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: morphine sulfate / pronestyl / quinidine-quinine analogues / mexiletine / captopril / sulfa (sulfonamide antibiotics) / latex / nitrofurantoin attending: chief complaint: progressive dyspnea major surgical or invasive procedure: right heart cath picc placement history of present illness: mrs. is a 56 year old woman with a history of severe dilated cardiomyopathy with an ef of % (?viral vs post-partum) s/p icd placement who was admitted on for severe shortness of breath and pnd, presumably due to worsening congestive heart failure. given the lack of edema or hypoxia, the patient was continued on her home regimen fo torsemide 30mg po qam and 10mg po qpm. notable findings during her stay included a bnp >4000 (baseline of 1000), trigger for severe dyspnea/orthopnea, and an echo that showed profoundly worsened ef now down to 5% from 10-15%, with severe dilation of the lv. at the behest of her cardiologist, dr. , she underwent a right heart cath with plans for a trial of milrinone therapy. rhc revealed markedly elevated left and right heart filling pressures that significantly improved with milrinone infusion. if this milrinone trial fails, she would likely be transferred to for a heart transplant evaluation. . on arrival to the ccu, the patient subjectively felt much better after milrinone infusion. she had by that point made nearly 700cc of urine. . review of systems 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. she 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, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: - diabetes, - dyslipidemia, - hypertension 2. cardiac history: - idiopathic vs post partum cardiomyopathy atleast since , ef of % - 64 year old female with post-partum dilated cardiomyopathy s/p abdominal icd implantation for nsvt and inducible vt in ep study in . she had an abdominal icd generator change on . in she had abdominal icd explantation and lead capping due to discomfort. she had first transvenous icd implant on in the l pectoral region and had a device change . implantation of a secura vr single chamber icd in . 3. other past medical history: - incidental finding noted on chest ct scan of a 6 mm nodule, mild restriction on pfts - status post cholecystectomy, status post appendectomy, two c-sections - remote asthma and multiple allergies - anxiety - ovarian cysts - lyme disease seeing specialists in . social history: is married, lives with her husband and has two daughters. she smoked cigarettes in her 20s and has not smoked tobacco since. occasional wine. family history: father died suddenly at age 74. she reports he may have had a heart attack and had diabetes near the end of his life. mother is alive and fairly healthy. physical exam: admission physical exam: vs: t 97.8 hr 90 bp 95/63 rr 25 o2 95%ra general: chronically ill appearing woman in nad, aox3 and appropriate but mildly drowsy heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with no jvd cardiac: large palpable precordial heave rrr, normal s1, s2. no m/r/g. 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: warm extremities with good cap refill. no c/c/e skin: no stasis dermatitis, ulcers, scars, or xanthomas. physical exam on discharge: vs: t97.4, hr:95, bp99/50, rr18, o2sat:97%ra general: less drowsiness extremities: picc in place exam otherwise unchanged from admission pertinent results: admission labs: wbc-8.9 rbc-4.82 hgb-14.3 hct-42.6 mcv-88 mch-29.7 mchc-33.6 rdw-13.1 plt ct-275 neuts-74.3* lymphs-21.1 monos-3.1 eos-0.7 baso-0.7 glucose-120* urean-27* creat-0.9 na-140 k-3.4 cl-98 hco3-31 angap-14 probnp-4779* ctropnt-<0.01 . studies: . cxr (): pa and lateral views of the chest are compared to previous exam from . again seen is cardiomegaly which is essentially stable from prior. the lungs remain clear. there is a small left pleural effusion. pacemaker wires are in stable position. there are surgical clips in the upper abdomen, potentially from prior cholecystectomy. impression: small left pleural effusion. stable cardiomegaly. . right heart cath (): 1. resting hemodynamics revealed severely elevated filling pressures with a mean pcpw of 39mmhg and an rvedp of 25mmhg. there was severe pulmonary hypertension with a pa pressure of 71/41mmhg. cardiac output was diminished at 2.4l/min with an index of 1.3l/min/m2. 2. following milrinone bolus and infusion of 0.5mcg/kg/min, pcwp decreased to mean of 30mmhg. pa pressure fell to 60/42mmhg, and cardiac output increased to 3.4l/min with an index of 1.9l/min/m2. final diagnosis: 1. severe right- and left-sided heart failure with elevated filling pressures at rest. 2. positive response to milrinone infusion with decrease in pa pressure, pcwp, and increase in cardiac output. . echo (): left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. overall left ventricular systolic function is profoundly depressed (lvef= 5 %). the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with severe global free wall hypokinesis. the mitral valve leaflets are structurally normal. