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: aspirin / lasix / monosodium glutamate / cucumber (cucumis sativus) / lisinopril attending: chief complaint: fatigue major surgical or invasive procedure: - synchronized electrical cardioversion - avnrt ablation history of present illness: the patient is a 77 year old male with medical history that includes non-ischemic cardiomyopathy thought to be secondary to velcade/rituxan (now with normalized left ventricular function), paroxysmal atrial fibrillation on coumadin, supraventricular tachycardia, severe tricuspid regurgitation, esrd secondary to waldenstroms macroglobulinemia, and metastatic prostate cancer who is transferred from hospital with hypotension and supraventricular tachycardia. for the past couple weeks he reports worsening dyspnea. at baseline his functional status is limited as he becomes dyspniec with ambulation of 10-20feet. lately, however he becomes short of breath just with transitioning from sitting to standing or any ambulation. he also endorses episodes of waking up at night feeling very short of breath. he also endorses worsening lower extremity edema but is not clear if his weight has changed. he denies chest pain, fever, chills. he reports stable bone pain related to his metastatic prostate cancer. at dialysis this past week, he was felt to be volume overloaded and underwent extra ultrafiltration with removal of 6.5kg tuesday, 2.5kg wednesday, and 1kg thursday with some improvement in his breathing and lower extremity edema. per notes, he usually tolerates a blood pressure in the 80s during dialysis. . he is followed by dr. for cardiomyopathy and was referred to dr. in for evaluation of supraventricular tachycardia. in , he underwent successful dccv for atrial fibrillation. during the procedure, he went into supraventricular tachycardia that did not respond to vagal maneuvers but broke with adenosine. since that time he has been noted during dialysis session to be in svt, limiting fluid removal. he underwent holter monotoring where he was predominantly in an ectopic atrial rhythm with episodes up to 14hrs in duration of atrial tachycardia. he was seen by dr. in and was started on amiodarone after declining invasive procedures to further characterize/treat his rhythm. . he presented to hospital on complaining of generalized weakness and fatigue where initial vitals were 98.2 82/53, hr 129, and 98%ra. ekg revealed regular narrow complex tachycardia. he was felt to be volume overloaded on exam. he underwent hemodialysis on saturday with removal of 1kg of fluid. cardiology recommended starting dobutamine for hypotension. he was transferred to on 5 of dobutamine with 2piv. . on arrival to ccu, blood pressure was 71/40, hr 140s regular narrow complex tachycardia, respiratory rate of 20 with o2 sat mid 90s on room air. ekg showed narrow complex tachycardia with rate of 148 with long r-p interval. he was given adesonine 6mg and then 12mg without significant change in rate (130s) or rhythm. bedside tte showed hyperdynamic lv and dilated rv with adequate wall motion and moderate/severe tr. he was then given 2 mg versed and underwent dccv 200j after which he transiently went into an atrial ectopic rhythm with rate in 80s and then atrial fibrillation with rates in 80s-90s. his blood pressure improved to 88/50 and then later to 90s/50s. on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he 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, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. non-ischemic cardiomyopathy attributed to velcade and rituxin (with improved lvef following discontinuation) 2. waldenstrom's macroglobulinemia s/p velcade and rituxan (last rx in ) 3. metastatic prostate cancer - lupron every 3 months 4. esrd due to waldenstrom's macroglobulinemia - hd tues, thurs and sat 5. hypertension 6. hypercholesterolemia 7. s/p rv perforation and surgery with complication from rv biopsy to rule out amyloidosis social history: retired photographer who lives with his wife, (she is also is hcp). quit smoking since . denies current alcohol use; none since . family history: father died of throat cancer at age 58 (prior smoker) and mother died in her 90's - ? brain tumor. physical exam: on admission: . vs: 97.8 71/44 147 22 95%ra general: oriented x 3. affect appropriate, speak full sentences. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp elevated to 10 cm, prominent v waves. cardiac: pmi located in 5th intercostal space, midclavicular line. normal s1, s2.iii/vi systolic murmur heard at llsb worsened by inspiration, regular rhythm, increased rate lungs: tachypnic, no accessory muscle use. decreased bs at bases abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no cyanosis or clubbing with 2+ peripheral edema to the level of the mid-thighs bilaterally. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 06:19am blood wbc-3.5* rbc-3.24* hgb-9.4* hct-31.1* mcv-96 mch-29.1 mchc-30.3* rdw-23.8* plt ct-157 . 09:50pm blood neuts-79.5* lymphs-15.9* monos-3.0 eos-1.0 baso-0.5 . 09:50pm blood pt-54.3* ptt-56.9* inr(pt)-5.4* . 09:50pm blood glucose-121* urean-23* creat-3.1* na-140 k-4.2 cl-96 hco3-30 angap-18 . 09:50pm blood alt-19 ast-52* ld(ldh)-399* ck(cpk)-53 alkphos-662* totbili-1.8* . 09:50pm blood ck-mb-2 ctropnt-0.13* probnp-* . 