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: sulfa (sulfonamides) / verapamil / salmeterol / tiotropium / nystatin / tricor / flovent hfa attending: chief complaint: lightheadedness, dyspnea on exertion major surgical or invasive procedure: pacemaker placement history of present illness: mr. is a 72 yo m with pmh of cad, chf (ef 20%) dm2, htn, copd presenting with one month history of dyspnea on exertion and lightheadedness with exertion. per his admission note he reported that for the last month he has been having shortness of breath with exertion such as walking acrossing the room while as prior to that he had been able to walk two miles without difficulty. in addition, he has been having lightheadedness associated with the dyspnea requiring him to stop and rest and hold onto something to steady himself. he does reports that his weight has decreased from 285->272 over the past month as well. he denied any chest pain, palpitations, fainting/loss of consciousness, fevers, nausea, vomiting, diaphoresis, diarrhea. . according to his wife he has been in an irregular heart rhythm for the past month however he did not go to his doctor until the day of admission. . right leg with recurrant cellulitis, has been treated with antibiotics in the past with improvement. . in the ed t98.6 hr 100 bp 125/71 rr 14 93%ra. he was given asa 325, levofloxacin 750 and metoprolol 25 po x1. . he was admitted to the medical service. his anti-biotics were discontinued as there was doubt the small infiltrate represented pneumonia. he remained afebrile with blood pressures ranging 110-120s systolic and hr ranging from 90s-112. he was rate controlled with increasing doses of metoprolol with home dose 150 mg daily to 100 mg then to tid on . he was started on coumadin. on the night of ccu transfer he was found down on floor of his room. his roommate called for help. the patient had been on telemetry at the time. his rhythm of atrial fibrillation had changed to ventricular escape with pauses up to 7 seconds. briefly no pulse could be detected. he had spontaneous return of circulation. he received no atropine or epinephrine. he was transferred to the ccu for further monitoring. he states that he doesn't remember the events either before or after being surrounded by medical and nursing staff. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. he states that at home he had several episodes of feeling lightheaded particularly with standing up. he denies having passed out. he states that he has lost ~ pounds over the past 3 weeks. all of the other review of systems were negative. . *** cardiac review of systems is notable for absence of chest pain, pnd, orthopnea, palpitations, or syncope. past medical history: type ii dm htn chf - ef 20% asthma copd djd obesity ibs pvd with stent in his leg ibd? . cardiac risk factors: +diabetes, +dyslipidemia, +hypertension . cardiac history: cabg: n/a . percutaneous coronary intervention: n/a social history: lives with wife and kids. retired construction worker and former soldier. smoked 1 ppd for 40 years and quit in . denies other drugs or alcohol family history: has 12 brothers and sisters who have dm and htn. brother had mi in his 30's. no ca physical exam: physical examination: vs: t 96.2, bp 128/90, hr 98, rr 21, o2 100% on nrb -> 97%4l gen: obese middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple. jvp unappreciable due to body habitus. cv: pmi located in 5th intercostal space, midclavicular line. irreg irreg normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominal bruits. ext: no c/c/e. no femoral bruits. skin: stasis dermatitis, right shin ulcers, mild diaphoretic pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; + dp left: carotid 2+ without bruit; femoral 2+ without bruit; + dp neuro: alert, orient x3. cn ii-xii intact. 5/5 strength to hand grip, plantar/dorsiflex. light touch intact to face/hands/feet. pertinent results: 11:40am blood wbc-12.7* rbc-5.42 hgb-11.4* hct-35.9* mcv-66* mch-21.1* mchc-31.9 rdw-17.5* plt ct-258 04:50am blood pt-18.5* ptt-31.9 inr(pt)-1.7* 11:40am blood glucose-175* urean-30* creat-1.5* na-136 k-5.7* cl-98 hco3-25 angap-19 01:30am blood wbc-18.0* rbc-5.86 hgb-12.3* hct-39.4* mcv-67* mch-21.0* mchc-31.3 rdw-18.0* plt ct-325 05:19am blood wbc-13.5* rbc-5.21 hgb-10.4* hct-36.2* mcv-69* mch-19.9* mchc-28.7* rdw-17.5* plt ct-216 05:19am blood pt-18.7* ptt-34.1 inr(pt)-1.7* 05:19am blood glucose-133* urean-28* creat-1.0 na-138 k-4.2 cl-103 hco3-26 angap-13 01:30am blood alt-764* ast-1406* ck(cpk)-206* alkphos-93 totbili-2.3* dirbili-1.1* indbili-1.2 06:20am blood alt-813* ast-1590* ld(ldh)-1428* ck(cpk)-155 alkphos-96 totbili-2.1* 07:28pm blood ck(cpk)-109 05:19am blood alt-513* ast-537* ld(ldh)-358* alkphos-82 totbili-1.3 11:40am blood ck-mb-7 ctropnt-<0.01 01:30am blood ck-mb-7 ctropnt-<0.01 probnp-4526* 06:20am blood ctropnt-<0.01 06:20am blood caltibc-419 ferritn-271 trf-322 04:50am blood tsh-1.3 medical decision making . ekg demonstrated afib @ 95 rightward axis no st-t changes. delayed rwp with no significant change . telemetry demonstrated: afib @ 60s. then ventricular escape with ~7 second pauses . 2d-echocardiogram performed on demonstrated: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (ejection fraction 20 percent). no masses or thrombi are seen in the left ventricle (definity used for left ventricular opacification). there is no ventricular septal defect. the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated. there is severe global right ventricular free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . laboratory data: see addendum below . imaging: cta chest: 1. no evidence of pulmonary embolism. 