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 attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: 61 y.o. male with h.o. cad s/p 5v cabg, chf s/p aicd, systolic and diastolic dysfunction, hypothyroidism, a. fib p/w dyspnea. pt states that yesterday evening he noted sudden onset of shortness of breath. he denies any fevers, chills, nausea, vomiting, chest pain, melena, hemetemesis, hematochezia, diarrhea, constipation. in the pt's initial vs were noted to be t96.2, hr 68, bp 118/84, rr 24, sat 96%. his initial ekg was concerning for possible v tach however on further review it was noted to be a. fib with aberrancy, pt was given 5mg iv lopressor which resulted in decrease of hr from 130s to the low 100s, sbp down to the mid 90s. pt underwent cxr which showed fluid overload and he was thus given furosemide 40mg x 1. he was also given vancomycin 1gm iv x 1 due to concern for possible pna. his labs were notable for lactate of 13.7, mild leukocytosis of 12.3. alt/ast were noted to be 133/243, alk phos 257 with a tuberculosis of 5.1. his glc was noted to be 42 with an anion gap acidosis. his inr was noted to be 3.4, digoxin level 0.3, bnp 6682. he received a ruq u/s which showed edematous gallbladder wall but no cholecystitis, pt also had cholelithiasis. he also had a right ij placed and underwent a ct abdomen/pelvis without contrast to eval for source of high lactate. ct scna was negative for bowel wall thickening, pneumotosis but did showed ground glass opacities in the lung. prior to the ct scan he was given levofloxacin and zosyn given his acutely ill appearance and elevated lactate. past medical history: cad s/p cabg anterior mi h/o massive ugib in gastritis nsaids and coumadin(intubated, c/b mrsa vap, had tracheostomy) chf (ef 25% by last echo) with biv pacer and icd placement l hip arthritis hyperlipidimia hypothyroidism h/o afib in past (not currently on coumadin) social history: married > 25 years. has three adult children. lives with his wife. used to work in computers but on disability for health reasons. denies tobacco, occasional etoh. no illicits. family history: fh: father died of mi at age 52 physical exam: at admission: general: chronically sick appearing male, appears jaundices lying down in nard. heent: left sclera icteric, eomi, perrl neck: jvp noted at mandible lungs: crackles noted over right hemithorax and left base. cv: distant s1, s2, irregularly irregular, no murmurs, rubs, gallops abdomen: soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, no murphys ext: lower extremities cool to touch, sensation intact, movement intact. healing wound noted on lle. pertinent results: 12:10am pt-33.9* ptt-35.9* inr(pt)-3.4* 12:10am plt count-234 12:10am neuts-68.8 lymphs-24.3 monos-6.2 eos-0.2 basos-0.5 12:10am wbc-12.3* rbc-4.98# hgb-12.2* hct-42.1 mcv-84# mch-24.4*# mchc-28.9*# rdw-18.3* 12:10am digoxin-0.3* 12:10am calcium-8.8 12:10am ck-mb-6 probnp-6682* 12:10am ctropnt-0.05* 12:10am lipase-25 12:10am alt(sgpt)-133* ast(sgot)-243* ck(cpk)-116 alk phos-257* tot bili-5.1* dir bili-2.0* indir bil-3.1 12:10am glucose-42* urea n-22* creat-1.5* sodium-137 potassium-4.7 chloride-94* total co2-17* anion gap-31* 12:19am k+-4.2 01:10am urine hyaline-0-2 01:10am urine rbc-0-2 wbc- bacteria-mod yeast-none epi-0-2 01:10am urine blood-neg nitrite-neg protein-100 glucose-neg ketone-15 bilirubin-sm urobilngn-12* ph-6.5 leuk-neg 01:10am urine color-amber appear-clear sp -1.018 01:36am lactate-13.7* 05:42am pt-43.7* ptt-42.5* inr(pt)-4.7* 05:44am plt count-182 05:44am wbc-11.5* rbc-4.54* hgb-10.8* hct-38.0* mcv-84 mch-23.7* mchc-28.3* rdw-18.6* 05:44am albumin-3.5 calcium-8.1* phosphate-4.4# magnesium-2.0 05:44am ck-mb-notdone ctropnt-0.05* 05:44am alt(sgpt)-284* ast(sgot)-770* ld(ldh)-1290* ck(cpk)-90 alk phos-219* tot bili-5.2* 05:44am glucose-90 urea n-24* creat-1.4* sodium-134 potassium-4.2 chloride-94* total co2-17* anion gap-27* 05:53am o2 sat-73 05:53am lactate-11.2* 07:18am tsh-2.8 07:18am osmolal-291 07:23am o2 sat-96 carboxyhb-2 07:23am lactate-9.0* 07:23am type-art po2-106* pco2-33* ph-7.39 total co2-21 base xs--3 comments-add on car 08:33am hypochrom-2+ anisocyt-2+ poikilocy-1+ macrocyt-1+ microcyt-normal polychrom-occasional schistocy-occasional burr-occasional elliptocy-occasional 09:23am urine rbc-* wbc-* bacteria-mod yeast-none epi-0-2 09:23am urine blood-lg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-sm urobilngn-8* ph-5.0 leuk-neg 09:23am urine color-amber appear-clear sp -1.023 12:49pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 12:49pm alt(sgpt)-589* ast(sgot)-* ld(ldh)-2362* alk phos-185* tot bili-3.8* 12:49pm glucose-99 urea n-27* creat-1.3* sodium-135 potassium-3.6 chloride-98 total co2-25 anion gap-16 