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: zithromax attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: ms. is an 85 year old russian-speaking woman w/pmhx of cad s/p cabg, systolic and diastolic chf, afib on coumadin, cri (basleine creatinine ~1.5), complete heart block s/p permanent pacer, hip fracture after a fall who presents with sob. history is taken with help of her son as an interpreter. her son noticed that occasionally at rehab she was on oxygen intermittently but was not requiring oxygen at home. she has been at rehab since and came home 1 day prior to admission. her lasix dose was being adjusted at rehab. she has been progressively short of breath with worsening le edema for the past few weeks but markedly worse since in the past days. no chest pain or pressure. no lightheaded or dizzy feelings. no fevers or chills. she has a non-productive cough. + orthopnea which is chronic. she uses a walker at home and has had worsening doe. her son thinks she was adhering to a low salt diet. . in the ed, initial vs 99.8 73 139/60 16 100% 15l nrb, weaned to 97% on 2l. bnp was 23,00. cxr showed chf. she received 60mg iv lasix and a foley catheter was placed. ecg was paced. vitals prior to transfer: 98.7 72 138/57 18 98%/2 l nc. past medical history: 1. cad - s/p 2v cabg to om/cx and to rca. recath - occluded rca , om disease, previously diseased lcx and lad free of disease (followed by vainov/) 2. chronic systolic heart failure ef 30-35% 3. atrial fibrillation on warfarin and amiodarone 4. s/p ddd pacer for 2:1 av block 5. hypertension 6. hyperlipidemia 7. peptid ulcer disease 8. glaucoma 9. hypercalcemia hyperparathyroidism - s/p parathyroid resection in ''s now with recurrence; noted to have new large complex left-sided thyroid nodule (inconclusive biopsies) - followed by endocrine 10. s/p tah/bso 11. osteoporosis 12. h/o neurogenic bladder, urethral stricture 13. hyperplastic colonic polyps 14. h/o mod mr, mild pah, lae (tte ) 15. congestive heart failure, systolic, ef 40% 16. hypothyroidism social history: she lives alone in an apartment in and cares for herself. son and daughter live nearby. husband died last year. she denies any tobacco or etoh use. retired ent physician from . family history: non-contributory physical exam: vs: t97.2 bp 108/80 hr 72 rr 20 96% on 3l. general: well-appearing woman in nad, comfortable, appropriate. heent: nc/at, perrla, eomi, sclerae anicteric, mmm, op clear. neck: supple, no thyromegaly, jvd ~13cm. visibly pulsatile carotid pulse in the neck. no carotid bruits. heart: rrr, harsh ejection murmur at rusb. + chest heave. lungs: resp unlabored. diffuse wheezes and crackles through left lung field. right is more clear. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding. extremities: wwp, 2+ peripheral edema to thighs bilaterally, l perhaps slightly greater than r, 2+ peripheral pulses. skin: no rashes or lesions. lymph: no cervical lad. . discharge exam: vs: 97.0 131/63 71 28 95%2l general: nad, thin, pale elderly woman heent: perrl, eomi, mmm, op clear. neck: supple, no jvd heart: rrr, harsh ejection murmur at rusb lung: stable diffuse rhonci and crackles at 1/2way up, good airmovement. abd: soft/nt/nd, no masses or hsm, no rebound/guarding. extremities: wwp, 1+ peripheral edema to thighs bilaterally. skin: no rashes or lesions. lymph: no cervical lad pertinent results: blood counts 10:00pm blood wbc-7.6 rbc-4.23# hgb-12.7# hct-38.1# mcv-90 mch-30.0 mchc-33.4 rdw-16.7* plt ct-252 12:00pm blood wbc-14.4*# rbc-4.67 hgb-13.6 hct-42.9 mcv-92 mch-29.2 mchc-31.8 rdw-16.1* plt ct-233 05:05am blood wbc-17.1* rbc-4.19* hgb-12.4 hct-37.4 mcv-89 mch-29.6 mchc-33.2 rdw-16.6* plt ct-191 04:18am blood wbc-7.8 rbc-3.79* hgb-11.0* hct-33.2* mcv-88 mch-29.0 mchc-33.1 rdw-15.6* plt ct-169 coags 10:00pm blood pt-22.5* ptt-26.7 inr(pt)-2.1* 04:18am blood pt-33.8* ptt-30.8 inr(pt)-3.4* chemistry 10:00pm blood glucose-126* urean-35* creat-1.8* na-144 k-3.6 cl-106 hco3-27 angap-15 07:20am blood glucose-86 urean-30* creat-1.5* na-143 k-3.6 cl-103 hco3-33* angap-11 07:08am blood glucose-89 urean-50* creat-1.7* na-149* k-3.4 cl-110* hco3-29 angap-13 04:18am blood glucose-82 urean-36* creat-1.5* na-145 k-3.9 cl-106 hco3-30 