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: naprosyn / aspirin / nylon 12 / spironolactone attending: chief complaint: chest pain major surgical or invasive procedure: attempted biventricular upgrade of icd history of present illness: 57 year old male with cad s/p mix4, cabg, dm2, hld, htn, chf, cva p/w with chief complaint of substernal chest & back pain with diaphoresis which occurred around 10am in lobby. pt. took 2 sl ntg at 10:15am & again 10:30 am (o.6mg). came up to 7 for cardiology appt with more substernal/back pain withdiaphoresis. given 2 more sl ntg at 11am with relief. dr. evaluated pt. ekg lbbb morphology which is wider, sr. bp122/80 /standing, after ntg 114/80, hr 86-90. no n/v/sob. feels some indigestion. dr. requested cta to rule out aortic dissection & pe, ? cath. . in the ed, he had no further chest pain (initially). a cxr with no acp and no mediastinal widening. per ed, it was discussed with dr. and he was put into obs for two sets and a stress. he ruled in on the second set with a trop of 0.13. he received ? 1-2l of ns for unclear reasons and an amiodarone bolus for 5 beat run of nsvt. the ed then found him c/o chespt pain with radiation to back and tachycardic and believed that he was in afib with rvr. he developed a new o2 requirement with 91% on 5l and a cxr was apparently c/w pulmonary edema. he received 0.125 mg digoxin, zofranm large doses of morphine,was placed on bipap, ntg drip, heparin drip with resolution of his chest pain. his ekg was c/w sr with apcs and vpcs. after ccu admission was requested, he then received 5 mg of iv metoprolol and 50 mg of lopressor for hr 130. his rate fell to 80's. he also received 60 mg of iv lasix. . on review of systems, he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: -chf (last echo , ef 20-25%) -coronary artery disease, status post myocardial infarction times four; last one in . status post 3x coronary artery bypass grafting in . stented in ', but had re-stenosis within 6 months. had 3-vessel disease on cath in . 3. other past medical history: -history of left middle cerebral artery stroke in with residual broca aphasia. -history of seizure disorder with last seizure in of . -type 2 diabetes mellitus; most recent hemoglobin a1c of 7.3. -gastroesophageal reflux disease. -peptic ulcer disease. -history of upper gastrointestinal bleeds. -bilateral cea social history: canadian. the patient is married. his wife was recently discharged from the hospital with a new diagnosis of alzheimer's disease. he is responsible for most of the chores at home. he has a 70 pack-year tobacco history. he quit two years ago. sometimes he would smoke up to four packs per day. he denies alcohol or drug abuse. he was previously an ombudsman in and was a handyman in the united states. he notes financial struggles. family history: the patient's father died of a myocardial infarction at age 50. his mother has a history of cad, dm2, and bladder cancer. the patient has multiple siblings who have had heart attacks in their 40s. physical exam: on admission: bp: 119/73 pulse: 85 rr: 21 o2: 99% general appearance: well nourished, no acute distress, overweight / obese eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal), s3 peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (percussion: no(t) dullness : ), (breath sounds: crackles : bibasilar) extremities: right lower extremity edema: trace, left lower extremity edema: trace, no(t) cyanosis, no(t) clubbing skin: not assessed, no(t) rash: neurologic: attentive, responds to: not assessed, oriented (to): x3, movement: not assessed, tone: not assessed on discharge: t: 98.2 hr: 62 bp 125/60 rr 18 o2: 95% ra gen: nad cv: irregularly irregular, normal s1/s2 resp: ctab abd: soft, nt/nd ext: no lower ext edema skin: warm, dry pertinent results: cbc: wbc-8.6 hgb-13.1* hct-39.8* mcv-92 plt ct-275 wbc-8.7 hgb-10.6* hct-31.3* mcv-92 plt ct-234 bmp: bg-214* urean-17 creat-1.4* na-138 k-4.3 cl-98 hco3-33* angap-11 calcium-10.0 phos-3.6 mg-1.7 bg-107* urean-27* creat-1.3* na-136 k-4.1 cl-94* hco3-32 angap-14 calcium-8.7 phos-3.6 mg-1.8 coags: pt-14.2* ptt-25.2 inr(pt)-1.2* pt-15.8* ptt-60.5* inr(pt)-1.4* cardiac enzymes: 12:00pm blood ctropnt-0.03* 06:40pm blood ctropnt-0.13* ck-mb-107* mb indx-10.4* ctropnt-1.40* ck-mb-51* mb indx-6.8* ctropnt-2.39* ck-mb-20* ctropnt-2.46* 03:22am blood alt-30 ast-133* blood ck(cpk)-1024*, ck(cpk)-755*, lipid pannel triglyc-101 hdl-42 chol/hd-3.8 ldlcalc-99 blood digoxin level digoxin-1.3 other studies - ecg: sr at 120 with apc and vpc, lbbb . - echo : the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis (lvef <20 %). the estimated cardiac index is borderline low (2.0-2.5l/min/m2). the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: severe left ventricular dilation with severe global left ventricular hypokinesis. mildly dilated right ventricle with moderate global hypokinesis. mild to moderate mitral regurgitation. . cxr stable chest x-ray examination with no acute pulmonary process identified. the tracheal deviation in the course of the contiguous lead is in keeping with a large left thyroid lobe which grossly is stable. cxr 1. new mild pulmonary edema. 