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: ciprofloxacin / zometa / keflex / tetracycline / erythromycin / iodine containing agents classifier attending: chief complaint: decompensated heart failure major surgical or invasive procedure: : right heart catheterization : left picc line insertion history of present illness: ms. is a 68y/o lady with a history of a nonischemic cardiomyopathy (ef 10-15%) originally diagnosed at age 49 (possibly related to a viral cardiomyopathy) s/p biv icd placement, paf s/p ablation and severe asthma who was admitted to the cardiology floor yesterday from cardiology clinic for right heart catherization and is transferred to the ccu for milrinone initiation. she has been followed by dr. for perhaps 20 years and during this time her lv contractile function has been persistently and severely reduced. she received cardiac resynchronization therapy in which resulted in a transient marked improvement in her functional status. however, during the past year or so, there has been a progressive and severe decline in her functional status, accompanied by the development of significant mitral regurgitation, pulmonary hypertension, and tricuspid regurgitation. she is now at the point where she is unable to function. she is in heart association class iii (borderline stage iv), with dyspnea during any physical activity including ordinary activities of daily living. she does have occasional orthopnea but in general sleeps on two pillows. she denies chest pains, palpitations, lightheadedness, dizziness, presyncope, and actual syncope. yesterday's echocardiogram shows an even further deterioration of both left ventricular and right ventricular contractile dysfunction. she now has a severely dilated and severely hypocontractile right ventricle. on right heart cath today, procedure went well per attgs, pt had excellent response to milrinone. picc placement failed due to ?sclerosed veins. upon arrival to the ccu, ms. was feeling "ok". she denies ha, sob, cp, abdom pain; only feels slightly tired. past medical history: 1. severe nonischemic cardiomyopathy with lvef of 10% s/p bivicd placment 2. severe mitral regurgitation, severe tricuspid regurgitation and moderate pulmonary hypertension. 3. paf status post ablation. 4. severe asthma. 5. old compression fractions of t8 and t10. 6. venous stasis disease. 7. anxiety, depression. 8. restless legs syndrome. 9. recent septic bursitis of the right knee. social history: the patient used to work as a jeweler and makes jewelry. she lives with her husband. remote smoking history, quit over 40 years ago, occasional etoh and no illicit drug use family history: father may have had a heart attack, but died from a blood clot to the brain. mother had diabetes and cirrhosis. son with -1 antitrypsin deficiency. physical exam: admission physical examination: general: nad, but does get short of breath during conversation. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, jvp not assessed as pt has to be supine. cardiac: pmi displaced laterally, rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles bilaterally half- way up the lung fields, slightly decreased bs on left. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 2+ pitting edema to the level of the mid-shin. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge physical exam: pertinent results: admission labs: 05:40pm blood wbc-14.8*# rbc-4.37 hgb-13.4 hct-43.3 mcv-99* mch-30.7 mchc-30.9*# rdw-14.2 plt ct-240 05:40pm blood pt-20.4* inr(pt)-1.9* 05:40pm blood glucose-94 urean-22* creat-1.1 na-141 k-4.2 cl-104 hco3-27 angap-14 05:40pm blood calcium-9.4 phos-2.7 mg-2.2 discharge labs: imaging: echocardiogram : the left atrium is mildly dilated. the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (quantitative biplane lvef= 20 % ) secondary to severe global hypokinesis with the basal infero-lateral and antero-lateral segments contracting best. a left ventricular mass/thrombus cannot be excluded. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal septal motion/position. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. the mitral valve leaflets do not fully coapt. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study dated (images reviewed), lvef has improved slightly, mainly due to more vigorous contraction of the basal lateral segments. other findings are similar. bilateral upper extemity ultrasound : impression: patent internal jugular, subclavian and axillary veins bilaterally. patent right upper extremity veins. the svc cannot be seen with ultrasound. imaging assessment of the svc, if indicated, could be performed with contrast-enhanced ct (it is reported to us by the clinical team that the patient would require premedication for such due to contrast allergy). procedures: cardiac catherization: 1. limited resting hemodynamics revealed modereately elevated right and left sided filling pressures with an rvedp of 24mmhg and lvedp of 29mmhg. there was severely elevated pulmonary artery systolic pressure at rest of 78mmhg. at rest there was severely depressed cardiac index of 1.39l/min/m2. patient was infused with milrinone, first bolused with 50mcg/kg over 3 minutes then 0.375mcg/kg/min over 15 minutes. with milrinone infusion there was a significant improvement in cardiac index from 1.39 to 2.22l/min/m2. there was a significant reduction in pasp from 78 to 58mmhg. final diagnosis: 1. severe reduction in cardiac index and elevation in pasp at baseline. 2. marked hemodynamic response to milrinone therapy. 3. will admit to ccu for monitoring. 