07pm blood calcium-8.5 phos-3.7 mg-2.2 11:35am blood lactate-1.7 06:54pm blood lactate-1.1 11:35am blood freeca-1.04* discharge- 07:25am blood wbc-14.7* rbc-3.59* hgb-10.2* hct-31.9* mcv-89 mch-28.3 mchc-31.9 rdw-13.9 plt ct-353 07:25am blood pt-16.2* ptt-30.8 inr(pt)-1.5* 07:25am blood glucose-111* urean-13 creat-0.8 na-136 k-4.7 cl-101 hco3-24 angap-16 07:40am blood alt-59* ast-48* alkphos-123 totbili-1.0 07:25am blood calcium-8.3* phos-3.7 mg-2.0 pericardial fluid- 01:45pm other body fluid wbc-900* hct,fl-20.0* polys-54* lymphs-31* monos-15* 01:45pm other body fluid totprot-4.5 ld(ldh)-1361 amylase-15 albumin-2.6 mircobiology- - 1:45 pm fluid,other pericardial fluid. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): fungal culture (preliminary): no fungus isolated. - 1:45 pm fluid received in blood culture bottles. fluid culture in bottles (preliminary): no growth. - blood culture, routine-pending-prelim no growth to date - blood culture, routine-pending-prelim no growth to date - urine culture (preliminary): gram negative rod(s). >100,000 organisms/ml. - legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. pericardial fluid cytology: negative for malignant cells. echocardiographs -portable tte ( at 7:46:05 pm) there is moderate regional left ventricular systolic dysfunction with at least mid to distal anterior/anteroseptal hypokinesis. a ventricular septal defect cannot be excluded. right ventricular chamber size and free wall motion are normal. there is a moderate to large sized pericardial effusion. no right ventricular diastolic collapse is seen. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling. impression: moderate to large circumferential pericardial effusion. evidence of early tamponade physiology. there are echo dense elements within the effusion and fibrous strands causing loculation. there is approximately 2cm of fluid over the anterior right ventricle during diastole, suggesting that a sub-xiphoid approach would be safe. moderate regional lv systolic dysfunction consistent with lad infarction. a ventricular septal rupture cannot be excluded on the basis of this study. -portable tte ( at 2:56:00 pm) there is moderate regional left ventricular systolic dysfunction with hypokinesis of the mid to distal anterior wall and anterior septum. there is abnormal septal motion/position. there is a trivial/physiologic pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the pericardial effusion has been tapped. tamponade physiology is not present. there is a septal bounce seen, which is often seen after tap and is probably due to mild effusive-constrictive physiology. -portable tte ( at 8:38:30 am) there is mild regional left ventricular systolic dysfunction with septal hypokinesis. the remaining segments contract normally (lvef = 40%). right ventricular chamber size is normal. with borderline normal free wall function. there is abnormal septal motion/position. there is no aortic valve stenosis. no aortic regurgitation is seen. there is a very small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. the echo findings are suggestive but not diagnostic of pericardial constriction. impression: very small residual echodense pericardial effusion with suggestion of constrictive physiology (by 2d echo only). studies- -chest (pa & lat): moderate left and small right pleural effusions with adjacent basilar atelectasis, most substantial in the left lower lobe. co-existing pneumonia cannot be excluded in the appropriate clinical setting. brief hospital course: 80 yo m with h/o cad s/p stent to lad in with recent admission for stemi (in-stent rethrombosis) with successful ptca who was sent from an outside hospital with new pericardial effusion and acute anemia. . # hemorrhagic pericardial effusion: the etiology was felt to likely post-stemi in the setting of an elevated inr (pt was on anticoagulation therapy for apical akinesis, as below). he received 5 units of fresh frozen plasma and underwent a pericardiocentesis, during which 1050 ml was removed. the drain was removed the following day when it was noted to be no longer draining fluid and a repeat tte did not show evidence of persistent effusion. he remained hemodynamically stable throughout his hospital stay. he is not to be discharged on anticoagulation beyond his dual-antiplatelet therapy for his cad. . # acute anemia: this was likely secondary to known gastritis given heme positive stools. his hematocrit remained stable following the transfusions he received on admission. he is to follow up with gi as an outpatient. he was also started on a ppi during this admission. . # apical akinesis: noted on his previous admission following his stemi and he was started on warfarin for ppx. as above, he presented with a hemorrhagic pericardial effusion in the setting on an elevated inr (3.3 on admission). the risks and benefits of continued anticoagulation were discussed and the patient is not to be discharged on warfarin. he is to continue his plavix and increased aspirin dose. . # cad: the patient is s/p ptca and thrombectomy to open lad stent re-thrombosis. he was continued on his plavix and his aspirin dose was increased