2. intact /pacemaker lead in standard position. 3. stable rightward tracheal deviation due to known thyroid mass. brief hospital course: 57 year old male with cad s/p mix4, chf, cva p/w with chief complaint of substernal chest & back pain found to have nstemi who was not a candidate for interventional therapy so received medical management. . active issues: # nstemi: pt presented with cp and found to have nstemi by enzymes. previous cath suggested pt would benefit best from medical management. started on nitroglycerin drip, heparin gtt x 48 hrs, (allergy was previous gi bleed) and . nitro drip d/c'ed on and pt re-started on home imdur. pt experienced another episode of cp while undergoing pt, though no ekg changes were noted. amlodipine 10mg was added to help improve pt's cp. max dose of crestor was added in place of atorvastatin for suboptimal lipid control. also started on . pt was not started on an acei during this admission as it had been noted in the chart that he had developed hyperkalemia when on aceis in the past. . # rhythm: pt's rhythm is underlying sinus though marked by considerable ectopy. pt is s/p icd from a previous admission. to improve functional status, pt was upgraded to biv pacing on though the ventricular lead could not be positioned, so an epicardial lead may have to be placed at a later date. during the procedure, the patient had an episode of afib/flutter which converted back to sinus with apc and vpc. pt's home metoprolol and amiodarone were continued. . chronic issues: # chronic systolic chf: per prior echo, pt's ef is 20% and had evidence of dyskinesis for reason why crt was pursued and should continue to be followed as an outpatient. pt's bps were in the low 100s throughout most of the hospitalization so his home torsemide was introduced as pt's bp could tolerate. pt's home digoxin was continued. . # hld pt's ldl (99) is above his goal given his recent cardiac event. pt was switched from atorva 80 to crestor 40 to better optimize his lipid levels. . # diabetes type 2: pt's blood sugars were in the 300s while on sliding scale insulin but improved upon resumption of pt's home regimen of 40u lantus . . # ckd: pt's cr was at his new baseline of 1.6. meds were renally dosed and nephrotoxins avoided. . # goiter/hyperthyroidism: continued pt's home methimazole . # s/p lmca cva: stable. he has chronic broca's aphasia at baseline. in addition to his home , was started this admission as pt's allergy was a hx of gi bleed. . # seizure disorder: stable. continued pt's home keppra. . # gastroesophageal refulx disease/peptic ulcer disease: stable. continued pt's home ranitidine. . # asthma: stable. continued home advair and albuterol prn . transitional issues: 1. biv placement was unsuccessful. will need follow up with ct surgery for evalution for placement of epicardial lead. 2. blood pressure: consider adding as an outpatient. it was deferred in the hospital because pressures were tenuous in the setting of uptitrating of other medications. 3. diuretics: patient was also very sensitive to his home dose of torsemide while in the hospital perhaps because of effective salt restriction. please reevaluation kidney function and weight in next clinic visits. 4. aflutter: patient was found to have aflutter during his ep procedure, otherwise in sinus. deferred the question of anticoagulation to his outpatient physicians. medications on admission: albuterol sulfate - prn amiodarone - 200 mg tablet daily atorvastatin - 80 mg tablet daily azelastine - 137 mcg qd clopidogrel - 75 mg tablet - qd digoxin - 125 mcg tablet - qd fluocinolone - 0.025 % ointment - for eczema fluticasone - 50 mcg spray - 2 sprays qd fluticasone-salmeterol 500 mcg-50 mcg/dose glucagon emergency kit - 1mg kit insulin glargine - 40 twice a day insulin lispro - qid ss isosorbide mononitrate - 60 mg qd levetiracetam - 500 mg tablet - 3 in am and 2 in pm methimazole - 20 mg daily metoprolol succinate - 50mg nitroglycerin - 0.6 mg prn oxycodone-acetaminophen - 5 mg-325 mg tablet q4-6 prn potassium chloride 20meq qd ranitidine hcl - 150 mg tablet torsemide - 20 mg tablet - 4 tablet(s) by mouth in the morning once goes up to 258 lbs or higher discharge medications: 1. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 2. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. methimazole 10 mg tablet sig: two (2) tablet po daily (daily). 4. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 5. