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: sulfa (sulfonamide antibiotics) / simvastatin attending: chief complaint: progressive sob and leg swelling major surgical or invasive procedure: picc line placement history of present illness: 68 y/o female with nonischemic cardiomyopathy (ef 25% on ), htn, mitral valve prolapse, intermittent lbbb, atrial fibrillation (in rvr 40% of time from device interrogation) and h/o vf arrest s/p biv icd placement who presents with 1-2 days of progressive sob and leg swelling. the patient reports that since friday she has been having some worsening shortness of breath, increased dyspnea on exertion. this labored breathing has been intermittent since her last discharge from the hospital in early . she reports that her orthopnea has been stable (1 pillow), and she has pnd, but reports that it is stable compared to her baseline. denies any current chest pain, denies any palpitations (reports that she has not had any palpitations since getting her icd placed). had one episode of vomitus today; reports that it was mucousy. of note, she has noticed increased le edema/pedal edema for the last few days; she has never had swelling like this in the past. the patient also reports general fatigue. she checks her blood pressures at home and for the last few days notes systolic pressures in the 70-80s, and reports that since being discharged from the hospital in , she has never had systolic pressures >100. . she reports eating out more instead of cooking at home, but denies any increase usage of salt on her food. she has been compliant with her medications. of note, the patient reports that she has not been feeling well since this past , with intermittent episodes of labored breathing and shortness of breath. she also reports that she has had baseline shortness of breath for "years." . of note, she was recently admitted from - for a chf exacerbation possibly worsened by af with rvr. during that hospitalization she received aggressive diuresis with lasix. fo her atrial fibrillation she was initially transitioned from metoprolol to carvedilol but was changed back to metoprolol for low blood pressures. she also underwent tee with cardiovesion on but subsequently developed torsades following a dose of dofetilide in the settinf of a long qtc and later ventricular fibrillation, for which she received defibrillation x one. following her arrest, amiodarone drip was initiated with transition to oral. a biv icd was placed successfully on with lead revision on . she was discharged the following day. . she had an office visit in device clinic on , during which she reported ongoing fatigue but improving doe and no palpitations. at that time she was still on coumadin, which was started during her recent hospitalization. at an appointment on , the patient was scheduled to undergo cardioversion for atrial fibrillation. a tee was recommended in the setting of subtherapeutic inrs but the patient declined. she was subsequently started on dabigatran 150 mg , but this was subsequently stopped about three weeks ago gi upset; the patient also noted that her shortness of breath worsened on it. she was then restarted on coumadin. . she also had an office visit on with dr. for follow-up after her recent discharge. at that time, he decided to decrease her metoprolol xl from 150 mg to 100 mg daily. her lisinopril was discontinued (although the patient reports that she has been taking lisinopril 20 mg daily) and her spironolactone temporarily held. . on arrival to the ed, initial vital signs were 123, 128/91, 26, 99%. she received lasix 80 mg iv once with improvement in her respiratory symptoms. prior to transfer her hr was noted to be in the 110s. . on arrival to the icu, the patient appears comfortable, complaining of being hungry and thirsty. she is still complaining of some shortness of breath, but denies any chest pain, palpitations. past medical history: -hypertension -atrial fibrillation on coumadin -mitral valve prolapse -intermittent left bundle branch block -nonischemic cardiomyopathy with ef 25% on tte with elevated pulmonary artery systolic pressure and moderate mr social history: -tobacco history: 20 pack yr history, quit 30 years -etoh: denies -illicit drugs: denies lives at home with her husband; has two adult children (43,41) who live nearby. also has one 8 y/o grand daughter. she works 12 hours/week as a bank receptionist. family history: father: htn, stroke at 50 paternal aunt: mi at age 48, passed away mother: heart disease in 80s sisters: htn physical exam: on admission: vs: 96.6 106 111/85 24 99% on 2l general: pleasant woman, nad, laying comfortably in bed heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, jvp noted to edge of mandible. cardiac: irregular rhythm, tacycardic, normal s1, s2, no murmurs/rubs/gallops appreciated lungs: bibasilar inspiratory crackles, good air movement, no wheezes/rhonchi abdomen: soft, nontender, nondistended, +bs extremities: trace-1+ pitting edema, warm, well perfused extremities, l knee with ecchymoses skin: bruises on left cheek, l knee pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: normal strength/sensation throughout . on discharge: vitals - tm/tc:98.6/98 hr:78-18 bp: 98-115/60-71 rr: 20-24 02 sat:98% ra. general: 69 yo f in no acute distress heent: mucous membs moist, no lymphadenopathy, jvp 10 cm chest: ctab cv: s1 s2, irregular irregular. abd: soft, non-tender, non-distended, bs normoactive. ext: wwp, no edema. dps, pts 1+ neuro: cns ii-xii intact. 5/5 strength in u/l extremities. skin: left cheek bruise and hematoma, left icd site with healing incision and no swelling. pertinent results: on admission: 02:20pm blood wbc-7.6 rbc-4.09* hgb-12.8 hct-40.4 mcv-99* mch-31.3 mchc-31.6 rdw-15.9* plt ct-283 02:20pm blood pt-31.6* ptt-28.6 inr(pt)-3.1* 02:20pm blood glucose-165* urean-36* creat-1.4* na-133 k-5.5* cl-95* hco3-19* angap-25* 08:20pm blood calcium-9.1 phos-3.9 mg-2.0 02:32pm blood glucose-149* lactate-6.1* na-134 cl-99 calhco3-18* 02:20pm blood ck-mb-2 probnp-* . on discharge: 04:52am blood wbc-5.4 rbc-3.79* hgb-11.9* hct-36.6 mcv-97 mch-31.5 mchc-32.7 rdw-15.1 plt ct-230 04:52am blood glucose-82 urean-18 creat-0.9 na-138 k-3.5 cl-93* hco3-36* angap-13 . echo : the left atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20%). the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. severe (4+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is a trivial/physiologic pericardial effusion. impression: biventricular cavity dilation