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: morphine / penicillins / ciprofloxacin hcl / warfarin / cozaar / norvasc / lisinopril / rosuvastatin attending: chief complaint: dyspnea major surgical or invasive procedure: none history of present illness: 86 yo male h/o cad, chf, copd presents with dyspnea. reports cough x3 weeks, denies hemoptysis. noted dyspnea which awoke him from sleep on the night prior to presentation. patient denies chest pain, fevers and chills. patient endorses worsening orthopnea over past month, previously slept with 1-2 pillows now requires 3 pillows. has additionally experienced pnd. has not noted swelling of his lower extremities or increased weight. his weight on admission of 154 is down from his most recent clinic weight of 168. he has noted swelling of his abdomen starting on the morning of admission. he reports this swelling was present prior to presentation in the ed and states it is not a problem he has previously experienced. in ed patient's initial vs were t 98.6, hr 88, 154/96, resp 22 98% ra, patient then experienced decompensation of his respiratory status, desaturated to 92% on room air requiring placement on bipap. patient received a cxr which showed increased vascular congestion and questionable pneumonia. patient received azithro, ceftriaxone, nebs x3 and solumedrol. on arrival to the micu, patient was noted to be saturating well on bipap, experienced increased shortness of breath when taken off of bipap. past medical history: cad: cath w/ 90% lad, 90% ramus intermedius lesions, both stented w/ cypher des; om1 w/ 50-60% lesion; repeat cath and showed patent stents - combined ischemic/non-ischemic cardiomyopathy: lvef 30-40% - chf: 30-40% - htn - hypercholesterolemia - ckd: baseline creat 1.7- 2.0 - gerd - cataracts: bilateral, not repaired - sleep apnea - lower back pain - osteoarthritis - hemorrhoid repair 20 years ago - hernia repair (epigastric, ; inguinal ) - bph - restless leg syndrome social history: patient works as a minister at this point. denies etoh and illicit drug use. quit smoking many years ago. family history: + for multiple siblings with heart disease. sister with esrd. physical exam: admission exam: general appearance: well nourished eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic lymphatic: cervical wnl cardiovascular: normal s1 and s2 without murmurs/rubs/gallops peripheral vascular: well perfused peripherall with pulses in all extremities respiratory / chest: symmetric expansion, crackles at bases, mild wheezes abdominal: distended, tense abdominal wall, no tenderness to palpation, tympanitic to percussion extremities: no lower extremity edema skin: warm neurologic: responds to: verbal stimuli, movement: purposeful, tone: normal discharge exam: tc 98.0 tm 98.0 bp 120/75 hr 62 rr 18 o2 98%ra general appearance: lying comfortably in bed, breathing easily heent: perrl, eomi, mmm cardiovascular: normal s1 and s2 without murmurs/rubs/gallops respiratory / chest: good air movement, crackles at bases, mild wheezes abdominal: distended, tense, soft, nontender. hyperactive bowel sounds. extremities: no appreciable lower extremity edema, warm, peripheral pulses present bilaterally radial and pedal. pertinent results: admission labs: 11:20am blood wbc-8.3 rbc-4.72 hgb-14.5 hct-44.3 mcv-94 mch-30.7 mchc-32.7 rdw-13.4 plt ct-131* 11:20am blood neuts-80.9* lymphs-11.0* monos-4.8 eos-2.8 baso-0.5 12:07pm blood pt-10.7 ptt-26.5 inr(pt)-1.0 11:20am blood glucose-192* urean-34* creat-1.9* na-145 k-3.7 cl-108 hco3-28 angap-13 11:20am blood probnp-1275* 11:20am blood ctropnt-<0.01 07:31pm blood ctropnt-<0.01 07:29pm blood type-art po2-161* pco2-48* ph-7.35 caltco2-28 base xs-0 07:29pm blood lactate-2.6* 05:40pm urine color-yellow appear-clear sp -1.014 05:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg micro: blood culture - no growth urine cutlure - no growth urine legionella antigen - negative imaging: cxr impression: findings suggesting mild vascular congestion. in the appropriate clinical setting, atypical pneumonia could also be considered. also, although it is difficult to exclude focal pneumonia at the lung bases, patchy basilar opacities with low lung volumes could also be seen with atelectasis. cardiac echo conclusions the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 35-40 %) with regional hypokinesis in basal-mid lateral hypo/akinesis and apical hypokinesis. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. moderate to severe (3+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the wall motion abnormalities and overall ejection fraction are similar. the degree of mitral regurgitation has increased but was probably underestimated on the prior study. impression: regional wall motion abnormalities in the inferior, lateral and apical territories with reduced ejection fraction to 30-35%. moderate to severe mitral regurgitation. mild aortic regurgitation. cxr comparison: . findings: as compared to the previous radiograph, the lung volumes have minimally increased, likely reflecting improved ventilation. otherwise, the radiograph is unchanged, including the pre-existing mild-to-moderate cardiomegaly. no pleural effusions are seen. no evidence of pneumonia. discharge labs: 09:00am blood wbc-12.2* rbc-4.70 hgb-14.3 hct-43.5 mcv-92 mch-30.4 mchc-32.8 rdw-13.5 plt ct-126* 09:00am blood glucose-127* urean-50* creat-2.0* na-143 k-4.3 cl-100 hco3-30 angap-17 09:00am blood calcium-8.6 phos-3.0 mg-3.2* brief hospital course: micu course: 87 year old male with productive cough x3 weeks and new onset of dyspnea on day prior to presentation who was admitted to the micu originally for bipap and quickly weaned off of it and transferred to the medical . # dyspnea: most likely represents chf exacerbation in setting of