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 9. isosorbide mononitrate 60 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 10. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. disp:*1 bottle* refills:*0* 11. levetiracetam 500 mg tablet sig: three (3) tablet po qam (once a day (in the morning)). 12. levetiracetam 500 mg tablet sig: two (2) tablet po qpm (once a day (in the evening)). 13. torsemide 20 mg tablet sig: four (4) tablet po daily (daily). 14. amlodipine 10 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 15. insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous twice a day. 16. insulin lispro 100 unit/ml solution sig: 1-12 units subcutaneous as per home sliding scale. 17. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 7 days. disp:*28 capsule(s)* refills:*0* 18. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 19. metoprolol succinate 100 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* 20. astelin 137 mcg aerosol, spray sig: one (1) spray nasal once a day. 21. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. discharge disposition: home discharge diagnosis: non st elevation myocardial infarction acute on chronic systolic congestive heart failure: no ace/ because of low blood pressures. secondary diagnosis: diabetes mellitus type 2 gastro esophageal reflux disease discharge condition: mental status: clear and coherent with baseline expressive aphasia s/p cva. level of consciousness: alert and interactive. activity status: ambulatory with cane discharge instructions: it was a pleasure taking care of you here at . you were admitted because you had chest pain and were found to have a mild heart attack. we treated your heart attack medically and did not perform a cardiac catheterization. we attempted to upgrade your icd to a type that paces both ventricles to help with your heart failure. we were not able to do this and you may need to return to have this done surgically. you have an appt with dr. to discuss this. in the meantime, please take all of your medicines and weigh yourself daily in the morning. call if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. take all your home medications as directed except for the following medication changes or additions that were made during your hospital stay: 1. we want you to start taking aspirin 325mg by mouth daily to help prevent another heart attack. your allergy is listed as a prior gi bleed which is not considered a true allergy. 2. we want you to stop taking atorvastatin 80mg by mouth daily and instead start taking rosuvastatin calcium 40mg po to control your high cholesterol. 3. we want you to start taking nitroglycerin 0.3mg under the tongue as needed for chest pain instead of nitroglycerin 0.6mg. you can also try taking an antacid such as mylanta to see if this helps with the pain. 4. we want you to start taking amlodipine 10 mg by mouth daily to help relieve your chest pain. 5. start taking cephalexin for one week to prevent an infection at the icd site 6. change the metoprolol tartrate to metoprolol succinate to treat your heart disease. this once a day formulation is better for your heart failure 7. continue to hold your valsartan because of your low blood pressure. dr. can consider adding this medicine back on if your blood pressure is a little higher. followup instructions: department: cardiac services when: wednesday at 11:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: radiology when: thursday at 9:00 am with: cat scan building: gz building (/ complex) campus: east best parking: main garage department: cardiac services when: monday at 9:15 am with: icd call transmissions building: none none campus: at home service best parking: none department: when: tuesday at 11:10 am with: , md building: (, ma) campus: off campus best parking: free parking on site we are working on a follow up appointment in cardiology with dr. within 2 weeks. the office will contact you at home with an appointment. if you have not heard within 2 business days or have any questions please call . procedure: implantation of cardiac resynchronization defibrillator, total system [crt-d] diagnoses: other primary cardiomyopathies subendocardial infarction, initial episode of care esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified personal history of tobacco use atrial flutter chronic kidney disease, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction other left bundle branch block epilepsy, unspecified, without mention of intractable epilepsy toxic diffuse goiter without mention of thyrotoxic crisis or storm acute on chronic systolic heart failure late effects of cerebrovascular disease, aphasia peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction procedure not carried out for other reasons 

Answer: The patient is high likely exposed to