from 81 mg daily to 325 mg daily. he was also continued on atorvastatin and metoprolol, although labile bps led to a dose reduction of metoprolol. his lisinopril was also held given labile bps. it should be restarted as an outpatient if his bp tolerates. . # acute on chronic systolic chf: the patient's previous echo showed a lvef of 40%. repeat echo's following pericardiocentesis revealed a stable ef with very small residual echodense pericardial effusion and then suggestion of constrictive physiology (by 2d echo only). he was diuresed as tolerated and appeared euvolemic upon discharge. he is to follow up with cardiology after discharge. . # altered mental status, acute confusional state c/w delirium. pt was noted have a new leukocytosis and was felt to be more somnolent by his wife on . a general infectious work up revealed a ua c/w urinary tract infection (multiple wbcs with bacteria noted). his cxr revealed a left sided pleural effusion, thought to be secondary to his recent stemi. although intrathoracic infection could not be officially ruled out, it was felt that given the patient's lack of s/sx c/w pna, this was not the source of his infection. he was started on levofloxacin to cover both a pulmonary and urinary source and when his prelim urine culture grew gram negative rods, he was transitioned to bactrim x7 day course for a complicated uti. the patient also reported loose stools and was started on empiric flagyl, but this was discontinued when the patient did not have additional diarrhea the following day. . ======================================= transitions of care ======================================= 1. pericardial effusion - pending studies include: final anaerobic culture (prelim no growth to date), final acid fast culture (afb smear negative), and final fungal culture (prelim no growth to date). 2. blood pressure medication changes - decrease of metoprolol dose and lisinopril held given labile bps in the hospital. can be restarted as tolerated. 3. other studies pending upon discharge: blood cultures, sent , prelim no growth to date. urine culture, sent , prelim gram negative rods (>100,000 colonies). medications on admission: 1. clopidogrel 75 mg tablet, 1 tablet po daily 2. aspirin 81 mg tablet, 1 tablet po daily 3. atorvastatin 80 mg tablet, 1 tablet po daily 4. metoprolol succinate 50 mg tablet, 1 tablet po daily 5. lisinopril 10 mg tablet, 1 tablet po daily 6. warfarin 2.5 mg tablet, 2 tablet po at bedtime 7. docusate sodium 100 mg, 1 capsule po bid 8. sertraline 100 mg tablet, 1 tablet po once a day. 9. ferrous gluconate 325 mg (36 mg iron) tablet, 1 tablet po bid 10. dulcolax 5 mg tablet, 1 tablet po daily prn for constipation. 11. ambien 5 mg tablet, 1 tablet po at bedtime. discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. sertraline 100 mg tablet sig: one (1) tablet po once a day. 6. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 7. dulcolax 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day) for 6 days. disp:*12 tablet(s)* refills:*0* discharge disposition: home with service facility: hospice program discharge diagnosis: primary: -pericardial effusion secondary: -urinary tract infection -coronary artery disease -coagulopathy -chronic systolic congestive heart failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure taking part in your care during this hospitalization. you were admitted because fluid had built up around your heart and you were experiencing chest pain. the fluid was drained and your pain improved. your blood was also very thin, and you were given medications to reverse this. this likely contributed to the fluid you had around your heart. we found that you were anemic. this may be due to inflammation in your gi tract and you should be sure to follow up with a gastroenterologist. an appointment has been made for you and is listed below. you also developed a urinary tract infection and are being treated with antibiotics. we hope you continue to feel well. please make the following changes to your medications: -start: bactrim 1 tablet twice daily x6 days (this is the antibiotic for your urinary tract infection -start: pantoprazole 40 mg daily (this is to decrease acid in your stomach) -decrease: metoprolol to 25 mg daily -increase: aspirin to 325 mg daily -stop: lisinopril unless otherwise directed -stop: warfarin followup instructions: name: , b. location: medical address: , , phone: appointment: tuesday 2:30pm department: cardiac services when: wednesday at 2:20 pm with: , md building: sc clinical ctr campus: east best parking: garage department: div. of gastroenterology when: tuesday at 2:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: pericardiocentesis diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension gout, unspecified percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia acute on chronic systolic heart failure other and unspecified coagulation defects knee joint replacement subendocardial infarction, subsequent episode of care unspecified gastritis and gastroduodenitis, without mention of hemorrhage hemopericardium cardiac tamponade 

Answer: The patient is high likely exposed to