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: premarin attending: chief complaint: reason for transfer: chf/respiratory distress major surgical or invasive procedure: right-to-left femoral-to-femoral bypass with polytetrafluorethylene. (ptfe) history of present illness: 75f y/o with htn, hld, s/p endovasculary repaired aaa , cad s/p emergent cabgx4 for stemi , chf (ef = 20-25%), readmitted w/ lle vasc occlusion, s/p fem- now with worsening sob, episodic hypotension and worsening l pleural effusion. recently admitted in for stemi, went to cabg from cath lab, required 3 pressors + a balloon pump pre-operatively and several days post-op. she had a post-operative ef of 20%. post-operative course was notable for fluid overload and need for diureses which was difficult given marginal cardiac output. extubated on post-op day 10. discharged home on . she was re-admitted for progressive sob since discharge, was found to have a l pleural effusion, underwent successful thoracentesis, repeat echo again showed her ef to be 20-25%. on presented to osh, was readmitted with progressive dyspnea, n&v, rlq pain and lle pain and numbness. as found to have a cold left extremity and loss of distal lle and was admitted to vascular surgery. prior to surgery, patient received 3l volume, interspersed with lasix. on , patient went to or for r to l fem-fem bypass with ptfe. ef was 15% intra-op and patient received albumin and fluid. pod1, she had a thoracentesis that drained -1l cc simple fluid and felt a lot better. in subsequent days, however, patient became progressively more tachypnic, and under the guidance of the ip team, patient was aggressively diured with progressively higher doses of iv lasix. throughout her entire hospital course (cardiac surgery team, vasc surgery team), she appears to be currently net even. on the morning of transfer, patient was in severe respiratory distress with rr 30s, desatting, and hypotensive with sbp 70s (after receiving 20mg iv lasix and carvedilol 3.125), limiting diuresis. she has an ij in place, showing cvp 15-17. on exam, she had no le edema, but does have significant sacral edema. on review of systems, she 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. she 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: 1. cardiac risk factors: + diabetes, + dyslipidemia, + hypertension 2. cardiac history: - cabg: cabg x4(lima->lad, svg->om1,svg-y-graft->diag, svg->pda) -atrial fibrillation 3. other past medical history: h pylori back pain osteopenia pancreatic cyst aaa s/p endovascular repair social history: she exercises three times a week at her adult day center. she is a nonsmoker. she does not drink alcohol or use illicit drugs. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: physical examination on admit: vs: t=98.7 bp=96/67 hr=91 rr=23 o2 sat= 98(3l) general: /portuguese-speaking only. nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. mmm. neck: supple with jvp of 12 cm. cardiac: rrr, distant heart sounds, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. sternotomy wound non-healing distally with serous drainage. lungs: ctab, no crackles, wheezes or rhonchi. abdomen: normoactive bowel sounds, soft, ntnd. extremities: 2+ sacral edema, no peripheral edema, peripheries are warm, well-perfused. left fem- scar healing well. physical exam on discharge: vitals - tm/tc: 98.4/98.5 hr:67-83 bp:83-90/57-61 rr:18 02 sat: 95% ra in/out: last 24h: last 8h:290/600 weight:61.9 (61.9) tele: sr, 80-100, bigeminy general: 75 yo f in no acute distress heent: mucous membs moist, no lymphadenopathy, jvp non elevated chest: ctabl no wheezes, no rales, no rhonchi. sternotomy approximated. cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. ext: bilat groins with dressing, no recent bleeding. neuro: 4/5 strength in u/l extremities. gait wnl. skin: no rash psych: concerned, alert, oriented per interpreter pertinent results: labs on admit: 01:03pm blood wbc-8.7 rbc-3.83* hgb-12.0 hct-38.3 mcv-100*# mch-31.5 mchc-31.5 rdw-17.2* plt ct-190 01:03pm blood neuts-77.5* bands-0 lymphs-17.9* monos-3.3 eos-0.5 baso-0.7 01:55pm blood pt-14.8* ptt-32.2 inr(pt)-1.4* 01:03pm blood