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: shortness of breath major surgical or invasive procedure: heart cath history of present illness: mr. is a 63 m with no significant past medical history who is being transferred from for severe as with heart failure. the patient initially presented to bidn with worsening shortness of breath. he first noticed increasing weakness about six weeks ago and then over the last two weeks, he also reports worsening shortness of breath. previously had very good exercise tolerance, but over the last two weeks has been getting dyspneic with walking. also reports having a new 2 pillow orthopnea that developed over the last two weeks, as well as intermittent pnd. the patient also reports having new le edema that for the last few weeks has been getting worse. . prior to this, the patient has been very active; he was a marathon runner, was working out up to four hours/day as recently as six months ago. of note, about six weeks ago, the patient reports that he started working again as a painter (mostly in the outdoor setting). . he reports having intermittent night sweats over the last few weeks; reports waking up with puddles of sweat. has had an occassional pm cough; only occassionally productive of whitish sputum-generally a dry cough. denies any bloody sputum. denies any recent fevers. reports decreased appetite for the last six weeks, with 5-6 pound weight loss over last two weeks. the patient also reports increased urinary frequency (but reports that this has been a long standing issue since he was in his teens), hesistancy; denies any blood in urine. no problems with bms, denies any blood in stool. denies any abdominal pain. he also reports having lower back pain that started about 5-6 weeks ago. . of note, ct from osh showed that the patient had a chest infiltrate, as well as concern for malignant lesions in bones. ct also showed enlarged heart, labs notable for: bnp 10,185, alk phosph 1709, hct 26, ldh 795, alt 119/ast 77, psa 573 he was also found to be hypoxic and have anemia. echo showed ef 20-25%, with severe left ventricular systolic dysfunction, mild ar, severe aortic stenosis. . at osh, the patient initially received 3l fluids, then was given lasix after which his pressures dropped into 90s, no beta blockers started, pt was tachycardic at osh. past medical history: none social history: - tobacco history: the patient denies any cigarette use in the past. - etoh: 3-4 beers daily, four days/week for last 30 years - illicit drugs: denies the patient lives with his mother who is a 85 y/o. he used to work as a physical education teacher. now intermittently works as a painter. family history: brother diagnosed with lymphoma at 51 y/o, sister with acromegaly, father with stroke at 87 y/o. denies any history of early mi or cardiovascular disease. physical exam: admission pe: general: nad, pleasant gentleman sitting up in bed, gets a little tachypneic with talking heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink. neck: supple, jvp not appreciated cardiac: pmi located in 5th intercostal space, below nipple slightly displaced to the left, hyperdynamic precordium, tachycardic, 2/6 sem loudest at lusb, no radiation to carotids, normal s1, s2. lungs: labored respirations, good air movement, slight bibasilar crackles, but lung fields generally clear to ausculation b/l abdomen: soft, + epigastric tenderness, +bs, non distended extremities: cool extremities with some mottling, 2+ pitting edema b/l, 3/4 up anterior shins skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ discharge pe: vs: tmax 98.5 t current 97.4, hr 98-101 rr 20-22, bp 85-96/55-63 o2 sat 99% ra. i/o: last 24 hours: 1080/945 weight: 72.9 . general: nad, pleasant gentleman sitting up in bed, no tachypnea noted. heent: conjunctiva were pink. neck: supple, jvd 14cm cardiac: hyperdynamic precordium, 2/6 sem loudest at lusb, no radiation to carotids, normal s1, s2. no carotid bruits. lungs: clear bilat abdomen: soft, nt/nd, nabs, no hsm extremities: cool extremities, no mottling, 3+ pitting edema b/l, 3/4 up anterior shins, none on ue or thighs. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ pertinent results: admission labs: 08:07pm blood wbc-12.9* rbc-3.67* hgb-9.3* hct-28.6* mcv-78* mch-25.3* mchc-32.4 rdw-16.8* plt ct-426 06:24am blood wbc-11.6* rbc-3.20* hgb-8.3* hct-25.6* mcv-80* mch-26.1* mchc-32.6 rdw-16.6* plt ct-418 03:00pm blood wbc-11.5* rbc-3.34* hgb-8.6* hct-26.7* mcv-80* mch-25.8* mchc-32.3 rdw-17.1* plt ct-420 06:24am blood pt-16.9* ptt-33.4 inr(pt)-1.5* 08:07pm blood glucose-170* urean-35* creat-0.9 na-133 k-5.3* cl-100 hco3-17* angap-21* 06:24am blood glucose-126* urean-35* creat-0.8 na-132* k-4.6 cl-100 hco3-19* angap-18 03:00pm blood glucose-151* urean-36* creat-0.8 na-131* k-4.7 cl-99 hco3-20* angap-17 06:24am blood alt-89* ast-125* ld(ldh)-2214* alkphos-2334* totbili-0.5 08:07pm blood calcium-8.1* phos-4.4 mg-2.2 06:24am blood calcium-8.0* phos-4.3 mg-2.1 cholest-105 03:00pm blood calcium-8.2* phos-3.9 mg-2.2 08:07pm blood ferritn-* 06:50am blood %hba1c-6.5* eag-140* 06:24am blood triglyc-73 hdl-20 chol/hd-5.3 ldlcalc-70 08:07pm blood tsh-5.1* 03:00pm blood pep-thickened igg-639* iga-158 igm-98 ife-no monoclo 08:29pm blood lactate-3.7* 03:08pm blood lactate-2.2* 07:23am blood lactate-2.0 . discharge labs: - ecg: sinus tahcycardia to 125, na, ni, ?lvh criteria, no t wave changes or st segment changes concerning for ischemia . - echo osh: ef 20-25%, with severe left ventricular systolic dysfunction, mild ar, severe aortic stenosis. . - ct from osh : ct chest: there are no filling defects in the pulmonary vasculature to suggest pulmonary embolism. there is severe cardiomegaly. coronary artery