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: # hypercarbic respiratory failure # hypertensive urgency # syncope major surgical or invasive procedure: intubation history of present illness: history dervied from report from floor team and patient's wife as patient unable to provide much at time of transfer. briefly, this is a 76 yo male with h/o htn, ras, thoracic dissection s/p stent and abdominal aaa repair who intially presented to the ed on after experiencing a syncopal episode on . he was at the pharmacy and had a witnessed syncopal event. at that time had no cp, n/v, sob, diaphoresis. he awoke and felt weak but otherwise okay and elected to go to the ed on . he came in for evaluation on as he was feeling generally fatigued. per wife, he has been very fatigeud and sleepy for the past few days. . in the ed --> was hypertensive with sbp ~ 200. he was given iv and po lopressor, followed by hydralazine iv, and was ultimately transferred on a nitroglycerin gtt. cxr showed postoperative changes, low lung volumes, no obvious infiltrate. his head ct was negative for ich. given intermittent hypoxia while in the ed, underwent v/q scan --> low prob for pe. . on arrival to floor, patient still on nitro gtt. when floor team evaluated the patient they noted him to be very somnolent but able to answer questions when asked. they also noted him to be intermittent hypoxic with sats 85-100% on face mask. abg with ph 7.18/ pco2 106/po2 82. patient was given lasix 40 mg iv x 1. ekg was unremarkable. ce sent. echo with lvef > 55%, pulmonary htn. given hypercarbia, patient was transferred to the icu for closer monitoring. . on transfer to icu patient started on cpap, which he did not tolerate. he was then intubated. following intubation, bp dropped with sbp 70-90 and patient was briefly on dopamine. this was weaned off and patient was again hypertensive and nitro gtt restarted. past medical history: - hypertension - per patient, sbps 120-130 with home cuff - ? cad - elevated cholesterol - paf (in setting of bleed / surgery) - s/p endovascular repair of thoracic aortic aneurysm () complicated by hemothorax / vats - s/p ballooning of thoracic stent in to manage type i endoleak - s/p infrarenal abdominal aortic aneurysm repair. - chronic renal insufficiency - baseline cr 1.6, renal scan in 6/0 shows no visible blood flow to right kidney - left kidney appears to be performing 90 % of the total renal function and the right kidney performing 10% - right hydronephrosis - s/p ureteral stent in - obesity social history: patient is married and lives with his wife. former but quit 40 yrs ago. family history: non-contributory physical exam: t 95.6 ax, bp 199/109, hr 103, rr 17, sat 99% vent: tv ac tv 600 fio2 100% rr 16 peep 5 gen: initially somnolent but answering questions appropriately,now intubated and sedated heent: pupils reactive, mmm lungs: occ insp/exp wheezes bilat, bibasilar crackles heart: reg, no murmurs appreciated abd: + bs, soft, non-tender ext: + lower ext edema, pitting pertinent results: 06:43pm blood wbc-6.1 rbc-4.47* hgb-13.3* hct-41.7 mcv-93 mch-29.8 mchc-31.9 rdw-16.4* plt ct-157 06:43pm blood glucose-89 urean-35* creat-1.8* na-147* k-4.1 cl-107 hco3-34* angap-10 06:43pm blood ck(cpk)-41 06:43pm blood ctropnt-0.01 03:15am blood ck-mb-notdone ctropnt-0.02* 03:44pm blood ck-mb-notdone ctropnt-<0.01 05:14pm blood calcium-9.0 phos-4.1 mg-2.7* 09:16pm blood tsh-0.63 04:34am blood type-art temp-36.9 o2 flow-3 po2-62* pco2-62* ph-7.43 caltco2-43* base xs-13 intubat-not intuba 02:02am blood type-art temp-37.1 fio2-70 o2 flow-12 po2-91 pco2-70* ph-7.39 caltco2-44* base xs-13 intubat-not intuba 10:55am blood type- temp-36.2 rates-/15 peep-5 fio2-50 po2-40* pco2-72* ph-7.35* caltco2-41* base xs-10 intubat-intubated . renal ultrasound bilateral kidney demonstrate echogenic cortex which may be associated with a variety of diffuse parenchymal renal diseases. there is no evidence of obstruction, hydronephrosis or calculi. technically limited doppler evaluation however no definitive evidence of renal artery stenosis was seen . cta 1. post endovascular repair of the thoracic aortic aneurysm, there is persistent significant endoleak with slight increase in the size of the thoracic aortic aneurysm as described above. 2. stable aortic dissection with the left main renal artery supplied by the false lumen, the celiac artery, superior mesenteric artery, right renal artery and accessory left renal artery supplied by the true lumen. 3. stable appearance to the excluded right common iliac artery aneurysm with retrograde filling. stable right external iliac artery aneurysm. 4. cardiomegaly with bibasilar effusions and passive atelectasis of the lower lobes likely suggestive of ccf. 5. jj stent in a decompressed atrophic right kidney and stable renal hypodensities, likely cysts. 6. stable left adrenal myelolipoma. . v/q scan 1. low likelihood ratio for acute pulmonary embolism. 2. findings consistent with a tortuous thoracic aorta, as seen on cxr, as well as central tracer pooling suggestive of airways disease. brief hospital course: 76 yo male who presents after a syncopal episodes two days ago, now with hypertensive urgency and marked fatigue. on the floor noted to be increasingly somnolent and found to have an elevated co2. . #syncope patient initially presented for syncope work-up. although soon after admission he required mechanical ventilation for hypercarbic respiratory failure, many etiologies of syncope were inadvertently evaluated during admission. telemetry showed many pvc's but no malignant arrhythmias. echocardiogram revealed moderate concentric lvh, mild as, grade i diastolic dysfunction, and moderate pulmonary hypertension. ekg and subsequent cardiac enzymes ruled him out for a myocardial infarction. cta of the chest showed increased size of thoracic aneurysm, however without rupture. the most likely sources of syncope include hypercarbia or vaso-vagal syncope. he will require follow up with his pcp in two weeks (appointment scheduled). . # hypercarbic