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: codeine / darvon attending: chief complaint: shortness of breath lower extremity edema major surgical or invasive procedure: cardiac catheterization history of present illness: 63 y/o male with etoh abuse, htn, hld, and possible remote history of mi admitted to the on with new onset congestive heart failure. patient reports that 2 months ago he developed a chest cold with congestion while working as a school crossing guard. he felt better after several weeks and then noticed that his lower extremities began to swell and he devloped progressive dyspnea on exeration, stating that before becoming ill, he could walk up 7-8 flights of stairs but this gradually worsened to only being able to walk up 4 flights of stairs in approximately 20 minutes, as he has to stop and take breaks. throughout this time he denied chest pain, palpitations. he denied orthopnea and pnd but did report gradual development of a right upper quadrant abdominal pain that coincided with his leg swelling. . he finally presented to on as he was dyspnic at rest. he was found to have pulmonary edema by cxr with a possible right base consolidation. a tte revealed severe biventricular hypokinesis and a small circumferential pericardial effusion. he was started on lisinopril, aspirin, and lasix 20 mg iv q6h with 2l. patietn was transferred to for further management. . currently, the patient is comfortable at rest. he states that his abdominal pain has significantly improved. he also states that his lower extremity edema is improving and that he is able to move his legs better than on admission. past medical history: past medical history: - hypertension (on medication until it ran out when insurance coverage was lost ~7 mo. ago) - hypercholesterolemia ("years ago," not recently on medication) - psoriasis - osteoarthritis - alcohol abuse (up to 20 beers daily years ago; up to 6 beers daily until 8 weeks ago) - cervical disk disorder (per patient, c5 herniation) - myocardial infarction (per atrius records, noted on problem list ; patient has no recollection of a cardiac event) - gerd (not active) - rectal bleeding (years ago; colonoscopy was normal per patient report, but no recent/repeat colonoscopy and full details of bleed unknown) . past surgical history: - right total hip replacement - left total hip replacement () - appendectomy ~age 20 - tonsillectomy childhood social history: lives alone. works as a school crossing guard (seasonal position, no benefits/insurance). smoked up to 1.5 ppd x decades but quit 7 months ago. has a history of heavy alcohol use (up to 20 beers/day) "years ago," but then cut back signficantly to 6 beers/day. no alcohol since present illness began 8 weeks ago. no history of withdrawal symptoms or seizure. no recreational/iv drug use. mother is hcp, though cousin will be his beneficiary. family history: patient is adopted; he believes his biological mother may have died of heart disease, but age and details are unknown. physical exam: admission exam: general: alert, oriented, mildly tachypneic with talking heent: sclera anicteric, mmm, oropharynx clear, perrl, eomi neck: supple, jvp elevated to angle of jaw, no lad lungs: diminished breath sounds throughout though most decreased at right base; + egophony, dullness to percussion and increased tactile fremitus over right lower lung field cv: tachycardic to 120s, no m/r/g. significant body hair. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, pitting edema bilaterally to above the knees. ttp over edematous areas. has bulging veins on upper extremities. . discharge exam: vs: t:96.7, bp: 102/61 (98-121/61-64), hr:88 (88-100), rr:18, so2:94% ra gen: comfortable, nad, eating breakfast heent: mmm, no jvd cv: rrr with intermittent periods of irregular tachycardia, normal s1 and s2, no m/r/g pulm: minimal bibasilar crackles, no wheezes, respirations unlabored abd: soft, no tenderness to superficial or deep palpation ext: 1+ pitting edema to the mid-shins bilaterally skin: diffuse non-pigmented patches on bilateral upper extremities neuro: cn ii-xii grossly intact, alert and oriented x 3 pertinent results: admission labs: 11:00am blood wbc-15.1* rbc-4.26* hgb-13.5* hct-42.5 mcv-100* mch-31.8 mchc-31.8 rdw-13.9 plt ct-375 11:00am blood neuts-88.7* lymphs-6.1* monos-4.7 eos-0.5 baso-0.1 11:00am blood glucose-99 urean-26* creat-0.8 na-135 k-4.6 cl-93* hco3-31 angap-16 11:00am blood calcium-9.2 phos-3.1 mg-2.3 . cardiac enzymes: 11:00am blood ck-mb-3 ctropnt-0.02* 06:20pm blood ck-mb-3 ctropnt-0.01 01:52am blood ck-mb-3 ctropnt-0.01 . heart failure evaluation: 11:00am blood ck-mb-3 probnp-* 03:19pm blood caltibc-230* ferritn-245 trf-177* 03:09pm blood vitb12-859 folate-18.4 03:19pm blood tsh-0.23* 03:09pm blood t4-5.8 free t4-1.3 10:30pm blood hiv ab-negative lyme serology negative . echocardiogram (): the left atrium is mildly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 15-20%). the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. the effusion appears circumferential. impression: dilated left ventricle with severe global systolic dysfunction. moderately dilated right ventricle with