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: lidocaine / shellfish attending: chief complaint: dyspnea, syncope on exertion major surgical or invasive procedure: intubation and trach tube placement on history of present illness: this is a 79 year-old male with a history of hypertension, hyperlipidemia who presents for evaluation of dyspnea and syncope on exertion. per team on the floor, the dyspnea on exertion and syncope have been getting progressively worse over the course of the last 2 months. pt's functional capacity is extremely limited; he is now only able to go from the bed to the bathroom and even this makes him presyncopal and dyspnic. pt has been having syncopal espisodes with prodrome for 2 years. on day of admission, pt was rushing to the bathroom when he had a syncopal episode. it is unclear if he syncopized while running to the bathroom or on the toliet. his son called the ambulance. the chest pain occured while the patient was recovering from syncope. the patient describes pain as , l shoulder tapping pressure, not radiating, not a/w nausea diaphoresis or shortness of breath. it resolved after about 10 minutes. patient denies symptoms at rest. . in the ed, initial vitals were t: 97.4 hr:82 bp:127/78 rr: 28. ekg showed a fib, pvcs. pt. was admitted for further evaluation and management. . on the floor, vs were: t98.8, bp 128/55, p 59, r20, o2 sat 98% on 2l. pt was also noted to be orthostatic. bb and acei were decreased. pt was planned for cardiac cath to evaulate coronary anatomy as cause of doe and initiation of sotalol afterwards for paf and possible contribution to dyspnea. pt has been on heparin gtt for subtherapeutic inr while in a fib with possible planned cardioversion. of note, ptt has been >150. . at 8:40 am on , pt was found unresponsive, slumped to the right, by nursing. he did slightly lift his head but would not follow commands. on examination by house officers, he was found slumped to the right. he lifted his head to sternal rub. pupils were equal and reactive, though sluggish. his right arm was noted to be flexed and rigid. code stroke/blue was called. bp was 155/114. hr was 114. throughout the code, pt maintained a blood pressure and pulse of 80-100. pt did desat to 80s. pt was found to have copious oral secretions and after suctioning o2 sats improved to 100%. a blood gas showed 7.19/109/254 during the code; it is unclear what the o2 sat was at the time. he was intubated for airway protection. of note, he was noted to have vomit on his . head imaging including ct and cta head showed no acute event preliminarily. neuro evaluated the pt and found no focal neurologic deficits. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism. he denies recent fevers, chills or rigors. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, ankle edema, palpitations. past medical history: past medical history: pacemaker for symptomatic bradycardia dilated cardiomyopathy atrial flutter, s/p ablation arrhythmia in ??????s requiring shock, ? afib hypertension hyperlipidemia cyst removed from chest s/p pacemaker placement in social history: social history is significant for the absence of tobacco use. there is no history of alcohol abuse. lives at home with several of his children. family history: there is no family history of premature coronary artery disease or sudden death. family history of dm. physical exam: vs - t99.8, p61, bp119/77, rr18, o2 sat 99 gen: intubated, sedated. heent: ncat. sclera anicteric. pupils constricted and reactive bilaterally. neck: supple. no jvd. no carotid bruits. cv: irregularly irreglular, no murmurs. chest: no chest wall deformities, scoliosis or kyphosis. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. no abdominial bruits. ext: trace pedal edema bilaterally. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: perrl, dolls eyes negative, babinski downgoing bilaterally, dtrs intact, moving all 4 extremities, no rigidity. . pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: admission labs: 04:28am blood wbc-6.5 rbc-4.12* hgb-12.3* hct-39.7* mcv-96 mch-29.9 mchc-31.1 rdw-15.0 plt ct-186 04:28am blood neuts-77.1* lymphs-17.4* monos-5.0 eos-0.5 baso-0.1 04:28am blood pt-15.8* ptt-28.0 inr(pt)-1.4* 04:28am blood plt ct-186 04:28am blood glucose-101 urean-23* creat-1.1 na-139 k-4.3 cl-96 hco3-39* angap-8 04:28am blood ck(cpk)-266* 04:28am blood ck-mb-8 04:28am blood ctropnt-0.09* 11:34am blood calcium-8.4 phos-4.3 mg-2.2 05:05pm blood tsh-12* 07:10am blood t4-2.1* 09:24am blood type-art po2-254* pco2-109* ph-7.19* caltco2-44* base xs-9 09:24am blood glucose-135* lactate-0.7 na-140 k-4.7 cl-90* calhco3-41* 10:23pm blood o2 sat-91 09:24am blood freeca-1.14 . . pertinent labs: . medical decision making ekg demonstrated a. fib with pvcs, unchanged from . . telemetry demonstrated: a fib with frequent pvcs, short period of pacing. . 