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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea major surgical or invasive procedure: intubation central line placement cardiac catheterization with no intervention history of present illness: 77 yo gentleman with history of multiple tias s/p recetn cea on brought into ed by ambulace for hypoxemia and respiratory failure. dr. underwent cea on and by accounts had an uneventful post operative course. by report he developed sob yesterday that progressivly worsened overnight. this morning he was unable to get out of bed secondary to weakness. ems was called and by their report he was found supine and purple in bed. they placed on 15l nrb and o2 sats only came up to 90%. on arrival to the ed his vs were notable for rr of 40 and sats in the 90'2 on 15l. he was awake and alert on arrival with a relativly clear mental status. he was only able to speak in one or two word sentences. a cxr demonstrated new onset pulmonary edema. he has no known pulmonary or cardiac history. he had no reports of fevers, post op or pre-hospital. he denied cough to ed staff. . in the ed he was initially placed on bipap and had improvement in his oxygenation. he was given a sublingual ntg and became hypotensive, this precluded him receiving nitro gtt. he did not receive ivf. he was noted to have several apneic episodes while on bipap and was intubated due to respiratory fatigue. the intubation was complicated by difficult to visualize airways and he suffered a laceration of his lips. by report there was no blood in the ett. . he is currently on fio2 100 %/peep 5/rate 17/tv 600. sedated on fentanyl and versed. on 6mcg of dopa with bp 113/68. he has had minimal uop. total uop 100. . his labs are significant for a troponin of 1.13, leukocyotsis 21.6, anion gap acidosis, cr of 2.5 (baseline 0.9) and an elevated lactate (6--->3 with intubation). past medical history: -h/o stroke in , treated at , l mca territory -bph with secondary hematuria -cystic pancreatic mass, following q2years social history: works at the mind body institute he founded and teaches at hms. no tobacco, etoh, illicits. lives with wife, he provides care for his wife and administers her medications. family history: brother had mi in 40s, sister has carotid stenosis. physical exam: ed admission exam: temp: 98.2 hr: 109 bp: 108/77 resp: 33 o(2)sat: 91 low constitutional: o2 sat 90% nrb fm; pulse 70s heent: pupils equal, round and reactive to light, extraocular muscles intact, normocephalic, atraumatic no wheezing; left neck with ecchymosis; no bruit; no puls mass; jvd on right 5 cm chest: bilateral insp rales way up cardiovascular: regular rate and rhythm, normal first and second heart sounds; no m/r/g abdominal: normal extr/back: normal skin: ecchymosis left neck but no other rashes physical exam on discharge: vs: 98.2/98.2 67-72 rr 18-20 bp: 125-152/74-76 o2 sat 92-97% ra i/o: 8 hour 84/425 24 hour 1130/ tele: sr, hr 70's weight: refused for 2 days gen: nad, sitting comfortably in chair heent: mmm, no conjunctival erythema or scleral icterus neck: no jvd; ecchymosis over left cea site but no fluctuance or mass cv: regular, s1 and s2, no murmur pulm: lungs cta throughout abdomen: nondistended, (+)bowel sounds, nontender extrem: 2+ dp and pt pulses bilaterally, no edema, warm feet neuro: alert, oriented x3, answers all questions appropriately pertinent results: admission labs: 01:30pm blood wbc-21.6* rbc-4.35* hgb-13.7* hct-43.1 mcv-99* mch-31.4 mchc-31.7 rdw-13.4 plt ct-265 01:30pm blood neuts-90.1* lymphs-4.9* monos-4.0 eos-0.8 baso-0.3 01:30pm blood glucose-279* urean-47* creat-2.5*# na-135 k-4.9 cl-94* hco3-23 angap-23* 05:31pm blood alt-41* ast-152* ck(cpk)-912* alkphos-88 totbili-0.7 relevant labs: 08:05am blood probnp-8203* 01:30pm blood ck-mb-40* mb indx-4.9 01:30pm blood ctropnt-1.33* 05:31pm blood ck-mb-46* mb indx-5.0 ctropnt-2.08* 12:45am blood ck-mb-44* mb indx-5.6 ctropnt-2.96* 04:02am blood ck-mb-11* mb indx-4.9 ctropnt-4.25* 05:27am blood ck-mb-4 ctropnt-5.38* 05:25am blood ck-mb-2 ctropnt-5.70* 03:18am blood ck-mb-2 ctropnt-5.21* imaging/reports: chest x-ray endotracheal tube positioned appropriately. ng tube appears also to be positioned appropriately, though the tip is excluded from view. diffuse pulmonary edema with pleural effusions again seen. tte the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is moderate to severe regional left ventricular systolic dysfunction with near akinesis of the distal 2/3rds of the septum, anterior wall, apex, and distal inferior wall. the remaining segments contract normally (lvef = 30 %). no intraventricular thrombus is seen. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#).no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be quantified. there is an anterior space which most likely represents a prominent fat pad. impression: normal left ventricular cavity size with extensiver regional systolic dysfunction c/w cad (mid-lad distribution) or takotsubo cardiomyopathy. no definite valvular dysfunction. compared with the prior study (images reviewed) of , the left ventricular wall motion abnormalities are new and c/w interim ischemia/infarction. tte : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is moderately-to-severely depressed (lvef = 30 %) secondary to extensive severe hypokinesis/akinesis involving the anterior septum, anterior free wall, apex, and inferior septum. