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: fluoride attending: chief complaint: ventricular tachycardia status-post ablation major surgical or invasive procedure: - ablation of ventricular tachycardia history of present illness: 86 year-old male with cad who is s/p cabg x 5 in . he is followed by dr. and underwent a nuclear stress test in . this revealed a severe fixed perfusion defect involving the inferior wall with a mild degree of peri infarction ischemia. there was also a fixed apical defect consistent with an old apical mi. there was akinesis of the inferior wall and apex with severe hypokinesis of the mid to distal anterior wall apex which is consistent with multi-segmental cad. the ejection fraction was 27%. he underwent biv icd placement on for primary prevention of sudden cardiac death. his course was complicated by a moderate pneumothorax, he was asymptomatic, and an x-ray the following day showed improvement of the pneumothorax and he was discharged. . 3-4 months ago he was pulling on a garden hose and he became dizzy and saw "lights". he leaned against a wall and received a shock from his icd. he felt fine within a minute. he went to where he stayed there 3 days. he denies any further testing or medication changes. . two months ago he was driving and felt poorly and noted his heart was "fluttering" he was able to drive home but had a near syncopal episode and he felt his icd fire. ems was summoned and he was found to be in vt at a rate of 140 bpm his icd did not fire as it was set for 170 bpm. patient states he knows his icd fired prior getting to the hospital. he was externally cardioverted. his amiodarone was increased to 400mg daily. . he denies any further fluttering or icd shocks. when he is resting he feels that he can feel his heart beating but denies any palpitations. he does report his heart rate has been fast and he has brief intermittent dizziness. his amiodarone was discontinued last week () by dr. as it was thought to be ineffective. . he denies chest pain, and reports some dyspnea with exertion along with mild dizziness if he gets up too quickly. he loses his balance frequently from his neuropathy. he has not been able to drive since his last icd shock. he was referred for vt ablation today. . during vt ablation, ep was able to induced 6 different vt in lab, ablate along the scar in the inferior septum at the base on lv. at the end of study, no longer able to induce any vt. bedrest for 6 hrs, continue carvedilol no antiarrythmic. in procedure, he was 2l positive and got lasix 40 iv. . on arrival to ccu, he appears to be comfortable. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: past medical history: 1. cardiac risk factors: - diabetes, + dyslipidemia, + hypertension 2. cardiac history: - cabg: cad s/p cabg x 5 in - percutaneous coronary interventions: none documented - pacing/icd: cardiomyopathy and lbbb s/p concerto d274trk biv icd 3. other past medical history: severe neuropathy prostate enlargement h. pylori colon ca peripheral neuropathy tia gerd hiatal hernia diverticulosis actinic keratosis ventral hernia polio age 8 depression weight loss with negative ct scan social history: he lives with his wife . has six children. he was an electrical engineer for the navy then working in local power plants. the patient's daughter will bring the patient to the procedure and arrange transportation home. . tobacco: smoked cigars 40-50 years ago etoh: rare family history: brother died of a "heart" problem at the age of 88. he thinks his mother may also have died of heart problems but he is not really sure. physical exam: physical examination on admission vs: t= 98 bp=102/41 hr=64 rr=18 o2 sat= 99% 2l general: nad. 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 with jvp of 8 cm. cardiac: 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. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ . physical exam on discharge vs: t 97.5, hr 60s, bp 120s/60s, rr 20, o2 sat 98% on ra gen: nad, a&ox3 heent: supple, jvp ~ 8cm heart: rrr, good s1, s2, no m/r/g lung: cta bl abd: soft, nt/nd, no hsm ext: no pitting edema, dp/pt 2+ bilaterally pertinent results: admission labs: 07:30am blood wbc-7.4 rbc-3.50*# hgb-11.3* hct-32.3* mcv-92 mch-32.3*# mchc-35.0 rdw-12.6 plt ct-159 04:54pm blood neuts-75.8* lymphs-17.2* monos-5.7 eos-0.9 baso-0.4 07:30am blood pt-11.9 ptt-25.1 inr(pt)-1.1 07:30am blood glucose-106* urean-35* creat-1.5* na-137 k-4.7 cl-105 hco3-23 angap-14 04:54pm blood alt-36 ast-51* ld(ldh)-246 alkphos-48 totbili-0.4 04:54pm blood