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: history of present illness: the patient is a 79 year old spanish speaking male with a history o coronary artery disease, ischemic cardiomyopathy with an ejection fraction of 25%, status post cardiac catheterization in at the outside hospital, which showed proximal left anterior descending stenosis of 60 to 70%, diagonal 1 80 to 90%; intervention was discussed at that time but elected for medical management; atrial fibrillation status post cardioversion and on amiodarone; diabetes mellitus type 2; chronic renal insufficiency with a baseline creatinine of 3.0 to 4.0, status post left arteriovenous fistula placement on , hypertension and hypercholesterolemia. he was transferred from the outside hospital for management of congestive heart failure and worsening renal function. the patient was admitted to coronary care unit on , after failing intravenous diuretic treatments on the regular medical floor. the patient had a tte showing ejection fraction of 25 to 30% with mild left ventricular hypertrophy and global hypokinesis, mild mitral regurgitation, mild to moderate aortic insufficiency, moderate tricuspid regurgitation, pap of 50 to 55%. the patient there was started on intravenous nesiritide with good urinary output initially, however, his creatinine was rising with decreasing urinary output progressively. his bun and creatinine on admission to the outside hospital was 48 and 3.7 respectively and they were increased to 71 and 5.4 respectively. the patient underwent placement of an arteriovenous fistula on . his coreg was rapidly titrated from initial dose of 3.1 to 5.0 twice a day to 18.75 twice a day. the day of admission to , still in the outside hospital, the patient was found to have "junctional bradycardia" with blood pressures systolic of 70, coreg and amiodarone were held. his bun and creatinine at that time were 85 and 6.2 respectively. ck times two were negative. the patient was transferred to at his son's request. past medical history: 1. coronary artery disease status post cardiac catheterization , proximal left anterior descending 60 to 70%, diagonal 1 80 to 90%, no intervention elected for medical management. 2. atrial fibrillation: status post cardioversion currently on amiodarone. 3. diabetes mellitus. 4. chronic renal insufficiency with baseline creatinine 3.0 to 4.0. 5. hypertension. 6. hypercholesterolemia. 7. hypothyroidism. 8. history of temporal arteritis with negative biopsy on , but continuing prednisone treatment. medications on transfer: 1. levoxyl 100 mg p.o. q. day. 2. prednisone 20 mg p.o. q. day. 3. protonix. 4. meclozine. 5. aspirin. 6. iron. 7. phoslo. 8. glucotrol. 9. epogen. 10. hydralazine. 11. isordil. 12. zocor. of note, coreg, amiodarone, natrecor and lasix were held. allergies: no known drug allergies. summary of hospital course: 1. cardiovascular system: the patient's junctional wide complex bradycardia was felt to be secondary to electrolyte derangement, specifically acidosis and hyperkalemia as well as arteriovenous nodal blockade with a combination of amiodarone and coreg. amiodarone and coreg were held. the patient's hyperkalemia was treated medically with calcium gluconate, insulin and d50 as well as kayexalate. the patient's serial cardiac enzymes were negative. the patient remained hemodynamically stable. in light of worsening renal function, the patient was fluid overloaded and natrecor and intravenous lasix were started with only small improvement in urinary output. the patient's bradycardia resolved as electrolyte derangements were corrected. the patient responded to natrecor and intravenous lasix only transiently with creatinine of 6.5. at this time, gentle fluid bolus was tried with improvement of urinary output and subsequent improvement in the patient's creatinine and renal function. the patient was closely followed by the renal service. it was discussed with the patient and his family that a lot of patient's dysrhythmias were secondary to metabolic derangements being derived from his progressive renal failure, however, the patient was not in favor of initiation hemodialysis prior to maturation of his arteriovenous fistula. the consequences and risks were explained to the patient and family and they were understanding of pros and cons of initiating hemodialysis at that time. after a few days improvement of urinary output, the patient's renal function starting worsening again with creatinine increasing to the peak of 7.7. on , it was thought that a pericardial rub was heard on a physical examination, prompting initiation of urgent hemodialysis, however, the patient and his family repeatedly refused such intervention. the patient has remained largely asymptomatic in bed, has been mentating fine. the patient has been followed by the renal service who likewise explained the consequences of not initiating hemodialysis at this time. it was also explained to them that the patient's renal disease is likely irreversible as evident by the patient's renal ultrasound which was done on admission which showed bilateral renal atrophy, no hydronephrosis and no kidney stones, which would go against the presence of reversible component. the patient has remained doing well with natrecor and lasix being weaned off and was started on hydralazine and nitroglycerin. ace inhibitors were avoided in light of worsening renal function. on , the patient went into atrial fibrillation with aberrant conduction. low dose beta blocker as well as low dose amiodarone were started and the patient was closely observed. the following day the patient converted back into sinus rhythm and has remained asymptomatic with creatinine being stable at 6.3 to 6.5. the patient was transferred to the general nursing floor and has done very well there for the next two days. two days later the patient developed junctional bradycardia with a rate of 40, hypotension with systolic blood pressures at low 60s. the patient was given a