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: service: medicine history of present illness: the patient is a 69-year-old woman with a history of diastolic congestive heart failure, boop, pulmonary artery hypertension, type 2 diabetes, hypothyroidism, and coronary artery disease, who presented to the emergency room with a complaint of increasing shortness admission. in the setting of this, the patient had a recent change in her lasix dose from 160 mg p.o. q.d. to 160 mg p.o. q.a.m. and 80 mg q.p.m. without relief of the shortness of breath. a tsh on was 2.2. the patient called life line on the day of admission for an acute of episode shortness of is on baseline 2 l of oxygen). the patient also during that time noted an episode of substernal chest pain which was in her (usual spot) without radiation and without associated symptoms of nausea, diarrhea or diaphoresis. this lasted about ten minutes and then spontaneously subsided. the patient had one more episode of this chest pain in the emergency room which was relieved with one sublingual nitroglycerin. no electrocardiogram changes were noted. the patient denied any recent fevers, chills, cough, sputum production, nausea, vomiting, or diarrhea. she did have a little bit of right yellow rhinorrhea but no other symptoms. no paroxysmal nocturnal dyspnea. no orthopnea. no change in her baseline lower extremity edema. in the emergency room, the patient was given 80 mg iv lasix to which she diuresed about 2 l over night with improvement in her symptoms and return of her oxygen saturation to her baseline. she was admitted to the medicine service for further management. past medical history: 1. boop, on prednisone and baseline home oxygen. last pfts on showed an fev1 of 1.08 (60% predicted), fvc of 1.64 (50% predicted). 2. congestive heart failure. last echocardiogram in showed an ejection fraction of 70%, mild trivial mitral regurgitation, and 1+ tricuspid regurgitation, and mild symmetric left ventricular hypertrophy. 3. paroxysmal atrial fibrillation, maintained normal sinus rhythm on dofetilide. 4. coronary artery disease status post pci in to the posterior descending artery, and also shown to have diffuse right coronary artery disease. 5. type 2 diabetes. 6. hypercholesterolemia. 7. obesity. 8. obstructive sleep apnea, not using cpap. 9. hypothyroidism. 10. chronic venostasis with chronic leg ulcers. 11. depression allergies: the patient is allergic to penicillin and tegretol. medications: prednisone 20 mg q.o.d., lopressor 75 mg t.i.d., oxycontin 20 mg b.i.d., morphine instant release 15-30 mg p.o. q.3-4 hours, neurontin 1200 mg t.i.d., recently changed to 400 mg t.i.d. after a neurontin level of 23 on , lasix 160 mg q.a.m. and 80 mg q.p.m., insulin nph 40 u with breakfast, 10 u with dinner, lisinopril 10 mg q.d., lipitor 10 mg q.d., celexa 60 mg q.d., protonix 40 mg q.d., tums 1500 mg t.i.d., calcitriol 0.25 mcg q.d., dofetilide 0.5 mg q.d., fosamax 70 mg p.o. q.monday, ativan 0.5 mg p.o. q.h.s., synthroid 200 mcg q.d., aspirin 325 mg q.d., buspar 15 mg t.i.d. social history: the patient lives alone. she works as an accountant. she quit smoking in . she denied alcohol. family history: the patient's father had an myocardial infarction at age 47. mother died secondary to colon cancer. physical examination: vital signs: on admission the patient's temperature was 98.4??????, blood pressure 118/74, heart rate 58, respirations 18, oxygen saturation 97% on 2 l. general: she was in no apparent distress. heent: pupils equal, round and reactive to light. extraocular movements intact. neck: supple. no lymphadenopathy. jugular venous distention of 12 cm. heart: regular, rate and rhythm. normal s1 and s2. there was a 2 out of 6 systolic murmur at the right upper sternal border. lungs: there were bibasilar crackles half way up from base. abdomen: soft, nontender, nondistended. active bowel sounds. extremities: there was bilateral 2+ pitting edema. right leg had two chronic leg ulcers on the dorsum of the leg with granulomatous tissue and one ulcer on the anterior tibia on the left leg. laboratory data: white blood cell count 8.2, hematocrit 27.7, platelet count 225; sodium 141, potassium 3.2, chloride 98, bicarb 36, bun 15, creatinine 0.9, glucose 114; the patient's initial ck was 51, troponin less than 0.3; lfts were normal. a kub showed no evidence of obstruction. chest x-ray showed stable cardiomegaly with an increase in her known right-sided pleural effusion, as well as upper zone redistribution of pulmonary vasculature and worsening congestive heart failure compared to a study from . electrocardiogram showed normal sinus