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: patient recorded as having no known allergies to drugs attending: chief complaint: abdominal pain, nausea, and vomiting. major surgical or invasive procedure: ercp x 2. history of present illness: 60 year-old male with history significant for severe nonischemic hypertensive cardiomyopathy (ef 20%), icd placement,diabetes who presents with abdominal pain, nausea, and vomiting since the morning of admission. the patient states he ate breakfast at 9 am, and approximately one hour later, the pain began and continued to wax and wane throughout the day, often reaching . the pain was described as bandlike across his abdomen, without radiation to the back. no aggravating factors other than eating. the pain was alleviated with morphine in the ed. the patient has never had this type of pain in the past. the patient also complained of nausea and vomiting, nonbilious/nonbloody. the patient denied diarrhea, melena or hematochezia. he denies any recent changes in his medications, recent travel, recent alcohol use, history of gallstones or symptoms of biliary colic. . in the ed, the patient received one liter ns, morphine, and a dose of levofloxacin. the patient was admitted to the micu. . in the micu he was given ns at 150cc/hr. antibiotics were not continued. the biliary team saw the patient and recommended ercp. the procedure was deferred due to the patient's inr. the patient's pain was improved on transfer. past medical history: 1. diabetes mellitus type 2, insulin dependent x 8 years 2. cardiomyopathy, ef 20% 3. icd placement 4. elevated transaminases, unknown etiology 5. chronic atrial fibrillation 6. chronic renal failure, most recent creatinine 1.7 7. umbilical hernia repair, social history: lives with his wife, has four grown children. not currently working, on disability. used to work in contruction. no tobacco, alcohol, or illicits. family history: no family history of heart disease. physical exam: vs: t 98.2 hr 74 bp 125/71 rr 18 o2sat 98% ra gen: awake, lying flat in bed, nad, well developed heent: atraumatic, mild scleral icterus, dry mucosa neck: no jvd, no lad cv: soft holosystolic murmur, lsb, irregular rhythm, regular rate lungs: cta b/l w/ good inspiratory effort abd: mildly distended, soft, tender to palpation in upper quadrants b/l and periumbilical. negative sign, no rebound ext: warm, dry, no le edema neuro: aaox3, follows commands, answers questions appropriately, no focal deficits pertinent results: labwork on admission: 08:20pm wbc-9.3 rbc-4.95 hgb-14.6 hct-40.5 mcv-82 mch-29.5 mchc-36.0* rdw-17.1* 08:20pm neuts-58 bands-0 lymphs-32 monos-8 eos-2 basos-0 atyps-0 metas-0 myelos-0 08:20pm plt smr-normal plt count-149* 08:20pm digoxin-1.0 08:20pm triglycer-165* 08:20pm ck-mb-3 ctropnt-<0.01 08:20pm calcium-9.9 08:20pm alt(sgpt)-272* ast(sgot)-485* ld(ldh)-594* ck(cpk)-135 alk phos-188* amylase-1472* tot bili-3.8* dir bili-2.0* indir bil-1.8 08:20pm glucose-140* urea n-25* creat-1.9* sodium-134 potassium-4.6 chloride-94* total co2-28 anion gap-17 08:20pm lipase-6160* . liver or gallbladder us (single organ) findings: the liver displays normal echotexture and architecture. no focal liver lesions are identified. the hepatic veins are dialated consistent with congestive heart failure. the main portal vein is patent with normal hepatopetal flow. the gallbladder demonstrates mild wall thickening without without intraluminal stone. there is a negative son sign. there is no pericholecystic fluid or gallbladder wall edema. there is no intra- or extra- hepatic biliary duct dilatation with the common bile duct measuring 5 mm. there is no right upper quadrant ascites. partially visualized portion of the pancreatic head and neck demonstrate no acute abnormality. impression: 1. no evidence of cholecystitis. 2. prominent hepatic veins consistent with venous congestion. . chest (portable ap) findings: there is stable cardiomegaly. left-sided aicd device noted with leads unchanged. no pleural effusion or pneumothorax identified. there is pulmonary vascular congestion although slightly decreased when compared to previous. there is no evidence of free intra-abdominal air. . ecg study date of atrial fibrillation indeterminate axis low limb lead qrs voltages delayed r wave progression with late precordial qrs transition nonspecific t wave abnormalities findings are nonspecific but clinical correlation is suggested for possible in part chronic pulmonary disease since previous tracing of , no significant change . ercp impression: a plastic stent placed in the pancreatic duct was found in the major papilla. evidence of a previous incomplete sphincterotomy was noted in the major papilla. cannulation of the biliary duct was performed with a sphincterotome using a free-hand technique. a mild dilation was seen at the biliary tree. there was a filling defect that appeared like sludge at the biliary tree. a sphincterotomy was performed in the 12 o'clock position using a sphincterotome. sludge was extracted successfully using a balloon catheter. the plastic stent was removed. . labwork on discharge: 08:15am blood wbc-6.7 rbc-3.67* hgb-11.0* hct-30.3* mcv-83 mch-29.9 mchc-36.3* rdw-17.5* plt ct-104* 07:40am blood glucose-131* urean-17 creat-1.4* na-139 k-3.8 cl-103 hco3-24 angap-16 08:15am blood alt-100* ast-62* ld(ldh)-251* alkphos-137* amylase-37 totbili-4.1* 07:40am blood totbili-3.4* 08:15am blood lipase-20 brief hospital course: 60 year-old male with congestive heart failure (ef 20%), status post icd placement, atrial fibrillation on coumadin, chronic renal failure presenting with abdominal pain, nausea, vomiting for 24 hours prior to admission and found to have pancreatitis. . 