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: indocin / allopurinol attending: chief complaint: chest pain major surgical or invasive procedure: s/p cardiac cath without intervention history of present illness: hpi: yo female with pmh htn, hypercholesterolemia presents with chest pain. pt has 1 week hx of difficulty breathing, cough, wheezing. pt saw pcp on , who started her on zithromax for treatment of presumed pneumonia; completed antibiotic course today. . pt states that chest pain began around 2pm after walking to get a glass of juice. describes pain as , pressure-like, located under left breast, non-radiating, associated with sob and racing heart rate. denies associated nausea, diaphoresis. pt called pcp who instructed her to go to . . pt arrived at at 1735. pt was hypertensive on admission with sbp up to 170s. labs included: hct 31.2, plt 220, creatinine 2.8, ck 145, tn 0.92. cxr read as slight increased vascular congestion. at osh given asa, lipitor, iv nitro. transfered to at for cardiac cath where cath did show 2 vessel dz but no culprit vessel. found w/ elevated filling pressures w/ wegde of 27, so given lasix, nipride gtt for systolic blood pressures in 200's, and transferred to ccu for further evaluation. . ros: pt denies ever having similar chest pain in the past. denies presyncope/syncope. states she had chronic non-productive cough, which has worsened over the past 2 weeks. +dob x days. denies medication or diet noncompliance. denies changes in medications. denies fever, chills, nausea, vomiting. past medical history: copd hypercholesterolemia htn diverticulosis gi bleed tic s/p hysterectomy for fibroids s/p mastectomy for breast ca () glaucoma cataracts social history: widowed. lives alone in elderly living facility. independent. home aide helps out. drives a car -quit smoking 20 years ago. 55 pack year history -denies etoh, drugs family history: mother had mi at age 61 physical exam: vs: temp 98, p99, 146/72, 97% on 3lnc gen: very pleasant, mild effort in breathing, lying on back s/p cath heent: 1mm right pupil minimally responsive to light, 5mm left pupil not responsive to light, eomi, clear op, mmm neck: unable to appreciated jvp, no cervical lymphadenopathy cvs: tachy, nl s1 s2, ?s3, no m/g/r appreciated lungs: expiratory wheezes throughout abd: soft, nt, nd, +bs right groin: no hematoma, no bruit ext: no edema bilaterally, dopplerable pulses bilaterally pertinent results: 09:54pm wbc-5.6 rbc-2.86* hgb-9.2* hct-26.2* mcv-91 mch-32.2* mchc-35.3* rdw-13.5 09:54pm plt count-221 09:54pm pt-12.9 ptt-74.5* inr(pt)-1.1 . 09:54pm glucose-148* urea n-32* creat-2.4* sodium-138 potassium-3.7 chloride-108 total co2-21* anion gap-13 09:54pm calcium-7.8* phosphate-3.3 magnesium-1.9 . 07:58pm type-art po2-97 pco2-38 ph-7.35 total co2-22 base xs--3 07:58pm hgb-9.2* calchct-28 o2 sat-97 . 09:54pm blood ck(cpk)-114 09:54pm blood ck-mb-8 ctropnt-0.32* 03:03am blood ck(cpk)-112 03:03am blood ck-mb-10 mb indx-8.9* ctropnt-0.32* 05:07am blood ck(cpk)-112 05:07am blood ck-mb-6 ctropnt-0.33* . 05:07am blood wbc-9.2 rbc-3.62* hgb-11.1* hct-32.4* mcv-89 mch-30.6 mchc-34.2 rdw-15.1 plt ct-208 05:07am blood plt ct-208 . 05:07am blood glucose-145* urean-31* creat-2.6* na-138 k-3.6 cl-101 hco3-23 angap-18 05:07am blood calcium-8.2* phos-4.3 mg-1.9 . ekg: initial: sinus rhythm @102. left axis deviation. 2-3mm st elevation in v2-v6 . after cath: sinus @93, 2-3mm st elevations in v3-6. . : tte conclusions: 1. the left atrium is mildly dilated. 2. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is moderately depressed (ef 35%). the distal third to one half of the left ventricle is akinetic. 3. the aortic valve leaflets are mildly thickened. 4. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. . : cxr cardiomegaly with no evidence of failure. no evidence of pneumonia. . : tte conclusions: 1. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is moderately depressed (ef 35%) 2. the aortic valve leaflets (3) are mildly thickened. 3. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 4. there is mild pulmonary artery systolic hypertension. 