rhythm at 60, with normal axis, no st changes, and no t-wave inversions. hospital course: 1. cardiovascular: the patient was ruled out for myocardial infarction with cks of 51, 35 and 61, and troponins of less than 0.3. she was continued on her aspirin, lipitor and lopressor. the heart failure service was consulted regarding her congestive heart failure, and she has been followed in the advanced heart failure clinic for quite some time. the patient is in heart association class iii-iv heart failure. she should be following a 2 g sodium diet; however, she has been using meals on wheels at home, which does not provide this. the heart failure clinic recommended restarting ace inhibitor, which had been held on admission, as well as to use lasix intravenously rather than p.o. for improved diuresis. the patient's initial weight was 216 lbs. it is felt that the patient's ideal weight should be slightly below the 200 range. the patient's did have good diuresis. her oxygenation had already improved to her baseline of 97% on 2 l following the diuresis in the emergency room. the patient's weight was followed, and she decreased her weight to 199 lbs on the day prior to discharge. she was returned to her oral regimen of lasix two days prior to discharge, and maintained on 1.5 liter po qd fluid restriction. of note, the patient's creatinine rose form 1.0 to 1.3-1.5, which was thoguht to be acceptable given her diuresis. she also developed contraction alkalosis. the patient will follow-up in the heart failure clinic with dr. on . as far as her rhythm is concerned, the patient did not receive her regular dofetilide on the day of admission since her potassium was 3.2. on the night following admission, the patient converted to atrial fibrillation. her blood pressure was stable, and heart rate was in the low 100s. the patient's dofedilide was restarted, and over the next two days, the patient switched between normal sinus rhythm and atrial fibrillation several times. the patient was started on lovenox, and the electrophysiology service was consulted. of note, the patient was completely asymptomatic during these episodes, so it is not known if she is in atrial fibrillation at home ever. the electrophysiology service felt that there was no need for cardioversion, and the patient should be continued on dofetilide, as well as lopressor with potassium repletion as needed. the patient converted to sinus rhythm about three days prior to discharge and maintained in sinus rhythm in the low 60s thereafter. electrocardiogram on and showed a qtc of 500 msec; however, the ep service was called again. the patient's creatinine was stable with a peak of 1.5 and 1.3 on the day of discharge, and it was felt that there was no need for adjustment of the dofetilide dosing at this point, as it was maintaining the patient in sinus rhythm and patient's potassium was maintained at 4-4.5. the patient's blood pressure continued to run in the low 100 range during diuresis, especially during the more aggressive phase. the patient did complain of occasional dizziness. her lopressor was decreased from 75 mg t.i.d. to 50 mg t.i.d., as she had not been getting the 75 mg given the hold parameters. her pressure was better maintained in the 100-110 range on 50 mg t.i.d., and this should be continued as an outpatient. as far as studies go, the patient had an echocardiogram on , to assess for changes in heart function as the cause of the heart failure. her ejection fraction was still good at 60%. she had dilated left and right atrium as previously noted. the left ventricular cavity size was normal; however, the study was of suboptimal technical quality, as it was done while the patient was in atrial fibrillation and may need to be repeated in the future. mild 1+ regurgitation was seen, as well as mild 1+ tricuspid regurgitation. pulmonary: regarding the patient's boop, the patient was seen by dr. regarding the question if boop was a contributing factor to the patient's shortness of breath. it was felt that the patient's boop did not contribute in a major way to the present symptoms. the patient had been on long-term prednisone therapy already. it was recommended that the patient should be switched to a 10 mg q.o.d. dose of prednisone for three weeks following discharge, and then the prednisone should be stopped. the last dose of prednisone will be done . with this, there will be a small chance of the patient relapsing, but the majority of the patients responding to steroid will not relapse after prednisone. the patient will need periodic checks of her pulmonary function and oxygenation as an outpatient every four months for about 12 months after the last steroid dose. overall the patient's respiratory status returned to her baseline oxygenation of 98% on 2 l, and the patient was stable throughout the hospitalization. 