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: ace inhibitors / levofloxacin attending: chief complaint: acute on chronic diastolic congestive heart failure major surgical or invasive procedure: left knee arthrocentesis right heart catheterization history of present illness: mr. is a 56 year old gentleman with signficant pmh of cad s/p mi in with des to rca and des to lcx, systolic chf with last lvef 25-30% and multiple admissions for schf exacerbations who presents as direct admission for refractory volume overload due to schf. patient is followed closely for his schf by dr. and is frequently seen in the chf outpatient infusion clinic. his last visit was on where his weight was 265 (baseline 250) and he received 80mg iv lasix and 5mg po metolazone. he says that he has had progressive weight gain and doe over the last several months, but notes no acute changes within the last several weeks. his legs are progressively becoming more edematous and he describes them currently as 'hefty'. he has consistent 2 pillow orthopnea and denies pnd. he can walk approximately 1 block before becoming shortness of breath. he denies any anginal or claudication pain. he does report eating a fair amount of 'processed' foods. notably, he was admitted for crf and hyperglycemia. during this admission, he reportedly made trips off the floor to the cafeteria, and his dietary compliance was questionable. on arrival to the floor, patient is ambulatory and out of bed upon entering the room. he has no complaints except for chronic back and knee pain and is asking for dilaudid. . review of systems as above, otherwise 10 point review of systems is unremarkable. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope past medical history: 1. cardiac risk factors: + diabetes, + dyslipidemia, + hypertension 2. cardiac history: - systolic chf (last ef 20 % on ) - cad s/p mi , des to rca and lcx 3. other past medical history: - diabetes - ckd - hypertension - hyperlipidemia - untreated hepatitis c - low back pain - substance abuse (cocaine, heroin, tobacco and alcohol) - history of angioedema - hiatal hernia - generalized osteoarthritis social history: patient is currently living at nursing home . he denies employment history and was incarcerated for several years. -tobacco history: 0.5 ppdx30 years, currently smoking -etoh: denies recent use -illicit drugs: history of cocaine and heroin. + ivda. reports quitting approximately 5 years ago. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; mother with hypertension, father with htn and cirrhosis, brother with hiv physical exam: on admission vs: t=98.4 bp= 145/82 hr= 73 rr=15 o2 sat=96%ra general: ambulatory at baseline. obese man in nad. wdwn. oriented x3. mood, affect appropriate. heent: sclera anicteric. perrl, eomi. mmm. neck: thick, unable to appreciate jvd due to habitus. cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: nonlabored at rest. clear to ausculation abdomen: obese, distended, nontender. no hsm or tenderness. extremities: + pitting edema to knees. skin: no rashes or lesions. on discharge: vs: temp 97.7, hr 71-82, rr 20, bp 100-168/80-102, o2 sat 100% ra weight 255 pounds general: alert and oriented, annoyed with staff cv: rrr, no m/r/g, unable to assess jvd chest: clear, no crackles abd: soft, obese, nt, pos bs extremeties: 2+ pitting edema to knees, has ace bandages for compression neuro: a/o, nad, memory intact, can be demanding of staff. pertinent results: admission labs: 12:37pm blood wbc-9.4 rbc-4.88 hgb-14.0 hct-43.7 mcv-90 mch-28.6 mchc-32.0 rdw-15.2 plt ct-235 12:37pm blood glucose-184* urean-35* creat-1.3* na-136 k-4.1 cl-100 hco3-24 angap-16 12:37pm blood alt-44* ast-41* ld(ldh)-433* alkphos-73 totbili-0.4 12:37pm blood albumin-3.9 calcium-9.4 phos-3.1 mg-1.9 radiology: radiology chest port. line placem portable upright frontal chest radiograph demonstrates interval placement of a left upper extremity picc, the tip of which projects over the upper svc. multiple blebs are again noted in the peripheral right upper lung, better seen on ct from . the cardiac silhouette is top normal in size, accentuated by portable technique. the pulmonary vasculature appears mildly engorged. there is no pleural effusion or pneumothorax. the mediastinal contours are normal. impression: 1. interval placement of left upper extremity picc, the tip of which is in the upper svc. 2. interval decrease in heart size from ; the pulmonary vasculature is minimally engorged. echo tte on milrinone; conclusions poor image quality. the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. there is mild to moderate regional left ventricular systolic dysfunction with infero-septal, inferior and infero-lateral hypokinesis suggested. there is no ventricular septal defect. rv systolic function is difficult to assess but appear borderline in some views. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , lvef has improved and lv systolic dysfunction now appears more regional than right heart cath : final diagnosis: 1. moderate elevation of the wedge pressure consistent with moderate left ventricular diastolic heart failure. 2. severe pulmonary hypertension with marked resipiratory variation. 3. moderately elevated pulmonary vascular resistance. 4. normal cardiac output and index on milrinone. portable abd xray : findings: study is limited due to the patient's extreme obesity. however, no signs of obstruction or ileus are noted. the lungs show pulmonary edema and cardiomegaly. picc line terminates in appropriate posistion. no obvious pleural effusions are noted. no free air or obstructive pattern. bony structures are unremarkable. impression: 1. pulmonary edema and cardiomegaly. 