09:50pm blood albumin-2.9* calcium-8.4 phos-4.1 mg-2.0 . microbiologic data: blood culture - pending mrsa screen - negative blood culture - pending . imaging studies: 2d-echo - there is mild symmetric left ventricular hypertrophy with normal cavity size. overall left ventricular systolic function is normal (lvef>55%). the right ventricular free wall is hypertrophied. the right ventricular cavity is moderately dilated with normal free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. normal lv function. dilated and hypertrophied rv with pressure and volume overload. severe tricuspid regurgitation. moderate pulmonary hypertension. compared with the findings of the prior study (images reviewed) of , there are now signs of worsening rv pressure and volume overload. . chest (portable ap) - bilateral effusions slighly increased since . old displaced anterior third rib fracture. intact sternal wires. left subclavian stent. brief hospital course: 77m with medical history that includes non-ischemic cardiomyopathy thought to be secondary to velcade/rituxan (now with normalized left ventricular function), history of paroxysmal atrial fibrillation on coumadin, supraventricular tachycardia, severe tricuspid regurgitation, esrd secondary to waldenstrom??????s macroglobulinemia, and metastatic prostate cancer who transferred from hospital with hemodynamically unstable supraventricular tachycardia with improvement in blood pressure following electrical cardioversion. . # supraventricular, narrow-complex tachycardia - the patient presented with a regular, narrow complex tachycardia with predominantly no p (or p in qrs). adenosine did not terminate (as typically occurs in avnrt; he received 6 mg iv push followed by 12 mg iv push without resolve) his rhythm or bring out p waves (as typically occurs in atrial tachycardia). in the past he was not interested in formal ep studies and potential ablation but this was re-addressed this admission. following electrical cardioversion, his rhythm converted to atrial fibrillation with a hr in the 80-90 bpm range; he reverted back to an atypical tachyarrhythmia with a rate of 130-140 bpm within 1-2 hours following cardioversion. he was prepared for an electrophysiology study on given his persistent rhythm issues. he was started on amiodarone 100 mg iv loading followed by a 0.5 mcg/min continuous infusion with improvement in his hr to the 100-120s with improvement in his bp to the 80/60s range. we initially held his av-nodal blocking agents. his tsh on admission was 6.4. we also initially held his anticoagulation (indication being atrial fibrillation) on admission, given that his inr was 5.4 - and he received 3 mg vitamin k po x 1 given his supratherapeutic inr and the need for an ep study. on he went to the electrophysiology lab and underwent an avnrt ablation with successful ablation of his re-entry pathway; although the passage of the wire was difficult given his wide-open tricuspid regurgitation. he was also transitioned to amiodarone 200 mg po daily following the procedure, however, he developed thrombocytopenia which was thought to be related to the iv amiodarone load he received, and this was briefly discontinued. after the procedure, he remained predominantly in nsr with frequent pacs but had some episodes of afib. prior to discharge, he had reverted back into afib and will be restarted on amiodarone in an attempt to maintain nsr. the thrombocytopenia was thought to be related to the iv amiodarone as he had previously tolerated iv amio with no observed drop in platelets. . # hypotension - the patient presented with hypotension in the setting of a supra-ventricular tachyarrhythmia, improved following electrical cardioversion initially, but then he spontaneously reverted to an atypical tachyarrhythmia with a blood pressure in the 70/50 mmhg range. while he met sirs criteria on admission, there was no clear source of infection at that time. culture data was obtained on admission, which was unrevealing, and we held off on empiric antibiotics. his admission cxr showed bilateral pleural effusions with no evidence of consolidation. his hypotension did improved with cardioversion and with initiation of anti-arrhythmic medication. he notably has blood pressures in the 80/60 mmhg range while at dialysis, per his records; without notable symptoms. . # decompensated heart failure with preserved ejection fraction - the patient has a history of non-ischemic cardiomyopathy with a previous ejection fraction of 50-55% on most recent echocardiogram (prior lvef was 20% while on chemotherapy agents). he has stage iii/iv nyha heart failure and appeared to be volume overloaded on exam when admitted (lower extremity edema, jvd in setting of moderate-severe tr). his labs (elevated bnp) and imaging studies (pleural effusions, mild pulmonary edema) supported these findings. he appeared to have moderate pulmonary artery hypertension with a dilated right ventricle and severe (4+) tricuspid regurgitation with overall worsened right ventricular function compared to his prior exam; with abnormal septal motion/position consistent with right ventricular pressure/volume overload (lvef 55%). the development of his tachyarrhythmia likely contributed to this acute decompensation. he has not been on acei/ therapy (creatinine 3.1 on hemodialysis). we initially held beta-blocker therapy given his hypotension; his home dose being metoprolol succinate 250 mg po daily. this was restarted fir rate control when he returned to afib. nephrology was consulted given the concern for volume overload and the need for ultrafiltration. we were only able to remove fluid by ultrafiltration and his volume status slowly improved during admission, he will continue to have fluid removed by ultrafiltration at hd after discharge. . # thrombocytopenia: during this admission, his platelets trended down from 100-150 at admission to 15 on hd5. the patient did not have any bleeding. hit antibody was negative, and the patient has been receiving heparin at dialysis routinely, making hit unlikely. no evidence of dic on labs. hematology was consulted, and he was treated with prednisone 50mg which was quickly tapered down and the patient's platetets improved. the