5. there is a small to moderate sized, loculated (over rv) pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. . : cxr again note is made of mild cardiomegaly. the mediastinal and hilar contours are unchanged compared to the previous study. again note is made of increased pulmonary vasculature, as well as increased interstitial markings, suggesting mild congestive heart failure. no parenchymal consolidation is noted. again note is made of multiple staples in the right axilla. . : tte lv apical kinesis, no aneurysm seen stable pericardial effusion brief hospital course: 1. cad: transferred from osh in the setting of chest pain, hypertension and impressive st elevations in leads v4-v6. cath however, failed to show culprit vessel. left main showed small ulcer on superior roof without evidence of thrombus or luminal compromise. lad: mild luminal irregularities. lcx: 80% om1 stenosis. rca: diffuse disease proximally and 60% stenosis in mid vessel. no evidence of flow reduction. no intervention performed. right heart cath was performed which did show elevated filling pressures with ra 6, rv 49/10, pa 49/24 and wedge of 27 w/ ci - 2.46. pt was ultimately transferred to ccu post cath chest pain free and started on nipride gtt for bp control. since there was no clear culprit vessel, it was decided to medically manage pt and maintain good blood pressure control. enzymes trended down during hospital course. repeat echo showed moderate lv systolic dysfunction with ef 35-40% and inferolateral hypokinesis/akinesis and apical akinesis/dyskinesis without evidence of apical aneurysm or thrombus. pt had several episodes of chest pain during admission associated with shortness of breath which were relieved with nitroglycerine and morphine. ekgs during these episodes showed no changes. pt continued to be medically managed on asa, plavix, lipitor 80. pt was unable to tolerate a beta-blocker secondary to wheezing and an ace inhibitor was unable to be started in the setting of her renal failure. her hypertension was managed by titrating up verapamil and isosorbide dinitrate. . 2. chf: found w/ elevated filling pressures on right heart cath w/ wedge of 27. echo on showed ef 35% but w/ e/a ratio of 0.6 and tr gradient of 30-36. had moderate mr and trace tr. thought to have component of diastolic dysfunction. diuresed w/ iv lasix 40 w/ moderate diuresis and started on beta blockade. given elevated creatinine, decided to hold and switched to hydralizine and nitrates. however, pt continued to remain mildly hypoxic and quite wheezy w/ cxr not showing florid failure. later, during hospital course, felt that shortness of breath, more likely secondary to copd/rad flare and pt started on po prednisone 60 qd. . 2a: pericardial effusion: echo w/ small to moderate pericardial effusion, loculated and echo dense thought secondary to inflammation. recheck on showed stable effusion and w/o pulsus paradoxus on a-line. will likely need f/u echo in future. . 3. rhythm: stable throughout hospitalization . 4. htn: found w/ elevated systolic bp's into the 200's in the cath lab. initially started on nipride gtt which was weaned off by hospital day 1. pt had been on from osh but given elevated creatinine (and unclear of baseline), opted to hold and switch to hydralyzine and nitrates. she was also started on bb in the setting of recent ischemia. however, discussions w/ pcp . suggested that pt did not tolerate bb secondary to wheezing, also consistent w/ hospital course at the . as such, bb d/c'd and restarted on verapamil 240 per day. hydralazine was discontinued and verapamil and isorsorbide dinitrate was titrated up good blood pressure control. these medications were converted to daily dosing prior to discharge: verapamil 480mg qd and imdur 60mg qd. . 5. wheezing: as mentioned above, initially treated for chf exacerbatioin w/ moderate diuresis but w/o significant improvement. recently treated w/ zithromax for ?copd flare. given significant wheezing and mild hypoxia (95 on 2 liters), decided to d/c bb. pt's wheezing and sob was thought to be secondary to copd flare superimposed upon mild chf. initially, we tried steroid inhalers but given persistent wheezing, elected to begin po steroids w/ prednisone 60 qd. after an episode of moderate respiratory distress with desats to 90s, pt was started on iv methylprednisolone which she received for a couple of days. pt was subsequently switched back to po prednisone and continued on a taper. initially given that she has not had fevers or wbc or change in sputum, we decided to hold on additional abx. on , pt was started on levofloxacin for question of pneumonia on chest x-ray; she received a 7 day course. etiology of pt's sob is likely multifactorial with elements of copd exacerbation, pneumonia, and mild chf. these issues were treated and pt's respiratory status improved significantly during the rest of the hospitalization. pt is being discharged on prednisone taper. she needs one more day of prednisone 20mg followed by 3 days of prednisone 10mg. . 