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: no known allergies / adverse drug reactions attending: chief complaint: sob, weight gain major surgical or invasive procedure: transesophageal echocardiogram dc cardioversion history of present illness: 82 yo man w/ hx of chf (ef 40-45% ), nstemi on , afib on coumadin and copd who presents from home with weight gain and worsening sob. per the patient's son, pt was seen in cardiology clinic yesterday and was supposed to have undergone cardioversion, but had a subtheraputic inr. over the past 2 weeks he has been having steady weight gain now 12 lbs above dry weight (dry wt 187 lbs at last d/c last month) in the setting of increased fluid intake. also has been using home o2 all day instead of just qhs for the past 2 days. he has not been having cp. states sob has been constant, he states he gets winded going up a flight of stairs at home. he has a chronic cough that is unchanged. he sleeps on one pillow with a blanket under at night. states he is able to lie flat without increased symptoms. he lives at home with son and wife, his son notes he found a pack of cigs a few weeks ago that was missing 6 cigs (son feels pt was smoking though the pt denies). son also notes the pt has been trying to follow a low sodium / fluid restricted diet, but he has been drinking more fluids recently. saw pcp yesterday and cardiologist earlier this month. have been considering cardioversion for his a fib but his inr has been subtherapeutic. pcp increased his lasix to 80mg po daily yesterday. pt denies f/c/s, abd pain, change in bowel habits. he does not like hospitalizations. . in the ed, initial vitals were 96.6 62 119/74 24 96% ra. labs and imaging significant for inr 1.8, cr 2.0 (baseline 1.5-2.0) patient given an albuterol nebulizer and 80mg iv lasix. vitals on transfer were 96.5, 65, 110/68, 20 100% 2l. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. past medical history: copd coronary artery disease (status post nstemi) ischemic cardiomyopathy congestive heart failure atrial fibrillation severe mitral regurgitation hypertension. hyperlipidemia. tobacco abuse. borderline obesity. social history: he is married. he lives with his wife and son in . he is a retired supervisor of the dishwashing department at . currently trying to quit smoking, but smoking intermittently currently. he previously smoked a half a pack of cigarettes daily for the past 50 years. he does not drink alcohol or use illicit substances, but did drink when he was younger. family history: his father died in his 60s of a myocardial infarction. his mother died at age of alzheimer's. he has two brothers, three sisters, and three sons. one sister has hypertension and one son has hyperlipidemia. there is no family history notable for stroke, diabetes, or early coronary artery disease or sudden cardiac death. physical exam: admission exam vs: t=97.6bp=126/81hr=65rr=20o2 sat= 96% 2l general: wdwn m in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvd to mandible cardiac: irregular rhythm, normal s1 and s2 with a soft holosystolic murmur at the apex, no rubs or gallops. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. b/l rales diffusely with course breath sounds, no egophony. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c. b/l pitting edema 1+ to the knee. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ left: dp 2+ discharge exam vs: t=98.4 bp=125/80 (120s-130s/80s-90s) hr=68 (50s-80s) rr=18 o2 sat= 97%ra los: -6l; wt: 89.5kg --> 88.5kg --> 89.1 --> 87.5 --> 87.3kg general: wdwn man in nad oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvd difficult to assess. cardiac: rrr, normal s1 and s2 with a soft holosystolic murmur at the apex, no rubs or gallops. lungs: no chest wall deformities, scoliosis or kyphosis. breathing unlabored. few crackles at the bases. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c. b/l pitting edema trace-1+ to the knee. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: adm labs: 08:45am blood wbc-7.6 rbc-3.80* hgb-11.0* hct-32.8* mcv-86 mch-28.9 mchc-33.5 rdw-16.0* plt ct-177 08:45am blood neuts-73.8* lymphs-20.0 monos-4.5 eos-1.5 baso-0.3 12:55pm blood pt-19.1* inr(pt)-1.7* 12:55pm blood urean-30* creat-2.1* na-140 k-4.5 cl-97 hco3-34* angap-14 08:45am blood ctropnt-0.02* 03:32pm blood ck-mb-3 ctropnt-0.02* 06:06am blood ck-mb-2 ctropnt-0.02* 03:32pm blood ck(cpk)-99 06:06am blood ck(cpk)-81 03:32pm blood calcium-8.7 phos-5.3*# mg-2.3 08:51am blood lactate-2.0 na-139 k-3.6 reports: cxr: upright ap and lateral chest radiographs demonstrate low lung volumes. hazy indistinctness of the pulmonary vessels may indicate mild edema, particularly in light of given history. no pleural effusion or pneumothorax is noted. the heart size is moderately enlarged and there is tortuosity of the aorta, both exaggerated by the low lung volumes. tee:the left atrium is mildly 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 has an accessory lobe (normal variant). the left atrial