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: history of present illness: the patient is a 65-year-old male with a past medical history of cad, nqwmi, status post two vessel cabg plus avr () and dc cardioversion, , who presented to the er with a two-day history of dyspnea and pnd. the patient has a history of atrial fibrillation and underwent dc cardioversion on . the patient was hypotensive following the cardioversion and required per report up to 7 liters of saline, accompanied by a weight change of approximately 9 pounds (from 186 pounds to 195 pounds). the patient states that he was feeling well prior to the dc cardioversion and that subsequently had dyspnea on exertion as well as shortness of breath at rest. the patient stated that he had approximately 3-4 episodes of pnd over the 2 nights prior to admission. he also had 1 brief episode of substernal chest pain that lasted 2-3 minutes the day prior to admission at 2:00 p.m. that began when he went from a sitting to a standing position and resolved spontaneously. he describes the chest discomfort as central, substernal, sharp, non-radiating, non-pleuritic and this is not associated with diaphoresis, palpitations, nausea or vomiting. he does deny lower extremity edema and denies having any significant history of angina since his cabg in . on further review of systems, the patient admits to having upper respiratory tract infection symptoms over the past 3-4 days including cough productive of clear white sputum. there were no fever, chills, diarrhea, headache, rash or arthralgia. the patient, of note, has a significant etoh history and drinks up to 8 beers per day. his last drink was at 6:00 p.m. on the day prior to admission. in the emergency department the patient received 40 mg of lasix, supplemental oxygen, 325 mg of aspirin and was started on nitroglycerin drip. his ecg showed sinus bradycardia with pr prolongation, as well as left ventricular hypertrophy and atrioventricular conduction delay and diffused st and t-wave changes, (there was no significant change in comparison with the prior ecg of ). the patient's chest film was consistent with mild chf. an echocardiogram revealed mild symmetric lvh with an ef of 50 to 55 percent and mechanical aortic valve prosthesis with 1 plus ar and 1 plus mr. past medical history: status post coronary artery bypass graft in at the hospital. he had an svg to the lad and svg to the om. this procedure was done in complement to an aortic valve replacement. per report, the patient received a st. number 23 mechanical valve for treatment of the aortic value stenosis. per report, the patient had non-q wave mi in . paroxysmal atrial fibrillation, status post dc cardioversion on as well as on . right parietal cva in with no residual symptoms. hyperlipidemia. diabetes mellitus, insulin dependent type 2 diabetic with retinopathy. he is followed by the clinic. the patient reports that he checks sugars 6-7 times per day and gives himself regular though no longer, i think, insulin. he had an a1c at 8.3 on most recent check. status post herniorrhaphy meckel diverticulum. gerd. significant ethanol use. no history of dts or seizures. allergies: the patient has no known drug allergies. medications on admission: 1. hydrochlorothiazide 25 mg (increased from 12.5 mg). 2. atenolol 25 mg q.a.m. 3. lisinopril 20 mg q.a.m. 4. coumadin 5 mg every tuesday, thursday, saturday; 6 mg every sunday, monday, wednesday, friday. 5. lipitor 80 mg q.d. 6. aspirin 81 mg q.d. 7. zantac 150 mg p.r.n. social history: the patient is married and lives with his wife. is a former smoker with an approximate 20-pack year history. the patient quit several years ago. he also drinks up to 8-9 beers per day though he states that he has cut down to 2 beers per day. denies any illicit drug use. the patient is a gambler and former boxer. he won a lottery several years ago. family history: noncontributory. physical examination on admission: temperature is 97.5 degrees, heart rate is 50, blood pressure initially 171/71 and decreased to 129/69 with nitroglycerin, respiratory rate 16, oxygen saturation 95 percent on room air. the patient is found sitting in bed awake in no acute distress. heent: nc/at. sclerae are anicteric. pupils are equally round and reactive to light. extraocular muscles are intact. mucous membranes are moist. oropharynx is clear. neck is supple, there are no bruits. jvd is 10-11 cm at 45 degrees. 2 plus pulses bilaterally. heart: regular rate. no bradycardiac rhythm with a 1/6 systolic ejection murmur at the right upper sternal border. the patient has bilateral diminished breath sounds at the bases, as well as bilateral rales at the bases bilaterally. there are no wheezes. abdomen is obese and soft, nontender, nondistended. normoactive bowel sounds. liver is palpable. the liver is approximately 10 cm to 11 cm at the mid clavicular line. rectal examination reveals guaiac-negative brown stool. extremities are warm and dry, there is trace pitting edema at the ankles bilaterally. neurological examination: the patient is awake, alert and oriented x3. speech is normal. cranial nerves ii to xii are intact. strength 5 plus in the upper and lower extremities. normal cerebellar examination. laboratory data on admission: white count is 12.3, hematocrit is 42, platelets are 291. sodium 136, potassium 3.8, chloride 92, bicarbonate 28. bun 18 creatinine 1.2, glucose 210. tsh 3.1, troponin t 0.19 with a ck of 295 and mb of 6. ua is nitrite negative. ecg shows sinus bradycardia, 45 beats per minute, normal axis. pr interval of 272 milliseconds, elevations in v1 and v2, q-wave inversions in v3, avf, and v6. chest film demonstrates mild chf. hospital course: cad. serial cardiac enzymes were obtained given the patient's history of chest pressure prior to admission. the patient's initial troponin t was 0.19 and increased subsequently to 0.21. however, his ck was 295 and subsequently decreased to 188. his ck-mb was initially 6, decreased to 4. as the patient is status post recent cardioversion and also has mild cri, i felt that his troponin elevation may well be due to both renal insufficiency as well as recent cardioversion. the patient underwent exercise tolerance test in which he carried out a modified treadmill test with a 70 percent target heart rate achieved (heart rate reached at 109 with a blood pressure of 180/110). there were no anginal symptoms or ekg changes with the baseline abnormalities at maximum workload. nuclear imaging revealed a mild reversible defect of the inferior wall. resting perfusion images did show resolution of this defect. ejection fraction was approximately 50 percent. there was lack of septal translation consistent with his prior cabg. the patient was restarted on atenolol though at a lower dose of 12.5 mg q.d. he was maintained on atorvastatin 80 mg q.d. as well as on the aspirin. his lisinopril dose was increased to 40 mg q.d. atrioventricular conduction delay. the patient was noted to have an elevated qt and qtc. his magnesium and potassium were repleted aggressively. his qtc on the day of discharge was 409 with a qt of 520. his hydrochlorothiazide was switched to aldactazide. he will take one-half tab q.d. for a total of 12.5 mg of hydrochlorothiazide and 12.5 mg of aldactone. he will also begin taking magnesium oxide 400 mg q.d. supplementation. the patient was asked and recommended on several occasions to undergo holter monitoring subsequent to discharge. however, the patient states that he is not willing to have a holter monitor over the next several weeks and will consider undergoing holter monitoring at his next visit with his cardiologist. chf. as mentioned in the hpi, the patient received significant fluid resuscitation following his recent cardioversion. the patient was aggressively diuresed back to his baseline weight. the patient reported resolution of his symptoms of shortness of breath, pnd and dyspnea on exertion. the patient's weight remained stable for several days prior to discharge. atrial fibrillation. the patient remained in sinus rhythm during the hospitalization. his is monitored on telemetry, and he is noted to stay in sinus rhythm. he was maintained on anticoagulation with coumadin both for his atrial fibrillation and for his mechanical aortic valve with target inr of 2.5 to 3.5. the patient was begun on disopyramide, on the day prior to discharge, he was loaded with 300 mg and ekg on the day of discharge did not reveal any significant change in qtc interval. the patient did not appear to have any adverse reactions to disopyramide and did have any urinary retention. the patient was explained at length in detail every possible side effect of the disopyramide including urinary retention and will contact his physician if he experiences any of the side effects. bradycardia. the patient was noted to be bradycardiac on admission and on several occasions throughout his admission. he improved off atenolol and his atenolol was restarted at the lower dose of 12.5 mg q.d. which he will continue taking after this hospitalization. diabetes mellitus. the patient was maintained on a sliding scale of regular insulin similar to his dosing. consult was obtained. the patient was intermittently maintained on nph insulin as well though he prefers to only take regular insulin and on several occasions refused with nph dosing. the patient was noted to have labile blood sugars over this hospitalization though did not allow changes in general from his sliding scale. ethanol abuse. the patient was placed on a ciwa scale given a significant drinking history. however, his ciwas remained zero and required no ativan. elevated lfts. the patient was noted to have significantly elevated liver tests on admission. his alt was 217, his ast was 192, alkaline phosphatase was 156 and his bilirubin total was noted to be 0.8. subsequent lfts revealed improvement in these values. lfts diminished to 73 with an ast of 28 and alkaline phosphatase of 112. it is likely that these abnormalities were related to his alcohol intake (though the alt greater than ast is somewhat atypical). it is recommended that the patient have followup lfts on an outpatient basis. the patient is discharged in stable condition. discharge diagnoses: coronary artery disease, status post coronary artery bypass graft. aortic stenosis status post mechanical aortic valve replacement. diabetes mellitus paroxysmal atrial fibrillation status post cardioversion. congestive heart failure. hyperlipidemia. atrioventricular conduction delay. the patient will follow up with dr. a. f. on at 11:30 a.m. he will also follow up with his primary care physician, . , in two weeks if discharged and will also be the followed by the clinic. medications on discharge: 1. ranitidine 150 mg b.i.d. 2. lisinopril 40 q.d. 3. atenolol 12.5 q.d. 4. disopyramide 150 mg p.o. b.i.d. 5. aldactazide 12.5/12.5 mg q.d. 6. magnesium oxide 400 q.d. 7. aspirin 81 q.d. 8. humulin insulin as directed per his sliding scale. 9. lipitor 80 mg q.d. 10. coumadin 5 mg tuesday, thursday, saturday; 6 mg on the other days. , procedure: diagnostic ultrasound of heart other cardiovascular stress test diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status heart valve replaced by other means diastolic heart failure, unspecified alcohol abuse, continuous conduction disorder, unspecified 

Answer: The patient is high likely exposed to