with severe global left ventricular hypokinesis c/w diffuse process (toxin, metabolic, etc. - cannot fully exclude multivessel cad but less likely). severe mitral regurgitation. pulmonary artery systolic hypertension. trivial pericardial effusion. compared with the prior study (images reviewed) of , the severity of mitral regurgitation is increased and right ventricular cavity enlargement with free wall hypokinesis are now seen. the heart rate is now higher and the rhythm now appears to be non-sinus (no transmitral a wave). . ecg : atrial fibrillation with rapid ventricular response and slowing of the rate as compared with previous tracing of . otherwise, no diagnostic interim change. brief hospital course: 68 y/o female with nonischemic cardiomyopathy (ef 20% on ), htn, mitral valve prolapse, intermittent lbbb, atrial fibrillation and h/o vf arrest present with acute exacerbation of her systoli chf thought secondary to dietary indiscretion and af/rvr. . #. acute on chronic heart failure exacerbation: the patient has a history of non-ischemic cardiomyopathy, with most recent ef 20%. received furosemide drip and bolus doses of furosemide for diuresis. weight decreased from 150# on admission to 143# at discharge. her doe improved and o2 sat on ra was 98% with ambulation. she was changed to torsemide 80mg daily instead of furosemide for ease of administration. digoxin and spironolactone was started to better control rate and increase forward flow. intensive teaching regarding na intake, daily weights and medications was done during hospital stay but pt remained somewhat resistant to changing diet and lifestyle. vna and home telemonitoring was refused by pt. . #. anion-gap metabolic acidosis (ag=17): agma with lactate 6.1 in ed, repeat down to 2.3. most likely due to hypoperfusion in setting of hypotension from combination of atrial fibrillation and chf. resolved now. . #. atrial fibrillation: patient with long-standing atrial fibrillation with rvr burden of 40% from recent interrogation of . metoprolol was increased to 200 mg daily and digoxin was added for rate control. amiodarone was continued. cardioversion was recommended by ep but pt refused as she said it had been ineffective in the past. inr was slightly high on admission so warfarin was decreased to 4mg daily. #. acute kidney injury: creatinine up to 1.4 on admission with baseline creatinine of 0.6-0.7, most likely due to decreased perfusion. creatinine to 0.9 by day of discharge. . #. h/o vf arrest s/p icd: the initial implant was , but there was need for lv lead revision on . no ventricular ectopic activity noted on telemetry. pt was discharged on kcl with increased dose of diuretic. she will f/u in the device clinic in . . transitional issues: 1. avj ablation: there was thought during her admission that this patient would benefit from avj ablation with the hope of increasing the proportion of her synchronized, biventricular beats to enhance her cardiac function and hopefully improve her symptoms. . 2. pt will need intensive counseling about her chf and successful treatment at home. a referral was made to clinic. labs should be drawn at that visit to check kidney function, k and inr. medications on admission: . amiodarone 200 mg po daily 2. furosemide 40-60 mg po daily (pt reports looking at her feet swellling/weight to determine dose) 3. metoprolol succinate 100 mg po daily (recently decreased from 150 mg po daily) 4. lisinopril 40 mg po daily (pt reports taking 20 mg daily) 5. potassium chloride er particles 20 meq po daily 7. warfarin 5 mg po daily as directed 8. zolpidem 5-10 mg po qhs prn insomnia discharge medications: 1. torsemide 20 mg tablet sig: four (4) tablet po daily (daily). disp:*120 tablet(s)* refills:*2* 2. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 3. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 4. digoxin 125 mcg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 5. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 6. zolpidem 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for sleep. 7. metoprolol succinate 100 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po daily (daily). disp:*60 tablet extended release 24 hr(s)* refills:*2* 8. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. 9. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: acute on chronic systolic congestive heart failure atrial fibrillation with rapid ventricular response non-ischemic cardiomyopathy acute kidney injury discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you had an acute exacerbation of your heart failure and developed swelling in your legs/feet and fluid overload in your lungs. you were diuresed with medicines including lasix intravenously and was transitioned to a new medicine called torsemide. we have also added two new medicines, spironolactone and digoxin to help your heart pump better. the fluid overload was propably due to a high sodium diet. you received information about a low sodium diet and it is extremely important that you follow this to prevent another admission for fluid overload. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. your weight at discharge is 143 pounds. please call dr. if you notice that your swelling is returning or if you feel tired and lightheaded. your torsemide dosage may need to be adjusted. . we made the following changes to your medicines: 1.decrease lisinopril to 2.5 mg daily for now, it will likely be increased over the next few weeks. 2. stop taking furosemide, take torsemide instead to keep the fluid from returning 3. start taking digoxin to help your heart pump better and slow your heart rate 4. start taking spironolactone to help keep the fluid from returning 5. increase to metoprolol to 200 mg daily 6. decrease the warfarin to 4 mg daily followup instructions: department: cardiac services when: monday at 12:30 pm with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 1 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: when: wednesday at 10:00 am with: , md building: (, ma) campus: off campus best parking: on street parking department: cardiac services when: tuesday at 1:30 pm with: , np building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: other primary cardiomyopathies acidosis mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation other left bundle branch block long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ acute on chronic systolic heart failure mixed acid-base balance disorder 

Answer: The patient is high likely exposed to