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: diovan / mavik / norvasc / diclofenac attending: chief complaint: dyspnea and weakness major surgical or invasive procedure: none history of present illness: ms. is an 81 yo f with a history of diastolic congestive heart failure who presents with one day of fatigue, dypnea on exertion, 3-pillow orthopnea, and trace lower extremity edema. she reports that she was taking furosemide and spirinolactone for her chf but this was making her feel weak. she couldn't sleep last night with worsening shortness of breath when lying down. she came in because she couldn't get an appoinment with her pcp fast enough and felt that her shortness of breath was worsening. she becomes short of breath just walking from the bed to the bathroom with her cane. she denies any cough, sore throat, fevers, or chills, and does not complain of chest pain or palpitations. in the ed, initial vs: 97.6 65 137/66 16 96%. she initially desaturated to 84% with ambulation but then maintained 91-93% with ambulation. upon transfer to the floor, vitals 98.3 88 18 170/82 1004lnc. currently, she has no acute complaints. she feels somewhat short of breath at rest adn tired but says that is similar to her usual state. review of systems: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: osa diastolic chf diabetes on insulin hypertension peripheral neuropathy hyperlipidemia osteoarthritis peripheral disease - left sfa stent and angioplasty. hysterectomy () social history: lives alone but often has children and grandchildren visiting. has 11 children, 9 living. denies smoking, etoh, illicit drug use. family history: mother: breast cancer (68) father: mi (95) daughter: dm physical exam: admission physical exam: vs - temp 97.6 f, bp 156/80 , hr 65, r 20, o2-sat 100% ra general - alert, interactive, well-appearing in nad heent - perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, jvd to the middle neck, no carotid bruits heart - pmi non-displaced, rrr, nl s1-s2, no mrg lungs - crackles at the lung bases bilaterally, no wheezing, good air movement, resp unlabored, no accessory muscle use; becomes short of breath when put in a supine position abdomen - nabs, soft/nt, somewhat distended, no masses or hsm extremities - wwp, no c/c, 1+ pitting edema to mid shin level bilaterally, 2+ peripheral pulses skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout. pertinent results: admission labs: 10:42am wbc-4.6 rbc-4.50 hgb-13.7 hct-41.8 mcv-93 mch-30.4 mchc-32.7 rdw-13.3 10:42am neuts-65.2 lymphs-25.8 monos-6.5 eos-1.1 basos-1.4 10:42am pt-12.6* ptt-30.3 inr(pt)-1.2* 10:42am plt count-198 10:42am probnp-1116* 10:42am ctropnt-<0.01 10:42am glucose-51* urea n-16 creat-1.0 sodium-136 potassium-4.9 chloride-91* total co2-39* anion gap-11 04:00pm ctropnt-<0.01 imaging: cxr: impression: persistent massive cardiomegaly without evidence of congestive failure. pertinent labs during hospitalization and prior to discharge: 10:20am blood wbc-5.7 rbc-4.21 hgb-13.4 hct-40.4 mcv-96 mch-31.8 mchc-33.2 rdw-12.6 plt ct-180 04:54am blood wbc-6.1 rbc-4.02* hgb-12.4 hct-37.3 mcv-93 mch-30.8 mchc-33.2 rdw-13.1 plt ct-165 07:33am blood wbc-5.9 rbc-4.31 hgb-13.1 hct-41.0 mcv-95 mch-30.4 mchc-32.0 rdw-13.0 plt ct-217 06:40am blood wbc-5.2 rbc-4.53 hgb-13.6 hct-44.4 mcv-98 mch-30.1 mchc-30.6* rdw-13.1 plt ct-191 05:35am blood wbc-5.6 rbc-4.32 hgb-13.2 hct-43.3 mcv-100* mch-30.6 mchc-30.5* rdw-13.4 plt ct-191 10:08am blood wbc-5.2 rbc-4.44 hgb-13.8 hct-43.9 mcv-99* mch-31.0 mchc-31.3 rdw-12.8 plt ct-219 01:25am blood wbc-6.3 rbc-4.35 hgb-13.3 hct-43.0 mcv-99* mch-30.5 mchc-30.9* rdw-13.1 plt ct-217 06:06am blood wbc-5.7 rbc-4.24 hgb-13.0 hct-41.5 mcv-98 mch-30.6 mchc-31.2 rdw-13.4 plt ct-179 05:15am blood wbc-5.0 rbc-4.34 hgb-13.3 hct-42.4 mcv-98 mch-30.7 mchc-31.4 rdw-13.1 plt ct-197 07:50am blood wbc-5.9 rbc-4.56 hgb-13.8 hct-44.8 mcv-98 mch-30.2 mchc-30.7* rdw-13.4 plt ct-174 10:42am blood neuts-65.2 lymphs-25.8 monos-6.5 eos-1.1 baso-1.4 10:08am blood neuts-63.7 lymphs-25.5 monos-8.4 eos-1.0 baso-1.5 10:20am blood pt-12.5 ptt-31.1 inr(pt)-1.2* 10:20am blood plt ct-180 10:08am blood pt-12.3 ptt-69.5* inr(pt)-1.1 01:25am blood pt-12.5 ptt-150* inr(pt)-1.2* 06:06am blood pt-13.1* ptt-150* inr(pt)-1.2* 05:15am blood pt-12.8* ptt-116.2* inr(pt)-1.2* 05:15am blood pt-12.8* ptt-116.2* inr(pt)-1.2* 05:15am blood plt ct-197 07:50am blood pt-12.6* ptt-33.9 inr(pt)-1.2* 07:50am blood plt ct-174 10:20am blood glucose-301* urean-16 creat-1.0 na-135 k-5.2* cl-87* hco3-42* angap-11 04:54am blood glucose-251* urean-21* creat-0.9 