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: penicillins / dilaudid / chlorhexidine attending: chief complaint: ventricular tachycardia major surgical or invasive procedure: electrophysiology study for attempted ventricular tachycardia ablation cardiac catheterization history of present illness: 58 year old male with a pmh of a-fib, osa, pvd secondary to a gunshot wound to his right lower leg, and non-ischemic cardiomyopathy with a reported ef of 15-20% in the past and a recent ef of 40%. he had an aicd placed in , and he has had 4 episodes of syncope in the past 2 months. he has been shocked 8x in total, with one episode shocking him four times consecutively. his history of cardiomyopathy (best attributed to a possible viral illness, per patient report), dates back 8 years. he has also had long standing a-fib, and it is unclear whether he had the cardiomyopathy or a-fib first as he has never been symptomatic until . . he has had 3 hospitalizations for syncope since . the first of which was weekend, when his wife reports witnessing him lose consciousness for a few seconds and falling out of a chair. he was evaluated at hospital, was found to have vt, and had an aicd placed on . . 0n he woke up from sleep, his aicd fired and 15 minutes later it fired again. he was asymptomatic at the time, he was then taken to and transferred to hospital. he was given a loading dose of amiodarone, and converted to lower dose because of dizziness. he was discharged home and on , he was feeding his horses and felt dizzy and lightheaded, fell to the ground had a jerking motion, his family again witnessed the event. he didn't feel like he was shocked, and had no palpitations at the time. he lost consciousness and his wife was able to get him into the car and take him to the hospital. he was initially treated for what was thought to be ischemic chest pain. at they gave him dilaudid for chest discomfort which caused him to flush and have diaphoresis. he was transferred to and they gave him nitroglycerin, which caused his blood pressure to drop. this entire course he was kept on amiodarone of 400mg . he had several 6-7 beat runs of nsvt while there and on monday he was intially increased to 400mg tid of amio, then due to persistent episodes of nsvt he was put on iv amio at 1mg/min and transitioned today to 0.5mg/min. . his outpatient cardiologist was concerned for aicd lead migration and on he was taken to the cath lab for lead replacement. subsequently he developed 20 beats of vt, at which time the aforementioned amio drip was started at 1mg/minute. since that time his ekg and tele has shown paced beats and ectopy. . of note at the osh his creatinine was 1.1, ce negative x 3, electrolytes wnl, vanc ppx for lead placement, coreg was decreased to 25 , coumadin was held, mag oxide added to keep a-fib better controlled. he was continued on digoxin and lisinopril. bps ranged 86-126/46-60. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for syncope, orthopnea (chronic), and lower extremity edema right greater than left, as well as absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, palpitations. . on the floor, initial vitals were t: 96.5, bp: 98/72, hr: 93, rr: 23, sao2 95% on ra, resting comfortably in bed, asymptomatic with his wife and son at the bedside. . past medical history: 1. cardiac risk factors: none 2. cardiac history: ventricular tachycardia chronic a-fib nonischemic cardiomyopathy with (?)ef of 20-25% -cabg: -percutaneous coronary interventions: -pacing/icd: aicd placed in 3. other past medical history: . osa on nasal cpap . pvd secondary to gunshot wound at 17 . colecystectomy social history: former boxer, asymptomatic with activity. currently a farmer. -tobacco history: denies -etoh: rare alcohol use -illicit drugs: denies family history: 2 sisters died from acute myocardial infarction. one sister was 33 at the time of her death, and his other sister was 50 when she died of myocardial infarction. he states they don't know what caused the heart attacks. physical exam: vs: t: 96.5, bp: 98/72, hr: 93, rr: 23, sao2 95% on ra general: well appearing man in nad. oriented x3. mood, affect appropriate. appears his stated age. heent: ncat. sclera anicteric. perrl, eomi. no pallor or cyanosis of the oral mucosa. neck: supple with jvp of ~7cm. cardiac: irregular rate with frequent extra beats, normal s1, s2. no m/r/g. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. sparse end inspiratory wheezes, but in all lung fields. mild scattered expiratory rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. scar on the umbilicus from prior cholecystectomy. extremities: no c/c/e. well healed scar, and considerable indentation close to the medial tibial plateau with scar vs skin graft well healed x many years on the right lower extremity skin: no stasis dermatitis, ulcers, or scars. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ . exam on discharge: vs: tmax: 98.9 t current: 98.1 bp: 100-125/50-71 hr: 69-85 rr: 18 sao2 98% on ra 24 hours: i=1040 o= 1440 8 hours: i=180 o=750 general: well appearing man in nad. heent: ncat. sclera anicteric. neck: supple, no jvd. cardiac: irregular rate, normal s1, s2. no m/r/g. lungs: resp were unlabored, no accessory muscle use. wheezes posteriorly. no cough. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. right groin sites with minimal ecchymosis and no hematoma. skin: rash improving, few patchy areas around pacer site, none on neck now. has peeling skin on left hand only, pt states this is chronic. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: 08:42pm blood wbc-8.3 rbc-3.95* hgb-12.1* hct-34.4* mcv-87 mch-30.7 mchc-35.3* rdw-13.7 plt ct-218 04:36am blood wbc-8.4 rbc-4.13* hgb-12.7* hct-36.2* mcv-88 mch-30.7 mchc-35.1* rdw-13.8 plt ct-219 06:13am blood wbc-8.9 rbc-4.19* hgb-12.6* hct-37.2* mcv-89 mch-30.2 mchc-34.0 rdw-13.8 plt ct-226 02:28am blood wbc-10.0 rbc-4.20* hgb-12.8* hct-36.4* mcv-87 mch-30.4 mchc-35.1* rdw-13.6 plt ct-234 08:42pm blood neuts-78.7* lymphs-14.1* monos-4.7 eos-2.2 baso-0.3 08:42pm blood pt-17.2* ptt-25.1 inr(pt)-1.5* 08:42pm blood plt ct-218 04:36am blood pt-17.6* ptt-40.7* inr(pt)-1.6* 04:36am blood plt ct-219 06:13am blood pt-15.8* ptt-53.5* inr(pt)-1.4* 02:28am blood pt-14.7* ptt-23.9 inr(pt)-1.3* 02:28am blood plt ct-234 08:36am blood ptt-58.3* 08:42pm blood glucose-114* urean-18 creat-1.3* na-137 k-4.2 cl-103 hco3-26 angap-12 04:36am blood glucose-115* urean-18 creat-1.3* na-139 k-4.2 cl-103 hco3-27 angap-13 06:13am blood glucose-109* urean-22* creat-1.5* na-136 k-4.3 cl-101 hco3-27 angap-12 02:28am blood glucose-100 urean-26* creat-1.5* na-137 k-4.1 cl-100 hco3-27 angap-14 08:36am blood na-136 k-4.4 cl-100 04:36am blood alt-51* ast-29 alkphos-98 06:13am blood calcium-8.6 phos-4.3 mg-2.7* 02:28am blood calcium-8.7 phos-4.0 mg-2.9* 08:36am blood mg-2.5 08:42pm blood calcium-9.0 phos-3.3 mg-2.4 04:36am blood triglyc-115 hdl-40 chol/hd-2.8 ldlcalc-48 04:36am blood tsh-4.3* 04:36am blood digoxin-0.9 . echo: the left atrium is moderately dilated. the right atrium is markedly dilated. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function appears severely depressed (lvef= 20-25 %) but is difficult to assess due to poor image quality and frequent ventricular ectopy. relative preservation of basal inferolateral wall function. there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. the right ventricular cavity is moderately dilated with depressed free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. . impression: suboptimal image quality. dilated left ventricle with severe systolic dysfunction. right ventricular dilation and dysfunction. . cardiac cath study date of comments: 1. coronary angiography in this right dominant system demonstrated no angiongraphically apparent disease. the lmca, lad, lcx and rca had no evidence of angiographically apparent disease. 2. resting hemodyanamics revealed slightly elevated right sided filling pressures with rvedp of 15mmhg. cardiac output was preserved at 7 l/min. final diagnosis: 1. coronary arteries are normal. 2. normal ventricular function. . tte (complete) done conclusions the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is moderate global left ventricular hypokinesis (lvef = 30-35%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , biventricular systolic cavity sizes are smaller and systolic function is slightly improved. . brief hospital course: 58 year old with a pmh significant for non-ischemic cardiomyopathy, chronic a-fib, and ventricullar tachycardia s/p aicd placement on , that was transferred from hospital in ri for treatment of ventricular tachycardia with ablation. . # ventricular tachycardia/dialated cardiomyopathy: mr. has ventricular tachycardia in the setting of non-ischemic cardiomyopathy. these episodes of ventricular tachycardia started in , he is s/p aicd placement and has had several instances recently of firing of his aicd. etiology of his v-tach is likely cardiomyopathy resulting in ectopy. an initial echo was done the morning after admission and showed dilated left ventricle with severe systolic dysfunction, also right ventricular dilation and dysfunction. hemodynamically stable and asymptomatic. he was conitnued on an amiodarone drip of 0.5mg/min until he was taken for ep procedure on . during the study, they were beginning to warm a site for ablation, and he went into fast vt, so the study was aborted. he converted back to his normal rhythm. his amiodarone was converted to 200mg po tid and he still had vt with walking minimal distances, therefore loading dose was increased to 400mg , with plan to transition to 200mg po bid in one week (starting ). now currently undergoing workup for heart transplant. ct chest completed which showed multifocal small ground-glass nodules predominantly involving the upper lobes, requiring a follow up repeat ct in weeks as an outpatient. ct abd/pelvis showed hypoattenuating left upper pole renal lesion, most likely benign, but a renal us could be considered as an outpatient. hepatitis a,b,c, cmv and hiv serologies were negative. while on the floor and he had increased runs of vtach resulting in aicd firing. the device fired once on at 9:30 in the morning when he was walking with the ep team to reproduce symptoms. on the 7th, he was washing his hair sitting at the sink and he became symptomatic with lightheadedness and flushing. he had 2 runs of vtach that both resulted in icd firings at 8:09 and 8:10 in the morning. he was taken to cath immediately following, and then he was taken to the ep lab for readjustment of his leads. the lead wires were adjusted to remove slack from the wires. he tolerated the procedure well and has been without any runs of vtach since. he received a tte on when compared with the prior study (images reviewed) of , biventricular systolic cavity sizes are smaller and systolic function is slightly improved to 30-35%. a right/left heart