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: increased shortness of breath. major surgical or invasive procedure: right heart catheterization on . history of present illness: patient is a 66 year old woman with a history of cad (status post mi in and ), dilated cardiomyopathy, and chf (ef 20-25% in , 50% in , 35% in setting of moderate to severe mr), who presented for a scheduled echo appointment today with two weeks of increasing shortness of breath. patient had been hospitalized in for a chf exacerbation, but the symptoms, currently, are not nearly as severe. she endorses 8 pillow orthopnea, pnd, and decreased ability to sleep over the past several weeks. she denies any chest pain, palpitations, or abdominal pain. she endorses an infrequent cough, productive of green sputum. she denies any recent weight gain or pedal edema. she also denies altering her diet over the holidays, as her daughter prepares her meals and is "careful not to use too much salt." she states that her exercise tolerance has not changed markedly since . she can climb one flight of stairs, but only does so once a night. she can go to the supermarket and push a cart through the aisles. patient is a direct transfer from outpatient clinic and is scheduled to be evaluated for an aicd or mitral valve replacement, after patient diuresed. on review, patient denies any previous sick contacts, hemoptysis, fevers, chills, or rigors. past medical history: -- htn -- chf, ef 20-25% in , 50% in -- cad, s/p mi , -- cri, baseline cr 1.9-2.1 in , 3.0 more recently per pcp's office -- dmii social history: she has a 30 pack-year history of smoking; she quit in . she does not consume etoh. denies illicit substance use. she lives alone and has five daughters. family history: no family history of cad or dm. physical exam: t:98.7 bp:148/73 hr:76 rr:22 o2saturation:100% on room air gen: pleasant, well appearing. sitting up in bed. appears stated age. heent: slight conjunctival pallor. no icterus. slightly dry mucous membranes. oropharynx clear. neck: supple. jvd appreciated 3cm below ear lobe. no cervical or supraclavicular lymphadenopathy. cv: rrr. normal s1 and s2. slight 4/6 systolic murmur in apex and left lower sternal border. no rubs or appreciated. lungs: crackles in lower lung fields, bilaterally. upper lung fields clear to auscultation, bilaterally. no wheezes or rhonci appreciated. abd: normal active bowel sounds in all four quadrants. soft. nontender and nondistended. no guarding or rebound. liver edge not palpated. no splenomegaly appreciated. ext: warm and well perfused. no clubbing or cyanosis. no lower extremity edema, bilaterally. 2+ dorsalis pedis and radial pulses, bilaterally. skin: no rashes, ulcers, petechiae, or pigmented lesions. no ecchymoses. no xerosis. neuro: alert and oriented to person, place, date. affect appropriate. pertinent results: right cardiac cath (): patient noted to have wedge of 36, ra 15, pa 55, rved 22, ci 3.25. . ekg(): sinus rhythm of 85. left axis. left bundle branch noted. could not appreciate any st segment elevations. . ef (): ef 35%. the left atrium is mildly dilated. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is moderate regional left ventricular systolic dysfunction with basal to mid inferior akinesis. overall left ventricular systolic function is moderately depressed. tissue synchronization imaging demonstrates no significant left ventricular dyssynchrony. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate to severe (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: moderate left ventricular systolic dysfunction (regional) without significant left ventricular dyssynchrony. mild aortic stenosis. moderate mitral regurgitation. . renal u/s: impression: 1. no hydronephrosis. 2. cholelithiasis without evidence of cholecystitis. . vein mapping: impression: patent bilateral subclavian veins and bilateral brachial arteries. although both cephalic and basilic veins are patent, they are all less than 0.20 cm. . echo: conclusions: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is moderate regional left ventricular systolic dysfunction with akinesis of the basal to mid inferior wall. right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. trace 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. the estimated pulmonary artery systolic pressure is normal. there is a small circumferential (0.6 cm) pericardial effusion. . right heart cath: comments: 1. resting hemodynamics revealed mildly elevated mean pcpw of 15mmhg. cardiac index was normal at 3.8 l/min/m2. . carotid artery u/s: impression: minimal plaque with bilateral less than 40% carotid stenosis. brief hospital course: assessment and plan: 66 year old woman with cad, status post mi in and , moderate mr, ef 35%, and chf who was hospitalized in for chf exacerbation, who presented for a scheduled appointment today and was noted to have increased shortness of breath over the past two weeks. admitted for fluid management of chf and potential mvr and/or icd. . #) chf: the patient was noted to have an ef of 35% on , in setting of moderate mr. has had increasing shortness of breath in the past several weeks. she denies any chest pain or palpitations. she denies any noncompliance with her diet as an outpatient and denies any recent weight gain or increased lower extremity swelling. right heart cath on revealted a wedge pressure of 36, ra 15, pa 55, and a ci 3.25. she was aggressively diuresed with lasix despite her acute on chronic renal failure. a repeat right heart cath on revealed much improved hemodynamics with a wedge pressure of 15 with a ci of 3.8. she was continued on hydralazine, isosorbide and amlodipine. an echo on showed 3+mr and mild as with an lvef of 30-40%. she was consulted by ct surgery for possible mvr. she had preop labs drawn and carotid u/s which showed bilateral less than 40% stenosis. she will