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: penicillins attending: chief complaint: icd lead extraction and reimplantation major surgical or invasive procedure: implantable cardioverter-defibrillator lead extraction and reimplantation history of present illness: 77 year old man with hx of ischemic cardiomyopathy ef 30%, s/p cabg , copd, prior cva, atrial fibrillation, ckd, and a prior dual chamber icd referred for lead extraction and reimplantation due to a and v lead fracture. under general anesthesia, his a and v leads were removed and a new icd device was placed without complications. his icd has not fired in several years since the amiodarone was started. . on review of systems, he denies any prior history of deep venous thrombosis, pulmonary embolism, myalgias, joint pains. he does have a chronic intermittently productive cough. no hemoptysis. no black stools or red stools, but has some constipation. he denies recent fevers, chills or rigors. he does have sob when walking up his 13 stairs or walking block. he used to have angina although this is much improved on ranolazine. + orthopnea (sleeps in recliner), no pnd. no current cp, sob, no palpiations, syncope, no new ankle edema. past medical history: . cardiac history: history of remote mis. -cabg: cabg in at bmw with a lima to the lad, svg to the om s/p subsequent rca and d1 stenting (3 stents in total per patient 6-7 years ago) -pacing/icd: ventricular tachycardia, s/p ablation x 2 ' and '. s/p single chamber icd in , s/p lead extraction and device revision in by dr. at , s/p generator replacement in + chronic atrial fibrillation + ischemic cardiomyopathy, lvef 30-35% by echo . 3. other past medical history: copd on chronic steroids (was on home o2 in the past, but not now) - sees dr. in chronic kidney disease prior cva with some loss of vision of left eye gout gerd cataracts spinal stenosis and chronic lower back pain hypothyroidism (likely secondary to amiodarone) - most recent tsh 12.4 (peak tsh 41.6) . past surgical history: back surgery approximately 4 years ago appendectomy remote bladder cancer s/p resection and intravesicle chemotherapy work related stomach laceration s/p repair many years ago social history: married, had five children, 3 of which live nearby, one passed away. retired home builder. etoh: rare tobacco: 2-3ppdx >20 years. quit smoking in . ivda: none family history: father died of mi in 60s, mother died of cva at age 89 but also had cad, sister died of mi in 80s, one sibling with lung ca. physical exam: vs: t 95.3 hr 60 av paced bp 153/68 rr 13 o2 sat 99% 2l general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. neck: supple with jvp 9 cm, no cervical lad. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. early peaking sem at rusb with radiation to carotids, also with 2/6 blowing holosystolic murmur at apex with radiation to axilla. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities. resp were unlabored, no accessory muscle use. ctab anteriorly: no crackles, wheezes or rhonchi. abdomen: soft, obese, nt, nd. no hsm. extremities: no c/c/e. diffuse ecchymoses on ue b/l, also brawny discoloration (statis dermatitis) le b/l with scabbed ulcer on anterior rle. icd entrance site bandaged, no serosanguinous discharge. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: labs upon admission: . 09:40am blood wbc-8.0 rbc-4.12* hgb-11.1* hct-34.9* mcv-85 mch-26.9* mchc-31.7 rdw-17.4* plt ct-248 09:40am blood neuts-74.0* lymphs-15.0* monos-3.5 eos-7.0* baso-0.6 09:40am blood pt-13.2 inr(pt)-1.1 01:15pm blood pt-13.6* ptt-26.4 inr(pt)-1.2* 01:15pm blood fibrino-455* 09:40am blood glucose-103* urean-51* creat-2.3* na-141 k-4.5 cl-104 hco3-26 angap-16 04:04pm blood calcium-8.7 phos-4.5 mg-2.0 01:21pm blood type-art po2-353* pco2-41 ph-7.41 caltco2-27 base xs-1 intubat-intubated vent-controlled 01:21pm blood glucose-105 lactate-2.2* na-139 k-4.3 cl-104 01:21pm blood hgb-10.3* calchct-31 01:21pm blood freeca-1.12 . labs upon discharge: . 06:05am blood wbc-6.5 rbc-3.32* hgb-9.1* hct-27.2* mcv-82 mch-27.2 mchc-33.3 rdw-17.4* plt ct-195 06:05am blood pt-13.7* ptt-29.2 inr(pt)-1.2* 06:05am blood glucose-97 urean-48* creat-2.3* na-141 k-4.7 cl-105 hco3-27 angap-14 06:05am blood calcium-8.6 phos-4.5 mg-2.0 . other labs: pt / ptt / inr:13.6/33.4/1.2, ca++:8.7 mg/dl, mg++:2.0 mg/dl, po4:4.5 mg/dl . osh labs () wbc 6.0 hgb 10.9 hct 34 plt 219 : creatinine: 2.57 per patient's wife . ekg: rate 60, av paced, pr 0.28, qrs wide, lbbb, no st/t changes . 2d-echocardiogram: . echo : . 1. the left atrium is mildly dilated. no thrombus is seen in the left atrial appendage. 2. no atrial septal defect is seen by 2d or color doppler. 3. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is mildly depressed (lvef= 40%). 4. the right ventricular cavity is mildly dilated with borderline normal free wall function. 5. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are simple atheroma in the descending thoracic aorta. 6. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). trace aortic regurgitation is seen. 7. moderate (2+) mitral regurgitation is seen. 8. there is a trivial/physiologic pericardial effusion. there is no enlargement of the pericardial effusion after lead extraction and replacement. . ett: last stress (unknown type) : inferior infarction with ef 28% stable with no ischemia. . cardiac cath: lad discrete proximal 100% lesion (bypassed by lima), dm1 discrete 95% lesion (later s/p pci), lcx discrete proximal 100% lesion (bypassed to om1 by svg), rca proximal 95% lesion and 50% lesion (both lesions later s/p pci) . cxr: post icd placement: 1. dual-lead pacemaker in appropriate position. 