albumin-3.2* calcium-7.9* phos-3.6 mg-1.9 12:54pm blood type-art po2-179* pco2-32* ph-7.38 caltco2-20* base xs--4 intubat-intubated 12:54pm blood glucose-134* lactate-0.7 na-136 k-4.1 cl-112* 12:54pm blood hgb-9.2* calchct-28 . discharge labs: 06:55am blood wbc-7.1 rbc-3.32* hgb-10.6* hct-30.1* mcv-91 mch-31.9 mchc-35.1* rdw-13.3 plt ct-107* 06:55am blood pt-12.1 ptt-23.9* inr(pt)-1.1 06:55am blood glucose-98 urean-25* creat-1.2 na-134 k-4.8 cl-105 hco3-23 angap-11 06:55am blood calcium-8.6 phos-3.3 mg-2.1 . urine: 10:24am urine blood-lg nitrite-neg protein-tr glucose-150 ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-tr 10:24am urine rbc-89* wbc-15* bacteri-few yeast-none epi-<1 . microbiologic data: mrsa screen - pending blood culture - pending . cytology urine - pending . imaging studies: cxr - reportleft transvenous pacemaker leads end in the standard position within the right preliminary reportatrium, right ventricle and through the coronary sinus. there is no pleural preliminary reporteffusion or pneumothorax. bilateral lungs are expanded and clear. ill-defined preliminary reportopacity with lucency in the right lower paracardiac region is likely a preliminary reportherniated bowel loop. mildly enlarged heart size, mediastinal and hilar preliminary reportcontours are normal. aortic arch and descending thoracic aorta are moderately calcified (preliminary report). . ct abd & pelvis w & w/o impression 1. no evidence of retroperitoneal or intra-abdominal bleed. 2. heterogeneous high-density material within the bladder which is nondependent and appears adherent to the bladder wall. recommend further evaluation with contrast-enhanced ct/mri or ultrasound. 3. benign-appearing bony lesion in the right ilium is most consistent with a bone island. given no history of prostate cancer, attention on followup studies is indicated. 4. large midline abdominal wall hernia containing loops of unobstructed small bowel without evidence of incarceration or strangulation. 5. small left pleural effusion and trace right pleural effusion with right pleural thickening. 6. cholelithiasis. 7. large hiatal hernia. . 2d-echo - the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is moderate regional left ventricular systolic dysfunction with inferior and infero-lateral akinesis (lvef 35%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. there is abnormal septal motion/position. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: this is an 86 year-old with a history of coronary artery disease who is s/p cabg x 5 in who presented with a history of ventricular tachycardia and underwent ablation on with procedure complicated by gross hematuria. . active issues # gross hematuria - the patient underwent his ventricular tachycardia ablation on and was noted to have gross hematuria with clot burden following foley catheterization; with evidence of a hemtocrit drop from 32.3% to 23.3%. he was admitted to the coronary care unit for closer monitoring and was transfused 2 units of packed red blood cells. his hematocrit improved to 27% following transfusion. urologic surgery was consulted and placed a three-way irrigating foley catheter. he had some residual clot burden, but this was otherwise stable. urine cytology was obtained and an outpatient cystoscopy will be performed. he remained hemodynamically stable otherwise. terazosin and finasteride were continued. . # ventricular tachycardia, status-post ablation - the patient has a history of ventricular tachycardia. his ep study was notable for a mixed cardiomyopathy with inferior scar and global lv dysfunction. multiple morphologies of vt were noted, induced with programmed electrical stimulation; all eminating from the scar. two morphologies were successfully ablated after mapping - along basal, septal and lateral scar margins. the patient had no further episodes of ventricular tachycardia following the ablation and remained hemodynamically stable. he received single doses of vancomycin and ceftriaxone following his procedure for prophylaxis. he was not continued on any anti-arrhythmics. . chronic issues # coronary artery disease - the patient has a history of significant coronary disease and markedly depressed ejection fracture with nuclear imaging showing irreversible deficits from prior ischemic events. he presented without chest pain or concern for active ischemia for his outpatient vt ablation. we continued his aspirin, acei, carvedilol, simvastatin and imdur, his home medications. . # congestive heart failure - the patient's home heart failure regimen