calcifications are present. there is no pericardial effusion. the aorta is normal in caliber without evidence of a dissection. there are small-to-moderate bilateral pleural effusions with associated bibasal atelectasis. in addition, there are perihilar consolidations in the upper lobes, right middle lobe, lingula, and the superior segments of the lower lobes. there is a mildly enlarged right hilar lymph node measuring 13 mm, and a prominent right infrahilar lymph node measuring 8 mm. no enlarged mediastinal or axillary lymph nodes are seen. . ct abdomen: there is diffuse mesenteric fat stranding with trace fluid, as well as severe gallbladder wall edema. these findings suggest fluid third spacing, such as may be seen in a low protein state or chronic systemic illness. no focal hepatic or pancreatic lesions are seen on this single phase exam. the spleen, adrenal glands, and kidneys are unremarkable. small bowel and colon loops are normal in caliber and grossly unremarkable, allowing for absence of oral contrast. . ct pelvis: the prostate appears to be near the upper limit of normal size. the bladder and rectum are unremarkable. . ct bones: the bones are diffusely mottled with apparent diffuse sclerotic infiltration. there is an 11 mm lytic lesion in the superior endplate of the l4 vertebral body (series 306b, image 36). . impression: 1. no evidence of pulmonary embolism. 2. severe cardiomegaly and coronary artery disease. no pericardial effusion. 3. multifocal perihilar consolidations, most suggestive of pneumonia. small-to-moderate bilateral pleural effusions with associated bibasilar atelectasis. mild right hilar lymphadenopathy, probably reactive. 4. severe gallbladder wall edema and mild fat stranding/trace fluid throughout the mesentery. these findings suggest a low protein state or sequela of chronic system illness. 5. diffusely abnormal, mottled bones with diffuse sclerotic infiltration, suggesting malignancy. given the patient's age and gender, prostate malignancy should be considered. focal lytic lesion in the l4 vertebral body, which be better assessed by a lumbar spine mri. . - ct head: no e/o mets, hemorrhage, edema. echo : the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed (lvef= 25 %) with regional variation (contractile function of the basal inferior and posterior walls appears relatively preserved). no masses or thrombi are seen in the left ventricle. the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated with depressed free wall contractility. there are focal calcifications in the aortic arch. the aortic valve leaflets are severely thickened/deformed. aortic stenosis is present, probably severe, (but could not be precisely quantified due to uncertainty regarding the reliability of the left ventricular outflow tract dimension). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: mr. is a 63 m with no significant past medical history who is being transferred from for severe as with heart failure, and possible new malignancy, with psa of ~500s and evidence of possibly bone malignancy. . # systolic chf with critical as, concern for cardiogenic shock: the patient was found to have ef 20-25% with severe as at osh which is confirmed on echo here with additional findings of smokey appearance of lv cavity (prelim read) concerning for possible developing thrombus. he has had progressively worsening heart failure symptoms over the past few weeks, including shortness of breath, increasing le edema over the last few weeks, and new orthopnea. bnp ~10,000, trops negative x 3. the patient does not appear volume overloaded on exam but is somewhat clamped down at periphery with cold feet. etiology of heart failure still unclear, but possibly related to his severe aortic stenosis. the patient was hiv negative. the patient was diuresed, with strict i/os and daily weights measured. his volume status was monitored clinically, and with diuresis, his respiratory status also improved. the patient's heart failure was medically optimized, and he was started on metoprolol and lisinopril. the patient was also transitioned to po torsemide 20 mg daily. because of the presence of spontanous echo contrast, the patient was initially started on iv heparin drip out of concern for thrombus formation. it was decided that anticoagulation was ultimately not needed and it was discontinued. . # aortic stenosis: the patient was found to have critical calcific aortic stenosis on echo. it is possible that his heart failure is secondary to as. while here, the patient was seen by c- for possible valve replacement. a carotid series was done, and the patient was also seen by dental. c- will follow the patient as an outpatient and arrange for possible surgery date. it is likely that his heart failure was at least, in part, due to his aortic stenosis. . # respiratory status: the initially had oxygen requirment on transfer from osh, and was satting well on 6l nc, with increased work of breathing, tachypnea, and severely decreased exercise tolerance. ct from osh shows evidence of pneumonia and he was started on ceftriaxone/azithro at bidn. pt has been afebrile while here, no clear infiltrate seen on wetread cxr. he was continued on antibiotics for cap. the patient was also aggresively diuresed and was started on a lasix drip, with good urine output seen. it is likely that his respiratory status was due both to be volume overloaded, as well as an overlying pneumonia. . # pna: the patient had shortness of breath, and new oxygen requirement, likely in part due to his heart failure and volume overload. ct from osh shows evidence of pneumonia and he was started on ceftriaxone/azithro at bidn the patient did not have a clear infiltrate on his cxr here. he