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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: atrial flutter ablation & d/c cardioversion () intubation for respiratory distress () left & right heart cardiac catheterization ( & ) placement of icd () history of present illness: 76 y/o man with h/o cad, s/p mi (, ), chf ef 20%, dm, a. fib/flutter admitted to hospital on for sob. of note, the pt had been admitted to hospital on with the same complaints. at that time, he pt was found to be in respiratory distress and was intubated and diuresed (and extubated 1 day following intubation). his respiratory decompsensation on was thought to be due chf after missing 2 days of lasix. on , the pt's wife called 911 after the pt became acutely sob at home. ems intubated the pt en route to hospital. again, the pt was diuresed with rapid improvement, leading to extubation within days. there was question of pna, for which he was tx'd with abx. myoview stress testing during the admission was reportedly negative for ischemia. echo on showed ef = 10%. pt found to be in afr creatinine w/ crt peaking at 2 upon admission but came back to baseline (thought to be ~1.7). additionally, during this admission to , the pt was in afib. (the pt does not know when his afib started, and has never undergone electrocardioversion. he was started on coumadin in early .) on , the pt was transferred to to undergo ep evaluation and possible intervention. . upon review of systems, the pt reported that he can walk the length of the hallway before getting short of breath. he denies lightheadedness, orthnopnea, pnd, leg edema, or ascites. he had self-limited palpitations yesterday. no current sob, and is comfortable and ambulatory on room air. past medical history: 1. a-fib - inr 3.0 2. chf ef 20% - echo: ef 20-25% with global hypokinesis, trace tr, mild pulmonary hypertension. - echo: severe global hypokinesis and ef of 10% c/w ischemic cardiomyopathy, mild la enlargement, rv systolic function mildly reduced, moderate mr, ivc dilated. 3. mi in 4. lbbb 5. copd 6. diabetes 7. hyperlipidemia 8. cri with baseline cr of 1.7 on 9. anemia social history: sh: retired, formerly worked as a carpenter. has been married for 33 years with his second wife, has 7 children with his first wife. , 63 pack years. rare alcohol use, no illicit drug abuse history. family history: fh: no h/o cad, no htn. grandmother and brother with diabetes. brother with laryngeal cancer, mom died of stomach cancer at 73, father died of aneurysm at 73. physical exam: vitals t: 97.0of hr: 88 bp: 110/50 rr: 16 o2sat: 96% ra ht: 5??????9?????? wt: 154lbs glucose 465 gen pleasant, nad derm skin normal coloration and texture for age, nails without clubbing or cyanosis. no rash. hair of normal texture for age heent anicteric. conjunctiva pink. perrla, eoms normal, vfs full. oropharynx clear. mucous membranes moist. trachea midline. neck supple. no cervical lad, no enlarged or tender thyroid. pulm ctab. no crackles or wheezes cv jvp 8 cm above the sternal angle at 45&#; elevation. irregularly irregular pulse, pulsus alternans. normal s1, s2. no c/m/r/g. pedal and radial pulses symmetrical and strong,. abd non-distended. no scars/herniae. +bs. no aortic/renal artery bruits. hollow to percussion. s/nt/nd. liver, spleen not palpable. ext no c/c/e. neuro mse: alert, ox3. rest of mmse not performed cn: ii-xii intact to direct testing. sensory: light touch intact in ues and . motor: good bulk and tone, rom full and smooth. strength 5/5 throughout. coordination: gait normal. pertinent results: 09:57pm glucose-358* urea n-46* creat-2.6* sodium-135 potassium-4.8 chloride-92* total co2-31 anion gap-17 09:57pm calcium-9.2 phosphate-4.3 magnesium-2.2 iron-68 09:57pm caltibc-397 ferritin-135 trf-305 09:57pm wbc-10.2 rbc-3.27* hgb-10.2* hct-28.8* mcv-88 mch-31.1 mchc-35.3* rdw-14.0 09:57pm plt count-358 09:57pm pt-15.5* ptt-27.8 inr(pt)-1.4* 09:57pm ret aut-4.0* 11:37pm blood type-art po2-74* pco2-39 ph-7.48* caltco2-30 base xs-5 11:57am blood glucose-151* 11:57am blood hgb-8.7* calchct-26 o2 sat-62 05:08am blood freeca-1.04* 10:02pm blood ck(cpk)-1035* 06:02am blood ck-mb-38* 06:02am blood calcium-8.2* phos-3.1 mg-1.7 06:02am blood glucose-182* urean-15 creat-1.9* na-137 k-3.6 cl-97 hco3-30 angap-14 06:02am blood wbc-11.1* rbc-2.88* hgb-8.9* hct-25.1* mcv-87 mch-30.8 mchc-35.3* rdw-14.7 plt ct-398 . tte : 1. the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. the left atrial appendage emptying velocity is depressed (~0.2m/s). no atrial septal defect is seen by 2d or color doppler. 2.the left ventricular cavity is dilated. overall left ventricular systolic function is severely depressed 15-20%. 3.there are complex (>4mm) atheroma in the descending thoracic aorta. 4.the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. 