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: aspirin / niacin attending: addendum: transferred to medicine service chief complaint: hyponatremia, sob major surgical or invasive procedure: posterior lumbar decompression l2-l5 with fusion l4-5 history of present illness: pt is a 64 yo female w/ h/o htn, osa, dm who initially presented to hospital for elective fusion-laminectomy of l3-l5. surgey went well however post op was complicated by hypotension, tachycardia, and hypoxia. she had lost apporximately 1300 cc of vblood duriing the procedure and received 2 untis of prbc post op. she was transferred to the tsicu for observation overnight. she stayed one night in the tsicu then was transferred back to the floor. subsequently her na began to drop, she had some mental status changes and continued to have sob. she was then transferred to medicine for management of her hypoxia, sob, and hyponatremia. on transfer patient complained of sob at rest. she had + orthopnea and was unable to lay flat. denied any fevers, chills, n/v, chest pain. past medical history: htn dm obesity arthritis osa- on bipap gerd neuropathy social history: lives alone, pet hamster, no tob/etoh/ivdu family history: no history of early cardiac death, hf. + cad there are family members with hf but developed later in life. physical exam: p115 bp 120/80 rr44 pox 98%/4l o2 nc gen-dyspneic at rest heent- mmm, no jvd neck-no appreciable jvd but neck obese cv- nl s1 s2 rrr no m/r/g pulm- bs at bilat bases way up w/ rales, exp wheezes throughout abd- +bs, soft obese, nt, nd, and tympanitic ext- no edema, warm; mild tenderness in r calf, non-tender l calf pertinent results: na 133->137->120->135 hct 30.9 dropped to 26.2. recieved blood responded to 34 then remained around 30. trop <0.01 times three then increased to 0.03 then 0.02 tsh 3.8 cpk peaked to 2500 after surgery around pod 5 was 253 ct abd/pelvis : 1. no intraperitoneal, retroperitoneal or operative site hematoma detected. 2. small bilateral pleural effusions. airspace opacity in the left lung base may represent pneumonia. ct chest : non-contrast study shows bilateral pleural effusions, cardiomegaly and septal lines consistent with left ventricular heart failure. echo conclusions: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is severe global left ventricular hypokinesis. the basal inferolateral wall contracts best. no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal. there is focal hypokinesis of the apical free wall of the right ventricle. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe biventricular systolic dysfunction c/w diffuse process. brief hospital course: please see surgical d/c summary for input on info prior to transfer. # pt was transferred from the ortho service to the medicine for concerns of sob and hyponatremia. on transfer the patient was extremely tachypneic and requiring 4l of oxygen. prior to her admission she had no sob at baseline or exertion and did not require oxygen. her post op course was complicated by hypotension, hypoxia, tachycardia, tachypnea. during the surgery she lost 1300 cc of blood per the tsicu admit note. she was given two untis of blood and fluids as well post operatively. her bp responded to the blood and however she continued to be tachycardic and hypoxic. she was then transferred back to the floor. she continued to be tachypneic with hypoxia requiring oxygen via nasa canula. her hr remained in the 120' and became hyponatremic so medicaine was consulted. cxr demonstrated bilateral pleural effusions. on transfer we were concerned about pe (pt was no on heparin, recent surgery, obese, and on evista) versus chf. plan was for cta however unfortunately patient lost iv access and therefore was only able to get nonconstrast chest ct. we then got a d-dimer which was elevated as expected, but decided to go ahead and start the patient on heparin iv for possible pe. a central line was placed by the procedure service. the ct chest ended showing moderate sized bilateral pleural effusion and pulm edema. thus we also gave patient some lasix which she responded to well. the following leni's were performed which showed no evidence of dvt. thus our suspicion at this point was chf and we felt comfortbale stopping the heaprin. echo was ordered and demonstrated severe biventricular dysfunction with ef of 20%. the finding of newly diagnosed was concerning given the fact that the patient had a stress mibi from which showed ef of 67%. it was unclear as to how the patient could have developed such severe hf over 1 year. we checked a tsh which was normal. also thought about ischemia in the setting of the surgery. however her troponin only increased to 0.03. her cpk's were elavated initially but this was in the setting of the surgery and mb's were not done. another possibilty was either tachycardic induced cardiomyopathy or idiopathic. it was noted that when reviewing the patient's old ecg's normally she had sinus tachycardia with prolonged pr interval. ecg during hospital showed no st changes but there was noted poor r wave progession. pt was lasix naive when getting her first dose and responded extremely well. after single dose of lasix her respiratory status improved. she was continued on acei which was subsequently titrated up. lasix iv was continued with goal of -1 liter per day. on iv lasix she diuresed several