na-137 k-4.2 cl-90* hco3-44* angap-7* 07:33am blood glucose-57* urean-18 creat-0.9 na-140 k-4.0 cl-92* hco3-40* angap-12 06:40am blood glucose-123* urean-18 creat-0.9 na-137 k-4.0 cl-89* hco3-42* angap-10 08:46pm blood urean-23* creat-1.1 na-139 k-4.5 cl-91* 05:35am blood glucose-57* urean-23* creat-1.4* na-137 k-4.9 cl-89* hco3-38* angap-15 10:06am blood glucose-119* urean-23* creat-1.1 na-135 k-4.5 cl-88* hco3-38* angap-14 01:25am blood glucose-240* urean-25* creat-1.3* na-136 k-4.5 cl-89* hco3-41* angap-11 06:06am blood glucose-307* urean-19 creat-1.0 na-138 k-3.9 cl-90* hco3-41* angap-11 05:15am blood glucose-260* urean-18 creat-0.9 na-135 k-3.9 cl-89* hco3-39* angap-11 07:50am blood glucose-196* urean-18 creat-0.9 na-138 k-4.0 cl-90* hco3-47* angap-5* 04:54am blood ck(cpk)-71 11:34am blood ck(cpk)-57 07:53pm blood ck(cpk)-67 08:46pm blood ck(cpk)-91 05:35am blood ck(cpk)-121 10:06am blood ck(cpk)-105 01:25am blood ck(cpk)-61 10:20am blood ctropnt-<0.01 04:54am blood ck-mb-1 ctropnt-<0.01 11:34am blood ck-mb-1 ctropnt-<0.01 07:53pm blood ck-mb-2 ctropnt-<0.01 08:46pm blood ck-mb-5 ctropnt-0.17* 05:35am blood ck-mb-5 ctropnt-0.17* probnp-1175* 10:06am blood ck-mb-5 ctropnt-0.18* 01:25am blood ck-mb-2 ctropnt-0.15* 06:06am blood ctropnt-0.12* 10:20am blood calcium-9.1 phos-4.2 mg-2.0 07:50am blood calcium-9.2 phos-3.0 mg-2.1 05:12pm blood type-art po2-79* pco2-98* ph-7.29* caltco2-49* base xs-15 07:26am blood type-art temp-37.0 po2-57* pco2-68* ph-7.45 caltco2-49* base xs-18 intubat-not intuba 06:58pm blood type-art po2-80* pco2-85* ph-7.36 caltco2-50* base xs-17 08:02pm blood type- po2-76* pco2-86* ph-7.36 caltco2-51* base xs-18 comment-green top 10:32pm blood type-art po2-76* pco2-85* ph-7.37 caltco2-51* base xs-19 08:12am blood type-art po2-88 pco2-94* ph-7.33* caltco2-52* base xs-18 intubat-not intuba 01:38am blood type- temp-36.8 rates-/18 po2-30* pco2-90* ph-7.35 caltco2-52* base xs-18 intubat-not intuba comment-peripheral 06:48pm blood type- po2-29* pco2-79* ph-7.33* caltco2-44* base xs-11 micro: 10:06am mrsa screen nasal swab.(final ): no mrsa isolated. imaging: trans-esophageal echocardiogram (tee): 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 right atrial appendage ejection velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). the diameters of aorta at the sinus, ascending and arch levels are normal. there are simple atheroma in the aortic arch and descending thoracic aorta. there are three, moderately thickened aortic valve leaflets with no aortic regurgitation. the mitral valve leaflets are mildly thickened with mild mitral regurgitation. there is no pericardial effusion. impression: no sec or thrombus in the atria. normal left ventricular systolic function. mild mitral regurgitation. v/q scan impression: matched decreased counts in the left lower lung likely due to cardiomegaly. low likelihood ratio for acute pulmonary embolism. lenis: impression: no evidence of dvt in the right lower extremity. trans-thoracic echocardiogram: the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is dilated with depressed free wall contractility. 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. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: suboptimal image quality due to body habitus. left ventricular systolic function is probably normal, a focal wall motion abnormality cannot be excluded. the right ventricle is not well seen but is probably dilated and hypokinetic. no significant valvular abnormality. unable to assess pulmonary artery systolic pressure. brief hospital course: assessment and plan: ms. is an 81 yo f with h/o diastolic congestive heart failure presents with one day of fatigue, dypnea on exertion, orthopnea, and lower extremity edema. # chronic heart failure exacerbation: the patient has a history of chronic diastolic heart failure, obesity-hypoventilation syndrome and obstructive sleep apnea (on cpap) who presented with progressive dyspnea on exertion despite lasix titration as an outpatient. on admission, she was found to have evidence of volume overload with an elevated jvp, bilateral crackles on lung exam, lower extremity edema, and new atrial flutter. bnp was 1116 on admission. tte showed ef 60%, rv dilatation with hypokinesis, indeterminate pa systolic pressure. she was diuresed with iv lasix with improvement of her dyspnea, lower extremity edema, pulmonary crackles, and elevated jvp. she continues to be slightly volume overloaded and was discharged on an increased dose of lasix 160 mg daily (from prior dose of 120 mg