respiratory failure during initiation of hospitalization patient experienced sudden hypercarbic respiratory failure which required mechanical ventiliation and itubation. patient has extensive smoking history as well as history of cpap use at night. in conjunction with chronically elevated bicarbonate, provision dx of copd and osa are likely contributors to his respiratory failure. he was initially ruled out for pneumonia and pulmonary embolus. treatment for pneumonia included vancomycin / piperacillin - tazobactam x 5 days for presumed hospital acquired pneumonia, however subsequent bal showed no evidence of this. patient also has a history of diastolic dysfunction, which may have contributed to impaired ventilation; cxr showed evidence of pulmonary congestion and patient was diuresed as well. patient was extubated on hospital day eight and transferred to the floor. diuresis and nebulization w/ albuterol / atrovent were continued and incentive spirometry was started. pt was consulted and recommended home with pt. at discharge the patient required 2l of oxygen by nasal cannula to keep his o2 sats > 91%. the new o2 requirement was thought to be secondary to his not-fully diagnosed copd and osa. we recommended that he follow up with his pcp for likely 's in the future. home vna and pt was also established. lastly, he was also continued on albuterol / atrovent until further workup with his pcp. . # hypertension patient presented w/ hypertensive urgency. it was initialy thought that increased blood pressures were to renal artery stenosis, however, no doumented ras in the chart. repeat renal imaging showed impaired flow to right kidney, which is chronic. although transiently hypotensive in the icu, patient's baseline elevated bp resumed and was treated w/ home doses of antihypertensives. his lisinopril dose was increased and his imdur dose was decreased. upon discharge his sbp was in the 90-100 range without lightheadedness, weakness, shortness of breath. his bp was titrated to be low given his taa and aaa. . # urinary retention patient initially failed a voiding trial in setting of increased r sided hydronephrosis. urology was consulted regarding his right ureteral stent and recommended stent replacement in the near future. urology will contact the patient regarding this procedure. . # likely cad exact history is unclear, however w/ known aaa and thoracic aneurysm, unlikely patient does not have cad. home meds of include asa, imdur, bblocker were continued. he ruled out for mi w/ 4 sets of cardiac enzymes. . # thoracic and abdominal aortic aneurysms known hx of taa and aaa. ct evaluation showed increased size of thoracic aneursym w/ endograft leak as well as stable abdominal dissection at the level of the left renal artery. thoracic surgery evaluated patient and discussed management options w/ the patient. the patient elected to forgo surgical management in lieu of medical management (bp control, statin). . patient was admitted w/ syncope. he subsequently underwent mechanical ventilation for respiratory failure, likely due to copd / osa / atelectasis. he was diuresed, provided w/ nebulizers and his resp status improved. he has chronically elevated bicarbonate and co2 retention. once transferred to the floor the patient remained hemodynamically stable and afebrile. he was started on home o2, albuterol, and atrovent. . medications on admission: asa 81 qd simvastatin 20 mg qd metoprolol 50mg tid lisinopril 10mg qd imdur 60mg qd discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed. disp:*qs * refills:*0* 4. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). disp:*qs * refills:*0* 5. home oxygen please dispense home oxygen; 2l by nc, continuous flow. 6. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. disp:*qs * refills:*0* 8. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 10. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*0* 11. outpatient lab work please have full chemistry panel checked in 1 week. please fax this to your pcp @ for management. discharge disposition: home with service facility: / home health and hospice discharge diagnosis: primary: hypercarbic respiratory failure, syncope nos secondary: thoracic aortic aneursym, abdominal aortic aneursym, hypertension, obesity discharge condition: stable discharge instructions: you were admitted to the hospital after losing consciousness (syncope or fainting). in the hospital you had difficulty breathing and required intubation (a breathing tube) for several days. we think this is due to underlying lung disease from smoking and being overweight. we were unable to determine an exact cause of why you fainted. . if you feel short of breath, experience fevers, difficulty breathing, chest or abdominal pain, please call your doctor or return to the emergency room for evaluation. . you also had difficulty urinating after the foley (bladder) was removed. the urologists evaluated you and determined that you need a stent change in your right ureter. the urology office will call you to schedule this appointment. if you need to contact them, please call . . we changed the dose of 2 medications; take only 30 mg daily of imdur. take 20 mg daily of lisinopril. . we also started a few new medications. take albuterol and ipatroprium followup instructions: please make sure to see your primary care doctor (ehrig) on , at 2:30pm. please call to make any changes to this appointment. pleae have your blood checked (chemistry panel) in 1 week; have these results faxed to your pcp . . please make sure to follow up with the urologists regarding your ureteral stent. please call the above number with questions or changes. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iii (moderate) acute respiratory failure retention of urine, unspecified hyperosmolality and/or hypernatremia hydronephrosis chronic diastolic heart failure hypertensive chronic kidney disease, malignant, with chronic kidney disease stage i through stage iv, or unspecified shock, unspecified 

Answer: The patient is high likely exposed to