2. no evidence of obstruction or ileus. . labs on discharge: 05:34am blood wbc-10.8 rbc-4.89 hgb-13.9* hct-43.5 mcv-89 mch-28.3 mchc-31.9 rdw-14.1 plt ct-314 05:34am blood glucose-377* urean-83* creat-1.6* na-132* k-3.8 cl-89* hco3-35* angap-12 05:34am blood mg-2.1 brief hospital course: mr. is a 56 year old gentleman with diabetes mellitus (dm), coronary artery disease (cad), and stage iii systolic heart failure (schf) who presented as a direct admission for milrinone and lasix drip for refractory edema. active problems: # refractory edema: likely due to worsening chronic schf. liver synthetic function was intact making hcv associated cirrhosis unlikely. diuresis was achieved with lasix gtt augmented with milrinone gtt as below. weight on admission was 119.75 kgs. # acute on chronic systolic function: patient with schf and lvef 25-30 % in . primarily has right sided symptoms at this time given his gross peripheral edema and clear lungs on admission. home regimen includes torsemide 100mg daily, spironolactone 25mg daily, carvedilol 25mg twice daily and valsartan 40mg daily. we initially continued his carvedilol and valsartan, but held valsartan following a bump in his cr early in his stay. torsemide and spironolactone held while on lasix gtt. he was loaded with midodrine 0.5mcg/kg over 15 minutes before beginning maintenance infusion of 0.375 mcg/kg/min, which was increased to 0.5mcg/kg/min for 2 days. after achieving a net diuresis of > 15 l during the admission, his milrinone was discontinued. he was restarted on torsemide 100 mg daily and metolazone was added at 2.5 mg 3 times per week. also continued on valsartan 40 mg daily, carvedilol 25 mg , aspirin 325 mg daily, simvastatin 20 mg daily, and spironolactone 25 mg daily for heart failure. weight on discharge was 255 pounds. # atrial fibrillation (afib): after several days of diuresis, he developed afib acutely. the inpatient team felt that his afib was precipitated by milrinone and aggressive diuresis. he was asymptomatic although he did develop heart rates to the 140s. he did not achieve rate control with metoprolol iv and so he was given diltiazem 10 mg iv and then diltiazem 30 mg qid for 2 doses. because we did not want to continue calcium channel blocker in a heart failure patient, the diltiazem was discontinued in favor of digoxin. he was loaded with 0.75 total dose of digoxin, divided over 18 hours and he converted to sinus rhythm. he refused a heparin gtt to bridge to warfarin. ideally, he would need to continue anticoagulation with warfarin for at least 1 month, however he stated that he would not be compliant with inr checks so he was discharged without anticoagulation. # chronic pain: patient with history of chronic low back pain, gout, and generalized oa. also likely has some element of neuropathy from diabetes and is also being treated for carpal tunnel syndrome with wrist splints. he is on extensive outpatient regimen of amitryptiline, gabapentin, percocet, tizanidine, and cyclobenzaprine. he was demanding dilaudid on admission. we had no record of him receiving dialudid in omr, and after calling his nursing home, there was no report of dilaudid use there. he was provided increased oxycodone dosing of 10mg po q4 hours with standing tylenol and transitioned to oxycontin 20mg every 12 hours. we continued his additional pain medications including gabapentin, amitryptiline, tizandine and cyclobenzaprine. lidocaine patch was also offerred. # gout: patient developed acute left knee pain on . aspiration of left knee was consistent with gout flare. he was started on a prednisone taper and continued chronic pain regimen as above. prednisone dose on discharge was 15 mg and should be decreased by 5 mg every 2 days. chronic problems # chronic kidney disease: recent baseline cr of 1.4-1.7. cr was 1.3 on admission but increased to 2.6 on . we held his valsartan and decreased his gabapentin dose. cr returned to baseline with further diuresis. gabapentin was returned to home dose and valsartan was restarted on discharge. cr on discharge was 1.6. # cad: history of mi in with des to rca and des to lcx. last catheterization in showed no significant flow obstructing lesions. home regimen includes carvedilol 25mg and asa 325. no current anginal symptoms. we continued asa, valsartan, carvedilol, and simvastatin. # diabetes: poorly controlled with last a1c 9.6 on . home regimen includes novolin 60 with lispro ss. we increased nph to 75 units because of hyperglycemia from prednisone. this should be tapered down slowly as prednisone is transitioned off and blood sugars decrease. enhanced sliding scale is attached. # hypertension: we continued his home carvedilol as above with diuresis. valsartan was restarted at discharge. # hld: last ldl 59 and hdl 62 in . we continued home simvastatin 20mg daily. # hcv: last viral load 31,400,000 in 4/. no history of treatment. patient to follow up with his pcp as an outpatient. # hiatal hernia: stable. continued omeprazole 20mg daily # polysubstance abuse: reports no recent alcohol or illicit drug use. continues to smoke, and we encouraged smoking cessation transitional issues: - please monitor for recurrent afib. if he has further afib, he should be investigated for other causes. - please address ongoing anticoagulation: as he has been non-compliant in the past and as the af lasted less than 24 hours, he will not be started on warfarin at this time but strong consideration should be given to this if he develops af again. - please assess fluid balance with weights and exam, adjust the doses of diuretics as tolerated by his kidneys and potassium. medications on admission: - allopurinol 100mg daily - amytryptiline 10mg qhs - carvedilol 25mg - cyclobenzaprine 5mg prn neck pain - gabapentin 600mg q8 hours - nph 60 units - humalog ss - lidocaine patch prn to knees or back - omeprazole 20mg daily - percocet 5-325 1-2 tabs q6 hours prn pain - miralax daily as needed - kcl 20meq daily - sildenafil 100mg prn - tizanidine 4mg qhs - torsemide 100mg qam - valsartan 40mg daily - asa 325 daily - bisacodyl 5mg prn - camphor-menthol lotion prn itching - docusate 100mg - senna 8.6 2 tabs qhs prn constipation discharge medications: 1. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). 2. amitriptyline 10 mg tablet sig: one (1) tablet po hs (at bedtime). 3. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. 4. cyclobenzaprine 10 mg tablet sig: 0.5 tablet po bid (2 times a day) as needed for neck pain. 5. gabapentin 600 mg tablet sig: one (1) tablet po three times a day. 6. nph insulin human recomb 100 unit/ml suspension sig: seventy five (75) subcutaneous twice a day: use this increased dose while you are taking the prednisone. 7. insulin lispro 100 unit/ml solution sig: as per sliding scale doses subcutaneous as per sliding scale. 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for knee pain. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po once a day as needed for constipation. 11. potassium chloride 20 meq packet sig: one (1) packet po once a day. 12. sildenafil 100 mg tablet sig: one (1) tablet po once a day as needed for ed. 13. tizanidine 4 mg capsule sig: one (1) capsule po at bedtime. 14. torsemide 100 mg tablet sig: one (1) tablet po every morning. 15. valsartan 40 mg tablet sig: one (1) tablet po once a day. 16. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 17. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 18. oxycodone 20 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours): discussed with outpt pcp. 19. metolazone 2.5 mg tablet sig: one (1) tablet po monday/wednesday/friday: pt is refusing dose this am, please give as well. 20. percocet 5-325 mg tablet sig: one (1) tablet po every hours as needed for pain. 21. prednisone 5 mg tablet sig: three (3) tablet po qday () for 2 days: and . 22. prednisone 10 mg tablet sig: one (1) tablet po qday () for 2 days: and . 23. prednisone 5 mg tablet sig: one (1) tablet po qday () for 2 days: and . then d/c. 24. spironolactone 25 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: nursing and rehab center - discharge diagnosis: primary diagnosis chronic systolic heart failure--ejection fraction 25-30% chronic kidney disease diabetes mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital because you were retaining a lot of extra fluid. this is due to your heart failure which causes the heart to pump only about 25% of the fluid with each beat. the rest of the fluid leaks out of your blood vessels into the area under your skin and causes swelling. you were treated with medications to increase the squeezing power of your heart and to force more fluid out in your urine. you responded well and we were successful in getting 15-20 pounds of fluid off. you also developed worsening knee pain, and we had our joint doctors (rheumatologists) examine the fluid in your knee. we found you developed a gout attack and gave you steroids both in your knee and by mouth to help with the pain. we also started new pain medications for you. please note the following changes to your medications: start oxycontin 20mg tab twice daily start prednisone 5mg tabs as directed to slowly decrease the dose increase nph insullin and sliding scale insulin to control your blood sugars start metolazone to decrease your swelling. no other changes were made to your medications. in the future, you will need to keep a very close eye on your medications, diet, and weight. weigh yourself every morning, and call your doctor if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. also, you need to keep a strict low salt diet which will help reduce the amount of fluid your body retains. make sure that you keep all of the follow-up appointments listed below. bring your medications to each appointment so your doctors update their records and adjust doses as needed. it was a pleasure taking care of you in the hospital! followup instructions: name: dr. location: /east address: , e/cc-6, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. department: cardiac services when: monday at 1:30 pm with: dr. building: sc clinical ctr campus: east best parking: garage department: rheumatology when: tuesday at 2:00 pm with: , md building: lm bldg () campus: west best parking: garage department: orthopedics when: wednesday at 1:15 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: wednesday at 1:35 pm with: , m.d. building: campus: east best parking: garage procedure: injection of steroid pulmonary artery wedge monitoring arthrocentesis injection of therapeutic substance into joint or ligament central venous catheter placement with guidance diagnoses: other chronic pain coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases polyneuropathy in diabetes percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction lumbago acute on chronic systolic heart failure acute gouty arthropathy diabetes with neurological manifestations, type ii or unspecified type, uncontrolled osteoarthrosis, generalized, site unspecified 

Answer: The patient is high likely exposed to