also need a left heart cath prior to surgery. this will be scheduled for next week and she will return the night before for pre-cath hydration. dr. office will contact her when the exact date is established. she may also need a biv icd in the future as a preventative measure. . #) cad: known cad s/p mi in and . she had no active ischemia during this admission. she was continued on aspirin, ezetimibe, plavix, metoprolol and imdur. her lipid panel showed tg 99, hdl 30, ldl calc 100. . #) rhythm: maintained on telemetry with occassional pvcs. . #) diabetes typeii: continued humalog 50-50 at home doses, but hold glipizide, due to renal insufficiency. started nph. . #) acute on chronic renal failure: appears that patient's creatinine function 3.0 on last admission and her baseline is about 2-2.5, which is most likely the result of longstanding diabetes and hypertension. her creatinine peaked at 4.9 but she still continued to make urine. at discharge her cr was 3.8. a renal consult was obtained and she will likely need dialysis in the near future. a renal u/s was performed which showed no hydronephrosis. vein mapping was performed and the patient was informed about fistula placement. she preferred to wait and follow this up as an outpatient. spep and upep were sent and found small monoclonal free lambda spike without a heavy chair; she should follow up in 6 months (likely mgus, doubtful myeloma kidney). the renal team recommended she be sent out on calcium carbonate at a high dose 650mg tid with meals. . #) anemia: appears to be chronically anemic. hematocrit between 28-31. most likely due to anemia of chronic disease with iron deficiency and cri as causes. she was on ferrous sulfate replacement and nephrology started her on epogen as well. she was guiac negative here, but should have an outpatient colonoscopy as she says she has never had one before. . #) endocrine: she had marked elevated of calcium on admission (11.8). a pth was sent and was found to be 14. vitamin d1, 25 was sent and found to be 7. spep and upep were sent. spep found gamma globulin and upep showed only albumin. her calcium quickly returned to limits and it was thought to have been elevated secondary to exogenous replacement she was taking (4 pills a day). . she was continued on her levothyroxine for hypothyroidism. . #) fen: will maintain on low salt, cardiac, diabetic diet. . #) prophylaxis: will order pneumoboots. start bowel regimen and ppi. . #)code: full medications on admission: -hydralazine 25 qid -isosorbide sr 30 -toprol 25 -amlodipine 2.5qd -ezetimibe 10 qd -levothyroxine 75mcg qd -clopidogrel 75 qd -ferrous sulfate 325 qd -humalog 50-50 9qam, 10 qhs -glipizide 5 qd -norvasc 5qd -lasix 80 po bid -asa 325 -toprol xl 50 qd discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 3. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 9. insulin lispro (human) 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 10. furosemide 80 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 11. hydralazine 25 mg tablet sig: 1.5 tablets po every six (6) hours. disp:*180 tabs* refills:*2* 12. epoetin alfa 10,000 unit/ml solution sig: one (1) 10,000u injection qmowefr (monday -wednesday-friday). disp:*15 ml(s)* refills:*2* 13. tums extra strength smoothies 750 mg tablet, chewable sig: one (1) tablet, chewable po qac: please take three times a day with meals in the middle of the meal. disp:*90 tablet, chewable(s)* refills:*2* discharge disposition: home discharge diagnosis: congestive heart failure- left ventricular systolic dysfunction with ef ~35%, +3-4mr end-stage-renal disease mitral regurgitation discharge condition: good, afvss, sao2 100% on room air discharge instructions: please take all of the medications prescribed for you. we have decreased your lasix dose to 80mg daily and increased your hydralazine dose to 35mg four times per day. you were admitted with congestive heart failure; to treat this you will need to limit your salt intake to 2g daily, limit your fluid intake to 1.5l/day and you should weigh yourself daily. if you gain > 2 lbs or if you have difficulty breathing you should contact your pcp or cardiologist who may want to increase your lasix dose. . you should seek medical attention if you have chest pain, shortness of breath, gain >2lbs, are light-headed or pass out, or for any other concerns. . you were also admitted because of your worsening kidney function. you should follow up in the nephrology clinic as listed below. you should stop taking your glyburide because it is not handled well by the kidneys. you should also adhere to a renal diet which is low in things like potassium and phosphorus which your kidneys are unable to extrete properly. we are also starting you on epogen shots for your anemia which is associated with your kidney disease . you will need to be readmitted to the hospital next week to be prepared for your heart catheterization and your mitral valve repair. dr. will contact you with details about this followup instructions: provider: , md phone: date/time: 10:40 . you will be readmitted later next week. if you have questions about this call procedure: transfusion of packed cells right heart cardiac catheterization right heart cardiac catheterization injection or infusion of nesiritide diagnoses: other primary cardiomyopathies anemia of other chronic disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere coronary atherosclerosis of native coronary artery pure hypercholesterolemia mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism chronic kidney disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin old myocardial infarction diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled other nonspecific abnormal serum enzyme levels infection and inflammatory reaction due to indwelling urinary catheter osteomalacia, unspecified 

Answer: The patient is high likely exposed to