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: mr. is a 64-year-old guatemalan man with a history of hypertension, diabetes, and smoking who was recently treated for bronchitis with azithromycin. he presented to his primary care doctor on the day of admission for followup. he was noted to have bilateral edema which developed over the past four days and a heart rate greater than 150. he was sent to the emergency room at -nishoba. there his ekg and echocardiogram were hemodynamically stable and he was transferred to for further care. he reports recent cough productive of sputum. there was no fever or chills. he also complained of throat pain and soreness. he described orthopnea but no paroxysmal nocturnal dyspnea. he denied chest pain, shortness of breath, diaphoresis, nausea, vomiting, abdominal pain, diarrhea, constipation, recent weight loss, or chills. he has never had a history of cardiac disease. past medical history: the patient has a past medical history of hypertension, cerebrovascular accident 15 years ago, diabetes mellitus times six years, right eye injury, right leg break, and ppd negative recently at his primary care doctor's office. medications: amaryl 2.5 mg p.o. q.d., accupril, azithromycin, glucotrol, and hydrochlorothiazide. allergies: not known. social history: the patient is married with four children and was recently in from . he was a teacher. family history: the family history is notable for liver cancer. physical examination: temperature was 99.6, blood pressure 100/70, heart rate 170 and irregularly irregular, and respiratory rate 17. the patient was saturating at 100% on 4 liters of oxygen. in general, he appeared alert, awake, and oriented times three lying comfortably. he had a small right pupil and the eye had a corneal scar. the left pupil was round and reactive. extraocular movements were normal. jugular venous pressure was elevated at 5 cm according to dr. note and 16 cm according to dr. . there were no carotid bruits. the thyroid was palpable. there was no lymphadenopathy. the chest revealed a few bibasilar crackles with good air movement bilaterally. there was no dullness. on cardiac examination, he had hyperdynamic precordium. there was a systolic ejection murmur across the precordium as well. the abdomen was soft and nontender with normal bowel sounds. no spleen was palpable. guaiac was negative. the liver was palpable 3.4 cm below the costal margin. the extremities showed good distal pulses. neurologically, cranial nerves ii-xii were intact. he had 5/5 strength throughout. there was a constant grimace and he had normal speech. laboratory investigations: sodium was 129, potassium 3.9, chloride 90, bicarbonate 26, bun 17, creatinine 0.5, glucose 308, white blood cell count 13.3, hematocrit 40.7, platelets 395,000. coagulation parameters were normal. magnesium was 1.8, albumin 2.6, calcium 8.5, ck 36. at the outside hospital he was noted to have elevated liver function tests and alkaline phosphatase. troponin was less than 0.2. an electrocardiogram revealed a rate of 170 in atrial flutter. there was normal axis and normal intervals with left ventricular hypertrophy and j point elevation. an echocardiogram obtained from -nishoba emergency room showed an ejection fraction of approximately 10%. the left ventricle was normal in size. there was severe global hypokinesis. there was moderate to severe tricuspid regurgitation. the right ventricle showed severe global hypokinesis. a chest x-ray on showed a large heart silhouette and right lower lobe mass. on , he had a question of congestion and persistent right lower lobe mass. ast was 35, alt 50, alkaline phosphatase 284, total bilirubin 0.4, tsh 1.2, free t4 1.2, serum iron level 30, tibc 300, trf 154. hospital course: in summary, mr. is a 64-year-old man with new onset atrial flutter and severely depressed cardiac function with evidence of congestive heart failure. his hospital course can be summarized as follows. rhythm: initially mr. was in atrial flutter with 2:1 block at a rate of 133. he was asymptomatic from this point of view and hemodynamically stable. he did not appear volume overloaded initially. a transesophageal echocardiogram was obtained to assess for the possibility of clots. this showed no mass nor thrombus in the left atrium nor the right atrium. there was evidence of mild aortic stenosis and diffuse atheromatous aorta. therefore, mr. was cardioverted and in less than one hour he reverted spontaneously to atrial fibrillation post procedure. to manage this, amiodarone was initially considered but because of concerns of liver and pulmonary toxicity, was not pursued. therefore procainamide intravenously was used and he converted to sinus rhythm; however when the procainamide was transitioned to an oral regimen, he reverted to atrial fibrillation and intravenous procainamide was therefore re-initiated. mr. converted to sinus rhythm again after 12 hours. a procainamide level check was 16 which was elevated. when he was once again changed to oral procainamide, he reverted to atrial fibrillation. therefore amiodarone was started on after which he developed