appendage emptying velocity is depressed (<0.2m/s). right atrial appendage ejection velocity is good (>20 cm/s). a small color doppler signal of left-to-right flow across the interatrial septum is seen at rest consistent with a small secundum atrial septal defect. overall left ventricular systolic function is mildly depressed. right ventricle with borderline normal free wall function. there are extensive simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. impression: small secundum type asd with left-to-right shunt at rest. no spontaneous echo contrast or thrombus in the la/laa/ra/raa. moderate to severe mitral regurgitation. extensive, simple aortic atheroma. tte: the left atrium is moderately dilated. the right atrium is moderately dilated. there is color doppler evidence of a small interatrial shunt (stretched patent foramen ovale).there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. there is mild to moderate regional left ventricular systolic dysfunction with basal to mid inferior akinesis/hypokinesis, inferoseptal akinesis/hypokinesis and basal to mid inferolateral akinesis. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , biventricular systolic function appears similar. mtiral regurgitation appears similar. tricuspid regurgitation is now more prominent. estimated pulmonary artery systolic pressure is now higher. . cxr: findings: upright pa and lateral views of the chest show improvement in the mild pulmonary edema. there has been a decrease in the left pleural effusion with better definition of the left hemidiaphragm. cardiac silhouette remains enlarged. no pneumothorax. impression: decrease in moderate pulmonary edema after diuresis. . discharge labs: 06:45am blood wbc-10.0 rbc-3.52* hgb-10.4* hct-30.2* mcv-86 mch-29.5 mchc-34.3 rdw-16.6* plt ct-149* 06:45am blood pt-25.8* ptt-36.2* inr(pt)-2.4* 12:55pm blood glucose-101* urean-32* creat-1.7* na-145 k-3.6 cl-102 hco3-37* angap-10 06:45am blood calcium-9.0 phos-4.4 mg-2.3 brief hospital course: course #1: 82 yo man w/ hx of chf (ef 40-45% ), nstemi on , afib on coumadin and copd who presents from home with weight gain and worsening sob c/w acute chf exacerbation. intially was diuresed, and given standing ipratropium nebs. he had per the son started smoking again, and the negative impacts of smoking on all aspects of his health was stressed with the patient. it was decided to pursue tee/dccv, with the premise that atrial kick would improve forward flow and decrease his rather high rate of decompensated heart failure admissions. ccu course: on the day of transfer, patient was cardioverted with tee, as it was felt that patient's poor forward flow might be improved with sinus rhythm. post cardioversion he was noted to be hypotensive and bradycardic with what appeared to be a junctional rhythm. he was started on a dopamine gtt and transferred to the ccu. his carvedilol, amiodarone and diltiazem were held. his pressure and hr improved and he was weaned off of dopamine and transferred back to . course #2: patient came back with sbps in 120s, hr in 60s, on 2l with sats 100%. his oxygen was weaned off during the day (pt uses home o2 2l qhs). diuresis was continued with lasix 80mg iv, and electrolytes. his blood pressures remained in the 110s-120s systolic with hr in 50s-60s for 36-48 hours post dccv. overnight , his pressures began to increase, as did his heart rate. carvedilol was added as the bp and hr tolerated, and valsartan was added as the bp allowed. spironolactone was also added given the degree of heart failure. albuterol was started given the degree of copd with great response - he was instructed not to use more than twice daily given the concern for it contributing the patient flipping back into atrial fibrillation. he was strongly encouraged not to smoke, and to limit his salt and water intake. this was stressed multiple times to him and his family. his lasix was changed to 120mg po daily in the morning, and he was instructed to follow-up closely. transitional issues: now in sinus still with severe mr copd may have worsened - pt may be sneaking smokes on occasion diltizem was stopped. carvedilol was decreased, warfarin was increased, albuterol was started (twice daily max - don't want to flip him back into afib), lasix was increased, spironolactone was started. medications on admission: amiodarone - 200 mg tablet - 1 tablet(s) by mouth daily atorvastatin - 80 mg tablet - one tablet(s) by mouth nightly at hour of sleep budesonide - 0.25 mg/2 ml suspension for nebulization - one vial inhaled via nebulizer machine daily carvedilol - 12.5 mg tablet - one tablet(s) by mouth twice daily diltiazem hcl - 30 mg tablet - one tablet(s) by mouth three times daily furosemide - 40 mg tablet - two tablet(s) by mouth every morning for three days, then decrease to 1 tablet per day. if weight increases by 2 pounds, take an additional tablet (20 mg) that day. ipratropium bromide - 0.2 mg/ml (0.02 %) solution - one vial inhaled by nebulizer machine four times daily as needed for shortness of breath, wheezing irbesartan - 150 mg tablet - one tablet(s) by mouth daily nitroglycerin - 0.3 mg tablet, sublingual - 1 tablet(s) sublingually x1 as needed for chest pain call 911 warfarin - 1 mg tablet - 2 tablet(s) by mouth once daily at 4 pm aspirin - (otc) - 81 mg tablet, delayed release (e.c.) - one tablet(s) by mouth daily discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. budesonide 0.25 mg/2 ml suspension for nebulization sig: one (1) vial inhalation once a day: one vial inhaled via nebulizer machine daily . 