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: patient recorded as having no known allergies to drugs attending: chief complaint: chest pain major surgical or invasive procedure: right femoral central line placement history of present illness: pt is an 85 yo m h/o dm 2, esrd on hd x1 year, htn who was recently hospitalized here for mechanical trauma related r knee pain and gout flare who presented to ed from outpatient hd complaining of chest pain which started at the end of his dialysis session today. pain described as sharp, anterior, nonradiating severe chest pain, pleuritic, only present when coughing or taking deep breath, not at rest. hd was discontinued early after 1.5 hrs due to tachycardia, noted to be in rapid af 150-180, bp initially 102/72, given 10mg iv diltiazem, became hypotensive to 80s. he had two attempts at dccv, wtihout success then started on diltiazem drip with hr improving to 90-100s, started on neo and levophed for bp support. levophed has since been titrated off. in addition, pt received vancomycin, ceftriaxone, levofloxacin in ed. head ct, chest cta performed. pt seen on arrival to ccu, denies any dyspnea, admits to persistent pleuritic anterior chest pain. aside from recent increase in knee pain, has been feeling at his baseline. no recent fever, chills, cough, nausea. he has ocassional vomiting for the last several months. no abdominal pain, brbpr, melena, he has ocassional loose stools. he make minimal urine. past medical history: -h/o bilateral knee replacements 6 yrs ago -esrd thought dm and htn ---dialyzed t,th,sat at in -hypertension -dm -hyperlipidemia -severe djd of the cervical spine with resultant gait disturbance -gout -known thyroid cancer (patient has declined resection) -probable renal cell cancer (noted by mri, not biopsied) social history: lives with wife, worked in social work supervising children with drug problems. tobacco, etoh, drugs. had used cane since knee surgery, more recently uses walker. family history: + hx heart problems, htn, stroke. physical exam: vs: t 97.4, bp 124/53, hr 86, rr 16, o2 sat 96% on 4l nc gen: elderly aa male in no acute respiratory distress, moderate discomfort with movement of r leg. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp no visualized as pt lying flat. cv: irregularly irregular, no m/r/g. chest: cta b/l anteriorly without crackles or wheezes. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. r femoral rlc in place. r leg much cooler, which is chronic according to pt, 2+ dp/pt in l leg, tr pt in r and dopplerable dp. r knee in immobilizer brace, no significant tenderness over r knee, significant tenderness over r femur. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: ekg demonstrated af with ventricular rate of 68, nl axis, no lvh, no ischemic changes, st depression noted on previous ekg resolved. . head ct: no acute intracranial process. . cta chest: 1. no evidence of aortic dissection or pulmonary embolism. 2. small bilateral pleural effusions and regions of discoid and subsegmental atelectasis. 3. cardiomegaly and marked left atrial enlargement. 4. mild vasculopathy. 5. right thyroid goiter resulting in mild tracheal compression and leftward tracheal deviation. . echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis or regurgitation. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. at least mild mitral regurgitation. mild pulmonary hypertension. . compared with the prior study (images not available for review) of , the findings are similar. . ugi impression: 1. no esophageal stricture or mucosal abnormality. 2. gastroesophageal reflux. brief hospital course: 85 yo m hx esrd on hd, htn, dm ii who presented with new onset atrial fibrillation, rapid ventricular rate and hemodynamic compromise associated with chest pain. . # atrial fibrillation-exacerbating factor was unclear and pt did not tolerate the rvr well and developed hypotension. there was no clear evidence of fluid overload. pt had continued hypotension after iv diltiazem, dccv attempts were unsuccessful in ed x 2. pt was started on iv diltiazem at 10mg/hr with pressor support for hypotension and admitted to ccu. pt responded well to diltiazem drip, hr improved to 80s and hypotension resolved gradually, able to be weaned off pressors overnight. he converted back to nsr the day following admission. an echocardiogram was obtained to look for structural abnormalities, showing mild , mild symmetric lvh with preserved global biventricular systolic function. thyroid function tests were normal. after discussion with pcp & family, decision was made to hold off on anti-coagulation given recent h/o fall. pt will continue on sc heparin while at rehab & re-address plan for anti-coagulation