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: shellfish derived attending: chief complaint: shortness of breath major surgical or invasive procedure: pulmonary vein isolation/ablation intubation history of present illness: 84 y.o male with past medical history of atrial fibrillation, status post failure of amiodarone and direct cardioversion x3 who was admitted to the hospital 2 days ago for a pulmonary vein isolation procedure. he initially converted to sinus rhythm, however reverted to atrial fibrillation subsequently. . the day after his procedure, he developed some worsening shortness of breath and on chest x-ray was found to have some pulmonary edema. he was given lasix without response. this morning, he got up to go to the bathroom and suddenly developed acute onset left sided hemiparesis. a code stroke was called he underwent emergent cta of the head and neck, which showed no demonstrable clot but high grade right ica stenosis with poor flow. given his anticoagulation and recent procedure he was not a candidate for tpa per neurology. he then developed worsening shortness of breath and desaturation on the floor, and was then intubated on the floor prior to transfer to the ccu. past medical history: 1. cardiac risk factors: positive for hypertension 2. cardiac history: persistent atrial fibrillation -cabg: none -percutaneous coronary interventions: stent years ago at hospital, unknown anatomy -pacing/icd: dual lead pacemaker. 3. other past medical history: icd placed initially 15 years ago (unclear reason) dual chamber icd upgraded copd cad s/p stent years hospital chf vs altitude sickness hypertension hyperlipidemia cholecystectomy gun shot wound to leg 30 years ago- s/p arterial repair left leg; bullet still in leg bladder spasm social history: works as an optometrist 5 days per week. lives alone. etoh: 1 glass of wine with dinner tobacco: no family history: not obtained physical exam: physical examination on admission: gen: intubated male in no acute distress. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. cardiac: crescendo decrescendo murmur heard best at rusb consistent with aortic stenosis. normal s1, 22 lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. 2+ radial pulses, 1+ dp and pt pulses. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: intubated, but responds to commands. opens eyes to voice. 5/5 strength on right, 4/5 strength plantar flexion and biceps flexion on left. 3/5 strength left finger flexion. upgoing toe on left. pertinent results: admission labs/discharge labs: 06:30am blood wbc-12.7* rbc-3.53* hgb-11.7* hct-34.0* mcv-96 mch-33.2* mchc-34.5 rdw-14.0 plt ct-429 04:57am blood wbc-11.4* rbc-3.25* hgb-10.9* hct-32.1* mcv-99* mch-33.5* mchc-34.0 rdw-14.3 plt ct-258 06:30am blood glucose-102* urean-24* creat-0.9 na-139 k-3.5 cl-100 hco3-34* angap-9 07:15am blood glucose-124* urean-15 creat-1.1 na-141 k-4.2 cl-104 hco3-29 angap-12 06:25am blood triglyc-79 hdl-37 chol/hd-3.7 ldlcalc-84 ldlmeas-87 07:05am blood tsh-1.3 pertinent imaging results: studies: ct brain : impression: 1. head ct shows chronic infarct in the cerebellum, but no evidence of acute hemorrhage or mass effect seen. 2. ct perfusion demonstrates no definite perfusion defect. 3. ct angiography of the neck demonstrates 60-70% stenosis of the proximal right internal carotid artery but the evaluation is somewhat limited secondary to exuberant calcification adjacent to the area. 4. ct angiography of the head demonstrates mild atherosclerotic disease at the left vertebral artery and proximal basilar artery with some dolichoectasia of the left vertebral artery. cta head and neck impression: 1. head ct shows chronic infarct in the cerebellum, but no evidence of acute hemorrhage or mass effect seen. 2. ct perfusion demonstrates no definite perfusion defect. 3. ct angiography of the neck demonstrates 60-70% stenosis of the proximal right internal carotid artery but the evaluation is somewhat limited secondary to exuberant calcification adjacent to the area. 4. ct angiography of the head demonstrates mild atherosclerotic disease at the left vertebral artery and proximal basilar artery with some dolichoectasia of the left vertebral artery. head ct : impression: 1. interval development of hypodensity in the right centrum semiovale, compatible with acute-subacute lacunar infarct. 2. no intracranial hemorrhage or large vascular territory infarction. 3. stable left cerebellar encephalomalacia. 4. diffuse mucosal thickening involving the paranasal sinuses, mastoid air cells, and ethmoid air cells. secretions in the posterior nasopharynx are compatible with intubation. carotid u/s : impression: right ica stenosis 60-69%. left ica stenosis <40%. discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 17:15 36.8* 06:30 12.7* 3.53* 11.7* 34.0* 96 33.2* 34.5 14.0 429 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 10:25 30.8 renal & glucose glucose urean creat na k cl hco3 angap 06:30 102*1 24* 0.9 139 3.5 100 34* 9 chemistry totprot albumin globuln calcium phos mg uricacd iron cholest 06:30 8.9 1.9* 2.2 brief hospital course: 84 y.o male with past medical history significant for afib s/p pulmonary vein isolation, diastolic congestive heart failure who presents now with acute shortness of breath after suffering from a right sided stroke on the floor. . major and active problems during hospitalization: # stroke: evidence of high grade internal carotid stenosis on ct scan. patient is not a candidate for tpa given that he is on coumadin and he is peri-procedure. furthermore, there was no evidence of a clot. a carotid us demonstrated stenosis: r 60-69%, and l stenosis < 40%, but an endarterectomy is not warrented at this time. permissive htn was allowed to to preserve the penumbra. upon discharge, his neuro exam was non-focal. he was moving all four extremities without any decrease in strength. - please monitor blood