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) / demerol attending: chief complaint: transfer for cath major surgical or invasive procedure: intubation central line placement ppm placement history of present illness: 75 f with copd, htn, bilateral hip replacements, depression, anxiety transferred from osh for nstemi. she was recently hospitalized at from to for a r hip dislocation s/p closed reduction. the hospital course was complicated by respiratory failure requiring icu stay for bilateral pna and copd flare. she was discharged to home on a course of doxycycline and steroid taper which she has not finished yet. at home, she really has not been active and on the night of , she felt so sob she could not sleep. she had trouble lying flat but did not notice weight gain or leg edema. she also reports having increased clear sputum over the past three days. she was brought to hospital where initial cxr did not show infiltrate or chf. she was thought to have another copd flare and was given ceftriaxone and steroids. she was thought to be dry in fact and was given fluids initially. eventually, her cardiac markers came back positive: troponins 8.8, 8.8 and 4.6, ck 237, 190, 163; mb 56, 43, 40. she was given plavix and lovenox and was transferred to for cath. during cath, she was found to have diffuse disease and she got 4 des to the lad. she was hypoxic and got 40 iv lasix and put out 1l. a rhc was not done. she was on a non-rebreather saturating 100% with sbp 110. she was then transferred to the ccu. ros: denies chest pain, abd pain, n/v/d. denies palpitations, lh, syncope. denies claudications. denies bleeding disorder or hematachezia or strokes. past medical history: copd on home o2 at one pt, and required intubation in the past bilateral hip replacement wrist fracture anxiety depression gerd social history: lives with her husband, 40 pack year smoking history, currently still smokes about 5 cigarretts a week. retired school nurse. family history: no early family history of cad. physical exam: gen: a+ox3, nad, mildly drowsy but answers questions appropriately heent: perrl, eomi, op clear, mmm neck: jvp to angle of jaw cv: rrr, no m/g/r, pmi at 5th intercostal space midclavicular line, no heaves or thrills pulm: diffuse crackles and tight air movement, minimal wheezing, no rhonchi. abd: soft, nt, nd, +bs ext: no peripheral edema neuro: cn ii-xii intact, mobilizes all extremities pertinent results: admission labs: 07:51pm blood wbc-13.2* rbc-4.24 hgb-12.7 hct-39.6 mcv-93 mch-29.9 mchc-32.0 rdw-13.9 plt ct-221 07:51pm blood pt-16.5* ptt-51.1* inr(pt)-1.5* 07:51pm blood glucose-117* urean-18 creat-0.9 na-137 k-4.5 cl-98 hco3-35* angap-9 07:51pm blood ck(cpk)-110 07:51pm blood ck-mb-15* mb indx-13.6* 02:51am blood alt-165* ast-68* ld(ldh)-417* ck(cpk)-76 alkphos-83 totbili-0.2 02:51am blood triglyc-81 hdl-52 chol/hd-2.8 ldlcalc-78 08:30pm blood po2-166* pco2-91* ph-7.18* caltco2-36* base xs-2 08:30pm blood lactate-0.6 micro: urine cx: negative x2 blood cx: ngtd x2 respiratory culture (final ): oropharyngeal flora absent. yeast, sparse growth. mold, 1 colony on 1 plate. imaging: cardiac cath: selective coronary angiography of this right dominant system revealed nonobstructive left main and 2 vessel obstructive coronary artery disease. the lmca had a 40% stenosis distally, extending into the ostium of the lad. the lad was a large vessel that supplied the apex, and was diffusely diseased and calcified. there was a 40% ostial stenosis, followed by sequential 70% and 90% stenoses of the proximal and mid lad. the lcx was totally occluded, and was collateralized distally by the rca. the rca had lumenal irregularities up to 30-40% stenosis of the proximal and mid vessel, but was otherwise patent. patient received 4 des to the lad. cxr: the heart size is mildly enlarged. the mediastinum is slightly shifted towards the right that might be due to atelectasis or scarring in the right upper lobe. lungs are overall hyperinflated with start increase in interstitial prominence in both lungs which might represent interstitial pulmonary edema in the presence of emphysema. round dense approximately 2 cm opacity projecting over the right hilus and may represent calcified lymph node. cxr: the et tube tip is 5 cm above the carina. the cardiomediastinal silhouette is stable with slightly decreased heart size. it might be due to initiation of mechanical ventilation. the lungs remain over- inflated and essentially clear except for minimal opacity at the right base which may represent atelectasis versus small aspiration and linear right perihilar scarring. the previously suspected nodular opacity is not seen on the current study and may be obscured, thus evaluation with follow-up radiograph is recommended. interstitial edema has resolved. ecg: probable atrial fibrillation with rapid ventricular response rate at 165. non-specific generalized repolarization changes consistent with tachycardia and/or ischemia. cannot exclude left ventricular hypertrophy. compared to the previous tracing of normal sinus rhythm with probable left atrial abnormality has given way to atrial fibrillation with rapid ventricular rate and the heart rate has nearly doubled. tte: moderate regional left ventricular systolic dysfunction (ef 40-45%) with severe hypokinesis of the basal to mid inferior and inferolateral segments and mild hypokinesis of the basal to mid anterior wall and anterior septum. systolic function of apical segments is relatively preserved. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). (1+) mitral regurgitation. mild pulmonary artery systolic hypertension. there is no pericardial effusion. ecg: sinus rhythm. non-specific st-t wave changes. compared to the previous tracing sinus rhythm has replaced atrial fibrillation. cxr: severe hyperinflation reflects copd. elevation of the minor fissure reflects volume loss in the right upper lobe. fullness in the right hilus may indicate adenopathy. routine radiographs are recommended as a first step and to see if additional imaging with ct scanning is indicated. lungs clear of focal abnormality. heart size normal. thoracic aorta is generally large but not focally aneurysmal. no pneumothorax. brief hospital course: 1. nstemi: patient transferred with positive biomarkers but already trending down at osh. event possibly from osh admission when she developed respiratory failure from bilateral pna, or shortly after discharge. had diffuse disease now s/p 4 des to lad. medical regimen includes aspirin, beta blocker, plavix, statin. also encouraged smoking cessation, nicotine patch use. no further complaints of chest pain during hospitalization. please note that she should have her aspirin dose reduced to 81 mg on (i.e. 4 weeks after her cath). 