1. pancreatitis: elevated amylase/lipase consistent with pancreatitis as the cause of the patient's abdominal pain. the elevated alkaline phosphatase/bilirubin was suggestive of a gallbladder etiology. there were no obvious gallstones seen on ultrasound; ercp showed abundant sludge, however. the pancreatic duct was stented during the first ercp but the common bile duct was unable to be cannulated; this was achieved with the second ercp. during the second ercp it was noted that the stent initially placed in the pancreatic duct had migrated and this was subsequently removed. amiodarone is known to rarely cause pancreatitis; the patient's amiodarone was held and was not restarted on discharge. the patient remained afebrile, without leukocytosis, and with normal lactate. antibiotics were therefore not indicated. the patient was initially maintained npo with intravenous hydration but tolerated clear liquids and then a regular diet soon after the second ercp. the patient's pancreatic enzymes trended down quickly. the patient's coumadin was held and the patient was transfused one unit fresh frozen plasma prior to ercp. coumadin should be held for ten days following ercp and can be restarted . . 2. elevated transaminases: the patient has a history of elevated transaminases and recently had an appointment in liver clinic; etiology remains unknown. recent hepatitis panel negative. the patient's acute transaminase elevation was likely due to gallbladder sludge. the patient's amiodarone and statin were held and were not restarted prior to discharge. the patient had follow-up scheduled with hepatology for further outpatient work-up. . 3. cardiac: a. vessels: clean coronary catheterization in . the patient had no ekg changes and cardiac enzymes were within normal limits on this admission. the patient's statin was held in the setting of elevated transaminases, although unlikely secondary to statin. b. pump: hypertensive non-ischemic cardiomyopathy, ef 20%. the patient's lasix was initially held and he was hydrated with intravenous fluids. the patient was subsequently hypervolemic but diuresed well with lasix. the patient was euvolemic on discharge. the patient was continued on coreg. diovan was initially held for concern for acute renal failure but was restarted when the creatinine was confirmed to be at baseline. c. rhythm: chronic atrial fibrillation, rate controlled with digoxin and coreg. the patient's digoxin level was within normal limits on admission and digoxin was continued. the patient was continued on coreg. diovan was initially held for concern for acute renal failure but was restarted when the creatinine was confirmed to be at baseline. coumadin should be held for ten days following ercp and can be restarted . . 4. diabetes mellitus, type ii: insulin-dependent, moderate control. the patient was given 1/2 dose of insulin 70/30 while npo but restarted on his home dose when taking a regular diet. the patient was maintained on a humalog insulin sliding scale. . 5. chronic renal insufficiency: recent baseline 1.4-1.7; at baseline. likely secondary to diabetes and hypertension. diovan was initially held for concern for acute renal failure but was restarted when the creatinine was confirmed to be at baseline. . 6. thrombocytopenia: recent baseline 93-157. the patient's platelet count remained stable during admission. unknown etiology. be due to liver disease. further work-up deferred to the outpatient setting. . 7. anemia: recent baseline low-30s. the patient's hematocrit remained stable during admission. likely component of chronic renal failure. recent iron studies were within normal limits. b12 and folate within normal limits on this admission. further work-up deferred to the outpatient setting. . code: full . disposition: home medications on admission: lasix 80 mg daily coreg 12.5 mg diovan 80 mg daily digoxin 125 mcg daily coumadin - dosed per clinic amiodarone 200 mg daily insulin 70/30, 30 units daily zocor 20 mg daily discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). 4. furosemide 40 mg tablet sig: two (2) tablet po daily (daily). 5. insulin nph-regular human rec 100 unit/ml (70-30) suspension sig: thirty (30) units subcutaneous once a day. 6. colchicine 0.6 mg tablet sig: one (1) tablet po 2x/day () as needed for gout. discharge disposition: home discharge diagnosis: primary: 1. gallstone pancreatitis status post stents to the common bile duct and pancreatic duct 2. elevated liver function tests 3. anemia 4. thrombocytopenia . secondary: 1. diabetes mellitus type 2, insulin dependent x 8 years 2. cardiomyopathy, ef 20% 3. icd placement 4. elevated transaminases, unknown etiology 5. chronic atrial fibrillation 6. chronic renal failure, most recent creatinine 1.7 7. umbilical hernia repair, discharge condition: afebrile, vital signs stable. discharge instructions: you were hospitalized with pancreatitis. this was due to gallstones occluding the pancreatic and common bile ducts. you had two procedures to stent open the ducts responsible. you should discuss follow-up with gastroenterology with your primary care physician. . please contact a physician if you experience fevers, chills, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, black stools or blood in your stools, or any other concerning symptoms. . for your congestive heart failure: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: one liter per day . please take your medications as prescribed. - you should hold coumadin for ten days after your ercp (until ). - you should hold amiodarone and zocor until follow-up with your primary care doctor. . please keep your follow-up appointments as below. followup instructions: previously scheduled appointments: follow-up with your primary care physician: : , date/time: 1:00 . provider: . phone: date/time: 4:00 . provider: clinic phone: date/time: 3:30 procedure: endoscopic sphincterotomy and papillotomy transfusion of other serum replacement of stent (tube) in biliary or pancreatic duct diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease pure hypercholesterolemia congestive heart failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation chronic kidney disease, unspecified automatic implantable cardiac defibrillator in situ calculus of gallbladder without mention of cholecystitis, without mention of obstruction diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled acute pancreatitis cardiomyopathy in other diseases classified elsewhere hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified 

Answer: The patient is high likely exposed to