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: benzodiazepines / heparin agents attending: chief complaint: respiratory distress, hypotension major surgical or invasive procedure: endotracheal intubation swan-ganz catheter placement blood component transfusions history of present illness: pt is an 88 yo male h/o cad, mi, aaa (s/p repair, no leak) recent aicd for syncopal episode nos (), severe cardiomyopathy ef 10%, who originally presented to osh with epigastric pain found to be hypotensive there to 60s systolic. he was then intubated for hypoxic respiratory failure with abg 7.26/52/41 (was dnr/dni). he was transferred to the ccu. a cta was done to rule out aaa and did not show any leak but aneurysm of 6.5 cm and stable. . pt was treated for his shock which was of unclear etiology. he was started on zosyn and vancomycin on and vancomycin was d/cd as sputum from grew gnr not further speciated. there was not found to be any other source of infection. in the ccu, pressors were weaned off . pt was started on steroids on for inappropriate cortisol stimulation test though it appears not drawn correctly. . called by floor team today as pt with "" abdominal pain that was sharp and radiated to his back x 10 minutes. their exam revealed pain out of proportion to it and concern was for mesenteric ischemia. lactate on a vbg was noted to be up to 2.4 but repeat with abg is 1.7. pt says that he vomited x 1 today, did not notice the color. +mild sob. +dry cough that started today. +abdominal pain when i saw pt. past medical history: cad s/p cabg paf aaa (s/p repair) severe cardiomyopathy-ef 10% s/p aicd for sick sinus syndrome() s/p biv pacer htn gerd hypercholesterolemia pvd s/p iliac stent placement bilaterally h/o dvt/pe in past social history: wife in , former smoker family history: non-contributory physical exam: t: 97 (r); bp: 106/70; hr: 88; rr: 22; o2 98 2l gen: sitting up in bed tachypnic speaking in full sentences heent: eomi; sclera anicteric; op clear neck: no lad. jvd not appreciated at 80 degrees cv: irregularly irregular, s1s2. i-ii/vi systolic murmur at lusb and apex lungs: good air flow. crackles at left base. no change to percussion abd: nabs. soft, nd. mild tenderness to deep palpation in epigastric area. no rebound or guarding back: no spinal, paraspinal, cva tenderness ext: no edema. dp 2+ neuro: cn ii-xii tested and intact. "" "". knew he was at a hospital, though not which one. pertinent results: cta -impression: 1. no evidence for aortic dissection or pulmonary embolus. 2. 6.5-cm infrarenal abdominal aortic aneurysm with evidence of graft repair distally. no evidence of aneurysm rupture or leak. 3. pulmonary vascular congestion, intra-abdominal ascites, periportal edema, and anasarca suggest congestive heart failure versus volume overload or both. 4. cardiomegaly. 5. bibasilar subsegmental atelectasis with small bilateral pleural effusions. . echo -the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis, ef 10-15%. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated. there is mild global right ventricular free wall hypokinesis. the ascending aorta is mildly dilated. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr ap (not official read)- enlarged heart s/p sternotomy wires. there are b/l pleural effusions. ? left retrocardiac opacity. . cta wet read from radiology: sma is patent. cant see graft. no post-ischemic changes. free fluid in abdomen and anasarca, all unchanged. no change from prior. brief hospital course: in brief, the patient is an 88 year old man with severe ischemic cardiomyopathy s/p biv-icd placement, atrial flutter, cad, chronic kidney disease who presented with hypoxic respiratory failure and shock which was stablized. his course was further complicated by acute abdomial pain, psoas muscle hematoma, upper gi bleed, acute on chronic renal failure, heparin induced thrombocytopenia with upper extremity dvt, intermittent hypoxia, and urinary retention. . 1) shock - patient intially presented in shock requiring vasopressors. cardiac index was normal with decreased svr which were not consistent with cardiogenic shock. the likely cause of was distributive/septic shock of unclear source of infection. he completed a full course of empiric antibiotics. he completed 7 days of hydrocortisone/fludrocort for sub-optimal response to acth. bp stablized by time of discharge. . 2) respiratory failure: the patient initially presented in hypoxic respiratory failure likely secondary to chf, hypoventilation and decreased mental status. he was intubated prior to transfer to . he was weaned from the ventilator successfully. he did have intermittent hypoxia largely secondary to pulmonary edema from inadequate diuresis. he was stabilized on standing twice daily lasix. he was started on bipap at night for hypoventilation. . 3) abdominal pain - during the hospital stay he developed acute severe epigastric pain. he was transfered to the micu for concern for mesenteric ischemia. an abominal cta was negative for this. a surgery consult was obtained and recommended no surgical intervention. the pain resolved without specific intervention. he was subsequently found to have an psoas muscle hematoma and required several blood transfusions with appropriate response in his hematocrit. 