2. acute on chronic systolic and diastolic hf: had crackles all the way up the lung fields bilaterally on admission. she diuresed with good response to lasix 40 iv. ef in was 45-50%, now 40-45%. she was continued on her blocker and (initially held with hypotension but restarted as hypotension resolved). exam improved with diuresis. 3. copd: increased sputum production and wheezing as well as hypercarbia suggestive of copd flare. was treated with levofloxacin 5 day course and steroid taper, which she had still been on from her last copd flare. sputum culture with yeast and 1 colony of mold, no clinical evidence of infection. she was continued on her inhaler regimen, and started on tiotropium. 4. afib/arrhythmias: pt developed afib with rvr on with hr to 150s. she was given iv diltiazem and amiodarone with good response. she had several subsequent episodes (approx 1-2 per day) which responded well to diltiazem iv. she was started on carvedilol which was uptitrated as tolerated, and amiodarone was continued po. she was started on coumadin without bridge. however, on she had a 20 second asystolic episode, likely secondary to vagal episode. code blue was called but patient quickly recovered blood pressure, heart rate and respirations wihtout intervention. review of tele appeared to have sinus brady and slowing before 20sec pause then sinus tachy with recovering of pulse. she was transferred back to the ccu, beta blockers, amiodarone and coumadin were held in the preparation for pacemaker placement by ep. the pacemaker was placed on . she was treated with 72 hours of antibiotics following. she will have her device checked in the clinic in one week. 5. blood pressure: patient developed hypotension requiring pressors after intubation likely related to intubation. given initial concern for infection or sepsis since she had a fever on arrival, she was treated with vanc <24 hours. this was discontinued as patient's bp improved after extubation. her losartan was discontinued since she was noted to be hypotensive, especially post pranidially. medications on admission: prednisone taper (starting on : 40mg x2d, 30mg x2d, 20mg x2d, 10mg x3d) doxycycline klonipin 0.5 in the am and q4h prn paxil 20 cozaar 50 nexium 40 simvastatin 10 calcium vit d 1200/400 advair 250/50 spiriva albuterol prn mvi discharge medications: 1. clonazepam 0.5 mg tablet sig: one (1) tablet po q am. 2. clonazepam 0.5 mg tablet sig: one (1) tablet po every four (4) hours as needed for anxiety. 3. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 4. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 10. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 11. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 12. cephalexin 500 mg capsule sig: one (1) capsule po every six (6) hours for 3 doses. 13. lasix 20 mg tablet sig: one (1) tablet po once a day. 14. xopenex 0.63 mg/3 ml solution for nebulization sig: one (1) inhalation every four (4) hours as needed for shortness of breath or wheezing. 15. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. 16. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 17. aspirin 325 mg tablet sig: one (1) tablet po daily (daily) for 1 months: after 1month change to 81mg daily. 18. pneumoboots when in bed patient should have pneumboots on for dvt prophylaxis 19. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily) for 6 weeks. 20. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 21. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). discharge disposition: extended care facility: healthcare discharge diagnosis: primary diagnosis: 1. copd exacerbation 2. nstemi 3. atrial fibrillation 4. vagal episode . secondary diagnoses: 1. bilateral hip replacement 2. anxiety discharge condition: stable. patient is tolerating oral intake and ambulating with assistance. discharge instructions: you were admitted to the hospital with shortness of breath. this is most likely related to your copd and heart disease. for your copd, you were treated with steroids, antibiotics, and inhalers. for your heart disease, you underwent a cardiac catheterization which demonstrated disease in your heart vessels. you had several stents placed in your heart vessels. while you were hospitalized, you also had an abnormal heart rhythm. this was improved with medications. . your weight increases by 3 lbs. please adhere to a low salt diet. . we have made the following changes to your medications: these medications were started: - atorvastatin - aspirin (please decrease to 81mg after one month) - plavix - lasix - coumadin - carvedilol - xopenex (as needed): this is in place of your albuterol inhaler - cephalexin (three more doses) . these medications were discontinued: - albuterol - simvastatin - losartan . these medications were continued: - advair - spiriva - paxil - klonipin - nexium - calcium and vit d . please seek immediate medical attention if you develop chest pain, shortness of breath, light-headedness, dizziness, passing out, wheezing, swelling in your lower extremities, headache, fevers, shaking chills, or night sweats. followup instructions: please follow-up with your primary care physician . on after you are discharged from rehabilitation. he can check your coumadin levels using a fingerstick test and will tell you how much coumadin to take. . please also follow-up with your cardiologist dr phone: date/time: at 2:00 pm clinical center, , . pulmonology: provider: . phone: date/time: at 10:30am. . pacemaker follow-up: device clinic phone: date/time: 1:30 clinical center, . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified coronary arteriography using two catheters left heart cardiac catheterization insertion of endotracheal tube initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of drug-eluting coronary artery stent(s) excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of four or more vascular stents diagnoses: subendocardial infarction, initial episode of care tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation atrial flutter dysthymic disorder other and unspecified hyperlipidemia acute respiratory failure syncope and collapse acute on chronic combined systolic and diastolic heart failure other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to