2d- performed demonstrated: on mild left atrial/atrial appendage spontaneous echo contrast without intracardiac or atrial/atrial appendage thrombus. biventricular cardiomyopathy. mild mitral regurgitation. mild aortic regurgitation. mild-moderate tricuspid regurgitation. simple aortic atheroma. . cxr: bibasilar atelectasis, however, no evidence of pneumonia. . : excercise mibi: 1. the left ventricle appears to be more enlarged when compared with the prior study. 2. the myocardial perfusion appears normal at the level of exercise attained. 3. we could not perform a gated study due to multiple ectopics. . excercise ecg stress: in reviewing the stress test's ekg component, it was difficult to interpret secondary to his av pacing. throughout the stress test, the patient demonstrated a rhythm that was paced with frequent polymorphic ventricular premature beats and several ventricular couplets. of note, however, the patient had to discontinue the study after 5 minutes with 3.2 mets representing limited functional capacity study for his age. also of note, the patient had a drop in systolic blood pressure from 152/90 to 130/64. . laboratory data: see below. . . discharge labs: 05:26am blood wbc-5.9 rbc-3.23* hgb-10.0* hct-30.7* mcv-95 mch-30.9 mchc-32.5 rdw-15.6* plt ct-207 11:34am blood neuts-92.5* bands-0 lymphs-4.5* monos-2.8 eos-0.1 baso-0.1 11:34am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-1+ microcy-normal polychr-1+ 05:26am blood plt ct-207 06:08am blood esr-11 05:26am blood glucose-96 urean-15 creat-1.0 na-140 k-3.8 cl-113* hco3-23 angap-8 09:38pm blood ck(cpk)-312* 09:38pm blood ck-mb-7 05:26am blood calcium-7.8* phos-2.1* mg-2.1 05:26am blood theophy-3.3* 05:59am blood type-art temp-37.1 rates-15/1 tidal v-500 peep-5 fio2-40 po2-111* pco2-38 ph-7.38 caltco2-23 base xs--1 vent-imv 04:42pm blood glucose-85 12:34am blood o2 sat-96 05:59am blood freeca-1.13 brief hospital course: patient is a 79 yo man with a past medical history pacemaker placement for symptomatic bradycardia, diastolic cardiomyopathy, and atrial fibrillation who presented with syncope and dyspena on exertion on . patient was found unresponsive on with hypercarbic respiratory failure and he was then transferred to the ccu. . #) hypercarbic respiratory failure: patient was found to be in hypercarbic respiratory failure on . he was intubated in the ccu on . he remained intubated until the 23rd. after extubation, patient had multiple episodes of apnea overnight. an eeg was performed which showed "mild encephalopathy or marked drowsiness. there were no focal lateralized or epileptiform features seen." patient was unable to have mri performed because of his his pacemaker. it appeared that he was experiencing symptoms of central sleep apena. patient was started on diamox for this process, which caused little to no improvement in his condition. on , an abg was drawn which showed a ph of 7.18, co2 of 74, o2 of 112. patient previous to this time had declared that he was dnr/dni, so he was encouraged to increase his own tidal volume. respiratory status and abg improved. on , patient reversed his code status and had an abg of 7.14, co2 81 and o2 of 93. patient was intubated and remained as such until . due to the patient's central sleep apnea, it was decided that the patient would undergo a tracheostomy placement, which was performed on . patient tolerated this procedure without complications. patient was placed on theophylline 80 mg po q6h, which he has tolerated well. . #)coronary artery disease: patient has a h/o biventricular hypokinesis, but he has no known cad. patient was continued on his home dose of aspirin, and his atorvastatin was increased to 80 mg po daily during this hospital admission. patient had no acute events relating to his coronary artery disease during this admission. . #)hypotension: patient had multiple episodes of hypotension unrelated to apnea during this hospitalization. patient's sbp would decrease to 60-80. the patient was asymptomatic during this episodes, and each responded to 250 cc ns fluid bolus. etiology of this hypotension remains unclear, but it could represent autonomic instability, disregulation of centeral bp control. patient's metoprolol was discontinued and