6. copd exacerbation: most likely triggered by attempting to start beta-blockade. pt was treated for copd exacerbation as stated above. . 7. id: cxr showed suggestion of consolidation. in the setting of pt's respiratory complaints, she was treated for presumed pneumonia with levofloxacin, of which she got a 7 day course. pt needs 3 more days of antibiotic treatment to complete a 10 day course. pt continued to have occasional elevated wbc while on antibiotic treatment with no other signs of infection; possibility etiology of wbc is steroid treatment. urine cultures were found to be negative. . 8. renal failure: pt has a baseline creatinine of 1.9. she was transferred from osh w/ creatinine of 2.4 w/ initial increase to 2.7. received gentle post cath ivf w/ bicarb and also received mucomyst. as mentioned above, ace was held. after the cardiac catherization, pt's creatinine progressive increased to peak of 4.7. the etiology of acute renal failure was felt to be contrast-induced atn. urine sediment was looked at with the renal fellow which showed granular casts. no intervention was done for atn and creatinine trended down; it is 4.3 on discharge. . 9. hematuria: pt has had a foley in for most of this hospitalization. on the day before discharge, pt was reported to pull at foley. pt developed hematuria without clots, which resolved overnight. a ua was sent during the episode of hematuria and showed 1000 rbc, 230 wbc, moderate leuks. however, urine culture was negative and pt was afebrile with normalized wbc. pt is unlikely to have a uti after 6 days of antibiotic treatment. we recommend rechecking the ua in a few days as well as completing 10 day course of levofloxacin. . 10. anemia: had decrease in hematocrit from reported baseline of 34 to 27 on hospital day 1. ultimately, required 2 unit prbc over course w/ appropriate bumps. hemodymically stable. guiac was negative. she has been continued empirically on protonix. she has also had lower dose of aspirin at 81 qd. pt's hct stabilized at 28-31. would consider transfusing for hct less than 28. . 11. code: based upon discussions w/ patient on several occasions, she wishes to be dnr/dni. medications on admission: verapamil 240mg qd moxepril cimetidine glaucoma eye drops discharge medications: 1. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. insulin lispro (human) 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 9. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 10. isosorbide dinitrate 20 mg tablet sig: one (1) tablet po tid (3 times a day): hold for bp<100. tablet(s) 11. nitroglycerin 0.4 mg tablet, sublingual sig: 0.75 tablet, sublingual sublingual prn (as needed) as needed for chest pain. 12. hydralazine hcl 10 mg tablet sig: three (3) tablet po q6h (every 6 hours): hold for bp<100. 13. verapamil hcl 240 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). 14. prednisone 20 mg tablet sig: three (3) tablet po daily (daily). 15. morphine sulfate 10 mg/ml syringe sig: one (1) injection q2h (every 2 hours) as needed. discharge disposition: extended care facility: tcu discharge diagnosis: st elevation mi - no culprit vessel, medical management hypertension congestive heart failure presumed copd/reactive airway flare acute on chronic renal insuffiency discharge condition: stable discharge instructions: if you develop chest pain or difficulty breathing, call your doctor or go to the emergency room. followup instructions: follow up with your primary care doctor, md. (). procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension obstructive chronic bronchitis with (acute) exacerbation personal history of malignant neoplasm of breast acute myocardial infarction of anterolateral wall, initial episode of care unspecified disease of pericardium injury to bladder and urethra, without mention of open wound into cavity diverticulosis of colon (without mention of hemorrhage) insomnia, unspecified other drugs and medicinal substances causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to