5.the mitral valve leaflets are structurally normal. moderate (2+) mitral regurgitation is seen. 6.there is no pericardial effusion. . cardiac cath : comments: 1. selective coronary angiography of this left dominant system revealed a one vessel coronary disease. the lmca was without flow limiting stenosis. the lad was a large vessel that gave rise to three diaginal branches. proximal lad had a diffuse 40% stenosis with a superimposed 90% focal stenosis before a take off of a major diagonal branch (d3). the lcx was a dominant vessel with a 30% proximal stenosis and a 30% stenosis of om3. the rca was a small non-dominant vessel with a mild diffuse disease throughout. 2. left ventriculograhy was deferred given renal insufficiency. 3. resting hemodynamics revealed a moderately high left sided filling pressures with a pcwp of 18. the ci was 2.47. 3. the proximal lad lesion was predilated with a 2.5 x 15 maverick balloon and stented with a 3.0 x 28 balloon. the final angiogram showed timi iii flow with no residual stenosis, no dissection, no embolisation and no perforation (see ptca comments) final diagnosis: 1. one vessel coronary artery disease. 2. moderately elevated left sided filling pressures. 3. successful ptca/stent of the proximal lad with excellent result. brief hospital course: i would like to mention at the onset that the patient has refused further care during this hospitalization and wants to go home. fllowing is his brief hospital course: upon arrival to , the pt underwent tee followed by electric cardioversion and aflutter albation. post procedure, the pt was transferred to the floor and was noted to be agitated by wife. became hypertensive with sbp in 180s, tachypnic & hypoxemic. he was intubated, given iv lasix and nitro gtt and transfered to the ccu. after receiving lasix, the pt diuresed well and showed rapid improvement. no other cause of resp distress was found, other than acute pulmonary edema. thus, he was extubated the following day. 24hrs s/p extubation the pt became anxious & sob again, progressing to respiratory distress. he was found, as before, to be in acute pulmonary edema. intubation was averted after giving morphine, nitro gtt, lasix, ativan and starting bipap. on , pt underwent right & left heart cath with ptci of lad with drug eluting stent placement. on , the pt underwent icd placement. despite medical therapy & the above interventions, the patient continued to have repeated episodes of acute pulmonary edema, each episode treated with morphine, lasix, ativan, +/- nebulizers and bipap, avoiding intubation in each instance. these episodes of acute (or "flash") pulmonary edema were triggered in some cases by a small to moderate volume load (for cardiac catheterization, for instance); however, other episodes were triggered by seemingly inocuous causes such as transfering onto a bed pan. the pt expressed the desire to not be intubated again, though he wants to have bipap therapy should he develop respiratory distress again. after discussing his prognosis and options for therapy with both him & his wife, he decided to be dnr/dni on . he also expressed the desire to minimize interventions and the amount of time hospitalized. his goal is to go home, knowing that he could die there in his condition. his wish is to spend as much time with his wife as possible at home, though he does not want to undergo extensive hospital care and therapy to accomplish this. after making these decisions, the pt again went into acute respiratory distress on the am of . he was treated with the same regimen as described above. his cardiac enzymes were elevated (w/ a troponin of 1.29). the pt agreed to undergo diagnostic catheterization to determine if his lad stent had occluded and also to determine his hemodynamic numbers. if the stent was found to be occluded or a new lesion was found, he agreed to treatment through ptci--with the aim of optimizing his condition before going home. at catheterization, the in-stent thrombosis was re-stented additional hospital course issues: ## cv: # cad - from the outset, it was thought that the pt very likely had extensive baseline ischemia--given his h/o cad, diabetes, smoking, and thick ventricle (diastolic failure). based on this, he was taken for a diagnostic cath on , where he was found to only have lad disease, which was stented with drug eluting stent. based on these results, it was concluded that he most likely has idiopathic ischemic cardiomyopathy. he was treated medically with asa, plavix, bb, & statin. on , pt's sbp dropped & his anti-hypertensives were held. it is thought that a new ischemic event may have contributed to this. # - pt's initial tee revealed global hypokinesis (ef ~20%). right heart cath on showed pcwp 18 and cardiac index of 2.47. post-lad