3. hematology: the patient's hematocrit was 27.7 on admission. this has been her recent baseline. her stools were guaiac negative, and the hematocrit was checked on a daily basis and fluctuated between 28 and 32; however, it remained stable. iron studies were pending at the time of discharge and will be followed as an outpatient. she had egd and colonoscopy for anemia in and without clinically significant finding. ddx of anemia was thought to include small bowel avm and renal insufficiency. as for anticoagulation, the patient was felt to be a poor candidate for coumadin in the past, as she is a fall risk and had had two significant bleeding events in the past year. she was maintained on aspirin therapy. 4. renal: the patient's creatinine rose to a maximum of 1.8 on , with aggressive diuresis; however, as studies continued, the patient's creatinine remained stable and was 1.3 on the day of discharge. this will have to be followed as an outpatient, and should the creatinine change dramatically, the dofetilide dosing may have to be decreased until this is stable again in the 1.3-1.6 range. of note, the patient's baseline is in the 1.0, and the hope is that with shifting of fluid balance, she will return to baseline. 5. endocrine: the patient's blood sugars were well controlled while in the hospital on her standard nph regimen, as well as sliding scale. this should be continued as an outpatient. 6. psychiatry: the patient was continued on buspar, as well as lorazepam and celexa. it was felt that the patient experienced intermittent periods of depression and tearfulness, as well as occasional vivid nightmares. she likely is experiencing worsening depression, as well as issues with coping of being in the hospital. she should undergo a mental health evaluation beginning at rehabilitation and eventually be referred to the mental health team at at for long-term management of her depression. she is followed there by therapist . 7. leg ulcers: the patient has chronic leg ulcers which are secondary to a combination in venous stasis and arterial insufficiency, and followed by dr. in vascular surgery. her vascular surgeon was consulted regarding the best management of these ulcers. the current recommendations are to use dry dressing p.r.n. on the left leg and to use saline and wet-to-dry dressing t.i.d. on the leg ulcer on the right foot and to use adaptic dry sterile dressing b.i.d. with saline drying prior to the dressing application on the right calf ulcer. as far as the patient's pain from the ulcers, she was maintained on her standard oxycontin and morphine with overall good pain control. this may need to be adjusted once the patient is more mobile again. the patient overall continued to improve while in the hospital and will be discharged to rehabilitation on . she will follow-up with the heart failure clinic on and will also need follow-up with dr. as an outpatient. condition on discharge: stable. discharge status: full code. discharge medications: lasix 160 mg p.o. q.a.m., 80 mg q.p.m., lisinopril 10 mg p.o. q.d., aldactone 25 mg p.o. q.d., lopressor 50 mg p.o. t.i.d., saran lotion 1 application q.i.d. p.r.n., colace 100 mg b.i.d. p.r.n., oxycodone sustained release 20 mg p.o. q.12 hours, instant relief morphine sulfate 15-30 mg p.o. q.4-6 hours, prednisone 10 mg p.o. q.o.d., last dose , lorazepam 0.5 mg p.o. q.h.s., dofetilide 0.5 mg p.o. b.i.d., alendronate 70 mg p.o. q.monday, protonix 40 mg p.o. q.d., buspar 15 mg p.o. t.i.d., senna 2 tab p.o. q.h.s. p.r.n., levothyroxine 200 mcg p.o. q.d., calcium carbonate 1500 mg p.o. t.i.d., calcitriol 0.25 mcg p.o. q.d., citalopram 60 mg p.o. q.d., gabapentin 400 mg p.o. t.i.d., lipitor 10 mg p.o. q.d., aspirin 325 mg p.o. q.d., insulin nph 40 u q.breakfast, 10 u q.dinner, regular insulin sliding scale, potassium chloride 10 mg p.o. q.a.m. to be discontinued if the patient's potassium is greater than 4.5., sublingual nitroglycerin 0.4 mg p.r.n. discharge diagnosis: 1. congestive heart failure. 2. atrial fibrillation 3. diabetes mellitus 4. leg ulcers 5. azotemia 6. anemia , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart arterial catheterization diagnoses: hyperpotassemia subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified acute on chronic diastolic heart failure acute respiratory failure hypotension, unspecified other specified alveolar and parietoalveolar pneumonopathies 

Answer: The patient is high likely exposed to