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the mitral valve leaflets are myxomatous. there is mild posterior leaflet mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared to the prior study of , moderate mitral regurgitation is now seen. renal us: findings: the right kidney measures 12.2 cm and the left kidney measures 11.4 cm. a 6 x 6 x 4 mm non-obstructing stone is present in the right kidney interpolar region. no left renal calculus. no hydronephrosis or mass seen in either kidney. the bladder contains a foley, is minimally distended, and cannot be assessed. impression: 6-mm nonobstructing right renal stone. no hydronephrosis cardiac catheterization : 1. selective coronary angiography in this left-dominant system demonstrated two vessel disease. the lmca had no angiographically apparent disease. the lad was occluded proximally and filled via right-to-left collaterals. the lcx was dominant and had mild disease. the nondominant rca was subtotally occluded but provided robust collaterals to the lad via an acute marginal. 2. limited resting hemodynamcis revealed normal systemic arterial blood pressure. final diagnosis: 1. two-vessel coronary artery disease. 2. normal systemic arterial blood pressure. dobutamine stress test : 77 yo man presented in respiratory failure secondary to subacute anterior mi post-op following left carotid endarterectomy on , cardiac catheterization revealing 2-vessel cad and depressed lvef was referred to evaluate for viability in lad territory. the patient was administered 2.5, 5, 10 and 20 mcg/kg/min of dobutamine (5 min stages) for a total infusion duration of 20 minutes. no chest, back, neck or arm discomforts were reported. no significant st segment changes were noted during the procedure. the rhythm was sinus with rare isolated vpbs noted. the heart rate response was appropriate. a blunted blood pressure response was noted with the dobutamine infusion. impression: no anginal symptoms or ischemic st segment changes. blunted blood pressure response to the dobutamine infusion. echo report sent separately. stress echo : the patient received intravenous dobutamine in 5 min (low dose 2.5mcg/kg/min) and 3 minute stages (>5mcg/kg/min) to a maximum of 20 mcg/kg/min. the test was stopped because the viability protocol was completed. in response to stress, the ecg showed no diagnostic st-t wave changes (see exercise report for details). the blood pressure response to stress was blunted. there was a normal heart rate response to stress. . resting images were acquired at a heart rate of 72 bpm and a blood pressure of 136/68 mmhg. these demonstrated regional left ventricular systolic dysfunction with severe hypokinesis to akinesis of the septum, anterior wall, mid to distal lateral wall, apex, and distal inferior wall. the remaining segments contracted well. (lvef = 25-30 %). right ventricular free wall motion is normal. there is a trivial pericardial effusion. doppler demonstrated trace aortic regurgitation and moderate mitral regurgitation with no aortic stenosis or significant resting lvot gradient. at low dose dobutamine 04:58am blood wbc-12.5* rbc-3.48* hgb-11.1* hct-33.9* mcv-98 mch-31.9 mchc-32.7 rdw-13.6 plt ct-313 04:58am blood glucose-165* urean-32* creat-1.6* na-137 k-3.9 cl-104 hco3-23 angap-14 07:40am blood calcium-8.1* phos-4.0 mg-1.9 brief hospital course: dr. is a 77 year old gentleman who presented 2 days s/p left cea with new-onset systolic chf secondary to peri-operative anterior mi. his course has been complicated by hypoxic respiratory failure (resolved/extubated after treatment of chf), afib (s/p cardioversion and amiodarone), and (likely from hypoperfusion, now resolving). # cad/acute mi: enzymes, ekg and history suggested recent mi associated with pulmonary edema and need for intubation in the er. was on lasix gtt and dopamine transiently in the ccu and ultimately extubated without difficulty once volume status optimized. unclear age or extent of infarct but likley had been >24 hours prior to admission and so did not complete urgent pci. tte showing lvef 30% with hypokinesis and akinesis of apex. troponins peaked at 5.7. patient was medically managed. he had a diagnosstic cardiac catheterization to assess for lesions that could be intervened upon. it showed left-dominant system two vessel disease (hydrated pre and post cath to avoid ). the lmca had no angiographically apparent disease. the lad was occluded proximally and filled via right-to-left collaterals. the lcx was dominant and had mild disease. the nondominant rca was subtotally occluded but provided robust collaterals to the lad via an acute marginal. no intervention was done at that time. a dobutamine stress test was obtained to assess for viability. this showed no viability, so patient not candidate for re-catheterization. continued home asa. started on toprol 50 xl daily, plavix. patient initially not on raas blocker due to , but as cr trended down, started lisinopril 2.5. patient was seen by representative from the life vest and agreed to use it on discharge. . #. mild transaminitis: initially suspicious for drug reaction to amiodarone or ceftriaxone. stopped offending agents. transaminitis improved. on d/c, patient was tolerating statin. . # paroxysmal afib: patient was went into atrial fibrillation with rvr on morning following admission. he was electrically cardioverted once in the ccu but promptly flipped back in to afib with rvr. he was oaeed with amiodarone and converted to nsr which he remained in for the duration of his stay. the amiodarone was eventually discontinued prior to discharge for a mild transaminitis. . # : baseline cr 1.0 but was 2.5 on arrival. most likely from poor perfusion in the setting of decompensated heart failure however arrived to ccu w/ clot in foley. changed to 3-way with cbi. was never oliguric. renal ultrasound showed no signs of obstruction. have had some component of atn. trended cr, avoided nephrotoxins, renally dosed meds. on d/c, cr was 1.6. . # bph: foley in place. some pink urine in bag. urine cultures were negative x2. continued