etiology of his thrombocytopenia was thought to be antibody-mediated amiodarone toxicity from the iv amiodarone load he received at admission. hematology recommended avoiding po amiodarone if possible, although this will be necessary to control his rate. at admission, he had been on po amiodarone and had maintained his platelet count. . # esrd on hemodialysis - thought to be secondary to light chain cast nephropathy from waldenstrom's macroglobulinemia, on hemodialysis since . he presented with volume overload, but without significant metabolic derangements warranting urgent dialysis. nephrology was consulted and he continued to receive hd on a tuthsa this admission. he was maintained on nephrocaps 1 tablet po daily and all medications were renally dosed. . # prostate cancer - the patient is followed by dr. for castrate-resistant metastatic prostate cancer that has been refractory to docetaxel with a rising psa (most recently 1883 in ) on zytiga and prednisone at home. he has also received radiation to his right hip in the past for metastatic disease. we continued his home oxycodone medication (as needed) for pain control given his bone metastasis. . # anemia/leukopenia - his anemia and leukopenia are stable compared to prior recent labs and are thought to be due to bone marrow involvement of his prostate cancer; less likely due to waldenstrom's. his counts were serially trended on this admission. . # code status - full code (discussed with patient) . # transition of care issues: 1. will need inr monitored - was therapeutic at discharge and he will be continued on home dose of 1 mg daily 2. currently on tuesday, thursday, saturday hemodialysis schedule 3. need uptitration of his metoprolol dose if tachycardia persists. we decreased from 250 to 100 mg daily because of hypotension. 4. should have platelets monitored after discharge to ensure that he is not thrombocytopenic; given that he is going home on amiodarone. medications on admission: -amiodarone 200mg daily (started ) -metoprolol succinate 100 mg daily -nephrocaps 1 capsule po daily -lanthanum 1000 mg tablet po tid with meals -prednisone 5 mg po daily -coumadin 1 mg po daily -oxycodone 5mg q4 hours prn pain -vitamin e 400-800 mg po qd -hydroxyzine 25-50mg po bid prn -prochlorperazine maleate 10 mg po q8 hrs prn nausea -leuprolide 7.5 mg injected q 12 weeks discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily): take this medication with food. disp:*30 tablet(s)* refills:*0* 2. abiraterone 250 mg tablet sig: four (4) tablet po daily (): take 1-2 hours before prednisone. 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 4. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. 5. hydroxyzine hcl 25 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for itching. 6. oxycodone 5 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. 7. vitamin e 400 unit tablet sig: one (1) tablet po once a day. 8. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po three times a day: hold sbp < 100, hr < 55. 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 11. metoprolol tartrate 50 mg tablet sig: one (1) tablet po three times a day: hold sbp< 100, hr < 55. 12. leuprolide 7.5 mg syringe kit sig: one (1) injection intramuscular every 12 weeks. discharge disposition: extended care facility: rehabilitation and skilled nursing center - discharge diagnosis: primary diagnosis: . av node re-entrant tachycardia s/p ablation procedure hypotension paroxysmal atrial fibrillation . secondary diagnoses: . end stage renal disease waldenstrom's macroglobulinemia metastatic prostate cancer chronic diastolic heart failure severe tricuspid regurgitation thrombocytopenia of unclear etiology discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you during your admission at . you were admitted to the cardiac care unit because your heart was beating very fast and your blood pressure was low. we treated you with an antiarrhythmic drug called amiodarone and performed an ablation procedure in an attempt to prevent this event from happening again. you tolerated the procedure well. you also continued to receive dialysis during your admission to remove extra fluid that was causing swelling in your arms and legs. your platelet count dropped and have now increased again. you did not have any signs that you were bleeding. you will follow up with dr. next week and will need to get your platelet count followed regularly. . the following changes were made to your medications: 1. change metoprolol to tartrate and increase the dose to 50 mg three times a day to lower your heart rate 2. start amiodarone to slow your heart rate and keep you in a normal rhythm. followup instructions: department: hematology/oncology when: tuesday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 11:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 11:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: thursday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach diagnoses: hyperpotassemia end stage renal disease renal dialysis status pure hypercholesterolemia congestive heart failure, unspecified atrial fibrillation personal history of malignant neoplasm of prostate acute on chronic diastolic heart failure other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease personal history of other lymphatic and hematopoietic neoplasms other specified cardiac dysrhythmias accidents occurring in residential institution diseases of tricuspid valve secondary malignant neoplasm of bone and bone marrow anemia in neoplastic disease paroxysmal supraventricular tachycardia cardiac rhythm regulators causing adverse effects in therapeutic use macroglobulinemia other secondary thrombocytopenia secondary cardiomyopathy, unspecified 

Answer: The patient is high likely exposed to