was continued and he had no evidence of volume overload or signs of exacerbation of his underlying heart failure. we aimed for his goal fluid balance to be even and continued his acei, beta-blokcer, lasix and spironolactone. his daily weights, in's and out's and fluid balances were closely monitored. . # hypertension - we continued his carvedilol, lisiniopril and imdur. . # hyperlipidemia - we continued simvastatin at his home dosing. . # peripheral neuropathy - we continued gabapentin at his home dosing. . transition of care issues: # code status: full # pending studies at discharge: - blood culture - ngtd - mrsa screening - pending - urine cytology - # medication changes - start aspirin 81 mg qd # follow up plan - pcp follow up on - urology follow up on for cystoscopy - continue with routine pacemaker followup medications on admission: carvedilol 12.5 mg tablet by mouth twice a day isosorbide mononitrate 60 mg tablet er by mouth once a day simvastatin 10 mg tablet by mouth once a day aspirin 325 mg tablet by mouth once a day lisinopril 10 mg tablet by mouth once a day furosemide 20 mg tablet by mouth every other day megestrol 625mg/5 ml suspension - 1 (one) tsp by mouth every day nitroglycerin 0.4 mg tablet sl every 5 minutes x 2 prn chest pain omeprazole 20 mg capsule ec by mouth twice a day polyethylene glycol 3350 17 gram po once a day terazosin 1mg qhs finasteride 5 mg tablet by mouth once a day gabapentin 900 mg capsule in the morning, 300mg capsule at night discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 2. isosorbide mononitrate 60 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. furosemide 20 mg tablet sig: one (1) tablet po every other day (every other day). 6. megace es 625 mg/5 ml suspension sig: five (5) ml po once a day. 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual every 5-minutes as needed for chest pain: please do not use more than 3 times total at one time. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 9. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily). 10. terazosin 1 mg capsule sig: one (1) capsule po hs (at bedtime). 11. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 12. gabapentin 300 mg capsule sig: three (3) capsule po qam (once a day (in the morning)). 13. gabapentin 300 mg capsule sig: one (1) capsule po qpm (once a day (in the evening)). 14. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*0* 15. outpatient lab work please obtain lab for cbc and sent the result to dr. , at tele: , fax: discharge disposition: home with service facility: care discharge diagnosis: primary diagnoses: 1. acute gross hematuria 2. ventricular tachycardia ablation . secondary diagnoses: 1. hypertension 2. hyperlipidemia 3. ischemic cardiomyopathy 4. biventricular icd placement discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . you came to our hospital for a procedure for your recurrent abnormal heart rhythm called ventricular tachycardia. you underwent successful ablation in the cath lab. however, you were found to have bleeding in your urine, and was admitted to the coronary care unit (ccu). urology was consulted regarding the management of your bloody urine and an irrigating foley catheter was placed. you were transfused 2 units of packed red blood cells given a drop in your hematocrit. a ct study showed normal kidneys with some concern for a bladder mass or residual clot burden. you will follow-up with urology as an outpatient and a cystoscopy will be performed. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: - please stop taking aspirin 325 mg, instead, please start to take aspirin 81 mg tablet by mouth once daily . * you should continue all of your other home medications as prescribed, unless otherwise directed above. . it has been a pleasure taking care of you here at . we wish you a speedy recovery. followup instructions: name: , : internal medicine location: healthcare - address: one pearl st, , , phone: appointment: friday at 11:15am department: surgical specialties when: monday at 2:10 pm with: , md building: campus: east best parking: garage procedure: catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping diagnoses: congestive heart failure, unspecified unspecified essential hypertension coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status systolic heart failure, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia automatic implantable cardiac defibrillator in situ gross hematuria unspecified hereditary and idiopathic peripheral neuropathy 

Answer: The patient is high likely exposed to