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: dyspnea major surgical or invasive procedure: none history of present illness: mr. is a -year-old man with h/o htn, chf (ef 25-30%), chb/afib (s/p pacemaker, on coumadin and digoxin), as s/p avr , oa, presenting to pcp with progressive sob x2 days. . the pt's daughter endorses that he may have missed some doses of his home lasix. the pt endorses worsening fatigue on exertion and a 20 lb weight gain, pedal edema and sob, most notable since yesterday. denied other discomfort, including notable absence of chest pain, and ros for other major systems is negative. . in pcp's office at 3 p.m. appointment (urgent care given symptoms) 136/78, 116, 20, 97% ra, lungs with bibasilar crackles, tachycardic and irregular, with 3+ pedal edema. ekg rapid afib 136 - 160's. transported to ed via ambulance from his office. . in the pt noted to be hr 150 123/92 24 93% ra --> 99% 3l. cxr showing increased interstitial edema, worsening l sided effusion and possible left perihilar region. he received 20mg iv diltiazem and 40mg iv lasix in the ed. he felt ok in the ed and did not have cp. transferred to ccu for further management of chf exacerbation and afib. past medical history: complete heart block s/p pacer placement at aortic stenosis s/p avr (st. porcine valve, ) atrial fibrillation s/p cardioversion systolic congestive heart failure, ef 25-30% on tte htn gerd s/p orif "right leg" cholecystectomy cataract removal bph s/p turp carpal tunnel syndrome s/p release allergic rhinitis l hip oa s/p thr dementia dx h/o rhabdomyalysis social history: retired window cleaner, 3 children locally. he quit smoking 20 years ago and reports having smoked 1.5 packs per day for sixty years. he estimates drinking about 3 alcoholic drinks per month. he lives at an facility in . family history: non contributory. physical exam: 96 127 95/49 15 91-98% 3l nc elderly frail appearing gentleman in no distress even during high heart rate. pleasant, conversational. jvd and pulsations noted above the level of the earlobe at 30 degress. slight hepatojugular reflux noted. bibasilar loud end inspiratory crackeles, good air movement, no wheezes, no labored breathing or accessory muscle use grossly irregular and rapid, no murmurs appreciated but difficult to hear. abd soft, nt nd ble with gross pitting edema up to thighs, less so on the abdomen. chronic venous stasis changes and lle has a hyperkeratotic lesion mid shin. cn 2-12 intact, speech without dysarthria, no facial droop, alert and appropriate, moving all four extremities spontaneously pertinent results: chest (portable ap) study date of 6:13 pm impression: apparent interval enlargement of large left pleural effusion. diffuse interstitial edema, likely cardiogenic in etiology. underlying infiltrate, particularly in the left perihilar region cannot be excluded. consider repeat radiography after appropriate diuresis. if clinically feasible, consider pa and lateral views for improved detection. brief hospital course: -year-old man with h/o htn, chf (ef 25-30%), chb/afib (s/p pacemaker, on coumadin and digoxin), as s/p avr in , oa, admitted to ccu with worsening fatigue/doe, 20 lb weight gain (180 in --> now 196), worsening pedal edema, cxr with pulmonary edema and worsening l pleural effusion, all consistent with acute on chronic systolic heart failure and atrial fibrillation with rvr. . #. acute on chronic systolic heart failure: unclear precipitant but medication nonadherence seems likely per the pt's daughter who says he may have missed a couple days of lasix. patient was therapeutically anticoagulated on admission making pe less likely. infarct less likely given normal trop and negative mb. unclear why patient is not on beta blocker at home. patient was diuresed with iv lasix with improvement of his symptoms. he was transitioned to po lasix when euvolemic. patient was started on low dose beta blocker, and continued on acei, digoxin, and lasix on discharge. . #. afib with rvr: on presentation, patient had heart rates ranging 140-180's with wide complexes, irregular. felt to be afib with underlying ivcd. he was started on amiodarone drip with heart rate responding to 120s. patient was continued on digoxin and warfarin anticoagulation. ep was asked to interrogate his pacer which revealed that he has been in a fib for the last year but with increasing average ventricular rate over the last 2 weeks. patient had ep ablation performed on . . # hyperkeratotic lesion on leg: the dermatology service was consulted given concern for squamous cell carcinoma. the lesion was biopsied, biopsy results are consistent with stasis changes and porokeratosis. he will follow up with dermatology as an outpatient. medications on admission: azelastine (asteline) 137mcg 2 sprays each nostril digoxin 125mcg daily furosemide 40 daily lisinopril 2.5 daily omeprazole 20mg daily potassium 20meq sr daily tramadol 50mg prn pain warfarin 7mg mon, wed, thurs, fri, sun, 5mg tues & sat calcium carbonate 500mg tid docusate 100mg prn constipation ergocalciferol 400 iu daily ferrous sulfate 325 daily mvi daily senna prn constipation discharge medications: 1. astelin 137 mcg aerosol, spray sig: two (2) sprays nasal twice a day. 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 3. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): hold for sbp < 100. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. 7. tramadol 50 mg tablet sig: one (1) tablet po twice a day as needed for pain. 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. warfarin 5 mg tablet sig: one (1) tablet po 2x/week (tu,sa). 12. warfarin 2 mg tablet sig: one (1) tablet po 5x/week (,mo,we,th,fr): take with 5 mg tablet for total of 7 mg every sun, mon, wed, thurs, fri. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 14. ferrous sulfate 325 mg (65 mg iron) capsule, sustained release sig: one (1) capsule, sustained release po once a day. 15. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 16. outpatient lab work please check inr, chem-7 and hct on wednesday with results to dr. at discharge disposition: home with service facility: homecare discharge diagnosis: acute on chronic systolic congestive heart failure atrial fibrillation with rapid ventricular response right and left lower extremety lesions, biopsy done. 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: you missed some doses of lasix at home and you retained a lot of fluid that required intravenous lasix to diurese. you will have home telemonitoring to more closely follow your fluid status. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. you also had atrial fibrillation that was very rapid. you underwent an ablation and your pacemaker was adjusted to that you are now dependent on your pacemaker. your digoxin was discontinued as it is not needed anymore. there were two areas on your right and left shin that were concerning for skin cancer. a dermatologist removed these lesions and the biopsy results should be back in a week. please call dr. office below for the results if you don't hear in a week. there was no evidence of infection. . medication changes: 1. your digoxin has been discontinued 2. you have been started on metoprolol succinate for your heart failure. 3. all of your other medicines are unchanged. followup instructions: primary care: , a. phone: date/time: friday at 11:15am. previously scheduled: date/time: 11:30 . dermatology: an appointment has been made for you to follow up the results of your skin biopsy on friday at 245pm with dr. , in building, . phone: . cardiology: provider: , md phone: date/time: 1:40 procedure: catheter based invasive electrophysiologic testing closed biopsy of skin and subcutaneous tissue diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation atrioventricular block, complete long-term (current) use of anticoagulants unspecified disorder of skin and subcutaneous tissue cardiac pacemaker in situ heart valve replaced by transplant acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to