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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath, leg swelling major surgical or invasive procedure: tee guided dc cardioversion () history of present illness: this is a 63m patient with pmhx of ?gerd and ?htn who presented to his pcp with one month of exertional dyspnea, orthopnea, 2 weeks of worsening lower extremity edema, and abdominal bloating found to be in afib with rvr and sent to ed. patient states that beginning in he experienced some abdominal bloating and distended abdomen and sought treatment from pcp who has been prescribing probiotics. probx have helped with the distention, but only temporarily- patient has noticed increased distension in last 2 months. starting about 2 weeks ago, had significant orthopnea, pnd, and increased leg swelling. has had some dyspnea on exertion; patient usually can walk a mile but has been getting short of breath on walks. no changes in diet- eats high vegetable diet. patient describes some vague back and chest pain on and off but he attributed this to musculoskeletal injury as he has been active recently. denies palpitations and dizziness/syncope. no nausea/vomiting/diarrhea, diaphoresis, fevers. the new onset leg swelling prompted patient to go to pcp (care at atrius) where he was found to have a hr in the 170s and in afib. pcp sent him to er. ed course: in the ed patient presented with systolic bp in 140s. he was started on nitro gtt at 5 mcg/min and his bp rapidly dropped to 60 systolic but recovered to 100 systolic with discontinuing the nitroglycerin drip. he received 20mg iv furosemide and put out 750 cc urine. . he received 4 baby aspirin tablets. he received a total of 7.5mg of iv metoprolol in 2.5mg boluses with a reduction in his heart rate to 120s an echocardiogram was performed by the on-call fellow where the lv appeared severely reduced and the rv function was depressed as well. no valvular abnormalities were noted. no pericardial effusion noted. patient was then transfered to ccu for further medical management past medical history: past medical history: 1. cardiac risk factors: (?) diabetes, (-) dyslipidemia, (?) hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: -pacing/icd: -ett: negative ett with occasional ventricular premature beats during exercise. -ett: - normal. j point elevation found, no worrisome st changes. 2 episodes of svt during recovery, and rare vbps during exercise. -stress test: exercise duration was normal. heart rate and blood pressure response to exercise was normal. the patient had no symptoms and the test was terminated secondary to leg fatigue. no st segment changes. nuclear: myocardial perfusion imaging is normal. global and regional systolic function are normal 3. other past medical history: -gerd, although elucidation of history indicates it may be cardiac related -htn- says has had white coat htn. monitors bp at home and has sytolic bps consistently 120s-130s with diastolic "higher than it should be" social history: -tobacco history: denies -etoh: 1 oz/week -illicit drugs: denies family history: mother with disease, father with mi at 60 y/o. 2 uncles with cabg. father's side with significant cardiac disease, although unspecified. no history of sudden cardiac death physical exam: on admission vs: t=97.8 bp=114/64 hr=136 afib rr= 20 o2 sat= 97% general: in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 11 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. irregular irregular rhythm, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles auscultated at the base abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 2+ pitting edema to knees bilateral les. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ on discharge temp 98.6, hr 90's-120's af, bp 112-134/70-80's, o2 sat 98% ra. heent: jvd at 8cm cv: irreg irreg, no sig murmurs chest: ctab posteriorly abd: soft, nt, nd extr: 1+ edema bilat to knees right hand: small ecchymotic dark area around iv site, mild swelling around anterior hand site with redness extending to wrist. ttp. weight 102 kg. pertinent results: on admission 08:20pm glucose-110* urea n-26* creat-1.2 sodium-140 potassium-4.8 chloride-111* total co2-17* anion gap-17 08:20pm wbc-10.2 rbc-5.57 hgb-16.1 hct-49.1 mcv-88 mch-28.9 mchc-32.8 rdw-14.3 08:20pm plt count-200 08:20pm calcium-8.7 phosphate-4.5 magnesium-2.1 pertinent results tee no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. lv systolic function appears depressed. there is depressed right ventricular free wall contractility. there are simple atheroma in the descending thoracic aorta (to 30 cm from the incisor). the aortic valve leaflets (3) are mildly thickened. a minor tee procedure related complication occurred (see comments for details). impression: no evidence of spontaneous echo contrast or clot in the la, laa, ra, or raa. depressed biventricular global systolic function but this was not fully evaluated. tte the left ventricular cavity is mildly dilated. overall left ventricular systolic function is severely depressed (lvef= xx %). right ventricular chamber size is normal. with depressed free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , biventricular systolic function now appears slightly more vigorous. 