4. likely left sublclavian vein stenosis. brief hospital course: ms. is a 68y/o lady with nonischemic cardiomyopathy (ef 10%), paf s/p ablation and severe asthma who has had a marked progressive decline in functional capacity over the past year with worsened mr/phtn/tr/rv function, directly admitted with cardiology clinic for initiation of milrinone infusion. active issues: # non-ischemic cardiomyopathy: now end-stage chf, nyha class iii/iv. right heart cath showed excellent response to milrinone. main options for symptomatic improvement include heart transplant (though she is at the upper limit of age for this) or pde inhibitor in order to reduce her pulmonary hypertension and improve right ventricular function. patient admitted to ccu for milrinone infusion given good co and pah response to milrinone. she was maintained on milrinone 0.38 mcg/kg/min which she tolerated well. in terms of rest of her heart failure regimen she was continued on digoxin 0.125 mg daily, valsartan 20 mg daily, metoprolol and spironolactone 12.5 mg. repeat tte on milrinone showed improved lvef due to more vigorous contraction of basal lateral segments. a picc line was placed on in anticipation of pt being discharged on continuous infusion. # paroxysmal atrial fibrillation: rate-controlled, on warfarin. held warfarin while in ccu because inr therapeutic and plan to go to cath lab for picc line placement. as inr became subtherapeutic she was started on a heparin drip to bridge. anticoagulation is both for atrial fibrillation in addition to exremely low lvef. her coumadin was restarted on after picc line placement. on discharge her inr was 2.2 and she will follow-up to have her inr rechecked on . # asthma: recent admission for exacerbation, though currently stable without evidence of exacerbation during this admission. she was treated with her outpatient regimen including advair diskus, singulair 10 mg qhs, albuterol nebs. previous exacerbation started on prednisone taper, this was continued while in house. she was discharged on 10 mg of prednisone. inactive issues: # depression: chronic, stable, continued sertraline 200 mg # restless leg syndrome: chronic, stable. continued ropinirole 0.25 mg qhs, gabapentin 300 mg qhs transitional issues: 1. follow up inr check on medications on admission: home medications: advair diskus 500/50 inhaler 1 puff prednisone 10 mg daily ferrous sulfate 325 mg dialy dmv asa 81 mg digoxin 0.125 mg daily pantoprazole 40 mg daily sertraline 100 mg daily magnesium oxide 400 mg daily tums 500 mg a day valsartan 20 mg torsemide 40 mg daily lopressor 75 mg daily vitamin d3 800 units daily loratidine 10 mg daily spironolactone 12.5 mg daily warfarin (as directed by clinic) gabapentin 300 mg qhs ropinorole 0.25 mg qhs montelukast 10 mg qhs trazadone 25 mg qhs discharge medications: 1. milrinone in d5w 200 mcg/ml piggyback sig: 0.38 mcg/kg/min intravenous infusion (continuous infusion). disp:*qs mcg/kg/min* refills:*2* 2. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. prednisone 10 mg tablet sig: one (1) tablet po daily (daily): please continue to taper your prednisone dose as previously directed. 4. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 10. tums 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po once a day. 11. valsartan 40 mg tablet sig: 0.5 tablet po daily (daily). 12. torsemide 20 mg tablet sig: two (2) tablet po daily (daily). 13. metoprolol succinate 50 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po daily (daily). 14. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 15. loratadine 10 mg tablet sig: one (1) tablet po once a day. 16. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 17. warfarin 2.5 mg tablet sig: as directed by the coumadin clinic tablet po once a day. 18. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 19. ropinirole 0.25 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 20. montelukast 10 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 21. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 22. outpatient lab work please have your inr checked at the clinic on wednesday . 23. sertraline 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: primary: nonischemic cardiomyopathy secondary: asthma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a privilege to provide care for you here at the hospital. you were admitted because you were having trouble breathing due to your heart failure. you were found to have excess fluid in your body, which was removed with medications. you received a right-heart catheterization and were started on milrinone and you had a very good response to the new medication. your condition has improved and you can be discharged to home. the following changes were made to your medications: started milrinone continuous infusion followup instructions: department: cardiac services when: monday at 10:00 am with: dr. building: sc clinical ctr campus: east best parking: garage name: , h. address: 131 ornac , ste#800 jcb bldg, , phone: appt: at 1:45pm procedure: coronary arteriography using a single catheter right heart cardiac catheterization central venous catheter placement with guidance diagnoses: other primary cardiomyopathies mitral valve disorders congestive heart failure, unspecified atrial fibrillation asthma, unspecified type, unspecified other chronic pulmonary heart diseases depressive disorder, not elsewhere classified long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ acute on chronic systolic heart failure diseases of tricuspid valve restless legs syndrome (rls) 

Answer: The patient is high likely exposed to