angap-13 cardiac 10:00pm blood probnp-* 10:00pm blood ctropnt-0.01 07:30am blood ck-mb-2 ctropnt-<0.01 07:20am blood ck-mb-2 ctropnt-0.02* reports cxr: cardiomegaly with mild congestive heart failure. probable small bilateral pleural effusions and left basilar atelectasis. . cxr: increasing confluent opacities within the left mid lung zone and right lower lung zone may represent pulmonary edema given the rapid onset with the differential being infection or aspiration. . tte: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with mid- and distal anterior and septal akinesis, as well as inferior hypokinesis and probable akinesis of the true lv apex (segment incompletely visualized). the remaining segments contract normally (lvef = 35%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. moderate regional left ventricular systolic dysfunction, most c/w multivessel cad. mild aortic regurgitation. moderate to severe mitral regurgitation. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , there is more prominent anterior/septal regional lv dysfunction and the overall lvef is lower. the other findings are similar. . video swallow: several episodes of penetration and aspiration with administration of thin liquids. the study and the report were reviewed by the staff radiologist. brief hospital course: hospital course 85 year old russian-speaking woman p/w worsening systolic chf, course complicated by aspiration pneumonia, s/p abx and diuresis, ready for discharge to rehab . active issues: # acute on chronic systolic heart failure: patient was admitted with sob and hypoxia with signs of fluid overload on exam/imaging and an markedly elevated bnp. course was complicated by a stay in the ccu for a lasix drip to treat hypoxia in the setting of failure. patient was subsequently diuresed with improvement in resp status and transfer back to the floor. diuresis was also complicated by an episode of hypotension thought to be secondary to over diuresis and scheduling of medications; decreased dosing of spironolactone and isosorbide mononitrate, and spread out administration of medications to decrease risk of hypotension during the daytime. the remaineder of her chf regimen (carvediolol, digoxin and losartan) was continued unchanged. . # recurrent aspiration pna: during hospital course patient was found to have rll infiltrate. vanco/cefepime was started for treatment of presumed aspiration pna. video swallow showed unpreventable silent aspiration with all fluid consistencies. per family meeting, patiend wished to continue eating and to be rehospitalized if she aspirates in the future. at discharge patient was planned for cotinuation of antibiotics until . . # medication changes due to age: ativan, hydroxyzine, ambien, meclizine were stopped given patients age and risk of causing delirium. . inactive issues: # cad: continued aspirin, carvedilol . # anemia: continued iron sulfate. . # afib on coumadin: pacer dependent, on coumadin and amiodarone (inr goal ). chads2=2. . # glaucoma: continued latanoprost. . #hypothyroidism: continued levothyroxine . transitional issues: 1. code status - patient remained dnr/dni 2. pending labs - no labs/studies were pending at time of discharge 3. transition of care: patient was discharged to rehab facility in . 4. barriers to care: the family was made aware of the unpreventable silent aspiration and a family meeting was held. the patient requested that she be allowed to eat and understood the potential risk for ongoing aspiration and re-hospitalization. she has asked to be rehospitalized and treated with antibitiotics. medications on admission: xalatan 0.005 % eye drops 1 drop qhs patanol 0.1% eye drops 1 drop each eye carvedilol 6.25mg po daily protonix 40mg po bid senna 8.6mg 2 tabs vitamin d2 50,000 units po every other week aspirin 81mg po daily ativan 0.5mg po prn anxiety calcitriol 0.25mg po daily losartan 12.5mg po daily digoxin 125mcg sig: .5 tabs po qod imdur 30mg po daily amiodarone 200mg po daily meclizine 12.5mg po daily nitroglycerin 0.4mg sl prn hydroxyzine 5mg po qhs prn itching spironolactone 25mg po daily ambien 5mg po qhs prn insomnia levothyroxine 50mcg po daily ferrous sulfate 325mg po daily warfarin 1mg daily (per son) lasix 60mg po daily discharge medications: 1. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 2. patanol 0.1 % drops sig: one (1) drop ophthalmic twice a day: each eye. 3. carvedilol 3.125 mg tablet sig: two (2) tablet po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 5. senna 8.6 mg capsule sig: two (2) capsule po twice a day. 6. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po every other week. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 9. losartan 25 mg tablet sig: 0.5 tablet po daily (daily). 10. digoxin 125 mcg tablet sig: one half tablet po every other day (every other day). 11. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 12. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tab sublingual once a day as needed for chest pain. 13. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 14. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 15. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. 16. lasix 20 mg tablet sig: three (3) tablet po once a day. 17. heparin, porcine (pf) 10 unit/ml syringe sig: ten (10) ml intravenous prn (as needed) as needed for line flush: picc. 18. cefepime 2 gram recon soln sig: two (2) g injection q24h (every 24 hours) for 1 doses: last day . 19. outpatient lab work vancomycin trough before pm dose. fax results to rehab physician for titration of vancomycin, goal trough = 15-20. 20. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation every six (6) hours. 21. spironolactone 25 mg tablet sig: 0.5 tablet po qpm (once a day (in the evening)). 22. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po daily (daily). 23. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q48h (every 48 hours) for 1 doses: last day . discharge disposition: extended care facility: rehabilitation and nursing of discharge diagnosis: primary: -acute on chronic diastolic heart failure -aspiration pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). - patient w stable ronchorus breathing, satting mid90s on 2 liters discharge instructions: it was a pleasure taking care of you at . you were hospitalized for treatment of shortness of breath. your symptoms were a result of your worsening of your heart failure (your heart having trouble pumping), in addition to an infection in your lungs. fluid was taken off from your lungs with medications, and you were given antibioitics. . your pneumonia was likely caused by difficulty swallowing, with saliva, liquids, and food falling into your lungs. the swallow team evaluated you and was unable to make diet recommendations to that would prevent this aspiration process. by continuing to eat, you will continue to have the risk of aspirating. they recommended that you see a speach therapist to help teach you proper eating techniques. you indicated that you would like to continue eating. . during this hospitalization the following changes were made to your medications: -started iv vancomycin to treat for pneumonia -started iv cefepime to treat for pneumonia -started nebulizer treatments -decreased isosorbide mononitrate -decreased spironolactone -stopped ativan, ambien, meclizine, hydroxyzine as this can cause disorientation in patient's your age followup instructions: your care after discharge will be overseen by the extended care facility physician. extended care physician should schedule follow-up appointment with your primary care physician 2 weeks after discharge from the extended care facility. department: voice, speech, and swallowing phone: please call and book a follow up appointment within 2 weeks of discharge. if you have any questions or concerns please call the office. md procedure: venous catheterization, not elsewhere classified diagnoses: anemia in chronic kidney disease congestive heart failure, unspecified acute kidney failure, unspecified unspecified protein-calorie malnutrition unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status unspecified glaucoma chronic kidney disease, unspecified other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of anticoagulants cardiac pacemaker in situ do not resuscitate status hyperosmolality and/or hypernatremia other and unspecified coagulation defects acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to