with pcp after return home. pt was transferred to floor & monitored on telemetry. he was noted to have some intermittent runs of a.fib or atrial arrythmia, but hr was well controlled on amiodarone 400mg & metoprolol 25mg tid. pt should continue amiodarone 400mg until , then decrease dose to 200mg ongoing. . # chest pain - pt was admitted with c/o chest pain & was evaluated with cardiac enzymes which were not elevated from baseline. cta of chest in the ed showed no evidence of pe or dissection. cp resolved after conversion to sr & did not recur during the remainder of the hospitalization. . # vomiting: pt noted a sense to food being stuck in chest & then had intermittent episodes of non-bilious, non-bloody emesis. ugi swallow showed normal peristalsis, reflux and upper esophageal deflection enlarged thyroid mass (known h/o thyroid cancer, decision made with patient & pcp to avoid intervention). pt denied abd pain but was noted to have one guaiac positive stool. it was thought likely that he had developed a gastritis due to high dose nsaids. ibuprofen was stopped and pt was switched to ppi . stool guaiacs should be monitored for resolution as outpt, and pt may need a follow up egd/colonoscopy if this does not clear after stopping nsaids. . # right leg pain-pt was recently hospitalized for mechanical fall related right knee pain and gout flare. pt had continued to have right knee/upper thigh pain at rehab. x-rays obtained were neg for fracture & pelvic/lower extr ct showed djd but no e/o fracture. pain improved on ibuprofen & oxycontin 10mg , and he continued to have good pain control after stopping nsaids. pt will need continued rehab for his rle injury. . # esrd - pt was followed by renal throughout hospitalization & was continued on his outpatient medications including cinacalcet. pt should resume his regular tu/th/sa dialysis schedule at . . # htn - bp meds initially held given hypotension, then metoprolol was restarted after resolution of hypotension. candesartan, lisinopril & nifedipine were stopped on admission and were not restarted. bp was well controlled and these agents can be restarted as needed while outpt. . # hyperlipidemia: pt was continued on atorvastatin 80mg. . # dm: glipizide was stopped while in house & pt was covered with humalog insulin sliding scale with decent bs control. . # ppx: heparin 5000u sc tid & ppi medications on admission: nifedipine 30mg daily lisinopril 40mg daily metoprolol xr 100mg daily candesartan 32 mg daily atorvastatin 80mg daily glipizide 5 mg daily omeprazole 20 mg daily cinacalcet 30mg daily tylenol prn discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twelve (12) hours. 3. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 4. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for reflux. 11. reglan 5 mg tablet sig: one (1) tablet po qid achs. 12. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): continue taking 400mg until , then decrease the dose to 200mg ongoing . 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 14. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 15. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: atrial fibrillation with rvr esrd on hd gastritis htn dmii thyroid cancer severe djd discharge condition: good discharge instructions: you were admitted with chest pain & found to be in atrial fibrillation with a rapid ventricular rate. you have been treated with medications to help slow the heart rate. you have been started on a new medication called amiodarone to help suppress this arrythmia & slow your heart rate. . you should continue taking amiodarone 400mg twice a day until 4rth, then you should decrease the dose to 200mg twice daily. we have increased the dose of the protonix to 40mg twice daily due to possible gastritis. we have started reglan 5mg qid, oxycontin 10mg , metoprolol 25mg tid. we have stopped the glipizide, candesartan, lisinopril, nifedipine & toprol. please discuss these changes with your pcp at your next follow up. . if you develop any new chest pain, shortness of breath or any other general worsening of condition, please call your pcp or come directly to the ed. followup instructions: provider: , m.d. date/time: 11:30 procedure: hemodialysis diagnoses: end stage renal disease diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation malignant neoplasm of kidney, except pelvis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia osteoarthrosis, unspecified whether generalized or localized, site unspecified chest pain, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage unspecified analgesic and antipyretic causing adverse effects in therapeutic use malignant neoplasm of thyroid gland 

Answer: The patient is high likely exposed to