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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation with sedation history of present illness: 89 year old russian speaking male with cad s/p cabg in , medically managed nstemi , afib (not on coumadin), tachy/brady syndrome s/p dual chamber ppm , dm, chf (ef 45-50%), and pvd who presented to the ed with progressive sob over the last 3 days. he was recenrlt discharged from rehab, and had not been taking any coreg or diuretic. his appetite in rehab was poor, and once he returned home he started eating more food with high salt content. he had gained some weight recently (unclear how much), buit the family thinks this was in the setting of his increased appetite. he did not have any significant edema, and it was unclear if he had any orthopnea or pnd. on arrival to the ed his vs were t:98.6, hr:74, bp:195/86, o2:88% on ra -> 98% on 100% nrb. cxr revealed bilateral fluffy infiltrates c/w pulmonary edema or a diffuse infectious process/ards. due to increased respiratory distress the patient was intubated. he was given ctx/azithromycin for possible cap, and about 1.3l of ivf total. initial labs were notable for mildly increased bun/cr (cr 1.1 up minimally from baseline if 0.9-1.0), a normal ckmb of 3, a tn of 0.01, wbc of 10.1, stable hct/plts, and a lactate of 1.3. ecg revealed v-pacing without significant ischemic changes. the patient was transfered to the micu for further monitoring. he was given broad spectrum abx for possible hcap, and given lasix and nitroglycerine for possible chf. cardiology was consulted for assistance in managing the patient's possible heart failure. the patient is unable to provide information on his review of systems past medical history: -atrial fibrillation with tachy brady syndrome, s/p ppm in , off coumadin -diabetes mellitus, type ii with complications, including neuropathy and disease -cad s/p cabg in , with recent nstemi -peripheral disease, left first toe ampuation -chronic systolic chf, ef 45-50% -orthostatic hypotension -eye blindness, left eye -cataracts -glaucoma -likely dementia social history: currently at . previously with wife at home. wheelchair bound. no alcohol, smoking per omr family history: unavailable at present from patient. physical exam: physical exam: vitals: 98.0 150/70 60 20 95 ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: bilateral basilar crackles 1/3 up abdomen: soft, non-tender, non-distended ext: trace peripheral edema pertinent results: admission labs 10:20am wbc-10.1# rbc-3.96* hgb-12.3* hct-38.3* mcv-97 mch-31.1 mchc-32.2 rdw-15.1 10:20am neuts-75.3* lymphs-13.4* monos-10.2 eos-0.9 basos-0.3 10:20am ctropnt-0.01 10:20am ck-mb-3 probnp-5457* 10:20am glucose-142* urea n-33* creat-1.1 sodium-143 potassium-4.6 chloride-110* total co2-24 anion gap-14 11:20am urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 11:57am type-art po2-147* pco2-35 ph-7.44 total co2-25 base xs-0 labs 10:00am blood wbc-8.1 rbc-3.75* hgb-11.6* hct-36.2* mcv-96 mch-30.9 mchc-32.0 rdw-14.9 plt ct-159 10:00am blood glucose-212* urean-33* creat-1.4* na-141 k-4.0 cl-100 hco3-35* angap-10 10:00am blood calcium-8.6 phos-3.8 mg-2.0 microbiology - all negative urine legionella urinary antigen -final inpatient mrsa screen mrsa screen-final inpatient sputum gram stain-final; respiratory culture-final emergency urine urine culture-final emergency blood culture blood culture, routine-pending emergency blood culture blood culture, routine-pending emergency imaging chest x-ray impression: severe pulmonary edema with bilateral pleural effusions. chest x-ray findings: as compared to the previous radiograph, there is an increase in extent of the pre-existing bilateral pleural effusions. the signs of moderate pulmonary edema are unchanged. increasing extent of the pre-existing basilar areas of atelectasis. unchanged size of the cardiac silhouette. unchanged monitoring and support devices. chest x-ray impression: ap chest compared to , 2:52 a.m. following extubation, lung volumes are slightly lower, exaggerating volume of the already moderate-to-large left pleural effusion. slightly smaller right pleural effusion has decreased. previous mild pulmonary edema in the upper lungs has improved, but atelectasis at the left lung base has worsened. mild-to-moderate cardiomegaly is unchanged. no pneumothorax. transvenous right atrial and right ventricular pacer leads are continuous from the left axillary pacer. chest x-ray impression: extensive pulmonary edema. bilateral pleural effusions, left greater than right. partial left lower lobe collapse secondary to effusion. chest x-ray in comparison with the study of , there is continued substantial