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 (sulfonamides) attending: chief complaint: transferred from osh for cath for st elevation, elevated concerning for stemi major surgical or invasive procedure: cardiac catheterization - history of present illness: 65 yo female with pmh of cad s/p des to lad in , squamous cell lung carcinoma s/p left lobectomy, chemo, and xrt, complicated by laryngeal paralysis, copd on 2l home o2, transferred from for cardiac catheterization. patient originally presented to her pcp office with respiratory distress, sob, and chills. pcp thought her to have a pneumonia given her symptoms of fever, cough, and sob, found that she was having o2 saturation of less than 88%, and sent her to the emergency room for possible pneumonia. at the ed, she was started on iv vanc/zosyn and steroids for pneumonia because of fever to 101 and leukocytosis. cxr with small amount chf and possible lll consolidation. she was initially treated with lasix, iv nitro but became hypotensive so nitro was stopped. she was admitted to the icu for poor respiratory status. in the icu, they noted st elevations on ekg in inferolateral leads, and a troponin of 4.84 and 6.75. patient was transferred to for cardiac catheterization for concerns of stemi. . cardiac cath was performed which showed that her prior lad stent was patent, lcx with 50% proximal stenosis, and rca with 50% mid segment stenosis. also noted to have pulmonary hypertension. patient was subsequently transferred to the ccu for closer monitoring given tenuous respiratory status. . on arrival, patient feels that she is short of breath. having difficulty speaking full sentences. not having chest pain, no pleuritic chest pain. overall feels very uncomfortable and anxious. past medical history: - cad s/p des to lad () - htn - severe copd on 2l home o2 - squamous cell lung carcinoma s/p left lobectomy, chemo, xrt - hyperlipidemia - uterine fibroids - laryngeal paralysis - s/p partial hysterectomy - h/o head injury with seizure disorder 11 years ago - anxiety - chronic back pain social history: patient is married. quit tobacco in , admits to occassional alcohol use. has good family support. retired from where she used to work as a financial coordinator. family history: father - cad in 50s mother - cad in 70s physical exam: on admission vs: 99.3, 125/73, 129, 91% on 3l gen: chronically ill appearing female, short of breath heent: perrla, eomi, mmm, no lad, no jvd cv: s1s2, tachycardic, no m/r/g chest: crackles on exam bibasilarly, wheezes throughout abd: soft, nd, nt, +bs ext: cath site clean and dressed. no bruit, no hematoma, no bleeding. no e/c/c, 2+ peripheral pulses neuro: cn ii-xii grossly intact, 5/5 strength throughout. pertinent results: cardiac cath study date of comments: 1. selective coronary angiography of this right dominant system revealed three vessel coronary artery disease. the lmca had no angiographically apparent flow limiting disease. the lad was a large tortuous vessel with widely patent stent. the lcx was a large tortuous vessel with proximal 50% stenosis. the rca was a large tortuous vessel with 50% stenosis at the mid segment. 2. resting hemodynamics demonstrated elevated right sided filling pressures with rvedp 12 mm hg, elevated left sided filling pressures with lvedp 29 mm hg and pcwp 22 mm hg. there was pulmonary artery hypertension with pa 72/28 mm hg, mean 43 mm hg. the cardiac index was 2.2 l/min/m2 which gives a calculated pvr of 9 units. 3. careful pullback across the aortic valve revealed no significant gradient. final diagnosis: 1. three vessel coronary artery disease. 2. pulmonary artery hypertension. 3. diastolic dysfunction with elevated left sided filling pressures. . tte (complete) done at 3:48:03 pm the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with extensive severe hypokinesis to akinesis of the septum, anterior wall, distal third of the left ventricle (including the apex). ejection fraction is difficult to assess in setting of marked tachycardia but appears severely depressed (ef 25). right ventricular chamber size is normal with moderate global free wall hypokinesis and distal dyskinesis of the apex. 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. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: extensive regional left ventricular systolic dysfunction c/w multivessel cad or stress-induced cardiomyopathy (or focal myocarditis). distal right ventricular dyskinesis. marked tachycardia. moderate pulmonary hypertension. . chest ct: lymphadenopathy in the mediastinum and right hilum extending along the bronchovascular structures in the right lung could be reactive due to infection, but is concerning for neoplasm given the patient's previous history of lung neoplasm and should be followed up with repeat ct thorax in 2 months to ensure resolution. brief hospital course: 65 yo female with pmh of cad s/p des to lad in , squamous cell lung carcinoma s/p left lobectomy, chemo, and xrt, complicated by laryngeal paralysis, copd on 2l home o2, transferred from for cardiac catheterization. transferred to ccu post-cath for poor respiratory status . #. hypoxia- shortness of breath is likely multifactorial, a combination of multifocal pneumonia superimposed on underlying poor pulmonary reserve in setting of cancer with resection and xrt with new development of acute systolic heart failure. patient has a history of largyngeal paralysis, making her more likely to aspirate. during her stay in the icu she was found to have a pneumonia. she was covered for both cap and aspiration pneumonia with ceftriaxone, levofloxacin, and metronidazole. discharged on flagyl and levofloxacin for total of 14 day course. spiriva and advair were continued. ct of chest report read: pe was of concern given tachycardia and sob, however patient was ruled out with cta. lymphadenopathy in the mediastinum and right hilum extending along the bronchovascular structures in the right lung could be reactive due to infection, but is concerning for neoplasm given the patient's previous history of lung neoplasm and should be followed up with repeat ct thorax in 2 months to ensure resolution. . systolic and diastolic congestive heart failure: ef 25%: it is possible that her elevated , changes, and tte findings of apical hypokinesis represents stress induced cardiomyopathy. it may have been caused by stress of pneumonia on top of already compromised lungs. viral cardiomyopathy is also a possiblility. patient was diuresed with iv lasix with improvement of respiratory symptoms. she also received scheduled nebulizer treatments and had gradual resolution of her symptoms. her pneumonia was treated as above. . #. h/o cad, stress cardiomyopathy/focal myopericarditis - s/p to lad in . tte at osh showed lvef of 30% which is decreased from a reported 50% in . tte on this admission shows ef of 25% with severe hypokinesis to akinesis of the septum, anterior wall, distal third of the left ventricle. given these focal wall motion abnormalities she was taken to cath which showed patent lad stent with 50% prox lcx lesion and 50% mid rca lesion, and given these findings of non-flow limiting cad in the setting of focal wall motion abnormalities, the pt was felt to have a stress related cardiomyopathy vs focal myo/pericarditis. ekg post-cath still showed st elevations however these resolved over time and the pt was without significant q waves. patient was continued on aspirin, plavix, atorvastatin, and metoprolol. losartan was temporarily held given hypotension but was added back by discharge. . #. hypotension - patient was initially hypotensive with sbp in the 70-80s, for which antihypertensives were held. concern was for sepsis given her pneumonia. as her blood pressure stabilized, beta blockers and losartan were restarted. by discharge, her blood pressures were in the 90's to low 100's. . # tachycardia - the pt was initially in the 140's on admission, with narrow complex sinus tachycardia and frequent ectopy. as her above problems were addressed, her heart rate gradually came down, and beta blockade was also added. by discharge, her heart rate had come down to consistently in the 90-100's. . #. severe copd - patient is on 2l home o2. during her admission, she saturated in the mid 90's on 3-4l of supplemental o2. patient had long acting tiotropium held while acutely sick. she was continued on advair and ipratropium nebulizers. . #. seizure disorder- patient has history of seizure disorder following head injury 11 years ago. patient was continued on dilatin. . #. chronic left side and low back pain - patient was continued on home regimen of ms contin and gabapentin . #. anxiety - patient has a history of anxiety for which she received ativan prn medications on admission: dilantin 200 mg rosuvastatin 40 mg daily diovan 80 mg tab daily asa 81 mg daily clopidogrel 75 mg daily metoprolol tartrate 50 mg sertraline 100 mg daily ms contin 15mg/30mg/15mg gabapentin 800mg tid spiriva 1 puff daily advair 250/50 1 puff lorazepam 0.5 mg po prn discharge medications: 1. diovan 80 mg tablet sig: 0.5 tablet po once a day. 2. phenytoin sodium extended 200 mg capsule sig: one (1) capsule po twice a day. 3. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. aspirin 81 mg tablet sig: one (1) tablet po once a day. 6. sertraline 50 mg tablet sig: one (1) tablet po hs (at bedtime). 