fluid bolus, urgently transferred back to the intensive care unit. the patient was found to have a creatinine of 7.7, potassium of 5.2. the patient's hyperkalemia was corrected. the patient was given atropine and was started on dopamine which we were able to wean off in the next few hours. the patient was nauseated and complained of abdominal pain. at this point, it was explained to the patient and his family that hemodialysis was urgent as patient was exhibiting signs of uremia. the patient subsequently underwent right femoral catheter placement for temporary hemodialysis and has undergone three consecutive hemodialysis treatments which greatly improved his physical condition. amiodarone and beta blocker were on hold since the second episode of junctional bradycardia. the patient remained in sinus rhythm. subsequently, the patient was transferred back to the general nursing floor and had a few runs of narrow complex tachycardia. the patient has remained asymptomatic since then with heart rate was in the 120s and 130s. at the same time, the patient also had a run of monomorphic ventricular tachycardia, 21 beats, asymptomatic. taking into account the above events, it was decided that the patient was at high risk for sudden cardiac death and he underwent an icd placement and permanent pacemaker placement implantation on . the patient's permanent pacemaker was set to capture at the rate of 60 and the patient's icd was set to delivery electrical shock in the ventricular tachycardia range. the patient had done very well post procedure and was started on amiodarone 400 q. day. his coumadin was restarted the day following the procedure. anti-coagulation was not started immediately after the procedure since the procedure was complicated by significant bleed and the patient developed a hematoma at the site of the surgical incision which has remained stable. 2. renal: the patient presented with acute on chronic renal failure. in order to exclude any reversible component, the patient had a renal ultrasound done which showed bilateral renal atrophy consistent with medical renal disease; most likely, the patient has had a progression of chronic renal insufficiency to end stage renal disease. the patient's creatinine initially responded to fluid boluses, but subsequently kept rising to the peak of 7.7. subsequently the patient developed signs of uremia which made hemodialysis urgent. the hemodialysis was not started electively prior to that as per wishes of the patient and family, who were trying to wait until the maturation of the arteriovenous fistula. subsequently, the patient underwent the placement of the right femoral temporary catheter for hemodialysis and has had two subsequent treatments with removal of net 1.5 liters of fluid. the patient has done extremely well with improvement in his mental status, and resolution of symptoms of uremia. the patient has not had any more episodes of junctional bradycardia since initiation of hemodialysis. the patient also underwent a placement of the tunneled catheter without any complications. the patient understands the importance of following up with hemodialysis treatment. the patient is to have hemodialysis as an outpatient at on tuesday, thursday and saturday since discharge from the hospital is planned on sunday or monday. the patient already has an outpatient hemodialysis set up for the upcoming tuesday. 3. gastrointestinal: on admission, the patient had significant transaminitis which was explained by likely shock liver secondary to hypoperfusion during an episode of junctional bradycardia at the outside hospital. the patient also had inr up to 3.5 which was also explained by loss of synthetic liver function. as the patient's cardiovascular status improved, the patient's liver enzymes were trending down and the patient's inr normalized. throughout the hospital stay, the patient was on proton pump inhibitor prophylaxis. 4. pulmonary: the patient's oxygen requirement was correlating with the patient's overall fluid status. as the patient's renal function was worsening, the patient subsequently was requiring more supplemental oxygen. since the initiation of hemodialysis, the patient has had excellent oxygen saturation on room air without any evidence of congestive heart failure or interpulmonary processes. 5. endocrine: the patient has been maintained on outpatient levoxyl dose of 100 mg p.o. q. day. 6. temporal arteritis: the patient has a history of temporal arteritis with a negative biopsy but has treated with prednisone as an outpatient. we kept the patient's outpatient dose of prednisone during this hospitalization. 7. fluids, electrolytes and nutrition: at the beginning of the hospitalization, the patient has been getting intermittent fluid boluses with hopes of improving urinary output. subsequently the patient has been on hemodialysis and has been euvolemic. as far as nutrition, the patient has been educated on the importance of cardiac and renal diet. the patient's electrolytes were repleted as needed. 8. patient education: the patient was educated extensively about implications of being on hemodialysis as well as implications of his congestive heart failure and the impact that electrolyte imbalances have on his congestive heart failure and rhythm. the patient showed understanding of above. the patient's family is likewise very understanding. this discharge summary is to be followed by an addendum. , m.d. dictated by: medquist36 d: 17:02 t: 17:34 job#: procedure: hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis catheter based invasive electrophysiologic testing implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: hyperpotassemia congestive heart failure, unspecified acute and subacute necrosis of liver acute kidney failure, unspecified hematoma complicating a procedure paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease giant cell arteritis atrioventricular block, unspecified 

Answer: The patient is high likely exposed to