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: penicillins / comtan / shellfish derived attending: chief complaint: ventricular tachycardia major surgical or invasive procedure: vt ablation history of present illness: mr. is an 81y/o gentleman with parkinson's disease, cad s/p cabg, schf (lvef 25%), afib on coumadin, and aicd who presented with hypotension, was found to be in vt, and is being transferred to the ccu due to recurrent vt after ablation today. . of note, he was recently admitted for pacer firing, and was started on amiodarone 400mg daily. due to nausea and loose stools, his dose was decreased to 200mg daily on . . per admission note, on this admission he initially presented from home yesterday () with a caregiver for low bp (80/60) and elevated hr (140-145). he had felt fatigued for the past 1.5 days, with baseline level of dyspnea. somewhat decreased po intake. in the ed, initial vitals were t 96.8, hr 144, bp 82/61, rr 18, and spo2 100% on ra. he triggered for tachycardia and initial ekg was concerning for vt at 145 bpm. he was given ns 500 ml. cxr showed moderate cardiomegaly and pulmonary edema. labs were significant for hct 33.9 near recent baseline, inr subtherapeutic at 1.6, cr 1.2 near baseline, largely unremarkable electrolytes, digoxin 0.5, and troponin 0.07 up from prior values 0.02-0.03. ep was consulted and he was pace terminated with ramp. he was admitted to the ep service for continued management. . in the ep lab, he was found to have various morphologies of vt and underwent ablation. after the procedure, he was found to be unarousable even off sedation, with right-gaze. code stroke was called and he underwent cta head/ct brain which did not suggest acute process. . he had 4 episodes of vt after his ablation: 1) in ct scanner. atp did not pace him out-->externally defibrillated. 2) outside cc3 elevator. received amio 150 bolus.-->externally defibrillated again. 3) ep lab holding area. lidocaine 100 bolus given. -->atp-terminated. 4) ep lab holding area. lidocaine drip started.-->defibrillated with his device. . on arrival to the ccu, patient is intubated, sedated. is on a lidocaine drip; had been on low-dose phenylephrine while in the ep lab holding area but this was discontinued. in icu, pt was extubated on without complications. he weaned off of lidocaine and has remained out of vtach. since extubation, pt has been experiencing some hypokinesia, and confusion, likely secondary to parkinsons. neuro is following and recommended continuing with home parkinsons meds. pt was also on heparin drip. restarted coumadin on and inr is now 3.2. pt was also diuresed with iv lasix in icu and was net negative 1l during stay there. this am, his cr bumped from 1.1 to 1.8, likely from overdiuresis. pt also has bicarb of 17 this am with gap of 20. on transfer, pt's vitals are stable 98.3, 80, 148/72, 18, 97% 2l. pt is oriented, but hypokinetic and hypophonic. past medical history: 1. cardiac risk factors: # dyslipidemia # hypertension 2. cardiac history: # cad -- mi in # cabg () -- (lima-lad, svg-diag, svg-om1, svg-om2, svg-rpda) # cath () -- 1. native 3 vessel coronary artery disease. -- 2. severely depressed ventricular function. -- 3. patent vein grafts to the d1, om1, om2. -- 4. patent lima to lad. -- 5. focal stenosis of svg graft to r-pda. -- 6. successful stenting of the svg to pda. # aicd: implantation in with generator change in . # chronic atrial fibrillation -- on coumadin # cardiomyopathy / systolic chf -- lvef 25% # sustained and nonsustained vt history # dilated aortic root -- moderate ar and mr -- aortic sinus 4.0 cm by tte in 3. other past medical history: # parkinson's disease # left femoral neck fracture () -- s/p hemiarthroplasty c/b mrsa infx post-operatively -- s/p multiple washouts with retention of prosthetic joint material -- suppressive abx since # c diff history # gonorrhea history social history: # home: lives alone, has 24h hha, uses wheelchair. # work: former stockbroker # tobacco: none currently, smoked cigars 1-2 per day for 10 years. # alcohol: none currently, 2 drinks per day for 10 years. # illicit: none family history: all parents and siblings are deceased, many due to cancer and heart disease. father had mi. brother with cardiac problem. was relatively healthy. physical exam: admission vs: t= 97.9 bp= 139/92 hr= 63 rr=20 o2 sat= 100 2l general: cachectic man 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 to ear cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. systolic murmur best heard over rusb. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, slightly distended. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no pulses 1+, feet are cold to touch. no femoral bruits. neuro: cn ii-xii tested and intact, strength 5/5 throughout, sensation grossly normal. gait not tested. skin: no stasis dermatitis, ulcers, scars, or xanthomas. physical exam on admission to ccu: vs: bp=120/67 hr=80 rr=16 o2 sat=100% fio2 100%, peep 5, rr 18, tv 500 general: elderly gentleman, intubated and sedated heent: ncat. sclera anicteric. vor intact. pupils 3mm and reactive to light bilaterally. neck: supple, no jvd. cardiac: s1 and s2, systolic murmur best heard over rusb. lungs: cta throughout all fields anteriorly. abdomen: (+)bowel sounds; no masses; nontender. extremities: no edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: 1+ dp and pt pulses bbilaterally. physical exam on discharge: vitals: 97.6, 106/68 60 20 100% ra wt = 85.4 kg heent: peerla, op clear neck no jvd cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. systolic murmur best heard over rusb, but can be heard throughout precordium. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, slightly distended. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: peripheral pulses 1+, feet are cold to touch. no femoral bruits. neuro: cn ii-xii intact. no cogwheel rig. aox3, some hyperkinesis pertinent results: labs on admission: 03:40pm wbc-5.6 rbc-3.81* hgb-10.0* hct-33.9* mcv-89 mch-26.3* mchc-29.6* rdw-17.6* 03:40pm neuts-84.3* lymphs-10.8* monos-3.7 eos-0.9 basos-0.4 03:40pm pt-16.7* ptt-36.8* inr(pt)-1.6* 03:40pm digoxin-0.5* 03:40pm calcium-9.3 phosphate-4.4 magnesium-2.2 03:40pm glucose-114* urea n-33* creat-1.2 sodium-139 potassium-4.6 chloride-104 total co2-22 anion gap-18 04:12pm lactate-2.3* relevant imaging: tte : severely impaired left ventricular systolic function (25-30%) with akinesis of the inferior and inferolateral walls. mild to moderate aortic regurgitation with mild aortic stenosis. mild mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary artery systolic hypertension. no obvious evidence of endocarditis. if clinically indicated, a transesophageal echo may better characterize valves and implantable cardiac defibrillator leads for possible vegetations. compared with the prior study (images reviewed) of , mild aortic stenosis is now present. the severity of aortic regurgitation and mitral regurgitation has increased slightly. the severity of tricuspid regurgitation is similar. . \ . cxr : no acute cardiopulmonary process. . cta head/ct brain : 1. no acute intracranial abnormality. 2. no perfusion abnormality to suggest acute infarct. 3. a linear hypodensity in the mid cervical segment (c2-c3 level) of the left internal carotid artery which may represent a dissection flap or streak artifact. further evaluation with mra of neck (dissection protocol) is advised if clinically indicated and if there is no contra-indication for mri. 4. no evidence of stenosis, occlusion or aneurysm greater than 3 mm in the arteries of head. . chest x-ray : et tube is in standard position. the tip is 4.2 cm above the carina. moderate-to-severe pulmonary edema has worsened. there is no pneumothorax. if any there is a small bilateral pleural effusion, larger on the right side. in the left lower lobe, there is a combination of atelectasis and worsening pulmonary edema. transvenous pacemaker leads are in the standard position with the tips in the right atrium and right ventricle. mediastinal widening is increased due to engorgement of the vasculature. cardiomegaly is grossly unchanged. : vt ablation. 1. 4 separate inducable vt morphologies 2. successful targeted ablation of inner loop of clinical vt with termination during ablation 3. successful substrate ablation of inferior lv scar 4. inability to wean from intubation, with ongoing stroke workup 5. post-vt ablation spontaneous vt (vt4) treated successfully from icd with internal cardioversion eeg this is an abnormal eeg in the awake state due to the presence of a slow, disorganized background. this finding is consistent with a mild to moderate encephalopathy which indicates widespread cerebral dysfunction but is non-specific as to etiology. there were no focal or epileptiform features. note is made of a regular tachycardia on the cardiac monitor. discharge 05:33am wbc-7.6 rbc-3.88* hgb-9.9* hct-34.5* mcv-89 mch-25.6* mchc-28.8* rdw-18.1* plt ct-271 03:21pm neuts-89.3* lymphs-6.7* monos-2.9 eos-0.9 baso-0.2 05:33am plt ct-271 05:33am 05:33am glucose-92 urean-36* creat-1.3* na-146* k-3.8 cl-115* hco3-20* angap-15 03:21pm ck(cpk)-336* 05:33am calcium-8.7 phos-3.2 mg-2.1 brief hospital course: mr. is an 81y/o gentleman with parkinson's disease, cad s/p cabg, schf (lvef 25%), afib on coumadin, and aicd who presented from home with hypotension/vt, underwent vt ablation, and subsequently had recurrent unstable vt. . #. monomorphic sustained ventricular tachycardia: s/p vt ablation with recurrent vt: patient with various vt morphologies as seen in ep lab. became hemodynamically unstable in vt. had 4 episodes after vt ablation two of which required external defibrillation. no more after device re-programming and lidocaine drip. was loaded wtih amiodorone. did not have any more episodes of vt in the ccu. lidocaine was weaned off on am. amiodorone was discontinued. maintained on metoprolol. of note, patient was treated with vancomycin iv for peri and post procedure ppx. on the floor, amiodarone and lidocaine were discontinued. he had an additional run of slow sustained vt on with hrs in 120s. he given lidocaine bolus and initial drip and ep antitachycardial paced him out of the rhythm. pacer was reset and he did not have any additional runs of vt for remainder of hospitalization. . . #. unresponsiveness/right-gaze: this occurred in the setting of vt. patient was evaluated by the neurology team and ct/cta head did not show any focal abnormalities. eeg was also obtained which showed diffuse encephalopathy, consistent with delerium. neurology stroke team felt that pt's symptoms were more likely secondary to a parkinsonian crisis as he missed numerous doses of sinemet during procedure. pt was intubated initially for airway protection. extubated on . he was called out to the floor on . pt's delerium waxed and waned throughout stay, but with frequent reorientation and controlling his sleep wake cycle, as well as restarting all of his home antiparkinsons medications, his mental status improved to baseline at time of discharge. neurology recommended maintaining all of his home antiparkinsons meds and he should follow up with his outpt neurologist. . #. h/o