pulmonary edema with bilateral effusions and compressive atelectasis in a patient with previous cabg and dual-channel pacemaker device in place. upper extremity ultrasound no evidence of dvt within the left upper extremity. transthoracic echo the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with inferior/inferolateral hypokinesis and apical hypokinesis/akinesis. no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. compared with the prior study (images reviewed) of , apical hypokinesis/akinesis appears to be new. comparison with prior study is limited by suboptimal views. brief hospital course: 88m history of af with tachy/brady syndrome s/p ppm in not on ac, dmii, cad s/p cabg and recent nstemi, schf with ef45-50% and orthostatic hypotension who presents with increased work of breathing per the wife. # respiratory failure: ddx originally included infectious versus cardiovascular. sepsis is felt to be unlikely given normal lactate, no bandemia, and negative u/a. infectious source could possibly be lungs, with history of sob, although collateral history is somewhat vague, per ed the patient did not have any fevers at home. was felt to most likely be secondary to a cardiogenic source, given patent was hypertensive on arrival, with sbp in the 200s, as well as a history of hf with an ef <45% with cxr consistnent with pulmonary edema. in addition, bnp is elevated from prior admission. echo showed a new decrease in ef to 30% with fwm abnormalities. the patient was treated with a nitro gtt as well as daily diuresis with iv furosemide (had not been on diuretics prior) which quickly weaned him from the need for bipap. he was called out to the floor off of a nitrogen gtt, with a plan to increase his blood pressure regimen to prevent further episodes of flash pulmonary edema. the patient was also briefly on hcap antibiotics, but upon from the icu was felt to no longer need these medications given a presumed cardiogenic etiology. antihypertensive medications were uptitrated and upon , he was normotensive with sbp 120-130, appeared euvolemic, with no oxygen requirement. sent home with po torsemide 40mg daily. # acute on chronic systolic chf, ef 45-50% : please see above discussion regarding respiratory failure. multiple medications including carvedilol and lisinopril initially helped in the icu, subsequently patient transitioned back onto home carvedilol and tid captropril (plan to transition back to lisinopril) as well as amlodipine, for bp control. - lisinopril 10mg - increased carvedilol to 6.25 - diuresed over 8l with iv lasix, transitioned to po torsemide 40 mg daily. # hypertension: sbp 200s on admission likely contributed to flash pulmonary edema. wife reports that carvedilol was stopped for unclear reasons at rehab, which may have contributed to uncontrolled blood pressure. adjusted medications as above and normotensive on . # altered mental status - pt self dc'ed lines overnight . has baseline dementia and h/o hospital delirium. - negative infectious workup to date, afebrile, no leukocytosis, negative legionella, sputum, urine cx, cxr shows stable pleural effusion, lll lung collapse # acute kidney injury - developed with cr 1.4 (from baseline 1.0-1.1) in the setting of aggressive diuresis, remained stable and was 1.4 on . # atrial fibrillation with tachy brady syndrome, s/p ppm in : - increased carvedilol 6.25 mg , continued amiodarone 200 mg po daily # cad s/p cabg in , with recent nstemi - cont asa 81 mg daily, atrovastatin 80 mg daily - increase lisinopril to 10 mg daily # peripheral disease, left first toe ampuation and chronic necrotic eschar on left 2nd toe without evidence of infection - cont asa 81 mg daily, atrovastatin 10 mg daily - follow-up with surgery regarding possible amputation # diabetes mellitus, type ii with complications, including neuropathy and disease: cont home sliding scale insulin # gerd: cont ranitidine # presumed bph: cont tamsulosin hs # glaucoma: cont lantanoprost 0.005% qhs & dorzolamide-timolol eye drops # psych: cont sertraline and mirtazapine # general care - continue multivitamin - cholecalciferol 800 mg daily transition of care issues - continue aggressive chest physical therapy - collapse of left lower lobe of the lung is most likely caused by pleural effusion from exacerbation of congestive heart failure. a chest x-ray should be checked in approximately 4 weeks (around ) to confirm resolution of collapse. if it persists, may consider bronchoscopy to rule out obstructing mass or lesion. medications on admission: preadmission medications listed are correct and complete. information was obtained from atriuswebomr. 