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: iodine; iodine containing attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 69 m with pmh significant for copd who initially presented to on with chest pain and shortness of breath. he is originally from , ny and came to the area for a fishing trip with his wife two days ago. according to his wife, his respiratory problems go back over the last 1-2 years. he was diagnosed with copd and told to use intermittent advair and oxygen at night. he was stable until the previous few days when he was having sore throat, cough productive of white sputum, and increased dyspnea. he went to his family doctor and was prescribed a z-pack, which he completed without much imporovement in his respiratory symptoms. he admitted occasional subjective fevers, but no chills, had more trouble breathing at night, and felt better sitting on edge of the bed, but did not wish to use more than 1 pillow at night. he has also noted some increasing ankle edema over the last few days. normally, he is physically active and able to maintain his farm with horses, dogs, cats, chickens, and rabbits without difficulty. . while on the fishing boat, he had worsening dyspnea and chest pressure, and was sent by ems to . his chest pressure improved with nitro, morphine, and aspirin. ekg appeared to have no ischemic changes. they gave 20 iv lasix and started heparin drip in the ed before transfer. he arrived at satting in the 80's on room air, and improved to 93% on 2l nc. given his somnolence, an abg was done which showed 7.25/94/45/47. cxr was felt to be consistent with failure, though official read was "clear", and he was given 20 iv lasix, resulting in 1500ml out. ekg was done which showed no acute changes. bnp was 209. he was admitted to the micu for concern of respiratory failure and potential requirement of mechanical ventilation. . in the micu, he was maintained on bipap with good results, and was able to be weaned down to 2l nc by the time of transfer to the floor. he was treated with solumedrol 125mg iv q8h, advair, spiriva, and albuterol nebs for presumed copd exacerbation. he had a non-contrast chest ct, which demonstrated diffuse patchy bilateral ground opacities and interlobular septal thickening, and moderate bilateral layering pleural effusions with atelectasis. no consolidations were seen. this am, he was satting well on 2l and feeling "100% better." his am abg was 7.38/65/78, with bicarb 42. he was called out to the floor for further management. past medical history: hypertension copd - on home o2 at night for "oxygen deficiency" since 1 year ago left hip replacement - horse accident social history: smoked 1 ppd x 40 years, quit 10 years ago. he lives in with his wife on a small farm with horses, dogs, cats, chickens, and rabbits. denies drinking or illicit drug use. family history: no fh of cad or dm physical exam: vitals: 98.4f bp: 138/59 p: 96 rr: 22 sao2: 96% 2l nc gen: pleasant caucasian male, lying comfortably in bed, ruddy complexion, nad, speaking in full sentences. heent: perrl, mmm resp: crackles bilateral bases, diminished breath sounds bilterally cv: rrr nl s1s2 +2/m sem at apex abd: soft, obese, nt/nd +bs no organomegaly ext: 2+ pitting edema bilaterally neuro: a&ox3, no focal deficits. pertinent results: cxr: hazy left lower area with slight cephalization of vessels. left cp angle clear, right not visualized. (though officially read as no pna or chf) . chest ct (same day as cxr): findings: there are diffuse patchy ground-glass opacifications within both lung fields. interlobular septal thickening is present. there is no focal consolidation. there are moderate-sized bilateral layering pleural effusions with associated atelectasis. the bronchi and trachea are patent. no significant bullae are seen. numerous small lymph nodes are seen scattered throughout the mediastinum, the largest being a 9-mm subcarinal lymph node. coronary calcifications are present. the heart, pericardium, and great vessels are otherwise unremarkable on this non-contrast-enhanced examination. imaged upper abdomen is unremarkable. degenerative changes are seen throughout the thoracic spine. impression: 1. patchy ground-glass opacifications, interlobular septal thickening and bilateral pleural effusions, all indicative of pulmonary edema. no focal bullae or consolidation. there are coronary calcifications. . tte: measurements: left atrium - long axis dimension: 4.0 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.5 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.9 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 1.1 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.1 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.4 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 2.6 cm left ventricle - fractional shortening: 0.41 (nl >= 0.29) left ventricle - ejection fraction: >= 60% (nl >=55%) aorta - valve level: 3.2 cm (nl <= 3.6 cm) aorta - ascending: 3.4 cm (nl <= 3.4 cm) aortic valve - peak velocity: *2.2 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 18 mm hg mitral valve - e wave: 1.3 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 1.30 mitral valve - e wave deceleration time: 205 msec tr gradient (+ ra = pasp): *42 mm hg (nl <= 25 mm hg) interpretation: findings: left atrium: elongated la. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness, cavity size, and systolic function (lvef>55%). normal regional lv systolic function. tvi e/e' >15, suggesting pcwp>18mmhg. false lv tendon (normal variant). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. normal ascending aorta diameter. aortic valve: ?# aortic valve leaflets. mildly thickened aortic valve leaflets. minimally increased gradient c/w minimal as. no ar. mitral valve: normal mitral valve leaflets. no mvp. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. conclusions: the left atrium is elongated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: preserved global and regional biventricular systolic function. minimal aortic stenosis. moderate pulmonary artery systolic hypertension. mild mitral regurgitation. based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. electronically signed by , md on 16:35. physician: , j. . wbc-12.2* hct-43.7 mcv-92 plt ct-228 neuts-82.3* lymphs-10.8* monos-5.0 eos-1.7 baso-0.2 wbc-10.4 hct-45.3 mcv-89 plt ct-235 . pt-13.3* ptt-34.0 inr(pt)-1.2* . glucose-99 urean-14 creat-0.6 na-145 k-4.4 cl-100 hco3-41* calcium-8.4 phos-3.7 mg-2.1 glucose-73 urean-18 creat-0.6 na-144 k-4.1 cl-99 hco3-42* . alt-34 ast-25 alkphos-85 totbili-0.4 . ck(cpk)-43 ck-mb-notdone ctropnt-<0.01 probnp-209 . 07:21pm blood type-art temp-36.7 o2 flow-3 po2-66* pco2-95* ph-7.25* calhco3-44* base xs-10 intubat-not intuba comment-nc 07:13pm blood lactate-0.8 brief hospital course: #) hypercapnic respiratory failure - thought to reflect copd exacerbation viral uri, but also confounded by volume overload. abg confirmed that mr. is co2 retainer, with probable baseline pco2 65. did well on floor, consistently satting well on 2l. he did, however, desat to 90% on ra, 85% when ambulating. he was continued on albuterol nebs, spiriva, advair, and predisone taper. his lungs were clear by the time of discharge, with no clinical evidence of ongoing copd flare. he should have repeat pfts done to better characterize his copd. he is being d/c'ed home on advair, spiriva, and a prednisone taper. due to the inability to maintain sao2>90% on ra, mr. should continue to wear o2 at all times for the time being. . #) chf: chest ct consistent with pulmonary edema. tte was done, which demonstrated predominantly diastolic dysfunction, most likely tachycardia in setting of increased sympathetic drive from copd exacerbation, and beta-blockade will be important facet of outpatient regimen. he was placed on metoprolol, which was titrated up without difficulty to 25mg po tid, and was started on lisinopril 5mg po qd. he was succesfully diuresed approximately 2l/day with lasix 20mg iv bid. his bicarb remained high, most likely compensation for his respiratory acidosis, as well as contraction alkalosis. he was given one dose of acetazolamide 250mg iv on the morning of d/c in hopes of mediating elevated bicarb. he was d/c'ed on toprol xl 75mg po qd and lisinopril 5mg po qd, as well as maintenance lasix 20mg po qd. mr. should also have an outpatient stress test, as described below. he was also instructed to make an appointment to see his pcp this week for follow-up of his respiratory and volume status, with further adjustments to be carried out on an outpatient basis. . #) chest pressure - admits stable anginal symptoms, with exertional chest pressure. ruled out x 3 at and . should have an outpatient stress test to r/o reversible defects once respiratory status optimized. he was treated with aspirin, metoprolol, and lisinopril. ldl found to be 84 at osh, so statin not started, although could consider adding statin as outpatient for overall efects on plaque stabilization if cad is ongoing concern. . #) htn: d/c'ed norvasc, as may have been contributing to le edema. as above, d/c'ed home on regimen of toprol xl, lisinopril, and lasix. . #) prophylaxis - maintained on subcutaneous heparin, bowel regimen. medications on admission: advair - has not been using norvasc 5 home o2 - 2l at night discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). disp:*1 disc with device* refills:*2* 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*2* 4. prednisone 20 mg tablet sig: as directed tablet po daily (daily) for 5 days: : 2 tabs : 1 tab : tab : stop. disp:*5 tablet(s)* refills:*0* 5. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. toprol xl 25 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po once a day. disp:*90 tablet sustained release 24hr(s)* refills:*2* 7. lasix 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: copd exacerbation diastolic congestive heart failure discharge condition: good discharge instructions: you have been diagnosed with an exacerbation of your lung disease, as well as volume overload. you are being sent home with several new medications, and it will be important to take these medicines as prescribed. you should see your physician for worsening shortness of breath. you should weigh yourself every day. if your weight increases by more than three pounds, you should call your physician. should eat a diet low in salt. followup instructions: you should follow up with your physician, . , this week. you should wear your oxygen at all times until seeing him. you should have dr. refer you to a pulmonologist, and should have repeat pulmonary function tests done. you also should have dr. schedule you for an exercise stress test within the next 2-4 weeks. procedure: non-invasive mechanical ventilation arterial catheterization diagnoses: congestive heart failure, unspecified unspecified essential hypertension obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to