afib: chads2 is 3. continued metoprolol for rate control and coumadin for anticoagulation. for procedure, his coumadin was held. it was restarted on and his inr became supratherapeutic after one day of coumadin at home dose (1mg). he decreased his dose to 0.5 but inr trended down, so was restarted on home dose. last inr was 2.4. . #.chronic systolic heart failure: lvef 25%. appeared euvolemic to dry. continued metoprolol. held lisinopril in the setting of , but was restarted. monitored daily i/os and weights. . # ?????? baseline cr was 1.1. before discharge from ccu, his cr was 1.8. ulytes showed pre-renal etiology. pt was diuresed in ccu and was not taking po during ccu stay. was given 500cc bolus x3 over 24 hrs and cr improved to 1.3. his urine output continued to be borderline low, but it picked up by time of discharge. his cr remained at 1.3, which might be a new baseline for him. . #. cad s/p mi: with mild troponin elevation on admission. never had chest pain. presented with troponin 0.07, mb 6 and then twelve hours later troponin 0.08. ekg difficult to interpret with regards to ischemia, but possibly represents demand ischemia. continued home aspirin, statin, metoprolol and ace. . #. htn: bp controlled with home medications. all bp meds were held during ccu stay, but restarted when he came back to floor. . #. parkinson's disease: with bradykinesia at baseline. continued carbidopa/levodopa. please see "unresponsive episode" above for more details transitional: - dr. , pcp will follow pts inr please see discharge paperwork - will need to be followed up in device clinic - if cannot take po's and needs dose of sinemet, give parcopa (oral disintegrating version) at 1:1 dose medications on admission: aspirin 325 mg po daily warfarin 1 mg po daily atorvastatin 10 mg po daily metoprolol succinate 25 mg po daily lisinopril 5 mg po daily amiodarone 200 mg po daily digoxin 125 mcg po every other day furosemide 20 mg po daily carbidopa-levodopa 25-100 mg 1.5 tabs po tid -- please give at 0800, 1500, and carbidopa-levodopa 25-100 mg 1 tab po tid -- please give at 1100, 1330, and 1800 minocycline 100 mg po bid quetiapine 50 mg po qhs ropinirole er 6 mg po daily trazodone 100 mg po qhs latanoprost 0.005% one drop qhs discharge medications: 1. outpatient lab work please draw pt, inr, bun, creatinine, potassium and sodium on and forward results to dr. at fax # 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 4. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 5. carbidopa-levodopa 25-100 mg tablet sig: 1.5 tablets po tid (3 times a day). 6. ropinirole 1 mg tablet sig: two (2) tablet po tid (3 times a day). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 8. minocycline 50 mg capsule sig: two (2) capsule po bid (2 times a day). 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: no more than 4g/day. 10. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 13. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. 14. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for increased secretions. 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. trazodone 100 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 17. quetiapine 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. discharge disposition: extended care facility: nursing center - discharge diagnosis: monomorphic sustained ventricular tachycardia parkinsonian crisis acute kidney injury discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to for ventricular tachycardia (vt). we performed a procedure called a vt ablation and changed your pacemaker/icd to prevent further episodes of this abnormal heart rhythm. after the procedure, you had a several more episodes of vt, and there was concern that you were having a stroke. this required you to be temporarily intubated and externally defibrillated and you had a short stay in the cardiac intensive care unit. our neurologists determined that you did not have a stroke and we got your heart rhythm under control. we now think that your pacemaker/icd have your heart rate under control and it is safe for you to go to rehab. we have made the following changes to your medications: change aspirin from 325mg daily to 81mg daily change metoprolol succinate 25mg daily to 100mg daily stop amiodarone 200mg daily stop digoxin 125mcg daily start guaifenesin 5-10ml by mouth every 6hrs as needed for increased oral secretions we have arranged for follow up appointments for you with your cardiologist and neurologist. please see below for details weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: department: cardiac services when: wednesday at 9:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 9:30 am with: , np building: campus: east best parking: garage name: -, md address: , , phone: ***the office is working on an appt for you in the next weeks and will call you at home with an appt. if you dont hear from the office by friday, please call them directly to book. md procedure: other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping intracardiac echocardiography diagnoses: abnormal coagulation profile congestive heart failure, unspecified acute kidney failure, unspecified aortocoronary bypass status paroxysmal ventricular tachycardia cachexia old myocardial infarction chronic systolic heart failure long-term (current) use of anticoagulants other encephalopathy dementia in conditions classified elsewhere without behavioral disturbance dementia with lewy bodies fitting and adjustment of automatic implantable cardiac defibrillator other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to