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. at least moderate tricuspid regurgitation is seen. there is no pericardial effusion. compared to the prior study of , the left ventricular ejection fraction is even further reduced, and now severe right ventricular contractile dysfunction is present, with markedly increased tricuspid regurgitation and at least moderate pulmonary hypertension. . lenis (): normal appearance of the deep venous structures of the right and left lower extremities. no evidence of deep venous thrombosis. . radiology report chest (portable ap) study date of 7:30 am findings: as compared to the previous radiograph, the patient has received a right internal jugular vein device, in addition to the left pacemaker. the size of the cardiac silhouette is still substantially enlarged and the presence of a small pleural effusion on the left cannot be excluded. otherwise, there are signs of minimal fluid overload but no overt pulmonary edema with no evidence of pneumonia. unchanged retrocardiac atelectasis. . radiology report chest port. line placement study date of 2:00 pm radiology report -77 by different physician date of 2:00 pm the right picc line tip is at the level of cavoatrial junction. right internal jugular line tip is at the level of superior svc. the rest of the findings are unchanged. . cardiovascular report ecg study date of 10:29:02 am sinus rhythm with ventricular premature depolarizations. compared to the previous tracing heart rate is reduced. otherwise, no significant change. tracing #2 . cardiovascular report ecg study date of 9:53:36 am sinus tachycardia. left atrial abnormality. non-specific qrs widening. left axis deviation. left anterior fascicular block. diffuse non-diagnostic repolarization abnormalities. compared to the previous tracing of heart rate is increased. otherwise, no diagnostic change. tracing #1 . lab results on discharge: 07:38am blood wbc-6.3 rbc-3.98* hgb-11.8* hct-34.9* mcv-88 mch-29.7 mchc-33.9 rdw-13.2 plt ct-213 05:50am blood neuts-72.7* lymphs-21.5 monos-3.8 eos-1.3 baso-0.5 09:00am blood pt-15.1* ptt-28.4 inr(pt)-1.4* 09:00am blood glucose-115* urean-17 creat-0.6 na-136 k-3.5 cl-102 hco3-28 angap-10 04:47am blood alt-59* ast-29 alkphos-85 totbili-0.4 11:00am blood ck-mb-1 ctropnt-<0.01 07:38am blood calcium-9.5 phos-3.7 mg-2.2 12:30am blood type-art po2-91 pco2-38 ph-7.49* caltco2-30 base xs-5 intubat-not intuba 12:30am blood glucose-105 lactate-1.7 na-137 k-3.5 cl-100 05:19am blood hgb-12.4 calchct-37 o2 sat-64 12:30am blood freeca-1.20 brief hospital course: primary reason for hospitalization: patient is a 56 year old woman with a history of severe dilated cardiomyopathy with an ef of 5% (?viral vs. post-partum) s/p icd placement who was admitted on for severe sob and pnd, secondary to worsening chronic systolic chf. she was started on milrinone drip and had improvement in symptoms and functional capacity in-house. she was discharged home on milrinone drip with follow-up with transplant cardiology at medical center. . acute care: 1. chronic systolic chf: patient presented with severe dypspnea/orthopnea. this was especially bad at night when she would have paroxysms of symptoms. her ef was found to be 5%, bnp elevated to 4000 from baseline of 1000, and left and right sided pressures were markedly elevated (40s and 70s systolic respectively) on right cath performed on admission. patient was subsequently admitted to ccu for initiation of milrinone. she improved significantly on milrinone 0.5/hr infusion: ci rose from 1 to 1.9, co improved and trans-pulmonary gradient decreased, which dramatically improved her pulmonary hypertension. she was transiently hypotensive on milrinone milrinone's vasodilatory effects, which subsequently resolved with maps consistently >55 afterward. given her profoundly reduced lv function, she was also started on coumadin. home torsemide was restarted once pt was normotensive. beta blocker was initiated per patient's cardiologist. picc was placed for home milrinone infusion. she was transferred back to the floor, where pt eval on milrinone showed asymptomatic during adl's and even climbing stairs. she was discharged home on the milrinone drip. patient will ultimately require heart transplant at after optimization of hemodynamics with milrinone. . # arrythmia: patient went into multifocal atach on hd#4 likely discontinuation of her beta blocker after initiation of milrinone. this resolved and she returned to nsr after metoprolol 5mg iv. per patient request and