12:59pm hgb-10.7* calchct-32 o2 sat-59 12:59pm lactate-4.8* 12:59pm type- po2-37* pco2-41 ph-7.37 total co2-25 base xs--1 01:33pm o2 sat-63 07:31pm plt count-138* 07:31pm wbc-10.0 rbc-4.22* hgb-10.4* hct-34.4* mcv-82 mch-24.7* mchc-30.2* rdw-19.7* 07:31pm calcium-8.0* phosphate-2.6*# magnesium-1.9 07:31pm alt(sgpt)-711* ast(sgot)-2094* ld(ldh)-1775* alk phos-201* tot bili-3.4* 07:31pm glucose-75 urea n-28* creat-1.4* sodium-135 potassium-3.8 chloride-96 total co2-28 anion gap-15 08:36pm lactate-3.4* brief hospital course: patient was admitted on for acute onset dyspnea. patient is a 61 yom with h.o. of severe systolic and diastolic function s/p aicd, cad s/p 5v cabg, hypothyroidism, a. fib p/w acute onset dyspnea, elevated lactate, transaminitis and fluid overloaded on exam. ##. elevated lactate: pt noted to have an elevated lactate of 13.7 on admission. unclear as to the exact etiology of the lactate level. initial workup included osmolar gap (1), serum tox (negative), co-oximetry (negative), and cyanide (pending). level was followed an rapidly trended down to 3.4 with fluids and diuresis. infection was considered however in the setting of a mild leukocytosis and lack of fever and unconvincing history, this seemed less likely. patient was pan cultured and a cxr was performed demonstrating substantial fluid overload. it was later felt that the lactate resulted from hypoperfusion stemming from prolonged svt with abberancy. lactate level was 1.7 on the day of discharge. ##. dyspnea/chf exacerbation: pt presented to ed with complaint of sob of sudden onset with no chest pain. on physical examination pt noted to have jvp, elevated elevated bnp and cxr which suggest fluid overload. chf exacerbation was immediately suspected, flash pulmonary edema during episode of af with rvr. cardiac enzymes were cylced and were negative and dyspnea quickly resolved with diuresis. he responded well to iv lasix (negative > 3 liters on ), and given the concern for further excess fluid, he was instructed to take 60 mg po daily for two days after returning home instead of his usual 40 mg. ##. transaminitis/hyperbilirubinemia: pt noted to have elevated ast, alt, tuberculosis on admission in the ed. in the ed he received a ruq ultrasound which showed cholelithiasis with gb wall edema, per radiology was not cholecystitis, as well as moderate ascites. pt does have cholelithiasis although no mention is made of any cbd or prominence. pt also fluid overloaded on examination, transaminitis was thought to have resulted from congestive hepatopathy with possible component of shock liver in setting of hypoperfusion. hepatitis serologies were drawn and statin was held. liver enzymes trended down over the course of the admission. therefore, medications with caution in hepatic failure were held at discharge (including lorazepam, clonazepam, simvastatin, midodrine, and zolpidem). ##. anion gap acidosis: pt's noted to have metabolic acidosis with an ag of 26. likely due to lactic acidosis given his lactate of 13.7. the gap resolved completely as lactate trended down. ##. a. fib with rvr: pt noted to go into a. fib with rvr in the ed. although he received 10 of iv lopressor, no response noted. pt has history of a. fib, not anticoagulated due to a prior gi bleed whilst on coumadin. coumadin was held and sotalol was continued. ep was consulted and pacer was interrogated demonstrating no ventricular arrhythmias and multiple episodes of svt with aberrancy. they recommended starting amiodarone; however, patient had allergic reaction to this in past. at discharge, patient was in a paced rhythm at 72 bpm. ##. hypothyroidism: patient was continued on synthroid ##. systolic/diastolic dysfunction: pt received an echo in which was notable for an ef of 20% as well as grade iii/iv lv diastolic dysfunction. patient was continued on digoxin. ##. depression: patient continued on home regimen of citalopram and bupropion. ##. insomnia: patient was taking lorazepam and zolpidem qhs at home. as these medications should be used with caution in hepatic impairment, they were held during this admission. the patient received a single dose of trazodone 25 mg po. he was discharged with a prescription for 14 days of trazodone 25 mg to assist with insomnia until his lfts can be re-evaluated and a decision made about a long-term sleeping aid. *** follow up care *** mr. will return home with visiting nurse services to attend to his wound care as well as to monitor his vitals (low blood pressure 90s/60s during this admission, but asymptomatic) and fluid status (assess for volume overload). mr. will see a health provider 1 week, and should have his lfts, electrolytes and cbc assessed at that time given the abnormalities noted