liters. her lung exam improved and required less oxygen. after diuresing her several liters the lasix was switched to po. when she was felt to be compensated bb was added for rate control and chf management. on discharge patient was compensated requiring no oxygen and able to ambulate without dyspnea. she will need follow up echo to evaluate her ef and will also need to be followed up by the heart failure clinic for medical management, with follow-up pmibi to assess for ischemic cause of chf. # pt had no history of cad prior to admission. p-mibi from showed no perfusion defects and normal ef. she had no chest pain during her hospital stay. cpk was elevated after surgery but this was likely secondary to the surgery itself, no mb or troponin was done. on transfer to medicine her enzymes were cycle with peak troponin to 0.03 due to chf. thus there was no indication the patient had an mi. after discharge patient should have a follow up p-mibi to evaluate for coronary artery disease. # pt had initial na of 137. after surgery this trended down to 122. she had some mental status changes which were likely effected by the electrolyte disturbance and narcotics. the hyponatremia was associated with her chf and increased adh in the setting of pain associated with surgery. we restricted her fluid intake to 1l per day and treated the underlying cause of chf. with restriction and resolution of chf her na returned to levels of 135. fluid restriction was liberalized to 1500cc per day by d/c. she will need f/u to assess for need for continued fluid restriction. # pt was started on riss and continued on her home regimen of metformin. on transfer to medicine metformin was stopped secondary for concern of development of side effects ie lactic acidosis. for added control pt was started on glargine qhs. when she had become more stable she was switched back to her home regimen of metformin; metformin was held for 2 days prior to d/c in the setting of ct dye load, but should be restarted on . # anemia- on admission hct was 30.9. after the surgery hct dropped to 26 and she was subsequently transfused two units. her hct increased to 36. this then trended down back to her baseline of 30. she was guaiac negative. fe studies revealed anemia of chronic disease with low fe and elevated ferritin. # back pt underwent successful fusion and laminectomy of l3-l5. her pain after the surgery was controlled by pcapump but this lead to mental status changes. narcotics were then intially avoided. as her other medical problems resolved we restarted percocet for pain control along with lidoderm patch to facilitate ambulation. she was able to tolerate pt and ambulation with good pain control. pt was ambulating with walker without difficulty. medications on admission: cyclobenzaprine 10 mg qday, tolterodine 2 mg qday, raloxifene 60mg qday, imipramine 30 am/100pm pramipexole 0.25 mg qday, lisinopril 10 mg qday, gabapentin 300 mg tid, metformin 850mg tid discharge medications: 1. tolterodine tartrate 2 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. metformin hcl 850 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 3. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*20 tablet(s)* refills:*0* 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q12 (). disp:*30 adhesive patch, medicated(s)* refills:*2* 5. acetaminophen-codeine 300-30 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. disp:*30 tablet(s)* refills:*0* 6. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 8. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. disp:*300 ml(s)* refills:*0* 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. lisinopril 30 mg tablet sig: one (1) tablet po daily (daily). 11. imipramine hcl 10 mg tablet sig: three (3) tablet po qam. 12. imipramine hcl 50 mg tablet sig: two (2) tablet po qpm. 13. neurontin 400 mg capsule sig: one (1) capsule po three times a day. 14. toprol xl 25 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po qam. 15. mirapex 0.25 mg tablet sig: one (1) tablet po once a day. 16. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: sheryle house discharge diagnosis: spinal stenosis chf dm anemia hyponatremia discharge condition: stable, neuro intact, wound healing primarily. able to ambulate without sob or need of oxygen discharge instructions: keep wound clean and dry. shower, no immersion please call to make follow up appointment with dr. (cardiologist) within 2-3wks. you also need to arrange with dr. for echo and stress test. please take all the medications as directed. if you experience any shortness of breath, chest pain, weight gain, lower extremity edema you should seek medical attention. followup instructions: follow-up as planned with dr. follow-up with dr. (cardiologist ) in weeks for stress test. provider: , m.d. where: phone: date/time: 12:00 provider: injections where: medical specialties phone: date/time: 10:30 provider: , rd where: medical specialties phone: date/time: 4:00 md procedure: venous catheterization, not elsewhere classified lumbar and lumbosacral fusion of the anterior column, posterior technique transfusion of packed cells fusion or refusion of 2-3 vertebrae diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia displacement of lumbar intervertebral disc without myelopathy acquired spondylolisthesis 

Answer: The patient is high likely exposed to