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: problems with speech right sided clumsiness major surgical or invasive procedure: ir guided picc history of present illness: the pt is a 53 year-old right-handed man with a pmh of afib off coumadin, htn, hld, dm and etoh use who presented to the ed with difficulty with his speech and clumsiness. he states that he stopped coumadin several months ago as he ran out. he did not pursue a refill. this morning he woke in his usoh. he watched tv in the morning and noticed intermittent episodes of problems with his vision on the r side. it was not complete visual loss and he is unable to describe if it was a portion of vision missing vs blurriness. this resolved, however around 3 pm he had abrupt onset difficulty with his speech. he states the he was barely able to speak but was clear about what he wanted to say. he also noticed that his r hand was very clumsy. he denied numbness or focal weakness however. he waited for several hours and went to the grocery store. he then called his recently separated wife around 7 pm. she noticed that he speech was non-fluent with very limited phrases and was concerned. she thought he had either consumed etoh or "was sick". she picked him up and brought him to the ed. past medical history: - dm - htn - hld - cad - afib off coumadin social history: -currently disabilty, former driver -etoh: 6-8 beers per night and "hard alcohol" (unspecified amount, no hx of dt's, sz or withdrawal) -tobacco: -drugs: denies family history: non-contributory physical exam: physical exam: vitals: t: 99.2 p: 82 r: 16 bp: 132/80 sao2: 99% on ra bs 258 nih ss: 3 1a. level of consciousness: 0 1b. loc questions: 0 1c. loc commands: 0 2. best gaze: 0 3. visual: 0 4. facial palsy: 1 5a. motor arm, left: 0 5b. motor arm, right: 1 6a. motor leg, left: 0 6b. motor leg, right: 0 7. limb ataxia: 0 8. sensory: 0 9. best language: 1 10. dysarthria: 0 11. extinction and inattention: 0 general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: pansystolic murmur in the mitral area abdomen: hepatosplenomegaly with ascites. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. pulses: all peripheral pulses present skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. attentive. language is non- fluent with frequent pauses. words sentences. repetition is almost intact "no ifs ands and buts". intact comprehension. normal prosody. there intermittent paraphasic errors ("captus"). pt. was able to name both high and low frequency objects. able to read without difficulty. speech was minimally dysarthric. able to follow both midline and appendicular commands. the pt. had good knowledge of current events. there was no evidence of apraxia or neglect. cn i: not tested ii,iii: vff to confrontation, pupils 4mm->2mm bilaterally, fundi normal iii,iv,v: eomi, no ptosis. no nystagmus v: sensation intact v1-v3 to lt vii: r nlf flattening viii: hears finger rub bilaterally ix,x: palate elevates symmetrically, uvula midline : scm/trapezeii bilaterally xii: tongue protrudes midline, no dysarthria motor: normal bulk and tone; no asterixis or myoclonus. + r pronator drift. delt tri we fe grip io c5 c6 c7 c6 c7 c8/t1 t1 l 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 ip quad hamst df pf l2 l3 l4-s1 l4 l5 s1/s2 l 5 5 5 5 5 5 r 5 5 5 5 5 5 reflex: no clonus tri bra pat an plantar c5 c7 c6 l4 s1 cst l 0-------------- flexor r 0-------------- flexor -sensory: no deficits to light touch. no extinction to dss. -coordination: no intention tremor, dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: deferred pertinent results: tte from the left atrium is normal in size. the right atrium is moderately dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = %). a left ventricular mass/thrombus cannot be excluded. transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. the right ventricular cavity is mildly dilated with depressed free wall contractility. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severely depressed left ventricular systolic and diastolic dysfunction. depressed right ventricular function. mild to moderate mitral regurgitation. moderate to severe tricuspid regurgitation. cannot exclude left ventricular apical thrombus. cthead/cta - prelim read stroke in the left mca superior division territory.left fronto-temporal hypodensity with increased mtt, decreased blood flow. no cut off seen on vessels. brief hospital course: 2d-echocardiogram performed on demonstrated: the left atrium is normal in size. the right atrium is moderately dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = %). a left ventricular mass/thrombus cannot be excluded. transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. the right ventricular cavity is mildly dilated with depressed free wall contractility. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severely depressed left ventricular systolic and diastolic dysfunction. depressed right ventricular function. mild to moderate mitral regurgitation. moderate to severe tricuspid regurgitation. cannot exclude left ventricular apical thrombus. cta head: no acute intracranial process with no abnormal enhancement, infarction or hemorrhage. #. cad: pt has h/o cad per records. he had a cath sometime in the past at which showed 90% lad lesion but not stented. started coreg for bp control as well as captopril. continued asa 81. held statin in setting of transaminitis but may consider starting as o/p if liver function tests wnl. #. pump: pt has severe systolic and diastolic chf and cardiomyopathy with lvef of 10. the cardiomyopathy is likely from cad and alcohol use. initially, pt seemed volume overloaded and at that point on his starling curve where is not able to mainten enough cardiac output. on lasixc gtt patient was diuresed. he then was put on a po dose of lasix for maintenance once he was euvolemic. he was started on an ace inhibitor and coreg. he was continued on asa. statin was held as below. he will discuss with his cardiologist whether he may benefit from an aicd if on follow up tte's he continues to have low ef. coreg, lisinopril, and spironolactone were initiated as well. #lv thrombus: pt has sever global hypokinesis. he ran out of coumadin a few months back and has not been taking it. likely source of embolic stroke. was placed on heparin gtt and then bridged onto coumadin. inr