1. duoneb *nf* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 ml inhalation q6h:prn bronchospasm 2. docusate sodium 100 mg po bid 3. multivitamins 1 tab po daily 4. carvedilol 3.125 mg po bid 5. lactulose 15 ml po daily 6. bisacodyl 10 mg pr hs:prn constipation 7. tamsulosin 0.4 mg po hs 8. senna 1 tab po bid 9. ranitidine 150 mg po daily 10. vitamin d 800 unit po daily 11. sertraline 25 mg po daily 12. amiodarone 200 mg po daily 13. atorvastatin 10 mg po daily 14. dorzolamide 2%/timolol 0.5% ophth. 1 drop both eyes 15. lisinopril 10 mg po daily 16. fluticasone propionate nasal 1 spry nu daily 17. latanoprost 0.005% ophth. soln. 1 drop both eyes hs 18. aspirin 81 mg po daily 19. amlodipine 5 mg po daily hold for sbp <100, hr <60 20. bimatoprost *nf* 0.03 % ou qhs 21. novolog mix 70-30 *nf* (insulin asp prt-insulin aspart) 100 unit/ml (70-30) subcutaneous directed 15 u am, 4 u before dinner 22. albuterol-ipratropium puff ih q6h:prn sob 23. lidocaine 5% patch 1 ptch td daily apply to site of pain 12 hours on and 12 hours off 24. mirtazapine 7.5 mg po hs 25. acetaminophen 325 mg po q4h:prn pain/fever 26. milk of magnesia 30 ml po daily:prn constipation 27. ferrex 150 *nf* (polysaccharide iron complex) 150 mg oral daily 28. fleet enema 1 enema pr daily:prn constipation medications: 1. amiodarone 200 mg po daily 2. amlodipine 5 mg po daily hold for sbp <100, hr <60 3. aspirin 81 mg po daily 4. atorvastatin 10 mg po daily 5. bisacodyl 10 mg pr hs:prn constipation 6. carvedilol 6.25 mg po bid hold for sbp < 100 or hr < 60 7. docusate sodium (liquid) 100 mg po bid 8. latanoprost 0.005% ophth. soln. 1 drop both eyes hs 9. lisinopril 10 mg po daily hold for sbp < 100 or k > 5.0 10. multivitamins 1 tab po daily 11. senna 1 tab po bid 12. sertraline 25 mg po daily 13. tamsulosin 0.4 mg po hs 14. vitamin d 800 unit po daily 15. clotrimazole cream 1 appl tp between toes 16. acetaminophen 325 mg po q4h:prn pain/fever 17. albuterol-ipratropium puff ih q6h:prn sob 18. bimatoprost *nf* 0.03 % ou qhs 19. dorzolamide 2%/timolol 0.5% ophth. 1 drop both eyes 20. duoneb *nf* (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 ml inhalation q6h:prn bronchospasm 21. ferrex 150 *nf* (polysaccharide iron complex) 150 mg oral daily 22. fleet enema 1 enema pr daily:prn constipation 23. fluticasone propionate nasal 1 spry nu daily 24. lactulose 15 ml po daily 25. lidocaine 5% patch 1 ptch td daily apply to site of pain 12 hours on and 12 hours off 26. milk of magnesia 30 ml po daily:prn constipation 27. mirtazapine 7.5 mg po hs 28. ranitidine 150 mg po daily 29. novolog mix 70-30 *nf* (insulin asp prt-insulin aspart) 100 unit/ml (70-30) subcutaneous directed 15 u am, 4 u before dinner 30. humalog 75/25 15 units breakfast humalog 75/25 4 units bedtime insulin sc sliding scale using hum insulin 31. torsemide 40 mg po daily hold for sbp<100 disposition: extended care facility: healthcare center - diagnosis: primary: acute on chronic systolic congestive heart failure exacerbation, pulmonary edema secondary: coronary artery disease, hypertension, diabetes mellitus, peripheral disease, atrial fibrillation condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. instructions: dear mr. , it was a pleasure taking care of you during your recent hospitalization for difficulty breathing. you were found to have fluid in your lungs which is likely because your blood pressure was elevated and your heart could not move fluid effectively. we gave you medications to help you clear the fluid, and your breathing improved. weigh yourself every morning, md if weight goes up more than 3 lbs. please attend the following appointments we have made for you. transition of care issues: - continue aggressive chest physical therapy - collapse of left lower lobe of the lung is most likely caused by pleural effusion from exacerbation of congestive heart failure. a chest x-ray should be checked in approximately 4 weeks (around ) to confirm resolution of collapse. if it persists, may consider bronchoscopy to rule out obstructing mass or lesion. followup instructions: department: cardiac services when: friday at 9:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 10:00 am with: , m.d. building: campus: east best parking: garage department: when: monday at 2:10 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes unspecified glaucoma pulmonary collapse acute respiratory failure diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled old myocardial infarction cardiac pacemaker in situ acute on chronic systolic heart failure unspecified cataract orthostatic hypotension unspecified circulatory system disorder profound impairment, one eye, impairment level not further specified dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to