cardiac catheterization that showed: right dominant system that demonstrated no angiongraphically apparent disease. the lmca, lad, lcx and rca had no evidence of angiographically apparent disease. resting hemodyanamics revealed slightly elevated right sided filling pressures with rvedp of 15mmhg. cardiac output was preserved at 7 l/min. his volume status was medically managed and he was transitioned back to his home po lasix of 20mg daily. . # contact dermatitis/cellulitis: he developed a likely contact dermatitis after lead replacement at osh. the contact dermatitis may have been from the chlorhexadine prep during the procedure as the patient reported that this happened in the past during a prior cath. the contact dermatitis likely became super-infected and he developed erispelas which was treated successfully with doxycyline for 7 days last dose . . # atrial fibrillation: his atrial fibrillation was rate controlled and medically managed. his coumadin was held secondary to need for cardiac catheterization and he was placed on a heparin drip throughout his admission. . # sleep apnea: his sleep apnea was medically managed with his cpap mask at night without complications. . the patient was full code for this admission. pt was discharged home with further outpt follow-up planned. medications on admission: on transfer from osh: . coumadin last dose 8/28 for a-fib . digoxin 0.25mg po q24 . lisinopril 40mg po q24 . coreg 25mg po q12 . mag oxide 400mg po q24 . lovastatin 20mg po q24 . aldactone 12.5mg po q24 . amiodarone 0.5mg/min iv discharge disposition: home discharge diagnosis: ventricular tachycardia non-ischemic cardiomyopathy acute renal failure discharge condition: alert and oriented x3 independent ambulation discharge instructions: dear mr. , you were initially admitted to the hospital for loss of consciousness, and were found to have an abnormal heart rhythm called ventricular tachycardia. you were transferred to for further management of your ventricular tachycardia and evaluation for potential ablation. unfortunately, the site of the abnormal heart rhythm could not be localized for ablation on this attempt. your pacemaker/defibrillator settings were adjusted to optimize your own normal heart rhythm and conduction. you felt significantly improved following the adjustment, and it was decided that your irregular heart rhythm would be controlled with medications. we required you to stay in the hospital for a few days to best optimize your medications for rhythm control. during this hospitalization, we also began the evaluation for a heart transplant in case this is something that might benefit you in the future. other issues on this hospitalization included a rash involving your chest, shoulders and neck. it was believed to be related to contact allergy to "chlorhexidine", a cleaning we commonly use before procedures. we also believe this skin rash became secondarily infected, for which we treated you with antibiotics. the following changes were made to your home medications: - amiodarone was continued at 400mg twice daily for 3 more days, then decrease to 400 mg once daily on . please continue that dose until you see dr. . - start metoprolol succinate to control your ventricular tachycardia - stop taking carvedilol, magnesium and digoxin - decrease the dose of warfarin to 4mg daily. please check your inr on monday with results to dr. . - start taking clindamycin, an antibiotic, to prevent infection at the icd site - start taking tylenol as needed for pain at the icd site - start taking lorazepam if you need for anxiety or sleep. please weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. check your inr at dr. office on monday . you should have the inr followed closely now that you are on amiodarone. please be sure to have your blood drawn at your doctor's office in months to check your thyroid and liver function tests because amiodarone can sometimes affect these with time. you will also need to have pulmonary function tests done to make sure the amiodarone is not affecting your lungs. your initial ct scan of your chest here showed that you have some non-specific nodules that may be due to an infection, inflammatory disease, or even cancer. please talk to your primary care doctor and cardiologist regarding ordering a follow up ct of your chest in weeks to evaluate whether there is any change. followup instructions: please be sure to keep all of your followup appointments, as listed below: department: cardiac services when: monday at 1:30 pm with: dr. building: sc clinical ctr campus: east best parking: garage . department: primary care name: dr. when: monday at 2 pm location: primary care center of address: , , phone: department: interventional cardiology name: dr. hordes when: friday at 3 pm. please call the office on after 1 pm to verify this appointment. location: cardiology address: , , phone: department: cardiac services when: monday at 12:30 pm with: , np building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach revision of lead [electrode] cardiac mapping diagnoses: other primary cardiomyopathies obstructive sleep apnea (adult)(pediatric) acute kidney failure, unspecified atrial fibrillation paroxysmal ventricular tachycardia mechanical complication of automatic implantable cardiac defibrillator dermatitis due to drugs and medicines taken internally local anti-infectives and anti-inflammatory drugs causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to