intermittent paroxysmal atrial fibrillation. a repeat transesophageal echocardiogram on showed a thrombus in the left atrial appendage and he converted to normal sinus rhythm spontaneously. in terms of his anticoagulation, this had initially been considered when he was in atrial fibrillation but because of intermittent symptoms of hemoptysis, this was not pursued. on bronchoscopy, when no endobronchial lesion was found, mr. was therefore heparinized. congestive heart failure: mr. was in florid congestive heart failure as evidenced by a jvp of 16 cm along with scrotal and pedal edema. his ejection fraction of less than 10% combining with severe global left ventricular hypokinesis and moderate aortic stenosis was likely a contributor to his congestive heart failure. our choice of therapy was limited by his blood pressure. his ace inhibitor starting with captopril 6.25 mg p.o. t.i.d. was poorly tolerated because of his hypotension. we therefore continued him on low dose ace inhibitor and held this with the parameter of systolic pressure of 80. the goal would be to help in ventricular remodeling and to enhance forward flow. as well, mr. was also started on lasix 20 mg p.o. q.d. initially and had a poor response but then diuresed well over the ensuing days. in the hospital, mr. complained of chest pressure/pain intermittently. electrocardiograms obtained repeatedly showed atrial fibrillation but no new ekg changes. his cks were cycled along with his symptoms and have remained negative to date. a catheterization was also considered but withheld because of mr. ' questionable lung mass. at the time of dictation, it is unlikely that we will pursue catheterization because it is unclear that this would change his prognosis. pulmonary: mr. ' right lower lobe mass was concerning for tumor. a bronchoscopy was delayed until because of his atrial fibrillation. this revealed no endobronchial lesions. sputum washings were obtained all of which have been negative for malignant cells. a thoracentesis was also performed for a right pleural effusion. this procedure was difficult and required multiple attempts under ultrasound guidance. eventually 150 cc of fluid was sent and the pathology revealed no malignant cells. he had no pneumothorax post procedure. mr. complained of shortness of breath intermittently. because of a concern for possible chronic obstructive pulmonary disease, he was begun on atrovent and levaquin on with symptomatic improvement. at the time of dictation, a vat versus transbronchial lung biopsy were under consideration by dr. given the non-diagnostic sputum/bronchial washings/pleural fluid. gastrointestinal: mr. ' elevated liver function tests were consistent with an obstructive picture. on hospital day #4, he developed some nausea which was felt to be secondary to either his elevated liver function tests/procainamide toxicity/diabetic gastroparesis/constipation. however, this resolved the next day with reglan 10 mg intravenously t.i.d. endocrine: amaryl was increased to 4 mg p.o. q.d. for his diabetes. a tsh was also obtained for underlying reasons for his atrial fibrillation and pre-amiodarone tft monitoring. the tsh remained at 1.2 which was normal. prophylaxis: mr. was on subcutaneous heparin initially but this was discontinued eventually. he was also on zantac. code status: full. social: mr. had excellent support from his daughter throughout the hospitalization course. unfortunately the absence of his insurance coverage could not allow for him to be covered in an acute rehabilitation setting as suggested by physiotherapy. we have therefore pursued a walker to help his mobility. a physical therapy consult felt that mr. had impaired strength, impaired mobility, and decreased functional ability. they were going to follow mr. throughout his hospitalization in place of acute rehabilitation. discharge diagnoses: new onset atrial fibrillation, status post dc cardioversion, procainamide trial, and currently on amiodarone; left atrial appendage thrombus, on anticoagulation with warfarin; congestive heart failure secondary to global cardiomyopathy likely of ischemic origin; right lower lung mass, not yet determined, status post non-diagnostic bronchoscopy. discharge medications: ecasa 325 mg p.o. q.d., amiodarone 400 mg p.o. b.i.d., amaryl 4 mg p.o. q.d., lasix 20 mg p.o. q.o.d., lisinopril 10 mg p.o. q.d. hold for blood pressure less than 80, levaquin 500 mg p.o. q.d. to end on , atrovent 2 puffs q.i.d. p.r.n., dulcolax 10 mg p.o. b.i.d. p.r.n., cepacol lozenges p.r.n., coumadin with the dose to be reconfirmed. disposition: regrettably because mr. ' insurance could not cover acute rehabilitation, the best we could offer is to go home with vna. discharge followup: dr. . , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage diagnostic ultrasound of heart diagnostic ultrasound of heart other esophagoscopy other esophagoscopy thoracentesis atrial cardioversion closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation atrial flutter endocarditis, valve unspecified, unspecified cause swelling, mass, or lump in chest 

Answer: The patient is high likely exposed to