with her cardiologist's permission, she was restarted on low-dose metoprolol without recurrence of mat. . # left wrist superficial thrombophlebitis: patient developed superficial thrombophelbitis of left wrist since peripheral line removal in the icu. there was a superficial 3x3cm area of erythema, warmth, and tenderness to palpation with a palpable cord on the lateral aspect of patient's left wrist. this initally improved with warm packs and elevation alone, but then developed increasing erythema, tenderness, and induration. she was started on a 7-day course of keflex to complete at home but noted some improvement after 2 days on antibitics in the hospital. . chronic care 1. h/o lyme disease, fungal infections: per patient report, she has history of chronic lyme disease for which she is followed by integrative medicine specialist at an osh. she also reports h/o fungal infections (no further details available). per id consult, no further workup needed at this time as these issues are unlikely related to her chronic heart failure. . 2. abnormal lfts: most likely secondary to congestive hepatopathy. iron studies and hepatitis viral studies wnl. they were downtrending to normal range and monitoring was stopped when they approached normal. . 3. depression/anxiety: patient endorsed depression and si without a plan in the ed. she later denied suicidality. she underwent psych eval in ccu where she was found to be mildly delirious and it was recommended that home benzos be limited. they also feel that she would benefit from talk therapy and possibly antidepressant therapy as an outpatient. also followed by social work. her mood and affect improved on hd#2, although she did remain significantly anxious requiring frequent reassurance and low-dose klonopin throughout. . 4. asthma: patient has a remote history of asthma and is on prn ipratropium at home. this was continued during hospitalization with no issues. . transitions in care: 1. medication changes: 1. start milrinone infusion at home. the rate is 0.5mcg/kg/minute. 2. start cephalexin 500mg by mouth every 6 hours for six days 3. start saline nasal spray and fluticasone nasal spray as directed while having nasal congestion. 4. start warfarin 5mg by mouth daily and adjust for inr under direction of the . this medication is important in lowering the risk of stroke. 5. start a daily multivitamin 6. start acyclovir 5% ointment. apply to the affected area on the lips every two hours while awake for three days. 7. start metoprolol succinate 50mg by mouth once daily 8. stop taking metoprolol tartrate 9. stop taking losartan as your blood pressure is not tolerating this medication 10. change torsemide dosing to 40mg by mouth once daily. 11. start fexofenadine 60mg by mouth twice daily. 12. stop nattokinase 13. start potassium chloride 20meq by mouth daily 2. follow-up: you will be contact by np that works with dr. at medical center for an initial appointment in evaluation for heart transplant. if you do not hear from them within a week, they can be reached at: please keep the following other appointments: department: cardiac services when: monday at 10:00 am with: dr. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 12:00 pm with: icd call transmissions building: none none campus: at home service best parking: none department: cardiac services when: monday at 11:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage please make an appointment to see your pcp 2 weeks of discharge. 3. outstanding clinical issues: -maintenance of coumadin therapy -evaluation for heart transplant -follow-up tte's -titration of milrinone with cardiologist medications on admission: active medication list as of : medications - prescription clonazepam - (prescribed by other provider; dose adjustment - no new rx) - 1 mg tablet - 1/2-1 tablet(s) by mouth three times a day as needed ipratropium bromide - 17 mcg/actuation hfa aerosol inhaler - 1-2 puffs inhaled twice a day for wheezing losartan - 25 mg tablet - one tablet(s) by mouth twice a day metoprolol tartrate - 25 mg tablet - 1 tablet(s) by mouth two times a day nattokinase - (prescribed by other provider) - - one capsule twice a day nystatin - 100,000 unit/gram powder - apply to inflammed area twice a day terconazole - 0.4 % cream - insert in vagina once a day torsemide - 20 mg tablet - 1.5 tablet(s) by mouth every morning, 0.5 tablets by mouth every evening medications - otc aspirin - (prescribed by other provider; otc) (not taking as prescribed: forgets) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day (not taking because she forgets) cholecalciferol (vitamin d3) - (prescribed by other provider) - 2,000 unit capsule - 1 capsule(s) by mouth coenzyme q10 - (prescribed by other provider; otc; dose adjustment - no new rx) - 300 mg capsule - 1 capsule(s) by mouth twice a day discharge medications: 1. milrinone in d5w 40 mg/200 ml piggyback sig: 0.5 mcg/kg/min intravenous continuous: ok to substitute 400mcg/ml strength formulation. weight:74.8kg. disp:*30 day supply* refills:*5* 2. clonazepam 1 mg tablet sig: 0.5-1 tablet po three times a day as needed for anxiety: do not drive or operate machinery while taking this medication. 