2. small, focal right upper lobe airspace consolidation, most consistent with pneumonia. recommend followup chest ct post-treatment to ensure resolution. . rle duplex: no dvt in the right lower extremity. . cxr: right lower lobe patchy opacity may indicate, focal atelectasis, exaggerated by overlying soft tissues, however an early pneumonia can not be excluded . ct head: impression: no acute intracranial process . cxr: impression: improvement in vascular engorgement. less well visualized right upper lobe opacity may indicate resolving aspiration pneumonia. however, the recommendation for chest ct in four to six weeks was discussed with at 11:20 a.m. . abd u/s: impression: mild splenomegaly, otherwise, unremarkable abdominal ultrasound. . echo: the left atrium is moderately dilated. the estimated right atrial pressure is 0-10mmhg. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20 %). the estimated cardiac index is depressed (<2.0l/min/m2). transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. compared with the prior study (images reviewed) of , the left ventricular function is similarly severely depressed. brief hospital course: mr. is a 72 year old man with severe biventricular systolic heart failure, dm2, copd who presented with new diagnosis atrial fibrillation, worsening dyspnea on exertion. 1)bradycardia/syncope: on day two of his admission he had a bradycardic pause with slow ventricular escape and was found down on the hospital floor. metoprolol had been increased from admission of 150 mg daily to 100 mg which is a possible contributing factor. a ct of the head was done which showed no bleed/stroke. the patient recovered from this acute bradycardia on his own with heart rates >90s with no intervention to reverse beta-blockade. he was transferred to the ccu and remained stable while in the unit. ep was consulted and the decision was to place a pacemaker for treatment of tachy-brady syndrome. a dual-chamber pacemaker-icd was placed without complication. he completed 3 day course of keflex. coumadin 5mg daily was started and he was transferred to the medical floor. he had no complications following and was arranged outpatient follow up with device clinic. 2)atrial fibrillation with rapid ventricular response - throughout his admission his rate was difficulty to control with maximal beta blockade. he had a tee which showed left atrial thrombus therefore he was not a candidate for cardioversion during this admission. amiodarone is a consideration although would be concerned about potential for medical cardioversion and embolization of his thrombus. instead he was started on verapamil which was titrated up to 80 for improved rate control. he was also discharged on metoprolol 300mg xl. he was also continued on coumadin with goal inr . 3)transaminitis - most likely due to r-sided heart failure, less likely shock liver from pause given that cardiac enzymes did not bump. he had a ruq ultrasound that was normal. his lft's continued to trend down during the remainder of his hospitalization. 4)gout -during his admission he had an acute gout flare in right knee, confirmed by arthrocentesis by the rheumatology consult team. his symptoms significantly improved following joint fluid removal and after prednisone injection. no evidence of dvt on le duplex. xray with suprapatellar effusion, no fracture. joint fluid with high wbc and polys somewhat concerning for possibility of infectious arthritis although no microorganisms on gram stain and culture with no growth. he was also started on colchicine. follow up in rheumatology clinic for inititation of allopurinol was arranged prior to discharge. 5)dyspnea on exertion, lightheadedness - most likely due to his atrial fibrillation and tachycardia in the setting of chf with ef of 20%. he persistently desaturated with activity to the high 80's likely due to poor ef and tachycardia. he improved with addition of verapamil to metoprolol. there was no evidence of pulmonary edema or pleural effusion on cxr. no pulmonary embolism on cta. he was continued on his home doses of furosemide and spironolactone. 6)acute on chronic systolic heart failure - acute failure likely afib with rvr and resulting decompensation. repeat echo this admission with ef of 20%, no significant change c/w prior. he was continued on lasix, spironolactone and lisinopril. his metoprolol was increased and he was started on verapamil as above. 7)rul consolidation -seen on cxr and ct, felt most consistent with a pneumonia. patient with dyspnea although no significant cough or fevers. he was not treated for a pna and he had no change on subsequent cxr. he will follow up with his pcp for outpatient repeat cxr. 8)pvd/cad - he has h/o right le stent for pvd, denies prior h/o mi although he does have significant systolic heart failure with depressed ef concerning for ischemic cardiomyopathy. his plavix was discontinued during this admission as it has been >3 years since stent was placed and he is now going to be on coumadin and aspirin. 9)type ii dm - he is on glucovance at home which was stopped on admission and he was covered with hiss. glucovance was resumed at home dose on discharge. 