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: dyspnea and peripheral edema major surgical or invasive procedure: none history of present illness: mr. is an 84 year old male with pmh of cad and biventricular congestive heart failure who presented to his pcp with chief complaint of increasing edema and fatigue. the patient was admitted to and found to have a hr up to 120; he received iv lopressor with a drop in his blood pressure. echocardiogram demonstrated ef 10% (down from prior 20-25%) as well as a thickened septum thought to be consistent with amyloid. he was placed on renally-dosed dopamine and bp meds were held. dr. evaluated the patient on and on interrogation of his aicd found him to be in atrial tachycardia at a rate 130. he was placed on iv heparin for atrial fibrillation. dopamine was continued but as his blood pressures improved, he was started back on a beta blocker and aldactone. the decision was made for transfer to for further treatment. at the time of transfer, the patient was still on dopamine at a rate of 7.5. he stated that his breathing is "not too good," but only woke up briefly to relate this. he denied chest pain. ros: endorses urinary frequency. not able to obtain other ros due to mental status. ekg demonstrated an atrial rate of ~ 100, ventricular rate 70. at times appeared v paced but not consistently. no st/t wave changes. past medical history: pmhx: biventricular heart failure:chf: dilated biventricular cardiomyopathy ef 20-25%. mild mr, pulm htn atrial tachycardia/atrial fibrillation (at osh); prior history of atrial fibrillation but taken off of amiodarone, pacemaker/icd 2v cad hypertension dm type 2, insulin dependent cri (baseline creatinine 2.6) dementia arthritis history of hernia repair gi bleed cardiac studies: cardiac cath : right dominant system. two vessel cad - 60% lesion in distal portion of the rpda. lcx 90% distal stenosis. elevated right and left pressures (rvedp = 24 mm hg; pcwp mean = 32 mm hg). severe pulmonary htn. final diagnosis: 1. two vessel coronary artery disease. 2. severe systolic ventricular dysfunction. 3. severe pulmonary hypertension. . echo: ef 25-30%. the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal with severe global hypokinesis and inferior wall akinesis. tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal with moderate global free wall hypokinesis. the aortic root is moderately dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: prominent symmetric left ventricular hypertrophy with global and regional systolic dysfunction c/w multivessel cad or other diffuse process. right ventricular free wall hypokinesis. dilated aortic root. social history: the patient lives in with his daughter and son-in-law who are essentially his 24 hour/day caregivers. retired. previously smoked but quit several years ago. he does not drink alcohol. family history: not obtainable from patient. physical exam: physical examination: vs: t 96.1 bp 96/66 hr 72 rr 14 o2 97% on 4 l nc wt 100 kg gen: obese male in mild distress. oriented to self. using accessory muscles to breath. drowsy but arousable. heent: conjunctiva injected bilaterally. perrl, eomi. no pallor or cyanosis of the oral mucosa. wearing glasses. neck: jvp at angle of the mandible. cv: rr and rhythm. normal s1, s2. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were slightly labored with use of accessory muscle use. crackles with rhonchi bilaterally throughout lung fields. abd: obese but nontender. normoactive bowel sounds. no hsm or tenderness. abd aorta not palpated. no abdominial bruits. ext: total body anasarca. r ue swelling more pronounced than l ue swelling. skin: scattered ecchymoses. pulses: right: carotid 1+ dp 1+ pt 1+ left: carotid 1+ dp 1+ pt 1+ pertinent results: laboratory data (from osh): potassium 5.6, bun 61, creatinine 2.8 wbc 6.6, hct 47, plt 133 bnp 866 (normal 0-100) ck 111 --> 107 troponin 0.22 --> 0.24 --> 0.22 lab results (at ): wbc-5.6 rbc-4.20* hgb-14.4 hct-44.1 mcv-105* mch-34.2* mchc-32.5 rdw-15.3 plt ct-118* wbc-5.8 rbc-3.44* hgb-12.3* hct-34.5* mcv-100* mch-35.7* mchc-35.7* rdw-16.0* plt ct-178 glucose-60* urean-54* creat-2.2* na-131* k-4.5 cl-95* hco3-29 glucose-175* urean-51* creat-2.2* na-129* k-4.1 calcium-9.4 phos-2.7 mg-2.3 alt-21 ast-26 ld(ldh)-293* alkphos-175* totbili-2.2* albumin-3.4 calcium-8.8 phos-3.1 mg-2.8* ekg from demonstrated v-paced (inconsistent) with atrial rate ~ 100. no st/t wave changes imaging: 2d-echocardiogram performed on at demonstrated (by report): lv not dilated; moderate biatrial enlargement. marked septal thickening (2.2). lv walls considerably more thickened compared to . elevated cvp 20 mmhg. elevated pa systolic pressure (50 mmhg). ef ~ 10%. rv is dilated. septal flattening consistent with volume overload. no significant valvular disease. does have restrictive mitral inflow pattern. tte performed on : the left atrium is markedly dilated. the right atrium is markedly dilated. the estimated right atrial pressure is >20 mmhg. there is severe symmetric left ventricular hypertrophy. overall left ventricular systolic function is severely depressed (ejection fraction 20 percent) secondary to akinesis of the inferior and posterior walls and severe hypokinesis of the inferior septum and lateral wall. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. the right ventricular cavity is dilated. there is severe global right ventricular free wall hypokinesis. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. the mitral inflow is consistent with a restrictive filling pattern, a marker of severe diastolic and/or systolic dysfunction. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is further depressed; right ventricular contractile function is now severely depressed. r upper extremity ultrasound performed on at was negative for dvt r upper extremity ultrasound on demonstrated: no evidence of dvt in the right upper extremity. kub on at : large amount of stool, mildly dilated small bowel loops which are nonspecific and probably due to ileus cxr (from , ): limited study with possible tiny pleural effusions or pleural thickening cxr demonstrated: the heart is enlarged. considerable tortuosity of the aorta is present. the position of the multiple pacemaker leads is unchanged since the prior chest x-ray of . no significant failure is present. costophrenic angles appear clear. impression: cardiomegaly, no gross failure. cxr : there is prominence of the indistinctness of pulmonary vessels with fullness of the hila, to a greater extent than before. there are no pleural effusions or pneumothorax.impression: new mild congestive heart failure. brief hospital course: pt is an 84 year old male with history of nonischemic cardiomyopathy, biventricular dysfunction, cad, atrial fibrillation with pacemaker, dm2 and htn admitted for decompensated heart failure. . cad. patient had catheterization in which demonstrated 2 vessel coronary disease (90% distal lcx stenosis, 60% distal rpda stenosis). no intervention was performed at that time. his current presentation did not appear consistent with ischemia. he had elevated cardiac enzymes that peaked, but were likely not significant given his renal insufficiency. . atrial fibrillation. patient has a history of afib and was thought to have an underlying atrial rhythm, so ep was consulted and his aicd/pacer was interrogated which showed atach/afib with multiple mode switches. patient was continued on a heparin drip. given patient's restrictive left ventricular dysfunction it was felt that rhythm control would not provide much benefit as the atrial kick would not contribute significantly to filling. rate control was targeted with iv lopressor which was titrated up as his blood pressure tolerated, to achieve a hr 70-90bpm, and he was eventually switched to po metoprolol 25mg po tid. he was weaned off the dobutamine drip. metoprolol was switched to toprol xl prior to discharge. patient was sent home on coumadin 2.5 mg po qday and the heparin drip was discontinued. inr to be monitored every week by hospice services and faxed to dr. at . inr goal is 2.0. pacemaker icd function was turned off prior to discharge. . pump. the patient had an ef of 10% at osh and 20% on echo done here, and was grossly volume overloaded with total body anasarca. patient was determined to be in decompensated heart failure and was maintained on a milrinone drip, which was titrated up to 0.5 mcg/kg/hr and a lasix drip which was titrated up to 15mg/hr. 250mg iv diuril was added daily to assist in diuresis, with good effect. we slowly attempted to change him to po meds, starting first by taking him off the lasix drip and giving bolus doses of iv lasix after po metolazone (thiazide diuretic). patient remained hemodynamically stable and