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: no known allergies / adverse drug reactions attending: chief complaint: elevated creatinine major surgical or invasive procedure: : right heart catheterization dual chamber icd placement history of present illness: mr. is a 54 year old gentleman with htn, dm2, ckd (baseline cr 2.0-2.2), cad s/p cabg , as well as systolic and diastolic heart failure (ef had been as low as 20% but last known to be 40%), who was recently admitted to the cardiology service from clinic on for worsening dyspnea over 2 weeks. chf exacerbation was in the setting of new inferior hk and he was diuresed with hopes of pursuing rhc/lhc. hospital course was complicated by (cr>3.0), piv-associated mssa bacteremia (did not want , dc'ed on iv nafcillin x4 weeks). rhc was done and showed elevated filling pressures, so he was transferred to the ccu for milrinone to assist with lasix gtt. due to infection, he was only on milrinone for a few hours. he was transferred back to the floor and was diuresed well prior to discharge. he followed up in clinic on and was found to have creatinine elevated to 5.4 despite holding torsemide on (took it ). he was admitted to for management of his . on interview this afternoon, he denies sob at rest. he hasn't been walking much, but doesn't feel "crushing fatigue" now like he did before. he has been sitting to sleep, which he does think is worse than when he was admitted. his itchiness continues, but isn't worse than when in the hospital. he does endorse nausea, diarrhea (8 loose stools a day) which he reports started with the nafcillin. denies fever, chills, abd pain. he reports "i don't do well with ivs. they always increase my creatinine regardless of what it is." he has been following the same diet and eating light. he reports poor intake of fluid as he's trying to avoid drinking a lot, "much less than 1l a day." his right eye seems like it has a swollen eyelid today, but he hasn't noticed. his wife reports that it always looks like this. no headache. reports we weighed 219 today (recorded as 219.2), 215 yesterday, 211 on discharge. on review of systems, he denies any prior history of stroke, tia, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. 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, palpitations, syncope or presyncope. +orthopnea, +pnd past medical history: hypertension dyslipidemia diabetes mellitus -retinopathy s/p laser surgery -peripheral neuropathy with ulcers chronic kidney disease (baseline cr 2.0-2.2) coronary artery disease -s/p cabg in (lima-lad, svg-pda, and radial-om1-om2) congestive heart failure -: b&wh admission with ef of 20% in chf, improved to 40% on discharge deep vein thrombosis x1 (s/p warfarin in the past) s/p right knee arthroscopy iron deficiency anemia gout social history: -home: lives in with his wife. married 20 years. -occupation: works as a financial planner, lawyer, runs a property company. -tobacco: used to smoke one cigar daily since high school until stopping after cabg. no cigaretters. -etoh: none -illicits: none family history: mom had cabg in 60s. 3 brothers all without heart disease or diabetes. father with ?lymph cancer. physical exam: admission physical examination: vs: 97.6 - 144/77 - 74 - 20 - 95ra - bs304 weight: 219.2 (on discharge , 96kg (211 lbs) general: alert, oriented x3. sitting in bed with wife at bedside. no respiratory direstress. heent: mmm, r eye seems ptotic neck: supple with jvp 8-9 cm cardiac: pmi closer to midline w/ rv lift. rr, s1, s2 w/ paradoxical splitting, s3. no murmur or rub. lungs: mild crackled bilateral bases, no wheeze abdomen: softly distended. abd aorta not enlarged by palpation. no abdominal bruits. bs present. +hepatojugular reflex extremities/skin: severe stasis dermatitis with anterior weeping ulcers on lower extremities. also continues to have scab on lateral r thigh. not grossly edematous (trace) neuro: cn 2-12 intact, bilateral ue's and le's , finger extensors , no sensation to light touch from mid calf downwards (stable from last exam), no decreased sensation to touch in ues. . discharge afebrile, normotensive (sbp 130s-140s), non-tachycardic, non-tachypneic, saturating well on ra exam same as above except: chest: l upper chest- well-appearing, no mass palpated, appropriately tender pulm: mild bibasilar crackles ext: le edema much improved, ulcers healing well pertinent results: admission labs 05:35pm blood wbc-6.8 rbc-3.80* hgb-9.1* hct-29.4* mcv-77* mch-23.9* mchc-30.9* rdw-18.8* plt ct-296 02:54pm blood urean-105* creat-5.4*# na-128* k-4.7 cl-85* hco3-27 angap-21 05:35pm blood glucose-261* urean-91* creat-4.9* na-132* k-3.7 cl-88* hco3-29 angap-19 05:35pm blood calcium-8.8 phos-7.0*# mg-3.0* . imaging: echo left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed (lvef= 30 %). right ventricular chamber size is normal. with borderline normal free wall function. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular cavity size is smaller and overall ejection fraction has increased. echo the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20 %). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with depressed free wall contractility. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , biventricular systolic function has decreased. cath comments: 1. right heart catheterization revealed severely elevated right and left sided filling pressures. the mean ra pressure was severely elevated at 18 mmhg, and the rvedp was severely elevated at 22 mmhg. there was severe pulmonary arterial hypertension with a pa pressure of 80/33 mmhg and a mean pa pressure of 49 mmhg. the mean wedge pressure was severely elevated at 32 mmhg. the cardiac output and index were reduced at 4.3 l/min and 2.0 l/min/m2. the pulmonary vascular resistance was moderately elevated at 316 dyne-sec/cm5. 2. ultrasound of the right internal juggular vein suggested thrombus which is possibly related to the patient's right sided picc line, however subsequent imaging indicated no thrombus but rij very medially displaced. final diagnosis: 1. severely elevated right and left sided filling pressures. 2. severe pulmonary arterial hypertension. 3. reduced cardiac output/index. 4. moderately elevated pvr. 5. possible thrombus in the right internal jugular vein which was not confirmed by subsequent studies which showed rij very medially displaced. cxr transvenous right atrial pacer and right ventricular pacer defibrillator leads are in standard positions. yesterday's mild pulmonary edema has resolved. there is no pneumothorax, pleural effusion or mediastinal widening. heart is top normal size, unchanged over the long term. also unchanged since at least are fractures of the two uppermost sternal wires, which developed sometime after when non-fusion of the manubrium was already evident radiographically. cxr findings: in comparison with study of , there has been placement of an icd device with the leads in the region of the right atrium and apex of the right ventricle. specifically, there is no evidence of pneumothorax. little change in the appearance of the heart and lungs. persistent separation of the upper sternal fragments therefore does not suggest infection, but it is an explanation for fracture of the wires cxr reason for examination: evaluation of the patient with systolic and diastolic heart failure. pa and lateral upright chest radiographs were reviewed in comparison to . heart size is enlarged in a globular manner, unchanged. mediastinum is stable. multiple broken sternal wires are redemonstrated. as compared to the prior study, there is interval improvement in interstitial pulmonary edema, currently mild. there is also improvement in more focal right upper lobe opacity. prominence of pulmonary arteries is demonstrated, most likely consistent with pulmonary hypertension. no appreciable pleural effusion is seen. renal u/s impression: no hydronephrosis seen in either kidney. small right renal nonobstructing stone. . discharge 04:00am blood wbc-7.1 rbc-3.28* hgb-8.4* hct-28.1* mcv-86 mch-25.7* mchc-30.0* rdw-23.2* plt ct-234 04:00am blood pt-15.2* ptt-37.4* inr(pt)-1.4* 05:00am blood glucose-220* urean-74* creat-3.3* na-133 k-3.5 cl-91* hco3-31 angap-15 05:00am blood calcium-9.3 phos-3.8 mg-2.1 brief hospital course: brief hospital course mr. is a 54y/o gentleman with htn, hld, dm2, ckd (baseline cr 2.0-2.2), cad s/p cabg (lima-lad, svg-pda, and radial-om1-om2) with systolic and diastolic heart failure, who was re-admitted from clinic for management of . #. acute on chronic renal failure: baseline cr 2.1, presented last admission at 2.5, and presented at this admission with creatinine 5.4 in clinic. his renal function fluctuated, and he was initially managed with 40mg torsemide. however, he did not respond well and had worsening renal function. accordingly, he underwent r heart cath, which showed severely elevated right and left sided filling pressures, severe pulmonary hypertension and depressed co/ci. he was admitted to the ccu for milrinone drip and more aggressive diuresis. on admission, urine studies