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: fluid overload major surgical or invasive procedure: hemodialysis history of present illness: pt is a 73 yo female w/ pmhx dm, htn, pvd, afib, hyperlipidemia, esrd on hd who presents today with acute shortness of breath. pt was last dialyzed on wednesday and she reports that was given back all of the fluid that was taken off. per dialysis nurse she is actually below her dry weight. last night she reports waking up feeling palpatations and sob when laying on her side, no le edema although she has b/l bkas. at that point had no diaphoresis, cp, nausea or vomiting. patient reports eating cheese and crackers and having chinese for dinner last night. no changes to her medications that she knows of. pt denies uri symptoms, fever, chills, cough, cp, abd pain, nausea, vomiting, diarrhea. she occasionally has constipation. . ems had a difficult time getting an o2 sat and placed her on cpap and brought her to the ed whree she was weaned to 4 liters nasal cannula. she received 1 sl nitro. on exam in ed, she was noted to have crackles on lung exam and she received asa 325 mg x 1, 100 iv lasix and she put out 400 cc which per patient made her feel better. renal was consulted and recommended emergent dialysis in the icu. she was also placed on nitro gtt because her initial blood pressure in ed was 210/104 and pressures is now down to 150/80s. ekg showed st elevation v1-v4 c/w prior ekg and recent prior cath 8 days ago was negative. . of note, she had a recent admission to with acute dyspnea and fluid overload and was dialyzed emergently there. she was then transferred from osh with elevated troponins and negative stress test to . pt had coronary catheterization which showed patent arteries at last week. she was thought to have elevated troponins in setting of renal failure and demand ischemia with aflutter. she underwent caval-isthmus atrial flutter ablation which was unsuccessful and she was put on coumadin and rate controlled. . in the icu, patient's initial vs were: t 97.4, hr 81, bp 124/62, r 23, o2 sat 100% on 4 l nc. she felt much better after the lasix given in the ed. denied dizziness, cp, palp, sob, abd pain, nausea, etc. past medical history: -hypertension -diabetes -peripheral vascular disease status post bilateral knee amputations in (l) and (r) -gerd -hypercholesterolemia -esrd on hemodialysis m,w,f. right ij permanent catheter in place. receives dialysis at hemodialysis center in . -paroxysmal atrial flutter, refused anticoagulation -peptic ulcer disease -hypertrophic obstructive cardiomyopathy. -mild mitral stenosis (mva 1.5-2.0 cm2) -secondary hyperparathyroidism cardiac risk factors: +diabetes, +dyslipidemia, +hypertension social history: social history is significant for the presence of current tobacco use, ppd x 50 years. there is no history of alcohol abuse. lives in facility and uses a mobile wheelchair. family history: her father died in his 90's and mother at the age of 102. patient unable to specify cause of death. she has one living sister at the age of 75 and 6 sisters and one brother who passed away. her family history is significant for coronary artery disease, cancer, and diabetes. physical exam: vs: temp: 97.4 bp: 124 /62 hr: 81 rr: 23 o2sat 100% on 4 l nc gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: mild bibasilar crackles cv: rr, s1 and s2 wnl, 2/6 sem at lusb and harsher hsm at apex abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: b/l bka, warm, no rashes skin: no rashes/no jaundice neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. rectal: deferred pertinent results: admission labs: wbc-18.8* rbc-3.99* hgb-12.4 hct-39.5 mcv-99* mch-31.1 mchc-31.4 rdw-19.8* plt ct-366 neuts-83.4* lymphs-12.9* monos-2.6 eos-0.9 baso-0.2 pt-40.7* ptt-43.9* inr(pt)-4.4* fibrino-506* glucose-119* urean-35* creat-6.8* na-139 k-5.0 cl-101 hco3-25 angap-18 calcium-8.9 phos-5.7*# mg-2.3 ck(cpk)-48 amylase-108* ck-mb-4 probnp-9533* ctropnt-0.12* ap portable chest: dual-lumen catheter via right internal jugular approach terminates near the cavoatrial junction. heart size is normal. aorta is tortuous. the interstitial markings are prominent and multiple peripheral septal lines are noted. both costophrenic sulci are blunted. there is no pneumothorax or focal airspace consolidation. the bones are somewhat demineralized. impression: interstitial edema and small bilateral pleural effusions. ekg: sinus rhythm. left atrial abnormality. q waves in leads v1-v2 with poor r wave progression. suggest old anteroseptal myocardial infarction. borderline left ventricular hypertrophy. st-t wave abnormalities, most likely related to secondary repolarization abnormalities from left ventricular hypertrophy. compared to the previous tracing of there is no significant diagnostic change. brief hospital course: patient is a 73 yo female with pmhx afib s/p failed ablation on coumadin, htn, hyperlipidemia, dm and esrd on hd who presented with acute dyspnea and pulmonary edema, treated in the micu with urgent dialysis, called out to the floor on hd#2 euvolemic. #. dyspnea - resolved quickly with hemodialysis, likely secondary to volume overload from being underdialyzed and dietary non-complaince. no evidence of pna on admission cxr, with resolved leukocytosis and afebrile. anticoagulated so pe is unlikely. she was discharged to continue her dialysis on regular m/w/f schedule. patient was educated about a low salt, heart healthy diet. #. htn- patient hypertensive to 200s when she came to ed and was started on nitro gtt. on admission to micu, sbp 120s and nitroglycerin gtt was quickly weaned off. this episode is likely secondary to fluid overload and sob fluid overload. patient was normotensive on transfer to the floor and remained normotensive on the day of discahrge. she was discharged on her home regimen with the uptitration of her beta blocker to continue dialysis regimen as above. #. esrd- on dialysis