10)copd - on albuterol prn, stable 11)leukocytosis - appears to have leukocytosis at baseline according to our past records from of unclear etiology. no evidence of acute infection on culture, cxr, ua. he will follow up with his pcp. 12)fen - cardiac, low salt diet, replete lytes prn, fluid restriction of 1.5l 13)code status - full confirmed with patient 14)contact: wife . medications on admission: current medications on transfer: humalog insulin sliding scale plavix 75 mg daily aspirin 325 mg daily ranitidine 150 mg atorvastatin 10 mg daily colace 100 mg multivitamin daily mesalamine 250 mg qam heparin 5000 sc tid bacitracin-polymyxin tp warfarin 5 mg daily metoprolol 100 mg tid (last dose was 11:30pm) lisinopril 40 mg daily senna prn albuterol mdi 2 puffs q4prn cepacol 1 prn discharge medications: 1. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 2. mesalamine 250 mg capsule, sustained release sig: one (1) capsule, sustained release po qam (once a day (in the morning)). 3. verapamil 80 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 4. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 7. hexavitamin tablet sig: one (1) cap po daily (daily). 8. glucovance 5-500 mg tablet sig: one (1) tablet po once a day. 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 12. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 13. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 14. vitamin b-12 1,000 mcg tablet sig: one (1) tablet po once a day. 15. omega-3 fatty acids 1,000 mg capsule sig: one (1) capsule po once a day. 16. flonase 50 mcg/actuation spray, suspension sig: two (2) spray nasal once a day. 17. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 18. toprol xl 100 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day: take in the morning. disp:*90 tablet sustained release 24 hr(s)* refills:*2* 19. outpatient lab work please check pt/inr on friday and monday . results should go to his primary care doctor, dr. p: or fax:. 20. coumadin 2 mg tablet sig: take as directed by dr. tablet po once a day: do not take on , do not start until instructed to do so by dr. . disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: heart block s/p biventricular pacemaker and icd placement atrial fibrillation with rapid ventricular response systolic heart failure gout type ii dm discharge condition: fair discharge instructions: you were admitted to the hospital because you were having shortness of breath and light headedness with walking. you were found to be in an abnormal heart rhythm called atrial fibrillation and your metoprolol was increased to 100mg three times daily. you had an event during your hospital stay with a pause in your heart beat that caused a fall. you were admitted to the intensive care unit and you had a pace maker and defibrillator placed to prevent this from happending again. you also had an ultrasound of your heart that showed a blood clot so we were not able to cardiovert your heart back into a normal rhythm. you will need to take comadin to prevent blood clots and stroke. you will have to have close monitoring of your blood work until the level of the coumadin is determinted. you also had a flare of gout in your right knee. you were seen by the rheumatologists and you had fluid removed from your knee which confirmed the diagnosis of gout. you had prednisone injected into the knee to help with the pain. you were also started on colchicine to help with the knee pain. you will need to follow up in rheumatology clinic as an outpatient. medications: 1) you were started on coumadin which you will need to take for your atrial fibrillation to prevent blood clots. it is very important that you take this medication exactly as instructed by dr. office as there is a risk of bleeding if the medication dose is too high. please do not take coumadin tonight, you will have your blood level checked tomorrow and dr. office will instruct you about the dose of comadin to take. 2) your metoprolol was increased to 100mg three times per day. this dose is the same as 300mg of the extended release metoprolol. prior to your admission you were on 150mg of extended release metoprolol. 3) you were started on a new medication called verapamil which you will take three times per day to help control your heart rate. 4) you were started on colchicine which you will take for your gout. 5) your plavix was stopped, you do not need to take this medication any longer. 6) your lipitor (atorvastatin) was stopped because you had some abnormalititis of your liver that were improving on discharge. you should follow up with dr. regarding when to restart this medicine. please follow up as below. please call your doctor or return to the hospital if you experience any concerning symptoms including fevers, chills, difficulty breathing, chest pain, light headedness, fainting, worsening of your knee pain, or any other worrisome symptoms. followup instructions: 1)you have an appointment in device clinic to evaluate your pacemaker: provider: clinic phone: date/time: 10:30 2) you have an appointment scheduled to follow up with dr. on thursday at 12:15 at the office. 3) you have an appointment scheduled to follow up with dr. , of rheumatology. phone: date/time: 12:00 procedure: implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation acute on chronic diastolic heart failure other and unspecified hyperlipidemia long-term (current) use of anticoagulants chronic obstructive asthma, unspecified sinoatrial node dysfunction irritable bowel syndrome osteoarthrosis, unspecified whether generalized or localized, other specified sites 

Answer: The patient is high likely exposed to