was not therapeutic prior to discharge so he was discharged on lovenox with coumadin. he will follow up with dr. for inr checks in 2 days. #elevated liver enzymes: pt had acute elevation of ast, alt (to 1000s range), ap, ldh and tbili. liver us didnt show e/o cirrhosis or portal vein thrombosis. denied any h/o recent etoh binge, mushroom consumption, herbal supplements. no past h/o viral hepatitis. no h/o acetaminophen overdose. the enzyme pattern was concerning for shock liver in the setting of poor forward flow from his cardiomyopathy. there was also concern for viral hepatitis. viral serologies were negative. transaminitis trended down over course of his stay with diuresis/treatment of chf. # dm2: uncontrolled with a1c 8.2%. monitored with fsbs. given 20units lantus per his home regimen (per patient) plus iss. was consulted and titrated his diabetic regimen further. will likely need further titration of diabetic regimen as outpatient as was uncontrolled pre a1c. # elevated cr: 1.3 on admission from 0.8 baseline. thought likely from poor perfusion. doesnt seem dehydrated. improved to baseline with diuresis. # alcohol abuse: initially had ciwa scale. never had signs of withdrawal and this was eventually d/c'd. social work was consulted and worked with the patient. he understands the dangers of continuing to drink and has said he will not drink in the future. # code: full medications on admission: none - the medications provided in the hpi were not what he was taking discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. outpatient lab work please check inr/coumadin level on thursday at dr. office. results to dr. at 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. lovenox 80 mg/0.8 ml syringe sig: one (1) injection subcutaneous twice a day for 2 days. disp:*4 doses* refills:*2* 7. coumadin 2.5 mg tablet sig: three (3) tablet po once a day: check coumadin level on . . disp:*90 tablet(s)* refills:*2* 8. carvedilol 6.25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 9. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. insulin glargine 100 unit/ml solution sig: twenty five (25) units subcutaneous at bedtime. disp:*1 bottle* refills:*2* 11. insulin lispro 100 unit/ml solution sig: as per sliding scale units subcutaneous four times a day: please check blood sugar 4 times a day and take lispro right before each meal. . disp:*1 bottle* refills:*2* 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: home discharge diagnosis: left superior mca stroke left ventricular thrombus severe acute on chronic systolic and diastolic congestive heart failure with ejection fraction 10% atrial fibrillation secondary diagnoses: uncontrolled type 2 diabetes hypertension discharge condition: the patient was afebrile and hemodynamically stable prior to discharge. discharge instructions: you were admitted with a stroke which affected your speech and gave some mild weakness in your right arm. your symptoms have improved. . the stroke was likely caused from a clot in your heart. you will need to remain on anticoagulation with warfarin (coumadin) and have your lab test called inr monitored for how thin your blood is. do not stop taking your coumadin or you risk having another stroke. your primary care doctor, dr. , check your inr test 2-3 days after you leave the hospital and help you change your coumadin dose appropriately. you should also take aspirin daily. you have congestive heart failure. this can make you become fluid overloaded. you must maintain a low salt diet (less than 2 grams per day) and restrict your fluid intake to 1.2 liters per day. you have been started on a medication called spironolactone and your furosemide (lasix) was continued to help keep the fluid off. you were also started on lisinopril to keep your blood pressure low and carvedilol to help your heart pump better. your new cardiologist, dr. , follow your heart function and possibly put in a defibrillator to make sure you do not have a cardiac arrest in the future. you can discuss this with him at your follow up appointment. you will also be seen in the heart failure clinic here at to help adjust your medicines. . you were seen by the clinic to help with improving your blood sugars. this will help prevent another stroke and possible kidney failure. take your long acting insulin at night and take the short acting insulin before each meal according to your blood sugar level. a sliding scale for the short acting insulin was given to you on discharge. medication changes: start: warfarin start: lisinopril start: carvedilol start: aspirin start: spironolactone continue: vitamin b6 and b12 as prescribed by dr. continue: lantus insulin at bedtime 20 units continue: humalog insulin before meals as per sliding scale. please check your blood sugar before each meal and at bedtime. you should measure your weight daily. if you gain more than 3 pounds in a week or less, please call dr. . please follow a low sodium diet to prevent the accumulation of fluid. information was given to you regarding a low sodium diet, daily wieghts and symptoms to watch for on discharge. . please call dr. if you notice any trouble breathing, cough, lying flat at night, swelling in your ankles, chest pain, nausea or any other concerning symptoms. followup instructions: neurology: dr. phone: ( date/time: friday at 2:00pm. clinical center, . , . . cardiology: dr. phone: ( date/time: monday at 3:15pm. , . . primary care: dr. phone: ( thursday at 2:30pm. please have your inr level checked and coumadin dosed appropriately. . diabetes: dr. phone: date/time: office will call you with an appt in the next 2-3 weeks. if you do not hear from dr. office in the next week, please call to schedule an appointment with any of the providers. . congestive heart failure clinic: dr. and : date/time: at 2:30pm. clinical center, . , . procedure: venous catheterization, not elsewhere classified diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver acute kidney failure, unspecified atrial fibrillation other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other ascites diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled cerebral embolism with cerebral infarction alcohol abuse, continuous acute on chronic combined systolic and diastolic heart failure other ill-defined heart diseases 

Answer: The patient is high likely exposed to