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: penicillins attending: chief complaint: nstemi; asa desensitization prior to cath major surgical or invasive procedure: cardiac catheterization history of present illness: this is a 59 year-old female with a history of non ischemic dilated cardiomyopathy ef 20-25% followed by clinic at who was admitted to nebh 3/309 with progressively worsening sob since , diaphoresis and chest pain. she was found to be in heart failure with elevated bnp and ruled in for nstemi with troponin i 5.97 peak, ck 212, ckmb 5.1 index 2.4. she was diuresed, started on nitro gtt and heparin gtt and underwent cardiac cath with 2vd with 50% proximal and 50% mid lad stenosis as well as 70-80% stenosis distal rca. heparin gtt d/c'd at 0800. due to reaction of anaphylaxis with asa she was transferred here for asa desensitization and pci. she report continued sob and diaphoresis which has been present since and was precipitaed by flu like illness. she denies any current chest pain buit has had intermittent epigastric discomfort typically relieved with maalox. she reports exertional dyspnea, pnd, orthopnea. symptoms have been progressive x months but acutely worsened 1 week prior to transfer one day after lasix dose decreased from 80 to daily ad dig stopped concern for dig toxicity. also has had dietary indiscretion with poor po intake but eating low sodium soup and saltines. . echo at osh: lv markedly dilated, severe global hk, ef 20-25%, dilated, rv mildly enlarged, rv fxn mildly impaired, ra mildly enlarged, moderate mr, mild-mod tr, small left pleural effusion. . on review of systems, report subjective fevers, diaphoresis, decreased po intake, nausea and vomiting. denies diarrhea, sob, cp, palpitations. past medical history: non ischemic cardiomyopathy ef 20-25% diagnosed 14 years ago asthma htn mitral valve regurgitation sleep apnea pulmonary htn hypothyroidism depression/anxiety . cardiac risk factors: -diabetes, dyslipidemia, hypertension . percutaneous coronary intervention, anatomy as follows: left main normal lad gives rise to mod diag, 50% prox and 50% mid lad stenosis left circ 30% ostial stenosis rca dominant. 70-80% stenosis distal rca. run off very good . pacemaker/icd: pt has refused in past social history: patient is single. works part time at library. social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: she has history of premature cad with father having mi in 50s. physical exam: vs - t 98.2, hr 105, bp 109/47, rr 22, 100% on 3l nc gen: wdwn middle aged female 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 jvp of cm. cv: pmi laterally displaced. tachy. reg. holosystolic blowing urmur radiating to apex. normal s1, s2. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. pt occasionally tachypneic with anxiety. crackles in bases anteriorly. abd: soft, nt. mildly distended with hepatomegaly 2-3cm below costal margin. no ruq tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. r femoral dsg cdi. ext slightly mottled skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs wbc-12.2* rbc-4.44 hgb-12.4 hct-37.6 mcv-85 mch-28.0 mchc-33.1 rdw-15.3 plt ct-335 pt-15.4* ptt-29.0 inr(pt)-1.4* glucose-167* urean-18 creat-1.0 na-134 k-4.9 cl-96 hco3-29 angap-14 alt-65* ast-40 ld(ldh)-311* ck(cpk)-120 alkphos-59 amylase-26 totbili-0.4 ck-mb-4 ctropnt-0.10* probnp-7323* albumin-4.0 calcium-8.9 phos-3.5 mg-2.7* cholest-137 %hba1c-7.8* triglyc-174* hdl-26 chol/hd-5.3 ldlcalc-76 miscellaneous labs tsh-2.1 ck-mb-6 ctropnt-0.06* glucose-149* urean-27* creat-0.9 na-132* k-3.9 cl-95* hco3-30 angap-11 pt-17.1* ptt-52.1* inr(pt)-1.5* wbc-10.5 rbc-3.97* hgb-11.4* hct-33.4* mcv-84 mch-28.7 mchc-34.1 rdw-15.5 plt ct-293 ck(cpk)-258* ck-mb-6 probnp-6482* ck-mb-4 ctropnt-0.10* probnp-7323* %hba1c-7.8* triglyc-174* hdl-26 chol/hd-5.3 ldlcalc-76 tsh-2.1 digoxin-0.6* 10:15pm urine rbc-24* wbc-10* bacteri-none yeast-none epi-0 10:15pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-lg 10:15pm urine color-yellow appear-clear sp -1.009 discharge labs wbc-11.8* rbc-4.05* hgb-11.5* hct-33.7* mcv-83 mch-28.4 mchc-34.2 rdw-15.7* plt ct-355 glucose-214* urean-24* creat-1.1 na-132* k-4.7 cl-92* hco3-26 angap-19 reports/imaging ecg : sinus tachycardia. left atrial enlargement. occasional ventricular ectopy. left ventricular hypertrophy. right axis deviation. downsloping st segment depression and t wave inversion in leads v4-v6 which may be left ventricular hypertrophy related. lateral ischemia cannot be excluded. no previous tracing available for comparison. clinical correlation of the right axis deviation and st-t wave changes is suggested. cxr : reason for exam: 