glucose-158* urean-24* creat-1.2* na-130* k-5.4* cl-96 hco3-13* angap-26* 05:32pm blood alt-76* ast-128* ld(ldh)-433* alkphos-123* amylase-68 totbili-1.0 05:32pm blood lipase-71* 01:55pm blood ctropnt-0.06* 03:40am blood probnp-* 02:20pm blood ck-mb-3 ctropnt-0.03* 10:32pm blood ck-mb-3 ctropnt-0.04* 01:03pm blood calcium-9.4 phos-5.0*# mg-2.2 02:11pm blood type-central ve po2-44* pco2-39 ph-7.31* caltco2-21 base xs--6 02:11pm blood lactate-6.2* k-6.1* labs on dc: 07:00am blood wbc-6.0 rbc-3.86* hgb-12.2 hct-36.5 mcv-95 mch-31.5 mchc-33.3 rdw-18.0* plt ct-290 07:00am blood pt-13.6* inr(pt)-1.3* 07:00am blood glucose-94 urean-10 creat-0.6 na-138 k-4.5 cl-100 hco3-29 angap-14 07:00am blood calcium-8.6 phos-3.2 mg-2.3 cxr : 1. increased moderate left pleural effusion with overlying atelectasis, underlying consolidation can not be excluded. possibly small right pleural effusion. 2. right lower lobe atelectasis versus infection. clinical correlation is recommended. cta aorta/bifem/iliac : 1. bilateral pleural effusions with a large left nonhemorrhagic pleural effusion and moderate right pleural effusion. 2. mild right renal artery stenosis. 3. subcentimeter hypodensities within the liver and right kidney which remain too small to characterize, statistically representing cysts. 4. replaced left hepatic artery arising from the left gastric artery. 5. thrombosis of the left common iliac artery with reconstitution of the distal common iliac artery at the bifurcation. slow flow within the left extremity vessels. there is two-vessel runoff on the left. the posterior tibial artery is not visualized. pleural fluid : negative for malignant cells. mesothelial cells, macrophages, neutrophils and lymphocytes. cxr : moderate left pleural effusion which reaccumulated following thoracentesis is stable since , as are small-to-moderate right pleural effusion, severe cardiomegaly, and pulmonary vascular engorgement. today, there is no finding of interstitial pulmonary edema. right jugular line ends centrally. no pneumothorax. brief hospital course: hospital course: 75f y/o with htn, hld, s/p endovasculary repaired aaa , cad s/p emergent cabgx4 for stemi , chf (ef = 20-25%), who was readmitted on w/ lle vasc occlusion, s/p fem- transferred to the ccu for worsening dyspnea, likely secondary to pulmonary edema, complicated by hypotension. was diuresed and dc/ed in stable condition. active issues: # acute on chronic systolic chf: patient's last tte showed ef 15-20% and she is frequently noted to be hypervolemic secondary to chf. she appeared euvolemic at dc. she was on low dose furosemide and captopril for afterload reduction. digoxin started this admission as well. holding off on aldactone. low dose bb. # cad: patient is s/p cabgx4 for stemi . sternotomy wound appears to be healing. we dced her on aspirin ec 325 mg po daily, atorvastatin 20 mg po/ng daily, clopidogrel 75 mg po/ng daily, lisinopril 5mg, digoxin 0.125 mg po/ng daily and metoprolol xl #atrial fibrillation/low ef/akinesis of apex: patient was noted on discharge from cardiac surgery service on to have been in afib so she was started on amiodarone 200mg . patient converted back to sinus rhythm by the time of discharge and has not been noted to be back in afib during this current hospitalization. coumadin was started for combination of apical hypokinesis and paf. # respiratory distress: resolved on d/c, breathing 93-98% on ra, can tolerate lying flat. # s/p fem-fem bypass: revascularized and good 1+ dp/pt pulses b/l. left-sided surgical scar was dry and healing. per vascular surgery, no special wound care is necessary. # hld: we continue home atorvastatin 20mg daily transitional issues: the pt was set up for f/up with pcp, for chf and vascular surgery. medications on admission: home medications: 1. aspirin 81 daily 2. docusate sodium 100 mg 3. atorvastatin 20 mg daily 4. amiodarone 200 mg 5. ipratropium-albuterol 18-103 mcg/actuation 2 puffs q4h 6. carvedilol 3.125 mg 7. tramadol 50 mg q4h 8. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic qid 9. furosemide 40 mg po daily 10. potassium chloride 20 meq daily transfer meds: albuterol 0.083% neb soln 1 neb ih q6h:prn bronchospasm artificial tears preserv. free 1-2 drop both eyes prn dry eyes aspirin ec 325 mg po daily acetaminophen 650 mg po/ng tid pain albumin 5% (25g / 500ml) 25 g iv once duration: 1 doses cepacol (menthol) 1 loz po prn sore throat carvedilol 3.125 mg po/ng dextrose 50% 12.5 gm iv prn hypoglycemia protocol docusate sodium 100 mg po bid furosemide 20 mg iv bid furosemide 20 mg iv once duration: 1 doses furosemide 1-10 mg/hr iv drip infusion glucagon 1 mg im q15min:prn hypoglycemia protocol heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin daily and prn. heparin 5000 unit sc tid start: in am ipratropium bromide neb 1 neb ih q6h:prn bronchospasm insulin sc (per insulin flowsheet) sliding scale morphine sulfate 1 mg iv q4h:prn breakthrough pain ondansetron 4 mg iv once duration: 1 doses senna 1 tab po/ng discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation every four (4) hours. 4. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po daily (daily). disp:*15 tablet extended release 24 hr(s)* refills:*2* 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. outpatient lab work please check chem-7 and inr on monday with results to dr. at phone: fax: 9. senna 8.6 mg tablet sig: one (1) tablet po at bedtime as needed for constipation. tablet(s) 10. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 11. warfarin 2 mg tablet sig: 2.5 tablets po once a day. disp:*75 tablet(s)* refills:*2* 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. discharge disposition: home with service facility: discharge diagnosis: -acute on chronic systolic congestive heart failure -left lower extremity ischemia with occluded left limb of a prior aortic endograft - diabetes - hypertension - coronary artery disease - atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the vascular service for left lower extremity vascular occlusion. you underwent a surggical bypass procedure in your leg to help your symptoms. you were transferred to the cardiology service, since you developed shortness of breath and extra fluid around your lungs. . in the icu, you had this fluid removed with diuretics. you developed an abnormal heart rhythm called atrial fibrillation, but this went back to a normal rhythm prior to discharge. you had an echocardiogram of your heart, which showed that the function of the heart is somewhat depressed. due to the above, we discussed using a blood thinner to prevent risk of stroke with your primary care doctor, and you will start a medication called coumadin for this. . medication changes: - stop amiodarone for your atrial fibrillation - stop carvedilol, start metoprolol succinate instead to lower your heart rate - start coumadin (warfarin)to prevent a stroke from the atrial fibrillation - start digoxin to help your heart pump better - start lisinopril to help your heart pump better - start plavix after your operation - change furosemide (lasix) to 20 mg daily instead of 40 mg daily - stop taking potassium - start taking senna as needed to prevent constipation h yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. followup instructions: department: internal medicine when: friday at 10:30 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: cardiac services when: monday at 11:30 am with: dr. building: sc clinical ctr campus: east best parking: garage department: vascular surgery when: thursday at 1:15 pm with: vascular lab building: lm campus: west best parking: garage department: vascular surgery when: thursday at 2:00 pm with: , md building: lm bldg () campus: west best parking: garage md, procedure: venous catheterization, not elsewhere classified thoracentesis other (peripheral) vascular shunt or bypass diagnoses: pneumonia, organism unspecified acidosis pure hypercholesterolemia unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation aortocoronary bypass status hypotension, unspecified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft hypoxemia hypovolemia acute on chronic systolic heart failure disorder of bone and cartilage, unspecified embolism and thrombosis of iliac artery acute myocardial infarction of unspecified site, subsequent episode of care 

Answer: The patient is high likely exposed to