2. mild pulmonary edema with small left pleural effusion. no evidence of pneumothorax. . brief hospital course: is a 77 year old man with history of ischemic cardiomyopathy ef 30%, s/p cabg, copd, prior cva, atrial fibrillation, ckd, and a prior dual chamber icd referred for lead extraction and reimplantation due to a and v lead fracture. . icd lead fracture: under general anesthesia and subclavian approach, his a and v leads were extracted and a new dual chamber guidant icd implant was placed without immediate complications. he received one dose of vancomycin and was started on a 7 day course of clindamycin. his warfarin will be held 7 days post-operatively to help prevent bleeding in the pacer pocket. post-implantation cxr showed proper lead placement, mild pulmonary edema and a small left pleural effusion. he will follow up at our device clinic on . . the patient's other medical issues including coronary artery disease, chronic systolic dysfunction with ef 30%, atrial fibrillation, chronic kidney disease, copd, hypertension, hypothyroidism were managed medically with his home medications without complications. . the patient was found to have a normocytic anemia that is most likely secondary to chronic renal insufficiency and/or anemia of chronic inflammation. he did not have any signs of acute bleeding, but this should be monitored as an outpatient by his primary care physician. . the patient was confirmed full code for this admission. medications on admission: allopurinol 100 mg tablet daily amiodarone 200 mg tablet daily budesonide-formoterol 160 mcg-4.5 mcg/actuation hfa aerosol inhaler 2 puffs every daily carvedilol 6.25 mg tablet ipratropium-albuterol 18 mcg-103 mcg (90 mcg)/actuation aerosol 2 puffs qid isosorbide mononitrate 60 mg tablet sustained release 24 hr daily levothyroxine 75 mcg tablet daily nitroglycerin dosage uncertain prn omeprazole 20 mg capsule, delayed release(e.c.) 1 cap prednisone 2.5 mg tablet daily ranolazine 500 mg tablet 12 hr sustained release once daily simvastatin 20 mg tablet every evening terazosin 5 mg capsule, 1 capsule qhs torsemide 20 mg tablet daily valsartan 80 mg tablet daily warfarin 5 mg tablet 0.5 (one half) tablet(s) by mouth every day except wed/friday. last dose folic acid 0.4 mg tablet daily discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 4. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation once a day. 5. combivent 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day. 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual asdir: take 1 tab as needed for chest pain, can take up to 3 tabs for persistent chest pain (wait 5 min between tabs), if chest pain continues, please call your doctor and seek emergency care immediately. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 9. prednisone 2.5 mg tablet sig: one (1) tablet po daily (daily). 10. ranolazine 500 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po once a day. 11. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 12. terazosin 5 mg capsule sig: one (1) capsule po hs (at bedtime). 13. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 14. valsartan 40 mg tablet sig: two (2) tablet po daily (daily). 15. warfarin 2.5 mg tablet sig: one (1) tablet po asdir (as directed): please restart on . take every day except wednesday and friday. 16. folic acid 400 mcg tablet sig: one (1) tablet po once a day. 17. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 18. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 6 days. disp:*48 capsule(s)* refills:*0* 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 4. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation once a day. 5. combivent 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day. 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual asdir: take 1 tab as needed for chest pain, can take up to 3 tabs for persistent chest pain (wait 5 min between tabs), if chest pain continues, please call your doctor and seek emergency care immediately. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 9. prednisone 2.5 mg tablet sig: one (1) tablet po daily (daily). 10. ranolazine 500 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po once a day. 11. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 12. terazosin 5 mg capsule sig: one (1) capsule po hs (at bedtime). 13. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 14. valsartan 40 mg tablet sig: two (2) tablet po daily (daily). 15. warfarin 2.5 mg tablet sig: one (1) tablet po asdir (as directed): please restart on . take every day except wednesday and friday. 16. folic acid 400 mcg tablet sig: one (1) tablet po once a day. 17. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 18. clindamycin hcl 150 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 6 days. disp:*48 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: ischemic cardiomyopathy secondary diagnoses: coronary artery disease chronic atrial fibrillation hypertension hyperlipidemia chronic obstructive pulmonary disease chronic kidney disease drug-induced hypothyroidism 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 the hospital in order to have a new pacemaker placed because your old pacemaker leads were not working well any longer. your procedure went very well with no complications. no changes were made to your regular home medications, but we would like you to add the following: - please start taking the antibiotic clindamycin 300mg every 6 hours x 6 days - please stop taking coumadin until one week after your procedure (start your normal home dose on ) please follow up with your physicians below. followup instructions: please be sure to keep your followup appointments. . provider: clinic phone: date/time: 11:00 am sc clinical ctr, . primary care physician: . , g. tuesday 2:10pm , ma procedure: implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: anemia of other chronic disease esophageal reflux long-term (current) use of steroids chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of tobacco use chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mechanical complication of automatic implantable cardiac defibrillator old myocardial infarction personal history of malignant neoplasm of bladder unspecified cataract cardiac rhythm regulators causing adverse effects in therapeutic use late effects of cerebrovascular disease, disturbances of vision other iatrogenic hypothyroidism unqualified visual loss, one eye 

Answer: The patient is high likely exposed to