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation (2 times a day) as needed for wheezing. 5. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 6. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 6 days. disp:*28 capsule(s)* refills:*0* 7. nystatin 100,000 unit/g powder sig: one (1) application topical twice a day. 8. terconazole 0.4 % cream sig: one (1) appl vaginal daily (daily) as needed for vaginal itching for 7 days. 9. torsemide 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 10. vitamin d-3 2,000 unit capsule sig: one (1) capsule po once a day. 11. coenzyme q10 300 mg capsule sig: one (1) capsule po twice a day. 12. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day) as needed for nasal congestion. disp:*1 bottle* refills:*2* 13. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dryness. disp:*1 bottle* refills:*5* 14. acyclovir 5 % ointment sig: one (1) appl topical asdir (as directed) for 3 days: apply to affected area on lip every two hours while awake for four days. disp:*1 unit* refills:*0* 15. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 16. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 17. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. disp:*30 tablet, er particles/crystals(s)* refills:*2* 18. outpatient lab work chem-10, pt/inr on discharge disposition: home with service facility: critical care systems discharge diagnosis: primary: chronic systolic heart failure secondary: chronic pulmonary hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , it was a pleasure taking part in your care. you were admitted for shortness of breath. you underwent cardiac catheterization which showed worsening heart failure. we started some new medications and adjusted others and your symptoms improved. you also developed skin infection in your forearm for which we started antibiotics. you are now discharged home to await evaluation for heart transplant. . please make the following changes to your medications: . 1. start milrinone infusion at home. the rate is 0.5mcg/kg/minute. 2. start cephalexin 500mg by mouth every 6 hours for six days 3. start saline nasal spray and fluticasone nasal spray as directed while having nasal congestion. 4. start warfarin 5mg by mouth daily and adjust for inr under direction of the . this medication is important in lowering the risk of stroke. 5. start a daily multivitamin 6. start acyclovir 5% ointment. apply to the affected area on the lips every two hours while awake for three days. 7. start metoprolol succinate 50mg by mouth once daily 8. stop taking metoprolol tartrate 9. stop taking losartan as your blood pressure is not tolerating this medication 10. change torsemide dosing to 40mg by mouth once daily. 11. start fexofenadine 60mg by mouth twice daily. 12. stop nattokinase 13. start potassium chloride 20meq by mouth daily . please take all other medications as prescribed . please keep all follow-up appointments. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: you will be contact by np that works with dr. at medical center for an initial appointment in evaluation for heart transplant. if you do not hear from them within a week, they can be reached at: please keep the following other appointments: department: cardiac services when: monday at 10:00 am with: dr. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 12:00 pm with: icd call transmissions building: none none campus: at home service best parking: none department: cardiac services when: monday at 11:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage please make an appointment to see your pcp 2 weeks of discharge. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters central venous catheter placement with guidance diagnoses: other primary cardiomyopathies other iatrogenic hypotension congestive heart failure, unspecified asthma, unspecified type, unspecified other chronic pulmonary heart diseases depressive disorder, not elsewhere classified anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified cardiac dysrhythmias cellulitis and abscess of upper arm and forearm automatic implantable cardiac defibrillator in situ other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of superficial veins of upper extremities acute on chronic systolic heart failure drug-induced delirium candidiasis of vulva and vagina parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to