stenting echo revealed no improvement in lv function (estimated ef ~15%). # rhythm - pt was in flutter upon arrival at . he underwent a.flutter ablation and cardioversion into nsr. his rhythm degenerated into afib after the procedure. pt treated with heparin and later coumadin for afib. pt underwent icd placement and cardioversion on (prior to deciding to be dnr/dni). given his disorganized atrial arrhythmias at times and his left atrial flutter and the apparent benefit of him being in sinus rhythm, he was started on amiodarone therapy (recommended by ep for month at 200mg and thereafter 200mg qd). . ## respiratory failure - intubated on after developing respiratory distress, which was thought to be due to acute pulm edema as above. pt extubated following day (). . #agitation/anxiety: likely contributed to episodes of shortness of breath. pt started on ativan 0.5mg , which was changed to longer acting clonazepam (started on ). . ## copd - though not previously documented, pt's appears to have copd--cxr reveals significant hyperinflation of lungs. he refuses to stop smoking. pt given spiriva inhalers & albuterol. . ## anemia- reportedly has h/o anemia, though cause unknown. pt's hct dropped during admission & he was transfused 1uprbcs during admission. hct stabilized thereafter. no obvious source of bleeding. . ## dm - pt's outpt glipizide & nph held. he was treated with riss and nph (when not npo). . ## cri - baseline creatinine estimated to be approximately 1.7. had arf thought to be pre-renal in nature with crt peaking at 2.3. arf now resolved with crt at 1.6. . ## hyperlipidemia - atorvastatin continued. . ## code - dnr/dni ## communication - wife , who is legally blind medications on admission: 1. digoxin 0.125mg qday 2. esomeprazole magnesium 40mg 3. salmeterol/fluticasone 250 1 puff 4. tiotropium bromide 18mcg qday 5. atorvastatin 20mg qday with supper 6. mylanta 30ml q6h prn 7. aspirin 325 mg qday 8. furosemide 80mg qam and 40mg qhs 9. glipizide 10mg 10. metoprolol 100mg 11. enoxaparin qday 12. acetaminophen 325-650mg q4-6h prn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. digoxin 125 mcg tablet sig: 0.125mg tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. morphine concentrate 20 mg/ml solution sig: 5-20 mg po q1hr prn as needed for shortness of breath or wheezing. disp:*60 cc* refills:*0* 5. ativan 1 mg tablet sig: 1-2 tablets po q2hr as needed. disp:*10 tablet(s)* refills:*0* 6. scopolamine base 1.5 mg patch 72hr sig: one (1) patch transdermal every seventy-two (72) hours. disp:*10 patches* refills:*0* 7. levsin/sl 0.125 mg tablet, sublingual sig: one (1) tab sublingual four times a day as needed for secretions. disp:*30 * refills:*0* 8. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. disp:*1 mdi* refills:*0* 9. combivent 103-18 mcg/actuation aerosol sig: two (2) puffs inhalation twice a day. disp:*1 mdi* refills:*0* 10. morphine 10 mg/5 ml solution sig: 5-20 mg po q1hr as needed for shortness of breath or wheezing. disp:*120 ml* refills:*0* 11. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 13. glipizide 5 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 14. clonazepam 0.5 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: severe diastolic & systolic chf with acute pulmonary edema, cad, ischemic cardiomyopathy, afib & copd discharge condition: stable but patient has refused any further care discharge instructions: continue taking aspirin and clopidogrel daily as instructed. do not stop these medications unless given permission by your cardiologist. please take all medications as prescribed if you have chest pain, shortness of breath, dizziness, palpitations, pain in abdomen, vomitting, diarrhea please call your primary care provider followup instructions: please call your pcp dr () to make a follow up appointment procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor injection or infusion of platelet inhibitor diagnostic ultrasound of heart insertion of endotracheal tube catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach non-invasive mechanical ventilation implant of pulsation balloon implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] transfusion of packed cells arteriography of renal arteries nonoperative removal of heart assist system insertion of drug-eluting coronary artery stent(s) infusion of vasopressor agent cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified acute myocardial infarction of other anterior wall, initial episode of care chronic airway obstruction, not elsewhere classified atrial fibrillation atrial flutter chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia cardiogenic shock old myocardial infarction other complications due to other cardiac device, implant, and graft acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to