suggested pre-renal cause of (feurea 44% is indeterminate, fena 0.86%). torsemide had been held between hospital admissions. nephrology was consulted and recommended cefazolin to substitute for nafcillin (though due to the short time period, they did not believe was consistent with nafcillin-associated acute interstitial nephritis and urine eosinophils were positive. sarna lotion and hydroxyzine were given for symptomatic relief of uremia-related pruritus. pt's cr trended down to mid 3s, plateaued and then steadily rised. after pt was switched from milrinone drip to dobutamine drip as well as optimized afterload reduction with hydralazine and isordil, cr consistently trended down. upon discharge, cr was 3.3. . #. acute on chronic chf: due to continued weight gain and poor response, he underwent a r heart cath . pt's beta blocker was restarted at a low dose and then later on discontinued as pt was in decompensated hf and later on put on dobutamine drip. afterload reduction was successful while up titrating hydralazine and isordil. upon discharge, pt's bp was ranging 130-140. heart failure team believed chf is both related to significant dyssynchrony and contractility issues, both most likely related to ischemia. pt was diuresed aggressively throughout course initially with lasix drip and then transitioned to iv lasix boluses with goal of .5l negative in 24h using 120mg boluses. pt was transitioned to 100mg torsemide at discharge. dyssynchrony component of hf was addressed with attempting to place crt-d. unfortunately, coronary sinus could not be accessed successfully and thus lv lead was not placed. contractility was addressed with dobutamine drip which pt was discharged with. after starting dobutamine infusion, ef improved from 20 to 30% on tte. pt will need to followup with ep in order to access lv for appropriate resynchronization and will probably have a cardiac catheterization to assess coronaries. . #. peripheral iv-associated mssa bacteremia: - changed nafcillin to cefazolin per id recs; he underwent a this admission, which did not show any valvular vegetations. as a result, he underwent a shortened course of iv antibiotics (2 weeks), which ended on . pt remained afebrile and stable thereafter. . #. loose stools - recent hospital stay could raise concern for c. diff (pt nauseous, but no f/c). per patient, he feels that loose stools began w/ nafcillin. either way, may contribute to pre-renal cause of (along with recent poor intake). loose stools resolved after stopping nafcillin. in addition, he was c. diff negative. . . #. cad s/p cabg last cath in noted severe native 3vd with patent lima-lad, svg-pda, and radial-om1-om2. tte on prior showed new inferior hk. he was continued on asa, pravastatin, and beta blocker (metoprolol changed to carvedilol). in the future he needs l heart catheterization in order to assess grafts/native vessels. pt was continued on asa and statin. carvedilol was ultimately held given decompensated heart failure and pt put on dobutamine infusion. . #. neuropathic & venous stasis ulcers: pt was seen by wound care specialist during hospitalization. ulcers appeared to heal more optimally when le edema decreased with aggressive diuresis. pt is to followup with pcp to continue dm management and may need referral to vascular surgery if ulcers persist or worsen. . #. diabetes mellitus: stable on iss, and discharged with lantus 44u at bedtime with iss. . # iron deficiency anemia: hct stable during last admission 30-33. iron studies showed low level of iron and pt was given 5 days of ferric gluconate iv 125mg to replete iron deficit. pt's anemia was stable thereafter and discharged with hct of 28.1. #elevated inr: pt's inr was elevated over 2 during hospital course without anticoagulation. this was attributed to vitamin k deficiency secondary to antibiotic use, malnutrition and malabsorption from congested bowels related to decompensated chf. dic labs were not remarkable. pt's elevated inr was refractory to po vit k which supported hypothesis of congestion in gi tract causing malabsorption issues. as pt's nutrition improved and preload reduction, inr trended down to 1.4 at time of discharge. pt was followed by nutrition during stay and would benefit from outpt nutrition management. . >> transitional issues - follow up with ep regarding crt lead placement into lv - could benefit from acei once kidney function improves - readdress restarting carvedilol when hf better controlled off of dobutamine - f/u with pcp regarding lower extremity wounds, medication