was started on antibiotics to cover for community acquired pna and completed a ten day course of azithromycin and ceftriaxone. the patient was not febrile while in patient. his respiratory status improved with the antibiotics, and upon discharge the patient was breathing comfortably on room air, with no oxygen requirement. of note, the patien initially had a lactate of 3.7 and anion gap of 16 on admission, that soon trended down. all blood and urine cultures were negative. urine legionella negative. . # ?prostate cancer/malignancy work-up: the patient was found to have psa ~500s, with evidence of bony lesions on osh imaging; cea 2.2, ca19.9 <3, and alk phos of 1500 at osh, also with hilar adenopathy on ct chest. it is likely that he has prostate cancer; oncology was consulted while in patient. they believe that his prognosis is another few years. rather than pursuing a full work up inpatient, the oncologist felt that his cardiac status be optimized first; he will follow up with heme/onc as an outpatient for skeletal survey, as well as possible tissue diagnosis, in addition to possibly initiating anti hormonal treatment. . # microcytic anemia: crit of 28, mcv of 78. retic of 2.9, corrected of 1.3. unclear what the chronicity is. b12 and folate wnl's at osh. low normal serum iron, low tibc, ferritin not checked. hypoproliferative, likely combo of bm infiltration and anemia of chronic disease in the setting of his likely underlying malignancy. . # protein malnutrition/protein status: pt with albumin of 2.5, states he has had poor po intake for weeks and has tried to consume milks and juices. the patient was seen by nutrition and given his possible malignancy status, his nutrition status was optimized with nutrition shake supplementation. . transitional issues: # need a bonescan prior to ct surgery to evaluate for ?lytic mets in sternum . # outpatient cardiovascular surgery appointment for possible aortic valve replacement . # outpatient heme follow up for further work up of prostate cancer . # pt will need to get lyte checks within one week of discharge medications on admission: none. discharge medications: 1. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 2. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. torsemide 20 mg tablet sig: 1.5 tablets po daily (daily). disp:*45 tablet(s)* refills:*2* 4. metoprolol succinate 25 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* 5. outpatient lab work please check cbc, chem-7 and ptt/inr on tuesday at dr office in clinical center. discharge disposition: home with service facility: discharge diagnosis: acute systolic congestive heart failure: ef 20-25% severe aortic stenosis, bicuspid valve community acquired pneumonia likely prostate cancer with metastatic bone disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had trouble breathing and a lot of swelling that was from your damaged aortic valve. you will need an aortic valve replacement and the cardiology surgery team will call you at home to arrange a surgery date. until that time, we have started you on medicines to help decrease the swelling and help your heart work better. it is very important that you take all of these medicines every day to help your heart work better. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. also call if you notice the swelling getting worse. you should avoid salt in your diet and information was given to you about this at discharge. please eat solid high protein foods in small meals and drink the shakes if you can't eat a meal. you were seen by the cancer specialists while you were here and we think that you have prostate cancer that may have spread to your bones. you will need to have more testing to see if this is the case and will need medicines to control the cancer. you will see dr. in the next week to talk about this further. it is more important at this time to fix your heart first though. we have made many doctor appts for you in the coming months and have started the medicaid application for you so that you have insurance. you should never be without insurance again. use the teds stockings every day to help decrease the swelling in your legs. please get your labs checked on tuesday when you see dr. . a prescription is attached for you to take to the lab. . we have started the following medicines: 1. start taking lisinopril to help your heart pump better 2. start taking metoprolol to help your heart pump better 3. start taking a multivitamin to help your nutrition 4. start taking torsemide to get rid of the fluid in your feet followup instructions: name: , location: cardiovascular division, e/rw-453 address: , , phone: **we are working on a follow up appointment with dr. within 2-4 weeks. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above.** department: when: tuesday at 10:10 am with: dr / post clinic building: sc clinical ctr campus: east best parking: garage **this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up.** department: when: thursday at 1:45 pm with: (med) building: sc clinical ctr campus: east best parking: garage **dr is your new physician at . she works closely with dr. , both will be involved in your care.** department: hematology/oncology when: tuesday at 11:00 am with: , md , md building: sc clinical ctr campus: east best parking: garage procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: pneumonia, organism unspecified anemia, unspecified congestive heart failure, unspecified unspecified protein-calorie malnutrition aortic valve disorders malignant neoplasm of prostate acute systolic heart failure secondary malignant neoplasm of bone and bone marrow chronic pulmonary heart disease, unspecified 

Answer: The patient is high likely exposed to