7. morphine 30 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 8. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 9. gabapentin 800 mg tablet sig: one (1) tablet po three times a day. 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. 12. metoprolol succinate 100 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day. disp:*45 tablet sustained release 24 hr(s)* refills:*2* 13. medical equipment commode for use in bedroom without a bathroom on same floor. 14. magic mouthwash sig: 15-30 cc three times a day as needed for mouth soreness. disp:*1 bottle* refills:*0* 15. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 16. levofloxacin 500 mg tablet sig: one (1) tablet po daily (daily) for 5 days. disp:*5 tablet(s)* refills:*0* 17. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 5 days. disp:*15 tablet(s)* refills:*0* 18. oral wound care products gel in packet sig: one (1) ml mucous membrane qid (4 times a day) as needed for mouth discomfort. disp:*60 ml(s)* refills:*0* 19. benzocaine 20 % paste sig: one (1) appl mucous membrane tid (3 times a day) as needed for mouth pain. 20. lorazepam 0.5 mg tablet sig: one (1) tablet po three times a day as needed for anxiety. disp:*45 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: cardiomyopathy with ef 25% acute on chronic systolic and diastolic congestive heart failure coronary artery disease s/p drug eluting stent to lad in sqamous cell lung ca s/p resection, radiation and chemotherapy chronic obstructive pulmonary disease laryngeal paralysis discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had trouble breathing and low oxygen levels and was admitted to for a cardiac catheterization after changes were seen on your ekg. the catheterization showed 50% blockages in 2 arteries. these do not need to be fixed at this time. your heart is also weak, possibly due to a virus or possibly because of stress/strain. your heart function made you retain fluid and we needed to give you furosemide (lasix) to take off the extra fluid. it is likely that you may retain fluid in the future so please weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. please eat a low sodium diet. you will need another echocardiogram to check your heart function in about a month. you had an outbreak of herpes type 1 lesions in your mouth. you received valacyclovir and are using some numbing mouthwashes and pastes to help with the discomfort. you can stop these once the lesions are gone. you also had a pneumonia that is probably caused in part by your laryngeal problems. will complete a 14 day course of antibiotics on . we made the following changes to your medicine: 1. change metoprolol 50 mg twice daily to metoprolol 150 mg daily 2. start furosemide (lasix) every day to prevent fluid overload 3. start magic mouthwash, oragel and benzocaine paste to treat the lesions in your mouth. 4. continue levofloxacin and flagyl orally to treat your pneumonia, last day is . 5. start lorazepam, a mild sedative to take when you are anxious. do not drive or operate any machinery when you take this medicine. followup instructions: cardiology: phone: date/time: at 1:00pm. clinical center, , , , . primary care: phone: ( date/time: please keep any regularly scheduled appts. . oncologist: dr. hematology-oncology, p.c. , phone: ( please note: lymphadenopathy in the mediastinum and right hilum extending along the bronchovascular structures in the right lung could be reactive due to infection, but is concerning for neoplasm given the patient's previous history of lung neoplasm and should be followed up with repeat ct thorax in 2 months to ensure resolution. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: pneumonia, organism unspecified other iatrogenic hypotension other chronic pain coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia anxiety state, unspecified other specified cardiac dysrhythmias malignant neoplasm of bronchus and lung, unspecified acute myocardial infarction of inferolateral wall, initial episode of care epilepsy, unspecified, without mention of intractable epilepsy enlargement of lymph nodes backache, unspecified secondary and unspecified malignant neoplasm of intrathoracic lymph nodes radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other respiratory abnormalities acute on chronic combined systolic and diastolic heart failure acute idiopathic pericarditis other dependence on machines, supplemental oxygen takotsubo syndrome leiomyoma of uterus, unspecified paralysis of vocal cords or larynx, unspecified coronary vasodilators causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to