4. ipratropium bromide 0.02 % solution sig: one (1) vial inhaled inhalation q6h (every 6 hours). 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes as needed for chest pain: take 1 tablet every 5 minutes until chest pain resolves up to 3 tablet maximum, if chest pain persists, stop taking and call your doctor or go to the er. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. oxygen 1-4 l by n/c as needed for shortness of breath 8. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. furosemide 40 mg tablet sig: three (3) tablet po daily (daily): please take until you see dr. on monday. disp:*21 tablet(s)* refills:*0* 10. irbesartan 150 mg tablet sig: one (1) tablet po once a day. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulization inhalation twice a day as needed for shortness of breath or wheezing for 30 days: please do not use more than 1 nebulization twice a day. disp:*qs vials* refills:*0* 12. outpatient lab work please obtain basic chemistry panel including bun and creatinine before your visit with dr. and fax the results to his office at 13. warfarin 1 mg tablet sig: 2.5 tablets po once a day. 14. carvedilol 12.5 mg tablet sig: 0.5 tablet po twice a day. 15. outpatient lab work please check your inr no later than monday with your care group vna discharge disposition: home with service facility: homecare discharge diagnosis: acute congestive heart failure severe mitral regurgitiation pulmonary artery hypertension atrial fibrillation copd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for heart failure. your weight had increased, as did your oxygen requirement. you were given medications to get rid of extra fluid. you also had a procedure to put your heart into a regular rhythm which was done because your cardiologists thought it would help your heart and lead to less extra fluid. after the procedure, your heart rate was low and your blood pressure was low, so you went to the intensive care unit for close monitoring. your blood pressure and heart rate improved, and you came back to the regular cardiology unit. we slowly added back medications for your high blood pressure and high heart rate for their benefits on their heart. you should make absolutely sure to watch what you eat and drink, and eat no more than 2 grams of sodium per day (salt). you should also not drink any more than 1.5 liters of fluid per day (which is the same as about 4 cans of soda per day). the nutritionist has seen you in the hospital on several occasions, and you should make sure to follow the recommendations. doing so will help prevent future hospitalizations, something you have stated you would like to do many times. you have several follow-up appointments. it is very important to keep this appointments. on monday, you are scheduled to see dr. . he is an expert on your condition (heart failure) and you are likely to benefit very much from seeing him - please make sure to keep this appointment! weigh yourself every morning, call your doctor if your weight goes up more than 3 lbs. we have made the following medication changes: please start taking: -spironolactone 25mg daily -coumadin 2.5mg daily and rechek your inr no later than monday with your care group vna -carvedilol 6.25mg daily (this is a decrease in your previous dose). -furosemide (lasix) 120mg once daily - this is an increase in your previous dose, you should take this dose until you see dr. on monday. -albuterol nebulization no more than two times per day as needed for shortness of breath or wheezing. please stop taking: -diltiazem followup instructions: department: cardiac services when: monday at 10:00 am with: dr. building: sc clinical ctr campus: east best parking: garage department: - adult med when: friday at 3:20 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: adult specialties when: monday at 2:40 pm with: , md building: (, ma) campus: off campus best parking: free parking on site md, procedure: diagnostic ultrasound of heart other electric countershock of heart diagnoses: other iatrogenic hypotension anemia, unspecified coronary atherosclerosis of native coronary artery tobacco use disorder mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other specified cardiac dysrhythmias ostium secundum type atrial septal defect old myocardial infarction long-term (current) use of anticoagulants acute on chronic combined systolic and diastolic heart failure other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to