m/w/f. per report, patient was under dialyzed on wednesday, two days prior to admission, because she was under her dry weight. she received hd on the evening of admission emergently and was sent home to continue hd on m/w/f when she was euvolemic. the renal followed during her stay and we continued sevelemer and nephrocaps. on the day of discharge, patient was mildly hyperkalemic and received kayxalate prior to discharge with plan for hd on the morning following discharge. #. leukocytosis- patient's count 18.8 on admission with no localizing signs of infection or fever. be stress related. resolved on transfer to the floor. urine culture negative on admission. blood cultures x2 with no growth to date still pending at time of discharge. #. paf- s/p failed ablation last admission on warfarin. inr supratherapeutic on admission at 4.4. her warfarin was held as inr was supratherapeutic and resumed on discharge once inr fell into therapeutic range. she was continued on metoprolol with uptitration to 100mg and diltiazem at home dose for rate control. telemetry showed continued paroxysmal atrial fibrillation during her stay. #. hyperlipidemia- continued simvastatin 80 mg qd. #. pvd- continued aspirin. #. dm - most recent a1c in was 6.9. she was maintained on nph 16 units qam as per home regimen. qachs finger sticks with sliding scale coverage and diabetic diet were provided during her stay. #. glaucoma- continued home meds. #. gerd/pud - continued ranitidine per home regimen. # f/e/n: hd, replete lytes prn. diabetic/renal/cardiac diet # ppx: bowel regimen, h2 blocker, supratherapeutic inr # access: piv, dialysis line # dispo: to home with hr and bp controlled and patient euvolemic on exam. # code status: full medications on admission: from discharge summary on - pt reports no changes 1. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 2. sevelamer hcl 400 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 3. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po bid (2 times a day). 4. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. diltiazem hcl 120 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. brimonidine 0.15 % drops sig: one (1) drop ophthalmic daily (daily): right eye. 11. dorzolamide 2 % drops sig: one (1) drop ophthalmic (2 times a day): left eye. 12. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily): left eye. 13. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime): left eye. 14. vigamox 0.5 % drops sig: one (1) drop ophthalmic tid (3 times a day): left eye. 15. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 16. insulin nph human recomb 100 unit/ml cartridge sig: sixteen (16) units subcutaneous once a day. 17. warfarin 2 mg tablet sig: 2.5 tablets po once a day. disp:*90 tablet(s)* refills:*2* 18. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days. (finished course) disp:*5 tablet(s)* refills:*0* discharge medications: 1. sevelamer hcl 400 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 2. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po bid (2 times a day). 3. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. brimonidine 0.15 % drops sig: one (1) drop ophthalmic daily (daily). 7. dorzolamide 2 % drops sig: one (1) drop ophthalmic (2 times a day). 8. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic daily (daily). 9. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 10. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 11. insulin nph human recomb 100 unit/ml cartridge sig: sixteen (16) units/ml subcutaneous once a day. 12. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 13. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 14. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 15. coumadin 5 mg tablet sig: one (1) tablet po once a day. 16. outpatient lab work please check inr on and fax results to anticoagulation management service (acms) discharge disposition: home with service facility: vna discharge diagnosis: pulmonary edema from volume overload end-stage renal disease on hemodialysis hypertensive urgency atrial fibrillation insulin dependent diabetes mellitus discharge condition: hemodynamically stable, saturating well on room air with no signs of volume overload on exam. discharge instructions: you have been treated for your sob with dialysis. please adhere to a low salt diet and take your medications as prescribed. your metoprolol was increased to 100mg twice daily from 75mg during your stay. during your stay, your coumadin was held because your inr was elevated. please resume your 5mg daily dose and have your inr checked on by the vna. your result should be faxed to anticoagulation management service (acms). please resume your monday, wednesday, friday dialysis schedule. please call your primary care provider or return to the emergency department if you have any chest pain, shortness of breath, fevers >100.8 or any other concerning symptoms. followup instructions: please resume dialysis on and have your inr checked this week by the vna. you have the following appointments scheduled: provider: , transplant center - non billing phone: date/time: 1:00 provider: , md phone: date/time: 12:00 provider: , md phone: date/time: 10:40 procedure: hemodialysis diagnoses: end stage renal disease esophageal reflux pure hypercholesterolemia tobacco use disorder congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation peripheral vascular disease, unspecified unspecified glaucoma atrial flutter hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia long-term (current) use of anticoagulants family history of ischemic heart disease secondary hyperparathyroidism (of renal origin) personal history of noncompliance with medical treatment, presenting hazards to health below knee amputation status personal history of peptic ulcer disease family history of diabetes mellitus family history of unspecified malignant neoplasm 

Answer: The patient is high likely exposed to