progressive orthopnea as well as contribution from concurrent copd exacerbation. likely exacerbated by abdominal wall tension with large amounts of bowel gas. abg on bipap shows mild respiratory acidosis. patient has previous spirometry results indicative of underlying restrictive pathology as well. his respiratory status improved after diuresis and he was weaned off fo bipap and stable on nc and transferred to the medical . on the floor he continued saturate comfortably on room air. in addition, he was placed on steroid burst and azithromycin x 5 days for copd flare. # chf: last echo shows lvef of 35-40%. patient received repeat echo on hospital day 2 with final report pending upon call out from icu. patient was continued on home chf medications of diovan, metoprolol and lasix. echo without marked interval change, ef 30-35%. # abdominal distension: kub shows diffuse bowel gas, no air fluid levels or signs of obstruction. abdominal exam currently without tenderness or rebound, not concerning for acute abdomen. distension preceded bipap initiation per the patient. patient endorses normal bms and continues passing some gas per rectum. patient received simethicone overnight with minimal improvement in bowel gas, also received aggressive bowel regimen. # ckd: cr noted to be at high end of patient's baseline, trended down. transitional issues: medication changes: increased prednisone to 40mg a day for and , then continue taking your home dose of 5mg daily started azithromycin (last day ) started advair twice daily and stopped flovent medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. acetaminophen w/codeine tab po q6h:prn pain 2. albuterol inhaler puff ih q6h:prn respiratory distress 3. allopurinol 100 mg po daily 4. lorazepam 0.5 mg po hs:prn restless legs 5. atorvastatin 20 mg po daily 6. calcitriol 0.25 mcg po 1x/week (tu) 7. zyrtec *nf* 10 mg oral daily 8. clopidogrel 75 mg po daily 9. clotrimazole cream 1 appl tp 10. cyclosporine *nf* 0.05 % ou 11. felodipine 5 mg po daily 12. fluticasone propionate 110mcg 1 puff ih 13. folic acid 1 mg po daily 14. furosemide 60 mg po daily 15. gabapentin 300 mg po bid 16. isosorbide mononitrate (extended release) 60 mg po daily 17. metoprolol succinate xl 25 mg po bid 18. nitroglycerin sl 0.4 mg sl prn chest pain 19. potassium chloride 8 meq po daily duration: 24 hours hold for k > 20. prednisone 5 mg po daily 21. valsartan 320 mg po daily 22. aspirin 81 mg po daily 23. docusate sodium 100 mg po bid constipation 24. multivitamins 1 tab po daily discharge medications: 1. allopurinol 100 mg po daily 2. aspirin 81 mg po daily 3. atorvastatin 20 mg po daily 4. calcitriol 0.25 mcg po 1x/week (tu) 5. clopidogrel 75 mg po daily 6. clotrimazole cream 1 appl tp 7. cyclosporine *nf* 0.05 % ou 8. docusate sodium 100 mg po bid constipation 9. felodipine 5 mg po daily 10. folic acid 1 mg po daily 11. furosemide 60 mg po daily 12. gabapentin 300 mg po bid 13. isosorbide mononitrate (extended release) 60 mg po daily 14. metoprolol succinate xl 25 mg po bid 15. albuterol inhaler puff ih q6h:prn respiratory distress 16. zyrtec *nf* 10 mg oral daily 17. potassium chloride 8 meq po daily duration: 24 hours hold for k > 18. nitroglycerin sl 0.4 mg sl prn chest pain 19. multivitamins 1 tab po daily 20. lorazepam 0.5 mg po hs:prn restless legs 21. acetaminophen w/codeine tab po q6h:prn pain 22. azithromycin 250 mg po q24h duration: 2 days last day rx *azithromycin 250 mg 1 tablet(s) by mouth daily disp #*2 tablet refills:*0 23. fluticasone-salmeterol diskus (100/50) 1 inh ih rx *fluticasone-salmeterol 100 mcg-50 mcg/dose 1 puff(s) inh twice a day disp #*1 unit refills:*0 24. simethicone 40-80 mg po qid:prn gas/bloating rx *simethicone 80 mg 1 tab by mouth every six (6) hours disp #*30 tablet refills:*0 25. valsartan 320 mg po daily 26. prednisone 40 mg po daily duration: 2 days after , resume 5mg daily rx *prednisone 20 mg 2 tablet(s) by mouth daily disp #*4 tablet refills:*0 discharge disposition: home with service facility: vna discharge diagnosis: chronic obstructive pulmonary disease exacerbation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure participating in your care at . you were admitted to the hospital because you were short of breath due to a flare up of your chronic obstructive pulmonary disease. you were given inhalers and nebulizers, as well as steroids and antibiotics that both reduce inflammation and protect against potential infection. medication changes: increased prednisone to 40mg a day for and , then continue taking your home dose of 5mg daily started azithromycin (last day ) started advair twice daily and stopped flovent followup instructions: department: when: tuesday at 12:10 pm with: , m.d. building: sc clinical ctr north campus: east best parking: garage department: when: wednesday at 10:30 am with: , rnc building: sc clinical ctr none campus: east best parking: garage department: rheumatology when: friday at 9:30 am with: , md building: lm bldg () campus: west best parking: garage procedure: non-invasive mechanical ventilation diagnoses: other primary cardiomyopathies acidosis hyperpotassemia obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified long-term (current) use of steroids hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified obstructive chronic bronchitis with (acute) exacerbation other specified forms of chronic ischemic heart disease chronic kidney disease, stage iii (moderate) acute respiratory failure hyperosmolality and/or hypernatremia acute on chronic systolic heart failure flatulence, eructation, and gas pain other disorders of calcium metabolism chondrocalcinosis, unspecified, site unspecified hematuria, unspecified examination of participant in clinical trial 

Answer: The patient is high likely exposed to