moderate global systolic dysfunction. mild functional mitral regurgitation. moderate pulmonary hypertension. . cxr (): large opacity projecting over the right hemithorax, may represent combination of consolidation, atelectasis, and possible underlying pleural effusion, worrisome for infection, however, underlying malignancy is not excluded, and followup to resolution is recommended. . cxr (): as compared to the previous radiograph, there is increasing atelectasis at the left lung base. the presence of a minimal left pleural effusion cannot be excluded. the pre-existing extensive opacities at the right lung base, likely to be accompanied by a right pleural effusion, are constant. . relevant ekgs: 1. : probable sinus rhythm with atrial premature beats. left axis deviation. left bundle-branch block. left atrial enlargement. compared to the previous tracing of left bundle-branch block and left atrial enlargement are seen on the current tracing. the rate is increased. 2. : sinus tachycardia with ventricular premature beats. left bundle-branch block. t waves are prominent, although this may be due to the left bundle-branch block. cannot exclude hyperkalemia or myocardial ischemia as the cause. 3. : sinus rhythm with atrial premature depolarizations. left atrial abnormality. probable left ventricular hypertrophy with incomplete left bundle-branch block. diffuse non-diagnostic repolarization abnormalities. . cardiac catheterization (): 1. selective coronary angiography in this right dominant system revealed no angiographically apparent coronary artery disease. the lm, lad, lcx and rca were free of angiographically apparent disease. 2. limited resting hemodynamics revealed normal left sided filling pressures with an lvedp of 7mmhg. there was normal systemic arterial pressure of 109/48mmhg. final diagnosis: 1. coronary arteries are normal. 2. normal lvedp. . tte (): the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. the effusion appears circumferential. impression: biventricular dilatation and severe hypokinesis. mild to moderate mitral regurgitation. moderate to severe pulmonary artery hypertension. biatrial dilatation. compared with the prior study (images reviewed) of , estimated pulmonary artery pressures are slightly higher. the other findings are similar. . discharge labs: 07:00am blood wbc-12.7* rbc-3.99* hgb-12.1* hct-38.1* mcv-96 mch-30.2 mchc-31.7 rdw-13.7 plt ct-486* 07:00am blood glucose-84 urean-17 creat-0.6 na-132* k-5.2* cl-97 hco3-33* angap-7* 07:00am blood calcium-8.3* phos-2.7 mg-2.0 brief hospital course: 63 y/o male with long history of etoh abuse, hypertension, hyperlipidemia, and possible remote history of mi who presented with new onset systolic heart failure. patient was initially admitted to icu and he received lasix boluses. tte revealed biventricular dilatation and severe hypokinesis with an ef of 15-20%, mild to moderate mitral regurgitation, moderate to severe pulmonary artery hypertension and biatrial dilatation. serial ekgs revealed intermitent atrial tachycardia (vs. sinus rhythm with apcs) with an incomplete lbbb. to investigate the etiology of his chf, the icu team checked hiv, which was negative, and iron studies, which were inconsistent with iron overload. tsh was low but free t4 was within normal limits. lyme serologies were negative. patient recieved high-dose thiamine intravenously so a thiamine level was not sent. the patient was then transferred to the cardiology service for further management and evaluation for cad. upon presentation to the cardiology service the patient revealed a history of significant contact with children as he worked as a school crossing guard in the winter months and developed a uri that preceded the onset of his symptoms by several weeks. his history of long-standing alcohol abuse was concerning for an alcohol-related cardiomyopathy as well. he was transitioned from lasix boluses to a lasix drip for more aggressive diuresis. patient was then taken for cardiac catheterization which revealed a right dominant system without angiographically apparent disease of the lm, lad, lcx and rca. he was continued on a lasix drip until he approached euvolemia, at which time he was transitioned to an oral regimen for outpatient management. early in his course he was also started on metoprolol (for chf and an atrial tachycardia), lisinopril and spironolactone. spironolactone was discontinued prior to discharge as patient was mildly hyperkalemic and there was concern for loss-to-follow-up. he was discharged on metoprolol succinate 100 mg, lasix 40 mg po and lisinopril 10 mg. his prior anti-hypertensives and diuretics were discontinued. given his low ef and lbbb, the patient may benefit from crt but this was not persued during this hospitalization given the acuity of his presentation. . transition issues: 1. titration of metoprolol and lisinopril 2. addition of spironolactone to current regimen given low ef 3. follow-up of labs for renal function and hyponatremia 4. follow-up of cbc with consideration of outpatient hematology-oncology referral 5. evaluation and consideration of crt given low ef and lbbb . other issues by problem: . #. hyponatremia: patient became hyponatremic following several days of diuresis, which was felt to be due to hypervolemia and not hypovolemia as the patient was not near his supposed dry weight. urine lytes were consistent with a prerenal etiology. his serum sodium stabilized in the low 130s for several days and was 132 at discharge. patient was home with close follow-up and instructions to have labs repeated. . #. leukocytosis: present throughout admission. unknown duration as patient has not seen an outpatient provider in several years. lyme serologies checked by the icu team were negative. initially attributed to possible pneumonia for which the patient received 5 days of levofloxacin. cbcs were consistently in the 12s with a differentials demonstrating a neutrophilic predominance without other concerning features. respiratory viral antigen screen and culture were negative. he remained afebrile throughout admission. he had no diarrhea throughout admission. . #. tachycardia: patient with hr in low 100s on presentation. ekg was consistent with an svt. patient was started on metoprolol tartrate that was titrated and then converted to metoprolol succinate 100 mg daily prior to discharge. . #. metabolic alkalosis: patient developed metabolic alkalosis in setting of diuresis. he received 48 hours of diamox when his serum bicarbonate reached 40. his bicarbonate downtrended and was 33 at discharge. . #. hypertension: patient remained normotensive to slightly hypotensive in the setting of aggressive diuresis. metoprolol, lisinopril and spironolactone were managed as above. . #. h/o etoh abuse: patient with significant etoh abuse history. he received high-dose thiamine for seven days, as well as folate and a multivitatmin. these were not continued at discharge, as the patient was discharged with multiple medication changes and there was a concerted effort fo facilitate his compliance. medications on admission: - hctz 25 mg po qd - amlodipine 5 mg po qd - atenolol 25 mg po bid discharge medications: 1. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 5. outpatient lab work please check chem 7 (na, k, cl, hco3, bun and cr) and magnesium on and . please fax the results to dr. at . his office phone number is . please also fax the results to dr. at . his phone number is . if needed, the icd-9 code is 428.0 (congestive heart failure). discharge disposition: home discharge diagnosis: new onset systolic heart failure non-ischemic cardiomyopathy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. : you were admitted to with swelling in your legs and shortness of breath which is most likely due to heart failure. a cardiac catheterization was performed and did not reveal any signficant disease in the coronary arteries of your heart. your heart failure may have been due to alcohol or a viral infection. it is very important that you do not drink alcohol again. . ** because of the severity of your illness and the new medications that you were started on, it is very important that you follow-up very closely with your new primary care doctor and cardiologist, dr. . ** . if you cannot keep your follow-up appointments, please call your doctors to -schedule. . weigh yourself every morning, md (dr. if your weight goes up more than 2 lbs. . you will also need to have labs checked once a week for the next few weeks until your medication regimen is more stable. please go to the nearest outpatient lab on and . there are several outpatient labs at , which is close to your home. . the following changes have been made to your medications: . start taking these medications: 1. start taking furosemide (lasix) 40 mg by mouth daily. this medication is a diuretic and will help keep your legs from swelling. as above, if you notice increased swelling of your legs or you gain weight (more than 2 lbs), please call your cardiologist. 2. start taking metoprolol succinate 100 mg by mouth once a day. 3. start taking lisinopril 10 mg by mouth daily. 4. start taking aspirin 81 mg by mouth daily. . stop taking these medications: 1. stop taking hydrochlorothiazide 25 mg by mouth daily. 2. stop taking amlodipine 5 mg by mouth daily. 3. stop taking atenolol 25 mg by mouth twice a day. . no other changes were made to your medications and you should continue taking other medications as previously prescribed. followup instructions: please keep all follow-up appointments: . name: , location: lown cardiovascular group address: , , phone: appointment: wednesday at 11:30am . name: , pa location: associates of health address: , 2nd fl, , phone: appointment: thursday at 2pm md, procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: pneumonia, organism unspecified other primary cardiomyopathies hyperpotassemia esophageal reflux pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension hyposmolality and/or hyponatremia personal history of tobacco use alkalosis old myocardial infarction acute systolic heart failure tachycardia, unspecified leukocytosis, unspecified other and unspecified alcohol dependence, continuous hip joint replacement chronic pulmonary heart disease, unspecified 

Answer: The patient is high likely exposed to