improved clinically with slowly decreasing edema and decreasing jvp. eventually milrinone was d/c'd and lasix was switched to po dosing with stable hemodynamics. patient was sent home on lasix 100 mg po bid and metolazone 5 mg po bid, 30 minutes prior to lasix. if patient becomes more symptomatic with increased shortness of breath, please titrate home oxygen therapy to comfort and administer roxanol prn. . r upper extremity edema. though patient was grossly edematous, patient had persistent r>l upper extremity edema, which was concerning for dvt. a repeat doppler of the rue on was negative for dvt (as above). care was made to avoid placement of bp cuff and rue and the edema appeared to decrease with overall diuresis. . hyperlipidemia. not on treatment with statin. . dm: on lantus with sliding scale insulin with fingersticks qid. oral diabetic meds were held while in the hospital. patient to continue on sliding scale with lantus 20 units qhs. . depression. on celexa. . anemia: patient on home iron. his hct was 47 at the osh but dropped gradually to 34.5 during admission. hct was monitored daily. . cri: patient's bl cr is 2.6. during the course of the hospitalization the cr remained stable at 2.1-2.5, in spite of aggressive diuresis. . fen: cardiac, diabetic diet. after heavy diuresis the patient became slightly hyponatremic. electrolytes were monitored regularly and repleted as necessary. . dispo. patient returned to with hospice. . code. dni/dnr per hcp (daughter) . palliative care was consulted to discuss long-term goals of care with family. a meeting was held with dr. in which the family expressed a desire for no escalation in care, with continuing to manage medically to d/c to with hospice care. if he deteriorates clinically while at home(i.e. worsening renal status, hyponatremia, worsening heart failure) he will be made cmo and there will be no further escalation of care. medications on admission: medications (on transfer): heparin gtt (not on upon arrival) glucotrol xl 15 mg daily humalog sliding scale celexa 20 mg daily namenda 10 mg iron 325 daily centrum daily glucosamine/chondroitin 500/400 1 tab qam, 2 tabs qhs toprol xl 25 mg daily lasix 40 mg iv aldactone 25 mg qam prilosec 20 mg daily lantus 25 u qhs midodrine 10 mg tid dopamine drip (at 7.5) meds at home: glucotrol 5 mg, lasix 80qam 40qnoon and 40 qpm, aldactone 25 mg daily, prilosec 20 mg daily, celexa 20 mg daily, iron, aspirin 325 mg daily, namenda 10 mg discharge medications: 1. roxanol concentrate 20 mg/ml solution sig: one (1) 5-20 mg po q1hour as needed for pain. disp:*60 mg* refills:*0* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for consipation. 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 7. erythromycin 5 mg/g ointment sig: one (1) ophthalmic qid (4 times a day). 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 9. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 10. metolazone 5 mg tablet sig: one (1) tablet po bid (2 times a day). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 13. warfarin 2.5 mg tablet sig: one (1) tablet po daily (daily). 14. furosemide 40 mg tablet sig: 2.5 tablets po bid (2 times a day). discharge disposition: home with service facility: nursing services discharge diagnosis: congestive heart failure discharge condition: patient is saturating well on room air, with minimal extremity edema. discharge instructions: you have been treated for your end-stage congestive heart failure with intravenous diuretics. it is recommended that you adhere to 2 gm sodium diet. . you will be continued on your coumadin. please have your inr checked every week. this will be performed by your visiting hospice nurses. dr. will be monitoring this level and adjusting your coumadin dosage as needed. please fax inr level to dr. at . if you experience any shortness of breath please use home oxygen and take roxanol as needed to relieve your shortness of breath. followup instructions: please call dr. office at to schedule a follow-up appointment in weeks. procedure: venous catheterization, not elsewhere classified diagnoses: other primary cardiomyopathies anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of tobacco use depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin automatic implantable cardiac defibrillator in situ encounter for palliative care chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to