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: sulfonamides / dicloxacillin attending: chief complaint: transfer from assited living with worsening sob major surgical or invasive procedure: central line placement history of present illness: this is a 86 y/o f with h/o atrial fibrillation off warfarin, diastolic chf ef 70%, cad, htn, sinus syndrom s/p ppm, severe as who presents with about 1 day of sob. . patient reports that she felt more sob about 1 day ago. denied fevers, chills, chest pain. she reports being compliant with her medications. no weight changes . in the ed, vs 102 t rectally, hr 104, bp 119/68, rr 37 sats 97% on nrb. chest x ray pulmonary edema. probnp . she received 125 iv solumedrol, 40 lasix, cefepime, levofloxacine. she was place cpap initially tolerated it, then bp droped into the 60's sbp, dopamine was started and a central line was placed. . ros: denied fever, chills, sob, cough, chest pain, abdominal pain, blood in stools, weight gain or weight loss past medical history: - atrial fibrillation: off coumadin secondary to epistaxis - sinus syndrome: temporary pacer placed during admission, was to return for permanent placement, which was again deferred during admission secondary to medical illness - hx of vt with torsades morphology in , was on amiodarone, recently stopped for hypothyroidism - aortic stenosis-> echo showing peak gradient 76 mm hg. - cad s/p nstemi in and s/p ballooning of lad - diasolic chf (ef 70%) - htn - hyperlipidemia - chronic venous stasis - squamous cell carcinoma: right medial calf, s/p excision , positive margins on 1st and 2nd excision attempts, needs xrt to area 6 weeks after the wound heals. - uti - rectal ulcers: possibly from constipation and straining - history of c diff colitis - anemia: from blood loss after gi bleed - urge incontinence - depression - colon adenoma in : last colonoscopy in , no polyps - s/p hysterectomy - hypothyroidism social history: currently living in chestnut park . no tobacco use. no history of alcohol abuse. her husband is deceased. she has a social worker at who follows her closely. family history: non contributory physical exam: vitals: t: 96.6 p:95 r:25 bp: 131/66 sao2: 95% nrb general: heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: jvd 15 pulmonary: lungs crackles bilaterally cardiac: rrr, nl s1-s2. rusb eyection murmur abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: 1+ edema. + r tibial ulcer. neurologic: alert, oriented, x3, non focal. pertinent results: admit labs: ----------- 03:10pm wbc-6.1 rbc-4.10* hgb-12.6 hct-38.7 mcv-94 mch-30.7 mchc-32.6 rdw-15.2 03:10pm neuts-78.7* lymphs-12.5* monos-8.0 eos-0.6 basos-0.3 03:10pm glucose-145* urea n-23* creat-1.2* sodium-136 potassium-5.4* chloride-103 total co2-22 anion gap-16 03:10pm ck(cpk)-86 03:10pm ctropnt-<0.01 03:30pm urine color-yellow appear-clear sp -1.013 03:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:22pm type-art temp-37.0 rates-/18 o2-100 o2 flow-10 po2-73* pco2-40 ph-7.41 total co2-26 base xs-0 aado2-613 req o2-98 intubated-not intuba 11:18pm tsh-4.5* 11:18pm ck-mb-5 ctropnt-0.08* 11:18pm ck(cpk)-62 . other labs/studies: ------------------- 03:59am blood wbc-3.3* rbc-3.52* hgb-11.2* hct-33.7* mcv-96 mch-31.9 mchc-33.3 rdw-14.5 plt ct-105* 07:00am blood wbc-3.5* rbc-3.53* hgb-11.2* hct-33.2* mcv-94 mch-31.7 mchc-33.6 rdw-14.2 plt ct-110* 03:10pm blood ck-mb-notdone probnp-* 08:00am blood t4-6.6 calctbg-1.00 tuptake-1.00 t4index-6.6 free t4-1.0 08:00am blood tsh-14* 5:59 am urine source: catheter. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. 5:30 am influenza a/b by dfa source: nasopharyngeal aspirate. **final report ** direct influenza a antigen test (final ): negative for influenza a viral antigen. direct influenza b antigen test (final ): positive for influenza b viral antigen. . tte (): the left atrium is markedly dilated. there is moderate symmetric left ventricular hypertrophy. there is severe regional left ventricular systolic dysfunction with global hypokinesis, akinesis of the mid and distal anterior wall and apex. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with mild global free wall hypokinesis. the ascending aorta is moderately dilated. the aortic valve leaflets are severely thickened/deformed. significant aortic stenosis is present (not quantified). no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is moderate thickening of the mitral valve chordae. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of . chest (pa & lat) 9:30 am there has been marked improvement in pulmonary edema, still there is mild interstitial pulmonary edema. left lower lobe retrocardiac atelectasis has decreased. there is a small left pleural effusion. there is no pneumothorax. moderate cardiomegaly is stable as are enlarged central pulmonary arteries very suggestive of pulmonary hypertension. left transvenous leads terminate in standard position in the right atrium and right ventricle. there is also a small right pleural effusion, lesser in amount than in the left side. impression: improved pulmonary edema. . tte (): the left atrium is markedly dilated. the right atrium is markedly dilated. the estimated right atrial pressure is 10-15mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is severe global left ventricular hypokinesis (lvef = 20-25 %) (basal lateral wall has preserved systolic function). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. with depressed free wall contractility. the ascending aorta is moderately dilated. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the tricuspid valve leaflets are mildly thickened. there is moderate to severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the lvef is now severely depressed . bilat lower ext veins 11:18 am bilateral lower extremity ultrasound: grayscale and doppler son of bilateral common femoral, superficial femoral, and popliteal veins were performed which demonstrate normal compressibility, flow, and augmentation. impression: no evidence of dvt. . us abd limit, single organ port 1:14 pm a limited portable ultrasound examination was performed by the radiology resident. survey demonstrates dirty shadowing from numerous loops of small bowel within the lower abdomen and pelvis. no mass lesions were identified. the bladder cannot be evaluated given intraluminal foley catheter. impression: limited ultrasound demonstrates no superficial mass lesions identified within the abdomen or pelvis. findings may be confirmed with non- emergent ct of the abdomen and pelvis if clinically warranted. brief hospital course: 87 yo woman with multiple medical problems including sinus s/p ppm, afib (off anticoagulation epistaxis), pumonary htn, diastolic chf, cad, severe as, copd who presents with shortness of , dfa positive for flu b. . the patient was initially admitted to the due to hypotension and need for vasopressors. . # respiratory distress/hypoxemia likely multifactorial, including influenza and acute heart failure (systolic). initially was on antibiotics for possible pneumonia, however there was no evidence of a bacterial pneumonia, so these were stopped. . # influenza dfa for influenza b was positive. patient was given a 5-day course of tamiflu. her oxygen saturation and overall respiratory status improved. she was maintained in respiratory isolation. . # acute systolic chf with h/o chronic diastolic chf this was likely in setting of acute viral illness (?-viral myocarditis). ef dropped from normal to 20-25%. the patient had significant pulmonary edema. she was diuresed with iv lasix with improvement in respiratory status. her b-blocker was subsequently restarted. ace inhibitor was held due to borderline blood pressure. a tte was repeated 4 days later and did not show any signifcant change. this should be re-assessed in about 3 months to determine need for icd. cardiac enzymes were mildly elevated (likely in setting of demand), however did not meet criteria for an nstemi. . # severe aortic stenosis confirmed on both echocardiograms. given this condition, patient was not diuresed more aggressively. patient will follow up with outpatient cardiologist to discuss treatment options; and lasix daily dose was halved to 20 mg daily. . # hypotension: normal wbc, no left shift in differential. normal lactate. in the setting of fevers concerning for sepsis. u/a negative. was initially on dopamine, however this was titrated off. blood pressure medications were slowly introduced. . # rhythm - atrial fibrillation/sss s/p ppm rate was well controlled. she had an episode in which she had an 80-beat run of what appeared to be a wide complex tachycardia. there was some thought that was v-tach and she was started on an amiodarone drip and then coverted to oral amiodarone. after discussion with her primary cardiologist, this appeared to be most consistent with an svt. after transfer to the medicine floor, the amiodarone was stopped as she has no tolerated this in the past and since a b-blocker had been restarted. . # ckd: basline 1-1.1. this was stable. . # hypothyroidism was continued on her home meds. rechecking tsh showed a level of 14. free t4 and free t4 index were normal. since dose was only adjusted two weeks prior, dose was left as is. tsh should be rechecked 6 weeks after dose adjustment to ensure adequate level. . # depression: continued on outpatient regimen medications on admission: tylenol advair1 1 puff albuterol sulfate 90 mcg 2 puff q4-6h as needed aspirin 81 atorvastatin 80 mg once a day atrovent hfa calcium 500 celexa 60 mg qd colace 100 mg\ iron 325 lasix 40 qd levoxyl 100 qd metoprolol xl 37 qd lisinopril 10 mg qd prilosec 20 qd senna vitamin c vitamin d discharge medications: 1. becaplermin 0.01 % gel sig: one (1) appl topical daily (daily): to r calf ulceration. . 2. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 7. calcium 500 500 mg (1,250 mg) tablet sig: one (1) tablet po three times a day. 8. ergocalciferol (vitamin d2) 400 unit tablet sig: 2.5 tablets po once a day. 9. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 10. toprol xl 25 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day: 37.5mg daily. 11. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 13. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 14. multiple vitamin tablet sig: one (1) tablet po once a day. 15. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation every six (6) hours as needed for shortness of or wheezing. 16. atrovent hfa 17 mcg/actuation aerosol sig: one (1) puff inhalation three times a day. 17. furosemide 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: of discharge diagnosis: primary: 428.33 heart failure, (b2) acute on chronic diastolic secondary: 401.1 hypertension, benign secondary: 414.01 cad, native vessel secondary: 311 depression, nos secondary: 496 chronic obstructive pulmonary disease secondary: 427.31 atrial fibrillation secondary: 424.1 aortic stenosis-insufficiency secondary: 428.21 heart failure, (a1) acute systolic secondary: 244.9 hypothyroidism secondary: 284.1 pancytopenia secondary: 427.0 tachycardia, supraventricular secondary: 487.1 influenza with other respiratory manifestations unsigned discharge condition: stable discharge instructions: return to the emergency department for: shortness of , fevers. followup instructions: provider: clinic phone: date/time: 9:30 provider: , m.d. phone: date/time: 10:00 provider: , m.d. date/time: 2:30 procedure: venous catheterization, not elsewhere classified diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders depressive disorder, not elsewhere classified chronic kidney disease, unspecified personal history of other malignant neoplasm of skin acute systolic heart failure influenza with other respiratory manifestations 

Answer: The patient is high likely exposed to