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: palpitations major surgical or invasive procedure: none history of present illness: 71 m w/hx of cva x1 (, residual left sided weakness, hoarse voice), htn, dyslipidemia and alcohol abuse presents with palpitations. . three weeks prior to admission, in , patient had episode of lightheadness with a fall in a sauna (scraped knee). since then he has had occasional recurrences of these symptoms. on , he felt lighthead in a restaurant, fell and scraped his chin. no history of seizure, loss of bowel/bladder continence or tongue biting. he has no recall of this event. in the days prior to admission, he has had sinus congestion with a 'sinus infection'. he took advil cold & sinus for several days without improvement. then started nasonex and most recently moxifloxacin x several days. today, , while driving, he felt a racing heart. drove to his office, called his staff to arrange an ambulance. . he was taken by ems to . he received amiodarone en route. at , he had a rate of 250 that fell to 140 with 6 mg of adenosine. he then received dilt 10 x 2, metoprolol, dilt drip, before his primary care physician, . arranged transfer to . . in the ed, he was afebrile, bp 114/82-125/90, hr 115-125, rr 14, spo2 1002-3l. he was symptomless and joined by his daughter. . review of systems: s/he denies any prior history of 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 past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: #. cva- history of right inferior mca stroke in with residual mild left hemiparesis #. ulcerative colitis- quiescent, followed by , m.d.; reportedly had 4+ guaiac stools in the past. #. depression #. htn #. history of gastritis #. hyperlipidemia #. chronic renal insufficiency- baseline cr 1.4, followed by , m.d. social history: cpa; widower, lost wife 6 months previous (cirrhosis). -tobacco history: 1-1.5 ppd -etoh: large cups of vodka; more than gallon of vodka every 10 days -illicit drugs: none family history: mother had ca father had mi physical exam: vs: , bp 114/82-125/90, hr 115-125, rr 14, spo2 1002-3l general: wdwn male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. no oral ulcers. filled caries neck: supple with non-elevated jvp of 5 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. tachycardic, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, globally decreased breath sound, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. 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+ let sided weakness on neuro exam. pulse slows with right sided carotid sinus massage. pertinent results: admission labs 03:10pm blood wbc-10.2 rbc-4.30* hgb-13.8* hct-41.0 mcv-95 mch-32.1* mchc-33.7 rdw-12.8 plt ct-261 03:10pm blood neuts-70.3* lymphs-19.0 monos-4.4 eos-5.7* baso-0.6 03:10pm blood glucose-97 urean-23* creat-1.7* na-140 k-4.6 cl-103 hco3-26 angap-16 03:10pm blood alt-16 ast-27 ck(cpk)-77 alkphos-72 totbili-0.7 03:10pm blood ck-mb-notdone ctropnt-0.02* 03:10pm blood albumin-4.7 calcium-9.6 phos-3.0 mg-1.5* 03:10pm blood tsh-0.46 ct chest there are no large lung nodules that correspond to the chest x-ray abnormality. there is bronchial wall thickening in the lower lobes bilaterally that might explain the abnormality and is due to inflammatory process. emphysema. 1-3 mm lung nodules. followup in one year is recommended. tte 3.16 the left atrium is mildly dilated (5.4cm). left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion 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. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: low normal left ventricular systolic function. compared with the report of the prior study (images unavailable for review) of , left ventricular function may be less vigorous. the atrial sizes are larger. estimated pulmonary artery pressures are now lower. brief hospital course: summary 71 m with hx of cva, htn, dl presents with 3 weeks of lightheadedness, falls and 1 day of palpitations. he was found with a rate of 250 that did not break with adenosine. he has been kept at 120's with diltiazem. he is admitted for workup and management of his narrow-complex tachyarrythmia. there was question as to whether he had atrial tachycardia or atrial flutter. there was evidence (flutterform waves during carotid sinus pressure) that his rhythm was flutter. on , he converted to atrial fibrillation. we attempted to manage him with nodal agents, but these only lowered his blood pressure (to the 90's) while his heart rate was steady in the 120's. on , with low bp and afib, he was transferred to the ccu for tee/cardioversion complicated by hypotension requiring transient pressors. he was started on coumadin (with heparin bridge) and amiodarone. by problem 1) svt - atrial flutter and atrial fibrillation with rvr hypotension the differential for his tachycardia was fairly narrow. it was either atrial tachycardia or atrial flutter. right carotid sinus massage (very light pressure was sufficient) effected a decrease in the ventricular response with a period of just flutter waves that also showed atrial repolarization or an "a" wave. his lack of response to adenosine rules out psvt. the tracings from the osh show a tachycardia to 260 with the same interval as the space between p waves when he