tamsulosin and finasteride. team was in communication with dr. , the outpt urologist. decided to keep foley in on d/c and dr. will d/c it as outpatient. . # s/p cea: vascular following. per vascular surgery, there was no concern for bovine graft infection or hematoma on admission. but given his initial leukocytosis they wanted to empirically treat with abx until it is clear he was never bacteremic. blood cx from were negative, so d/c'ed abx on . . #. leukocytosis: on admission, dr. had persistently mild leukocytosis (wbc ). wbc was trending up prior to d/c after cea, and was discharged on empiric cipro (had foley in place). upon initial presentation this admission, wbc was 21.6 but has persistently been since then. note that he was on vanc/zosyn from admission . however, here urine culture negative, initial blood cultures negative, and nothing on history or physical to suggest pna. loose stools but c.diff negative. vascular believed there was no bovine cea graft infection. no cellulitis. his current leukocytosis was likely related to mi in addition to ongoing stress response. antibiotics were d/c'ed on as above. . transitions of care: - repeat tte in 1 month or at cardiology followup to determine whether he needs the life vest/aicd placement - repeat lfts at pcp visit to ensure transaminitis is resolving - will have inr and chem7 checked on monday after d/c - follow up with urology to have foley removed - will need wbc trended and if persistently elevated will need to be worked up as outpatient - emergency contact : (wife/hcp) medications on admission: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 3. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 4. vitamin c oral 5. verapamil 180 mg tablet extended rel 24 hr sig: 1.5 tablet extended rel 24 hrs po once a day. 6. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*2* 7. ascorbic acid 500 mg tablet sig: two (2) tablet po bid (2 times a day). 8. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). disp:*30 capsule, ext release 24 hr(s)* refills:*2* 9. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*10 tablet(s)* refills:*0* import discharge medications discharge medications: 1. outpatient lab work please check chem-7 and inr on monday with results to dr. at phone: fax: icd 9: 410.01 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). disp:*30 capsule, ext release 24 hr(s)* refills:*2* 6. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 7. ranitidine hcl 150 mg capsule sig: one (1) capsule po once a day. 8. ascorbic acid 1,000 mg tablet sig: one (1) tablet po twice a day. 9. metamucil powder sig: two (2) teaspoons po once a day as needed for constipation. 10. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*2* 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. warfarin 2 mg tablet sig: 2.5 tablets po once a day. disp:*75 tablet(s)* refills:*2* 14. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual as directed as needed for chest pain: take 1 tab, wait 5 min, can take 1 more tab, call 911 if you still have cp. . disp:*25 tab* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: acute systolic congestive heart failure myocardial infarction acute kidney injury acute urinary retention transient atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear dr. , you were admitted to due to respiratory failure which was due to heart failure after peri-operative mi. you required intubation and diuresis but were able to be extubated. your stay was complicated by atrial fibrillation (now resolved), kidney injury due to your heart attack (slowly resolving), and continued urinary retention (for which you still have a foley catheter). please follow up with your pcp, , and urology (appointments listed below). due to the decrease in your ef, you should weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. you have also been fitted with a lifevest that will defibrillate ventricular tachycardia or fibrillation if it occurs. we made the following changes to your medications: 1. start taking clopidogrel to prevent further thrombus formation 2. start taking metoprolol to slow your heart rate 3. start taking lisinopril to help with remodeling of your heart and as an afterload reducer 4. start taking tamsulosin and finasteride to shrink your prostate 5. increase the atorvastatin to 40 mg daily 6. start taking nitroglycerin tablets as needed for chest pain 7. start taking warfarin to prevent clot formation in your left ventricle and prevent another stroke. followup instructions: department: surgical specialties when: tuesday at 11:00 am with: , m.d. building: campus: east best parking: garage department: when: thursday at 2:50 pm with: , md. post clinic building: sc clinical ctr campus: east best parking: garage *this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: cardiac services when: thursday at 2:20 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours coronary arteriography using two catheters left heart cardiac catheterization insertion of endotracheal tube other electric countershock of heart arterial catheterization pulmonary artery wedge monitoring diagnoses: acidosis coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified acute myocardial infarction of other anterior wall, initial episode of care cardiac complications, not elsewhere classified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) acute respiratory failure surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cardiogenic shock retention of urine, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea gross hematuria acute on chronic systolic heart failure chronic total occlusion of coronary artery unspecified hemorrhoids with other complication 

Answer: The patient is high likely exposed to