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 / aspirin attending: chief complaint: sinus bradycardia major surgical or invasive procedure: temporary pacer wire cenrtal venous line balloon pump tee history of present illness: 79m chf ef 25%, h/o left sided effusion s/p tap (thought to be chf), cad w/ nstemi , htn, who presents after having 7-second pause while on coreg 25mg; dose decreased, led to afib with rvr; transferred for ? pacer for tachy-brady syndrome vs also biv placement given low ef and potential exacerbation of chf secondary to dysynchrony. hypotensive requiring pressors, elevated lactate. intubated for pulmonary edema. on , pt witnessed to go into asystole -> externally paced with low bp requiring chest compressions, atropine and epinephrine -> bp up and stable without compression -> emergent temp wire placed at bedside. pt taken to cath lab for r ht cath, found to have pwcp 40 and iabp was placed. pt resumed on heparin drip given possible pci to eval for ischemia. patient with map 60-70's however anuric. patient given iv lasix 80mg x1 with no increase in uop -> started on milrinone drip and transferred to the ccu. past medical history: 1. coronary artery disease s/p cath with pci stent to lcx, rca 2. hypertension 3. crohn's disease 4. hypercholesterolemia 5. bph 6. macular degeneration both eyes - legally blind 7. hypothyroidism 8. s/p 2 hip surgeries 9. s/p back surgery . s/p knee surgery . history of gi bleed d/t pud 12. colonic polyps 13. chronic renal insufficiency baseline creat 1.3 social history: former . married with two daughters, lives with his wife. smoked 1-1.5 ppd x 35 years. quit in . etoh: ~ once a week, socially. no drugs. family history: mother with mi in 70s. father with mi 80s. brother and sister with "heart problems". physical exam: exam in ed t: 97.8 hr: 110s-120s bp: 106/89 o2: 99% on 2l nc gen: pleasant, blind elderly man in nad heent: ncat dry mm, no exudates or thrush, perrl, no carotid bruits, no jvd cv: rrr, distant heart sounds, 2/6 sem lusb, prominent lateral pmi lungs: crackles way up b/l abd: nt nd r inguinal bandage in place ext: 1+ pitting edema. weak, dopplerable dp pulses b/l, r>l, good femoral pulses, no bruits b/l gu: tender l testicle, no masses, varicoceles or enlarged epididymis palpated. nontender shaft w/o evidence of discharg. normal appearing meatus. neuro: aao x 3 pertinent results: :portable ap chest radiograph: again seen is stable cardiomegaly. mediastinal contours are stable in appearance. there is minimal perihilar haziness, without any overt prominence of the pulmonary vasculature. there is a probable left pleural effusion. there is opacity in the left retrocardiac area which may represent atelectasis. impression: stable cardiomegaly and probable left pleural effusion. no definite chf . echo : conclusions: 1. the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. left ventricular cavity is dilated, with severely depressed systolic function. there is severe global hypokinesis, with relative preservation of the basal inferolateral wall. 3.there is moderate global right ventricular free wall hypokinesis. 4.there are simple atheroma in the aortic arch and the descending thoracic aorta. 5.the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. 6.the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. 7.the tricuspid valve leaflets are mildly thickened. impression: no intracardiac thrombus. severely depressed left ventricular systolic function. moderately severe mitral regurgitation. compared to the previous report of , the mr is more severe and the rv function appears worse. . : cxr findings: a right subclavian swan-ganz catheter ends in the mid right pulmonary artery. an endotracheal tube ends in satisfactory position 4 cm above the carina. an ng tube passes beyond view into the stomach. a pacemaking device overlies the right chest with pacing electrodes in unchanged position compared to . an intra-aortic balloon pump ends 1 cm from the roof of the aortic arch. moderate cardiomegaly is unchanged. chf is slightly improved compared to the previous day. left lower lobe atelectasis and small bilateral effusions (left greater than right) are unchanged. no pneumothorax is identified. impression: 1. improved chf. unchanged left lower lobe atelectasis and bilateral effusions. 2. the tip of an intra-aortic balloon pump ends 1 cm from the roof of the aortic arch as previously communicated to dr on . urine culture: urine culture (final ): yeast. 10,000-100,000 organisms/ml.. enterococcus sp.. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ =>32 r chloramphenicol------- 8 s levofloxacin---------- =>8 r linezolid------------- 2 s nitrofurantoin-------- 32 s vancomycin------------ =>32 r brief hospital course: 79 yo m with ischemic cardiomyopathy (ef: 15-25%), s/p nstemi, hx of afib, htn recently admitted to for chf exacerbation and treated with lasix was readmitted after 7 second pause while on coreg at rehab (digoxin was d/cd at this time). after decreasing the coreg to 6.25mg , he experienced rvr to 130s-140s. he received 10mg iv diltiazem with good rate control and was referred here for icd placement. on admission, his troponin was up to 0.58 from 0.18 8 days pta without ekg changes. on night of admission, patient was "triggered" for increased hr and decreased urine output. his rate responded to metoprolol (4mg iv). he subsequently developed a 9 second pause on tele. pacer pads were placed and patient was evaluated for the ccu and transferred for closer monitoring. ep was consulted and he was started on heparin for acs. in the ccu: # tachy/brady - in the ccu, patient developed asystole and required atropine and chest compressions -> emergent pacer wire placed by ep. with this asystolic episode, he went into cardiogenic and liver and arf on crf. ## hypotension - this was felt to be a mixed picture of cardiogenic and sepsis - he was placed on pressors, cultured and given empiric abx given rising wbc - vancomycin and aztreonam. the question arose of a possible biliary source given elevated lfts. . # cardiogenic : - tte showed 15-20% ef with 3+ mr with severe global hypokinesis. - with the development of , emergent bedside tee was done which shoed 10-15% ef with 4+ mr and no clots were seen. - he was placed on a balloon pump x 1 day -> dcd on along with milrinone . # cardiac ? ischemia - troponin elevated; 0.53 on admission and rose to 0.73. with his worsening renal insufficiency, decreased gfr may have accounted for his rise in troponins. - since this was elevated beyond what is expected from cri and chf. however, his cks were not elevated. he was on heparin for afib/potential acs. - it was felt that ischemia was one potential source of his cardiogenic and catheterization was to be considered if patient stabilized. . # arf on crf - diuresing with lasix and diuril - this was felt to be a byproduct of his hypotensive episode. . # elevated transaminases: - initially, the elevations were thought to be chf -> as they were initially in vicinity of 1500-1700. however, with his hypotensive episode, they bumped to on -> hence, the rise was likely liver from asystolic episode -> decreased on . it wa snot felt that he was in dic given elevated inr and high lfts and no schistocytes on smear . # end of life: with his grave multiorgan system failure, the family in discussions with the ccu team decided to withdraw pressor support. it was planned to continue to keep the patient comfortable. he passed peacefully a few minutes after pressor withdrawl. autopsy was deferred. medications on admission: . atorvastatin 20 qd - recently d/ced on last hospital admission elevated lfts 2. aspirin 81 mg qd - recently d/ced on last hospital admission gib 3. sulfasalazine 1500 po bid 4. ferrous sulfate 325 qd 5. docusate sodium 100 mg 6. cyanocobalamin 50 mcg qd 7. multivitamin qd 8. lisinopril 5 mg qd - recently d/ced on last hospital admission elevated cr 9. paroxetine hcl 10 mg qd 10.carvedilol 25mg . 11. azathioprine 50 mg qd 12. pantoprazole 40 mg qd 13. furosemide 40mg qd - recently changed from 60 mg qam and 40 po qhs 14. levothyroxine sodium 50 mcg qd 15. albuterol inh prn 16. atrovent inh discharge medications: na discharge disposition: expired discharge diagnosis: deceased discharge condition: deceased discharge instructions: na followup instructions: na procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart insertion of temporary transvenous pacemaker system implant of pulsation balloon pulmonary artery wedge monitoring infusion of vasopressor agent diagnoses: acidosis hyperpotassemia coronary atherosclerosis of native coronary artery intermediate coronary syndrome acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver unspecified septicemia unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation percutaneous transluminal coronary angioplasty status other specified forms of chronic ischemic heart disease regional enteritis of unspecified site cardiac arrest cardiogenic shock old myocardial infarction sinoatrial node dysfunction systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction unspecified disorder of male genital organs 

Answer: The patient is high likely exposed to