pressure: goal sbp 140's. . # congestive heart failure: the patient had acute pulmonary edema currently which is likely the cause of his hypoxia on the floor. he was intubated and diuresed. his blood pressure was markedly elevated, which may have lead to flash pulmonary edema. . # atrial fibrillation: due to his stroke his blood pressure was allowed to rise, and his rate was difficult to control. he required esclating doeses of metoprolol and diltiazem, as well as amiodarone. his current regiment includes metoprolol xl in the am, and extended release diltiazem in the pm. - for any new medications, please check interaction with amiodarone. - please check inr daily until > 2.0. then, please check inr twice weekly. . # hypertension: his blood pressure was permissively high after his cva with sbp in the 180's. as he regained neurological function, he was restrated on his blood pressure medications. he was started on a clonidine patch which helped control his blood pressure. . # acute kidney injury: he had an elevated cr that was thought to be scondeary to decreased forward flow. his renal function improved, and has normalized. . medications on admission: digoxin 250mcg daily doxazosin 2mg felodipine 10mg daily fesoterodine 4mg daily furosemide 20mg daily labetolol 400mg pravastatin 10mg daily quinapril 40mg valsartan 320mg daily warfarin 2.5mg daily, 5mg thursday. medications on transfer: amiodarone 200 tid labetolol 400 digoxin 0.25 daily pravastatin 10 daily doxazosin 2mg valsartan 320 daily furosemide 20 daily quinapril 40mg discharge medications: 1. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) sublingual q5min () as needed for chest pain. 2. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 3. doxazosin 2 mg tablet sig: one (1) tablet po bid (2 times a day). 4. pravastatin 10 mg tablet sig: one (1) tablet po daily (daily). 5. toviaz 4 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qd (). 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). capsule, delayed release(e.c.)(s) 7. cxr cxr - pa and lateral dx: copd, initiation of amiodarone results to dr. and dr. 8. pft's pulmonary function test @ 2:45 pm - dx: copd - initiation of amiodarone results to dr. and dr. 9. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. 10. diltiazem hcl 180 mg capsule, sustained release sig: two (2) capsule, sustained release po qhs (once a day (at bedtime)). 11. metoprolol succinate 100 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po qam (once a day (in the morning)). 12. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qtues (every tuesday). 13. amiodarone 200 mg tablet sig: one (1) tablet po twice a day for 1 weeks. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 16. valsartan 160 mg tablet sig: one (1) tablet po bid (2 times a day). 17. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 18. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain fever. 19. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for dyspepsia. 20. enoxaparin 80 mg/0.8 ml syringe sig: one (1) syringe subcutaneous (2 times a day) for 5 days: please continue until your inr is between . disp:*10 syringe* refills:*0* 21. warfarin 2 mg tablet sig: one (1) tablet po once a day. 22. amiodarone 200 mg tablet sig: one (1) tablet po once a day: start after one week of 200 mg . discharge disposition: extended care facility: rehabilitation and nursing center - discharge diagnosis: atrial fibrillation icd copd cad, s/p stent hypertension hyperlipidemia ? tia chf vs altitude sickness discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital following a pulmonary vein isolation/ablation. your admission was complicated by a stroke, and fluid in the lungs. you were briefly intubated. upon discharge from the hospital you will need to take several new medications. you will need to take amiodarone as prescribed. please send daily ekg transmissions to dr. with the of hearts monitor for 2 weeks. you will need a pulmonary function test and chest xray outpatient on amiodarone therapy. these tests can be done locally with the result shared with dr. . the following medications were changed: coumadin: we gave you 2 mg coumadin for your inr. please have the inr checked daily until it is . then your inr should be checked on a weekly basis. you will require 5 days of lovenox therapy until your inr is . the following medications were added: amiodarone (twice a day) clonidine patch (once a week) diltiazem extended-release (take in the evening) metoprolol succinate xl (take in the morning) nexium lovenox twice daily (until inr for 24 hours) aspirin (daily) nitroglycerin tablets lovenox the following medications were stopped: digoxin 250mcg daily felodipine 10mg daily fesoterodine 4mg daily labetolol 400mg followup instructions: please call dr. office for an appointment one week after discharged from rehab. please call the clinic at for an oupatient visit one week after you are discharged from rehab. department: cardiac services when: monday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage dr. office will call with an appointment in the next 2 weeks. please call your nephrologist for follow up regarding your blood pressure and obtaining better control. name: , p address: , , phone: appt: at 11am name: , location: cardiology address: , , phone: appointment: thursday, , 2pm procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube excision or destruction of other lesion or tissue of heart, endovascular approach arterial catheterization atrial cardioversion cardiac mapping diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of anticoagulants cardiac pacemaker in situ hyperosmolality and/or hypernatremia other and unspecified coagulation defects aphasia hematuria, unspecified hemiplegia, unspecified, affecting unspecified side occlusion and stenosis of carotid artery with cerebral infarction 

Answer: The patient is high likely exposed to