daily) for continued diuresis. she was continued on her home spirinolactone 25mg po qd and started on losartan. # hypercarbic respiratory failure: the patient has a history of obesity-hypoventilation syndrome and obstructive sleep apnea (on cpap at home) who reported progressive somnolence over the past several weeks prior to presentation. she was appropriate, interactive, oriented, although tired and fatigued the evening of admission. the following morning, she was found to be very somnolent and somewhat disoriented, and abg showed: 7.29/98/78. she was transferred to the micu for bipap. she was likely becoming progressively hypercarbic as an outpatient due to progressive retention, as she was dozing off without cpap during the day and was also being diuresed with increasing levels of serum bicarb from contraction alkalosis, which may have further decreased her repiratory drive. the patient is a chronic retainer of co2 with bicarbonate levels around 40 for several years. also contributing was the fact that the patient was placed on supplemental oxygen in the ed, which further led to a decrease in her respiratory drive. in the micu, she received bipap and was transferred back to the floor. she did well until when she developed somnolence after dozing off without bipap during the day and in the setting of continued diuresis. she became increasingly somnolent and abg showed 7.36/85/80, the patient was started on bipap overnight. the following morning (), the patient was still drowsy and somnolent, and another abg showed worsening of her hypercarbia (7.33/94/88 on 2l nc) so she was transferred back to the micu for further management. she was placed on bipap with improvement, and had her settings adjusted to the following with good results: inspiratory pressure 9, expiratory pressure 6, supplemental oxygen 1-4l titrated to goal po2 88-92% she remained stable from a pulmonary standpoint without recurrence of somnolence on these bipap settings overnight, and was discharged with bipap and pulmonary follow-up. # atrial flutter: the patient presented with new atrial flutter in 4:1-3:1 block, likely secondary to her acute diastolic heart failure exacerbation. after multiple days of diuresis on iv lasix, it was thought that her fluid status would improve if she was in sinus rhythm so a flutter ablation was performed. tee did not show signs of any thrombus. the patient underwent an ablation while in the micu and was also cardioverted during the procedure for progressive pulmonary edema during the ablation. she has been in sinus rhythm since ablation and cardioversion. given her high chads score of 4, she was started on dabigatran, which we will continue for at least 4 weeks. the patient had been on plavix as an outpatient for peripheral disease, which was stopped in the setting of starting dabigatran after surgery determined the plavix could be stopped safely. her home atenolol had been switched to metoprolol tartrate 25 mg daily while she was in flutter, and she was discharged on metoprolol succinate (extended release) 75 mg daily. #. chest pain: the patient developed chest pain at rest on the floor of similar nature as episodes she had experienced as an outpatient. she had a stress test within the last year that was negative. troponin levels were slighlty elevated (0.17) but ck and mb (5) were normal. given concern for acs vs pe, she was started on a heparin drip briefly, but this was discontinued after ce's were negative. while in the icu, a v/q scan did not reveal pe and cardiology was consulted for her atrial flutter. elevated troponins were likely due to volume overload and chronic heart failure in the setting of acute renal failure. she was continued on her home statin, asa, and metoprolol. # hypertension: she was initially on atenolol, spirinolactone, and furosemide as an outpatient. her sbp was persistently elevated in-house in 150s-160s and she was started on losartan for additional blood pressure control and potential heart failure benefits. as stated above, her atenolol was switched to metoprolol while she was in atrial flutter. her blood pressures subsequently were improved but still mildly elevated (130's-150's). she underwent continued diuresis on lasix in-house, and was discharged on a higher dose of lasix 160 mg daily for further diuresis as an outpatient. she will need to have electrolytes checked for monitoring of her k+ and mg2+, as well serum bicarb, as a progressively increasing bicarb may lead to compensatory respiratory alkalosis and cause hypercarbia. # acute renal failure: initial cr was elevated (1.4) likely in the setting of poor forward flow and renal hypoperfusion secondary to chf exacerbation. she was diuresed with improvement of her cr. patient had flank pain and hematuria briefly in the micu that cleared subsequently. her renal function has improved back to baseline with a cr of 0.9. # diabetes: her home nph was decreased in-house for am hypoglycemia, and she was covered with an insulin sliding scale throughout her hospitalization. # gerd: continued on ranitidine. # hyperlipidemia: continue home simvastatin. she was transiently on atorvastatin during her episode of chest pain, which was switched back to her home simvastatin prior to discharge. # osteoarthritis: pain control with tylenol prn as needed. medications on admission: atenolol - 50 mg clopidogrel - 75 mg qd fluticasone - 50 mcg qd furosemide - 120 mg qd potassium chloride - 10 meq capsule, extended release - capsules qd while taking lasix ranitidine hcl - 300 mg qd simvastatin 40 mg qd spironolactone - 25 mg qd aspirin 81mg qd insulin discharge medications: 1. furosemide 80 mg tablet sig: two (2) tablet po daily (daily): total of 160 mg daily. disp:*60 tablet(s)* refills:*2* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 4. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. dabigatran etexilate 75 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 6. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. the patient needs to have electrolytes checked between - at the . sig: one (1) once. 8. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 9. humalog 100 unit/ml solution sig: as per sliding scale subcutaneous qachs. 10. nph insulin human recomb 100 unit/ml suspension sig: 60 units subcutaneous qam. 11. nph insulin human recomb 100 unit/ml suspension sig: thirty (30) subcutaneous qpm. 12. ranitidine hcl 300 mg tablet sig: one (1) tablet po once a day. 13. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal once a day. 14. potassium chloride 10 meq capsule, extended release sig: capsule, extended releases po as directed as needed for hypokalemia. 15. metoprolol succinate 50 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day: total of 75mg daily. discharge disposition: extended care facility: - discharge diagnosis: diastolic congestive heart failure exacerbation atrial flutter obstructive sleep apnea obesity hypoventilation syndrome discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital with shortness of breath and weakness. you were found to have an acute heart failure exacerbation with excess fluid in your body, which was removed with iv lasix. your respiratory symptoms improved, and you will be discharged on a higher dose of lasix for continued fluid regulation at home. you were also found to be in an abnormal heart rhythm called atrial flutter. the cardiologists ablated your heart rhythm, and you also underwent an electrical cardioversion. you have been in a normal heart rhythm since. the following medications were changed during your hospitalization: started losartan 25 mg daily started dabigatran 75mg twice daily decreased nph insulin to 60 units qam (continued nph 30 units qpm) inreased lasix to 160mg daily switched atenolol 50 mg twice daily to metoprolol succinate (extended release) 75 mg daily stopped clopidogrel (plavix) 75mg po daily followup instructions: provider: , dpm phone: date/time: 1:40 provider: , : date/time: 9:20 provider: imaging phone: date/time: 10:30 department: when: thursday at 9:20 am with: , np building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: pulmonary function lab when: thursday at 2:10 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: thursday at 2:30 pm with: dr. /dr. building: sc clinical ctr campus: east best parking: garage md, procedure: diagnostic ultrasound of heart other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach non-invasive mechanical ventilation cardiac mapping diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified acute on chronic diastolic heart failure peripheral vascular disease, unspecified atrial flutter constipation, unspecified other and unspecified hyperlipidemia acute and chronic respiratory failure diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin osteoarthrosis, unspecified whether generalized or localized, site unspecified other chest pain unspecified hereditary and idiopathic peripheral neuropathy family history of malignant neoplasm of breast benign essential hypertension obesity hypoventilation syndrome 

Answer: The patient is high likely exposed to