06:09am blood alt-67* ast-29 ld(ldh)-191 alkphos-74 amylase-50 totbili-1.0 06:09am blood albumin-4.0 phos-3.9 mg-2.2 brief hospital course: mr. is 63m with history of borderline htn, ?gerd, and ?dm who initially presented to his pcp's office with dyspnea and le swelling, found to be in atrial fibrillation with rvr and new diagnosis of acute on chronic systolic heart failure. # a fib with rvr: the patient was found to be in new onset atrial fibrillation, with rates initially in the 110s in his pcps office, but on transfer to the cardiac care unit was as high at the 150s. tsh =5. it was unclear if a fib was secondary to his systolic heart failure or if his heart failure was secondary to his a fib. morning after admission, a tee guided cardioversion was performed successfully. however, 1 hr later he returned to a fib. tee did not detect any atrial thrombus and dabigotran was initiated. in addition, the patient was loaded with amiodarone iv (1mg/min for 6hrs, 0.5mg/min for 18hrs) then transitioned to amiodarone 400mg tid. the patient was also given digoxin and carvedilol 12.5 mg for rate control. during hospitalization, ventricular rates decreased from 130's consitently to the low 100's. the patient has been advised to limit physical activity until he is medically optimized on digoxin, amiodarone, and carvedilol. #acute on chronic systolic heart failure- the patient presented with symptoms of lower extremity edema, pnd, and orthopnea, in the setting of having bnp of 3065. tte demonstrated global lv dysfunction with ef 20%. right ventricular chamber size was normal with depressed free wall contractility. the patient was started on iv lasix boluses with a robust urine output. electrolytes and renal function were consistently monitored with no complications. the patient quickly reported improvment in his shortness of breath and leg swelling. mr has been discharged on carvedilol, lisinopril 5mg/day which he will continue as an outpatient. he is also discharged with lasix 40mg po daily. # right peripheral iv cellulitis: noted after taking out iv. mild to moderate swelling that extended to mid wrist, tenderness and redness. rec'd heat and elevation. by , swelling and redness had almost resolved but tenderness remained. low dose cephalexin ordered for one week. transitional issues the patient will be following up with atrius cardiology in 2 weeks and with pcp office and on . the patient has been discharged on amiodarone 400mg tid x 4days and 200mg tid until the patient's appt with dr. . at this time, a long term dose of amiodarone will be assigned. dr. will also decide if and when the patient should have a repeat cardioversion after more aiodarone is on board. the patient will need a repeat echocardiogram to evaluate interval change of his chf. if caridac function does not improve over the long term, the patient may be a canditate for defibrillator and/or ablation with crt therapy. the patient has no history of coronary artery disease, but he should have a stress test to rule this out as a cause of his chf. medications on admission: none discharge medications: 1. carvedilol 12.5 mg po bid rx *carvedilol 12.5 mg one tablet(s) by mouth twice a day disp #*60 tablet refills:*0 rx *carvedilol 12.5 mg one tablet(s) by mouth twice a day disp #*60 tablet refills:*2 2. dabigatran etexilate 150 mg po bid rx *pradaxa 150 mg one capsule(s) by mouth twice a day disp #*60 tablet refills:*2 3. digoxin 0.125 mg po daily rx *digoxin 125 mcg one tablets by mouth daily disp #*30 tablet refills:*2 4. furosemide 40 mg po daily hold for sbp<90 rx *furosemide 40 mg one tablet(s) by mouth daily disp #*30 tablet refills:*0 rx *furosemide 40 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 5. lisinopril 5 mg po daily hold for sbp<90 rx *lisinopril 5 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 6. amiodarone 400 mg po tid duration: 4 days rx *amiodarone 400 mg one tablet(s) by mouth three times a day disp #*9 tablet refills:*0 rx *amiodarone 400 mg one tablet(s) by mouth three times a day disp #*12 tablet refills:*0 7. amiodarone 200 mg po tid take this until you see dr. rx *amiodarone 200 mg one tablet(s) by mouth three times a day disp #*90 tablet refills:*0 8. outpatient lab work please check chem-7 on monday at with results to dr and pa at phone: fax: icd 9: 427.3 discharge disposition: home discharge diagnosis: atrial fibrillation with rapid ventricular response acute systolic congestive heart failure hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr , you presented to the hospital with palpitations, shortness of breath, and chest pressure. you were found to be in an irregular heart rhythm called atrial fibrillation. we attempted a cardioversion of your heart back to a normal rhythm. this was only temporarily successful. we have started you on medications to control your heart rate and rhythm (digoxin, amiodarone, and metoprolol). we have also started you on a medication call pradaxa that thins your blood. patients with atrial fibrillation can form small clots in their heart . pradaxa can prevent this from happening. now that you are on a blood thinning medication, you may experience easy bruising and it will take longer for cuts and scrapes to stop bleeding. in addition, please contact your doctor if you sustain any traumatic injury, such as a head injury, since you may have increased risk of internal bleeding. ultrasound of your heart showed your heart was not pumping normally. we think this is closely related to your atrial fibrillation. we have started you on new medications to help your heart pump better and we hope that controlling the heart rate will help your heart recover. we are hopeful that treating your atrial fibrillation and heart failure will help relieve many of your previous symptoms and allow you to feel completely healthy once again. a detailed description of your medications is listed below. please follow up with your doctor appointments as listed below. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. it was a pleasure taking care of you, mr . followup instructions: department: primary care name: , pa for , x. when: monday at 9:10am location: address: , , phone: department: cardiology name: dr. when: dr. office is working on a follow up appointment for you in days after your hospital discharge. you will be called by the office with your appointment date and time. if you have not heard from the office in 2 business days please call the office number listed below. location: address: , , phone: procedure: diagnostic ultrasound of heart atrial cardioversion diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation acute systolic heart failure 

Answer: The patient is high likely exposed to