59-year-old woman with chf admitted with shortness of breath and chest pain, please evaluate for infiltrate or effusion. since , moderate left and small right pleural effusions are new with bibasilar opacity, likely atelectasis. heart size is difficult to assess. there are no signs of edema. scoliosis is unchanged. . cardiac cath comments: 1. selective coronary angiography revealed two vessel cad. the lm was angiographically normal. the lcx was angiographically normal. the lad had a mid 70-80% hazy lesion and the mid-distal lad had a 70% lesion. the rca had moderate diffuse distal disease but the discrete lesion seen on friday was clearly no longer evident. there was evidence of distal embolization with slow flow in rpl. 2. limited hemodynamics with bp 83/55 with hr 83 in sinus. we gave 500cc ns bolus. right heart cath was deferred. 3. stenting of lad with vision 3x8 and 3x12mm bare metal stents. 4. groin closure with mynx device final diagnosis: 1. two vessel coronary artery disease. 2. severe cardiomyopathy with ef 20% and cardiac index 1.3 on friday 3. nstemi involving rca territory. 4. stenting of lad. echo the left atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. overall left ventricular systolic function is severely depressed (lvef= 20 %) secondary to akinesis of the entire interventricular septum and inferior free wall and severe hypokinesis of the anterior free wall and apex. the posterior wall contracts normally and the lateral wall is only mildly hypokinetic. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. there is no ventricular septal defect. right ventricular chamber size and free wall motion 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. there is no mitral valve prolapse. the mitral valve leaflets do not fully coapt due to posterior and apical tethering of the leaflets. an eccentric, posteriorly directed jet of severe (4+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe, multifocal left ventricular contractile dysfunction with severe chamber enlargement, severe mitral regurgitation, preserved posterior wall contractile function, moderate pulmonary hypertension, and moderate-to-severe tricuspid regurgitation brief hospital course: patient is a 59f with non-ischemic dilated cardiomyopathy admitted with progressive sob and intermittent cp with borderline elevated biomarkers at osh transferred for asa desensitization and pci. . #. asa desensitization: patient completed asa desensitization per protocol with solumedrol, benadryl and singulair prior to desensitization. she was subsequently continued on asa 325 po daily which she tolerated. she did not have any adverse reactions to asa desensitization. . #. cad/chest pain: pt found to have 2vd on cardiac cath at osh. she had echo without focal wma so unclear if 2vd is true etiology of her current symptoms. ekg changes and elevated biomarkers may also be c/w strain. since it was felt that her symptoms may benefit from intervention, she was taken to cath lab on . her rca was not found to be occluded at the time and findings were consistent with recent lysis and embolization of an rca thrombus. the lad, however, was found to have approx 70%-80% stenosis. she had bms x 2 to lad. subsequently, she was continued on asa 325, plavix 75 daily, statin, imdur, beta blocker. . #. pump: pt has longstanding history of non-ischemic dilated cm of unknown etiology with ef 20-25% with severe global hk. symptoms over last several months most c/w decompensated systolic and diastolic heart failure. possible exacerbating factors include medication changes (lasix dose decreased by half), dietary indiscretion and recent viral illness with increased demand. from echo here, it is also possible that her longstanding history of cardiomyopathy may have been ischemic after all, although it is difficult to tell now. she was diuresed for net negative 1-2 liters per day, intially with iv lasix 40 iv bid then with 80 lasix iv bid. we considered titrated heart failure therapy with swan ganz catheter due to severity of elevated wedge and low ci at osh cath but did not feel it was neccessary since she was responding well to lasix iv and was comfortable on room air with sats in mid 90s. per notes, she is not candidate for heart transplant pulm htn and has refused icd in past. per osh records she had elevated dig level prior to admission. dig level 0.6 here. dig was restarted. she was continued on aldactone, beta blocker, ace. we attempted changing metoprolol to carvedilol but pt had increased wheezing with carvedilol so changed back to metoprolol. diuretic regimen changed from furosemide to torsemide atr discharge for improved heart failure