his fluid balance was regulated in the setting of increased fluid boluses. patient was started on florinef 0.1 mg daily. this dose was gradually increased to 0.4 mg daily, and the patient only had two episodes of hypotension in the 24 hours prior to discharge. . #) abdominal pain: patient had some abdominal pain subsequent to the placement of his peg tube; however these episodes resolved the next day. the tube was placed to suction, which seemed to help relieve his symptoms. on the day of discharge, the patient was receiving tube feeds comfortably, and was no longer experiencing any abdominal pain or distension. . #)diastolic congestive heart failure: patient has known history of diastolic cardiomyopathy w/ ef 40%. a tte was performed on this admission, and it was unchanged from prior studies. patient did not have any acute episodes in regards to his chf during this hospital stay. . #) hypothyroidism: patient's tsh on admission was elevated. however, patient's dose of levothyroxine had been increased two weeks prior to admission. patient was continued on this increased dose of levothyroxine. these studies should be repeated two weeks after discharge with the prospect of increasing his current dose of levothyroxine. . #. anticoagulation: patient was placed on a heparin gtt during this hospital stay. he was restarted on his home dose of coumadin three days prior to discharge. patient should be continued on his heparin gtt until his inr is within a therapeutic range (). patient should have daily inrs followed until he is stabalized on his home regimen. #. code: full medications on admission: atorvastatin 20mg qd furosemide 20mg qd levothyroxine 112mcg daily lisinopril 30mg daily metoprolol succinate 100mg qd warfarin 5mg qd asa 325mg qd discharge medications: 1. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 2. warfarin 5 mg tablet sig: one (1) tablet po daily (daily). 3. fludrocortisone 0.1 mg tablet sig: four (4) tablet po daily (daily). 4. theophylline 80 mg/15 ml elixir sig: eighty (80) mg po q6h (every 6 hours). 5. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po once a day. 6. heparin continuous drip sig: 1050 (1050) units/hour intravenous continuous: until inr > 2.0. 7. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 8. atorvastatin 20 mg tablet sig: one (1) tablet po once a day. 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 10. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q6h (every 6 hours) as needed. 11. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 14. flomax 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. 15. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: extended care facility: hospital discharge diagnosis: primary: central sleep apnea coronary artery disease syncope secondary: diastolic congestive heart failure hypothyroidism discharge condition: stable. patient's vital signs are stable. patient is asymptomatic with sbp in the 80s. discharge instructions: you were admitted to the hospital because you were experiencing shortness of breath and syncope on exertion. while you were here, you had two episodes of respiratory distress and you were subsequently intubated each time. you were found to have central sleep apnea, and thus you received a trach tube to help you breathe at night. while you were here, we made the following changes to your medications: 1. we increased your lipitor to 80 mg daily 2. we stopped your lasix 3. we discontinued your lisinopril 4. we discontinued your metoprolol please keep all previously scheduled appointments. please take all medications as prescribed. please return to the ed or your healthcare provider immediately if you experience shortness of breath, chest pain, loss of consciousness, dizziness, chills, fevers, or any other concerning symptoms. please weigh yourself every morning, and call your healthcare provider if you gain > 3 lbs in one week. please adhere to a low sodium (2 gm) diet. followup instructions: provider: phone: date/time: 11:00 provider: clinic phone: date/time: 8:30 provider: . phone: date/time: 9:20 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus diagnoses: other primary cardiomyopathies acidosis congestive heart failure, unspecified unspecified acquired hypothyroidism atrial flutter acute respiratory failure other specified cardiac dysrhythmias cardiac pacemaker in situ cerebral artery occlusion, unspecified with cerebral infarction syncope and collapse chronic diastolic heart failure primary central sleep apnea 

Answer: The patient is high likely exposed to