reconciliation and diabetes management - would benefit from outpt nutritional support (fluid restriction, diabetes) - would benefit from cardiac cath once kidney function stable and adequate to assess coronaries/ischemic disease related to heart failure - f/u with cardiology medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. nafcillin 2 g iv q4h four week course 2. aspirin 81 mg po daily 3. glargine 44 units bedtime aspart 22 units breakfast aspart 22 units lunch aspart 22 units dinner 4. pravastatin 80 mg po daily 5. carvedilol 12.5 mg po bid 6. hydralazine 50 mg po q8h 7. isosorbide mononitrate (extended release) 120 mg po daily 8. torsemide 60 mg po bid held torsemide on last discharge, from onwards discharge medications: 1. aspirin 81 mg po daily 2. isosorbide mononitrate (extended release) 120 mg po daily 3. pravastatin 80 mg po daily 4. hydralazine 75 mg po q8h please hold for sbp <100 rx *hydralazine 50 mg 1.5 tablet(s) by mouth three times per day disp #*45 tablet refills:*0 5. outpatient lab work for vna to draw: on tuesday , please draw na, k, bun/cre, bicarb, cl, glucose, mg. please fax results to: dr. at . diagnosis: chronic systolic heart failure. 6. dobutamine 5 mcg/kg/min iv drip infusion please double concentrate if possible rx *dobutamine 500 mg/40 ml (12.5 mg/ml) iv dobutamine 5 mcg/kg/min continous infusion disp #*30 bag refills:*0 7. torsemide 100 mg po daily hold for sbp <90 rx *torsemide 100 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 8. hydroxyzine 25 mg po q6h pruritus pt may refuse rx *hydroxyzine hcl 25 mg 1 tablet by mouth every 6 hours disp #*120 tablet refills:*0 9. potassium chloride 40 meq po daily rx *potassium chloride 20 meq 2 tablets by mouth daily disp #*60 tablet refills:*0 10. glargine 44 units bedtime insulin sc sliding scale using hum insulin 11. heparin flush (10 units/ml) 2 ml iv prn flush daily and as needed rx *heparin lock flush (porcine) 10 unit/ml 2ml to picc line flush daily and as needed disp #*100 milliliter refills:*0 discharge disposition: home with service facility: discharge diagnosis: primary acute on chronic kidney injury acute on chronic systolic heart failure secondary mssa bacteremia type 2 diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were first readmitted to for worsened kidney function as well as worsening symptoms of heart failure. you were then tranferred to the ccu because you required medications to help your heart pump. you were first started on milrinone with minimal improvement and were then started on dobutamine. you will go home on a continuous infusion of dobutamine. it is very important for you to follow up closely with your doctors and to take your medications as prescribed. while you were here we tried to place a crt device, however there was difficulty placing one of the leads. you now have an icd. you will need a different procedure in the future to place an additional lead on your heart for cardiac resynchronization. you will also need a cardiac catheterization as an outpatient. weigh yourself every morning, md if weight goes up more than 3 lbs. it was a pleasure caring for you, your doctors followup instructions: department: cardiac services when: wednesday at 10:40 am with: , m.d. building: campus: east best parking: garage please call and schedule the following appointments: 1) with dr. in the next week: 2) with your primary care doctor in the next week: jakhro, a at procedure: venous catheterization, not elsewhere classified left heart cardiac catheterization diagnostic ultrasound of heart implantation of cardiac resynchronization defibrillator, total system [crt-d] diagnoses: anemia in chronic kidney disease abnormal coagulation profile congestive heart failure, unspecified acute kidney failure, unspecified unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified aortocoronary bypass status other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use alcohol abuse, unspecified chronic kidney disease, stage iii (moderate) other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin other left bundle branch block iron deficiency anemia, unspecified personal history of venous thrombosis and embolism diarrhea other and unspecified infection due to central venous catheter unspecified intestinal malabsorption ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified acute on chronic combined systolic and diastolic heart failure penicillins causing adverse effects in therapeutic use deficiency of vitamin k 

Answer: The patient is high likely exposed to