management and diuresis. . #.leukocytosis: pt had mild leukocytosis with complaints of urinary dysuria and mildly dirty ua. foley catheter was d/c'd. urine culture grew enterococcus but u/a negative and pt without symptoms so antibiotics were not started at discharge. leukocytosis may have been partially related to steroids. . #. rhythm: sinus. continued beta blocker. . #. asthma: pt has h/o increased bronchospasm with asa in past. she tolerated asa well without exacerbation of asthma symptoms. continued outpatient regimen of advair, nebs, predisone 5mg po daily. . #. anxiety/depression: continued celexa, valium, buspar . #. hypothyrodism: continued synthroid. tsh wnl . #. code: full medications on admission: isosorbide 30mg po bid enalapril 20mg po bid spironolactone 25mg daily lasix 80mg toprol xl 12.5mg daily digoxin 0.125 mg daily buspar 30mg albuterol 2 puffs qid prn citracal d 2 tabs po bid prednisone 5mg daily levoxyl 50mcg daily lipitor 10mg daily effexor xr 300mg daily diazepam 5mg prn estradiol topical advair 250/50 prevacid 30mg daily colace 1 capsule temazepam 15mg qhs valium 5mg tid discharge medications: 1. buspirone 30 mg tablet sig: one (1) tablet po twice a day. 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. venlafaxine 150 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po once a day. 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. torsemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 9. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 10. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day as needed for shortness of breath or wheezing. 11. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 12. pantoprazole 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* 13. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. temazepam 15 mg capsule sig: one (1) capsule po hs (at bedtime) as needed. 15. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 16. enalapril maleate 10 mg tablet sig: two (2) tablet po bid (2 times a day). 17. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 18. isosorbide dinitrate 30 mg tablet sig: one (1) tablet po once a day. 19. glipizide 2.5 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* discharge disposition: home with service discharge diagnosis: acute on chronic systolic heart failure non st elevation myocardial infarction coronary artery disease severe mitral regurgitation hyperglycemia discharge condition: stable discharge instructions: you were admitted with a heart attack and had a catheterization at and was then transferred here for a stent and aspirin desensitization. you had another catheterization and 2 bare metal stents were placed in your left anterior descending artery. you will need to take plavix and aspirin every day for at least one month. do not miss or stop taking plavix unless dr. tells you to. we also changed some of your medicines for the heart failure. your weight at discharge is 137 pounds. medication changes: 1. stop taking furosemide, take torsemide 60 mg twice daily instead. 2. start taking digoxin again at 0.125 mg daily 3. start glipizide 2.5 mg daily 4. you were started on plavix to take every day for one month, do not miss or stop taking plavix unless dr. tells you to. 5. your atorvastatin was increased to 80 mg daily. you will need to get liver function tests checked in 6 weeks. 6. your nexium was changed to protonix. please speak to dr. about whether he wants you to continue with this medicine. weigh yourself every morning, md if weight > 3 lbs in one day or 6 pounds in 3 days. adhere to 2 gm sodium diet fluid restriction:1.5 liters or about 6 cups. . please call dr. if you develop increasing nausea, heartburn, trouble breathing, chest pain, diaphoresis or any other concerning symptoms. followup instructions: mammogram: provider: phone: date/time: 3:15 cardiology: dr. phone: clinical center, , . date/time: monday at 2:30 primary care: , r. phone: date/time: please call dr. after you get home and make an appt to see him after you see dr. . procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters left heart cardiac catheterization immunization for allergy transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other primary cardiomyopathies obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use unspecified acquired hypothyroidism asthma, unspecified type, unspecified other chronic pulmonary heart diseases dysthymic disorder family history of ischemic heart disease acute on chronic systolic heart failure diseases of tricuspid valve leukocytosis, unspecified personal history of allergy to analgesic agent secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to