4) cardiovascular: a. cad- history of mi s/p cabg. will continue asa, simvastatin, beta-blocker. . b. pump- severe ischemic cardiomyopathy with ef 10-15% s/p biv-icd placement. no evidence of cardiogenic shock upon initial presenation as c.i. was normal. medically managed chf with acei, beta-blocker, digoxin, spironolactone, furosemide. . c. rhythm- -v paced with underlying rhythm is atrial flutter/fibrillation. started on amiodarone for maintenance of sinus rhythm to maximize likelihood of atrial kick. also, amiodarone to decrease in-appropriate shocks from icd. 5) upper gi bleed - the patient did develop guaiac positive stools in the setting of anticoagulation for the atrial fibrillation. the hematocrit drop was largely due to the psoas hematoma as above. the patient refused egd. if the patient develops recurrent melenotic stools he could be referred to gi for endoscopy. he will continue on a ppi. . 6)acute on chronic renal failure - initial creatinine down from admission to peak 2.5 this was likely from pre-renal secondary to shock state; no evidence of atn. by time of discharge, the creatinine had resolved to baseline. . 7) anemia- in addition the the acute blood loss anemia as described above. the patient has a chronic microcytic anemia. iron studies were consistent with anemia of chronic disease (labs drawn before blood transfusions were given). also with regard to the significant microcytosis and his italian extraction, hemoglobin electrophoresis was performed to evaluate for thallasemia. these results were pending at time of discharge. . 8) thrombocytopenia - hit type ii. pf4 positive on , platelets stable at around 70k with subsequent recovery to greater than 150k. he did have a left upper extremity venous clot although the developement of this was after his platelets had stabilized. started argatroban on with transition to coumadin. he continued on argatroban until his inr on combined anti-coagulation was >4. at which time he was maintained on coumadin alone. . 9) urinary retention: - the patient has no prior history of urinary retention, nocturia, frequency or related bph symptoms. during one attempt at removing the foley catheter he had decreased urine output with a large volume detected on bladder scan. the foley was replaced. he was started on finasteride, not wanting to use an alpha-blocker that would likely cause hypotension when added to his extensive cardiac regimen. the catheter was left in at discharge. this should be removed in days followed by confirmation that the patient can urinate. . 10) code status: dnr/dni confirmed with patient and hcp. . 11) dispo: the patient was discharged to rehab medications on admission: hydrocortisone na 50 mg iv q6 riss ipratropium mdi prn tylenol prn albuterol prn lactulose 30 mg po q8 prn pantoprazole 40 mg po q24 hr amiodarone 200 mg po qday asa 81 mg po qday colace 100 mg senna fludrocortisone 0.05 mg po qday simvastatin 40 mg po qday heparin gtt zosyn 2.25 mg iv q6 discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed: to maintain at least 1bm per day. 7. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 8. metoprolol succinate 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 9. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for sleep. 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 12. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily): hold for sbp <95. 13. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours) as needed for wheezing, dyspnea. 14. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 15. warfarin 5 mg tablet sig: one (1) tablet po at bedtime: titrate to inr goal . 16. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 17. compazine 5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 18. outpatient lab work please draw pt/inr daily for 3 days and thereafter per protocol for inr goal 19. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 20. bipap bipap with mask at night 10cmh2o ps, 5 cmh2o peep. titrate fio2 to keep o2sat >95% discharge disposition: extended care facility: - discharge diagnosis: primary: septic shock hypoxic respiratory failure secondary: heparin induced thrombocytopenia acute blood loss anemia from psoas muscle hematoma urinary retention upper extremity venous clot ischemic cardiomyopathy atrial fibrillation/ atrial flutter congestive heart failure - systolic, compensated microcytic anemia discharge condition: good. stable vital signs. tolerating oral medications and nutrition. ambulating with minimal assist. discharge instructions: you have been evaluated for respiratory distress, and very low blood blood pressure. these resolved with time, antibiotics, and close management of your chronic heart disease. your course was complicated by a bleed into a hip muscle, a reaction to a medication called heparin, and difficulty urinating. these were all stablized over the course of the hospital stay. please take the medications as prescribed. please make and attend your recommended follow-up appointments. if you develop any concerning symptom particularly chest pain, shortness of breath, bloody or tarry stools please seek medical attention. followup instructions: please contact your primary doctor dr. at to be seen within the next 1-2 weeks. in the meantime you will be evaluated by the physicians at the rehab facility. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation pulmonary artery wedge monitoring transfusion of packed cells transfusion of other serum infusion of vasopressor agent diagnoses: acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia aortocoronary bypass status atrial flutter chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease acute respiratory failure blood in stool septic shock long-term (current) use of anticoagulants retention of urine, unspecified anticoagulants causing adverse effects in therapeutic use acute on chronic systolic heart failure abdominal pain, epigastric other disorders of muscle, ligament, and fascia fitting and adjustment of automatic implantable cardiac defibrillator 

Answer: The patient is high likely exposed to