prior to discharge to confirm that these values continue to stabilize. if lfts have returned to , consider restarting prior home medications which were held in the setting of transaminitis (statin, zolpidem, clonazepam, lorazepam, midodrine). he should also have bp checked (orthostatics performed, given his history) and volume status assessed - he may require increase in baseline lasix. medications on admission: bupropion 100 mg po bid citalopram 10 mg daily clonazepam 0.5 mg po bid digoxin 125 mcg, 1 tab/2 tabs alterating lasix 40 mg daily levothyroxine 50 mcg daily lorazepam 4 mg qhs midodrine 1 mg po tid simvastatin 40 mg daily sotalol 120 mg po bid spironolactone 12.5 mg daily triamcinolone 0.1% ointment zolpidem 10 mg qhs discharge medications: 1. bupropion hcl 100 mg tablet sig: one (1) tablet po bid (2 times a day). 2. digoxin 125 mcg tablet sig: 1-2 tablets po alternate 1 or 2 tabs every other day. 3. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily): take 1.5 tablets on (tomorrow) and (wednesday), then resume 1 tablet per day. 6. sotalol 80 mg tablet sig: 1.5 tablets po bid (2 times a day). 7. spironolactone 25 mg tablet sig: 0.5 tablet po once a day. 8. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia for 7 days. disp:*7 tablet(s)* refills:*0* 9. triamcinolone acetonide 0.1 % ointment topical discharge disposition: home with service facility: home health care discharge diagnosis: primary diagnosis: chf exacerbation congestive hepatopathy paroxysmal atrial fibrillation with rapid ventricular rate secondary diagnosis: hypothyroidism orthostatic hypotension discharge condition: good, respiratory status back to baseline discharge instructions: you were admitted to the hospital because you developed acute shortness of breath and weakness. upon admission we discovered that your heart was in an abnormal rhythm called atrial fibrillation with rapid ventricular response. this means that your heart was not able to pump blood appropriately because of this and because of your congestive heart failure. this allowed fluid to fill your lungs and made you feel short of breath. you were initially admitted to the icu were it was discovered that this had not only affected your heart and lungs but also your liver. you were treated with a called lasix which helped you cleared this fluid from your lungs. your condition improved with just one dose of this . you were subsequently transfered to the medical floor. we continued your lasix and your condition improved even more. as a result of this treatment your liver also recovered and it is now recovering. we made the following changes to your medications: 1. stop taking simvastatin until directed to resume use by your doctor. may cause liver damage if taken at this time. 2. stop taking clonazepam until directed to resume use by your doctor. may cause liver damage if taken at this time. 3. stop taking lorazepam until directed to resume use by your doctor. may cause liver damage if taken at this time. 4. stop taking zolpidem until directed to resume use by your doctor. may cause liver damage if taken at this time. 5. stop taking midodrine until directed to resume use by your doctor. may cause liver damage if taken at this time. 6. increase dose of lasix (furosemide) to 60 mg (1.5 tablets) by mouth daily for 2 days (tomorrow and wednesday). then resume your usual dose of 40 mg by mouth daily starting on thursday. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500 ml of fluid per day if you at any point experience chest pain, shortness of breath, weakness, nausea, vomiting, abnormal heart beats, increased leg swelling, defibrillator firing, fevers, chills or any other symptom that concerns you please return to the hospital or contact your pcp or your for further evaluation. please keep the follow-up appointments as outlined below. followup instructions: please keep the following appointments: provider: , md phone: date/time: at 2:10 pm provider: , md phone: date/time: at 2:50 pm provider: clinic phone: date/time: 9:30 am provider: , md phone: date/time: 10:20 am procedure: venous catheterization, not elsewhere classified automatic implantable cardioverter/defibrillator (aicd) check diagnoses: other primary cardiomyopathies acidosis congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation aortocoronary bypass status ulcer of other part of foot dysthymic disorder other and unspecified hyperlipidemia automatic implantable cardiac defibrillator in situ hepatitis, unspecified atherosclerosis of native arteries of the extremities with ulceration orthostatic hypotension acute on chronic combined systolic and diastolic heart failure impotence of organic origin 

Answer: The patient is high likely exposed to