later ran at 130. a long strip from the outside hospital additionally showed flutter waves. he had flutter waves with carotid pressure and the interval between qrss is variable. he was in atrial flutter with variable conduction. his risk factors are presumed copd, alcoholism and age. chads2 score is 3. we attempted to manage him medically without conversion for the dual concern of stroke and bleeding on anticoagulation (hx of uc and gastritis). after trial of betablockade from 25->75 mg metoprolol, his rate did not change and he became hypotensive. the dose was halved to 37.5 and his hypotension persisted, concommittant with his conversion to atrial fibrillation. he was transferred to the ccu for tee/cardioversion. after cardioversion, he went into a sinus rhythm with a large amount of atrial ectopy. however, his hypotension persisted after his cardioversion with blood pressures in the 60's to 70's systolic and after several boluses of phenylephrine with only 10 to 20 mm hg rise in systolic blood pressure including well after he had been given fentanyl and propofol for the tee and cardioversion he remained hypotensive requiring an arterial line and continuous phenylephrine intravenous infusion for hypotension which persisted after large volume of saline infusion (over 2 liters). this was continued overnight and he remained bradycardic with rates in the 50's with atrial ectopy and paroxysmal atrial flutter. he was given amiodarone po the next day because of the concern of his compromised blood pressure even in sinus rhythm. overnight his blood pressure improved to over 100 systolic and the pressor was weaned and he was returned to the floor from the ccu. follow up: inr checks through dr. follow up: patient placed on amiodarone and will need liver, pulm testing at intervals to be determined by outpatient physicians. 2) arterial vasculopathy, confirmed at least by coronary calcification in all coronary vessels on chest ct and atheroma in the ascending aorta seen on tee hx of cva; his stroke is now considered thromboembolic given recent events. peripheral artery disease hypertension, dyslipidemia patient has risk factors for heart disease but no prior documentation. he had a fairly large cva. his tee showed "simple atheroma" in the aortic arch and the ct of the chest for evaluation of a question of a nodule showed calcium in all the coronaries. patient has elevated troponin, in the setting of chronic renal failure. in the hospital, abi's were performed where he had bilateral systolics of 60 at the dp with brachial systolic of 90, indicating pad. the patient was admitted on aggrenox and aspirin, was discharged on coumadin w/o antiplatelet agents to lessen bleeding risk given the history of gastritis and 4+ guaiac stools in the past thought to be colonic or related to colitis in origin. followed by dr. . 3) alcoholism patient had his last drink the night prior to admission. he was placed on a ciwa that was never triggerred. he received supplementation with multivitamin, thiamine, folate. social work saw him as well. he was counselled to stop drinking. 4) copd/emphysema cxr showed hyperinflated lung fields and a lll opacity. ct chest non-contrast showed multiple 1-3 mm nodules. radiology reccommended 1 year follow up. patient was counselled to quit smoking 5). chronic renal insufficiency: baseline 1.4, as high as 1.8. discharged at 1.3 likely after nsaid abstinence and hydration; he had been taking nsaids chronically for headache to the day prior to this admission. he was counseled re: abstaining from all nsaids and aspirin and aspirin containing otc drugs. . #. hyperlipidemia - lipitor . #. h/o cva - discharged on coumadin for presumptive embolic source . #. ulcerative colitis - stable . # pump: there is no clinical suspicion of heart failure. he does not have electrocardiographic or echocardiographic evidence of lvh medications on admission: atorvastatin 40mg daily diphenhydramine hcl 25mg daily dipyridamole-aspirin 25 mg-200 mg folic acid 1mg daily lisinopril 10mg daily aspirin 325 mg daily thiamine hcl discharge medications: 1. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for allergy. 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. amiodarone 200 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 8. warfarin 5 mg tablet sig: 0.5-1 tablet po once a day: take 1 tab tonight, take tab tomorrow night and alternate the doses thereafter. . disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: atrial flutter emphysema alcohol abuse history of cva discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent followup instructions: provider: , m.d. phone: date/time: 10:45 provider: , md phone: date/time: 10:30 arrange followup with dr. ; inr on ; results to drs. and . procedure: diagnostic ultrasound of heart other electric countershock of heart diagnoses: other iatrogenic hypotension tobacco use disorder hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation atrial flutter chronic kidney disease, unspecified other and unspecified hyperlipidemia other emphysema late effects of cerebrovascular disease, hemiplegia affecting unspecified side ulcerative colitis, unspecified other and unspecified alcohol dependence, continuous 

Answer: The patient is high likely exposed to