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: bradycardia, increasing lower extremity swelling and pain major surgical or invasive procedure: dc cardioversion history of present illness: 73 yo f w/ h/o pulm embolism (), presumed diastolic chf (last echo normal), gout x 3 years, who presented to osh on with gradual increasing lower extremity edema, bilateral foot pain, and increasing doses of colchicine at home. at osh, she had decreased uop and hr noted to be 30-40 w/ response w/ atropine 0.5mg to 70s (unclear if symptomatic). at that time, the pt also had hct 24 with guiaic positive stool, transfused 1 unit prbcs, 1 unit ffp, and noted to be in renal failure with bun/cr 134/6.1. at this point she was transferred to . . here, the pt was noted to be afebrile, with abd pain, and received ivf with bicarb, and underwent abd ct, showing an abdominal aortic aneurysm, and right kidney hyperdense lesion, small effusion and atelectasis. also, she was given vanco, levo, and flagyl for presumed ?intraabd source in the ed. cards was consulted and felt that patient likely had sick sinus syndrome given sinus brady w/ junctional escape rhythm on her ekg. she was admitted to the icu. in icu, remained bradycardic and asymptomatic, normotensive. on am , immediately tachycardic to 130s, with ekg showing an irregular tachycardia, afib? w/ st depressions in lateral leads and in leads i and avl. renal was consulted as well regarding her arf, thought to a combination of increasing doses of colchicine and indocin in the setting of her increasing lower extremity pain/edema. she was dialyzed and , started on phosphate binders, epo on , and on , renal felt that her renal hd catheter could be pulled (had to be off heparin gtt for this). on , renal felt hd no longer needed. spoke w/ cards consult, originally felt that patient should not receive nodal for rate control but subsequently started po dilt 90mg qid. as of today (day of transfer, she is hemodynamically stable with an intact bp and so immediate plan will be to d/c her lopressor/norvasc and have atropine at bedside, keep pads in place. she was evaluated by ep for possible pacer placement for tachy/brady syndrome, however, ep would like pt to undergo dc cardioversion tomorrow in holding area prior to pacer plans. pt is to be continued on heparin gtt in anticipation of cardioversion. . the pt states she feels well. she c/o chronic bilateral lower extremity pain with swelling (several weeks). no cp/sob/palpitations. no n/v. tolerating po well. no abd pain. urinating ok. not able to walk "pins and needles" sensation in lower extremities when bearing weight. she states the pain is at the bottoms of the feet bilaterally, like "knives." no other complaints. past medical history: 1. gout: has had for past three years - mostly in left foot, recently in bilateral feet, knees. 2. chf - first diagnosed fall - echos reportedly "normal" 3. pe - diagnosed has been on coumadin since. 4. left carotid endarterectomy in . 5. h/o rheumatic heart disease as a child. social history: lives in with granddaughter, has five children. spent in . 4ppd for 30 years, quit 20 years ago. no etoh, no illicit drugs. family history: positive for strokes in mother, father, brother, cad in brother, son, physical exam: t 97.5 p 40s sr bp 111/69 rr 16 o2 sat 96% ra genl: sitting up in bed, speaking comfortably, mild distress. heent: anicteric, mmm, op clear. neck: supple, elevated jvd, no appreciable carotid bruits. heart: bradycardic, 2/6 sem at lusb. lungs: slight bibasilar crackles. abd: soft, hypoactive bowel sounds, non-distended, non-tender. guaic positive in ed. ext: + b le edema extending of the way up shins. tenderness to palpation diffusely on her bilateral feet. no erythema or warmth of her bilateral feet or knees. neuro: a&o x 3, cn 2-12 grossly intact . pertinent results: imaging: cxr : mild cardiomegaly. bibasilar atelectasis. no chf. . : abd ct: 1. small right-sided pleural effusion and right lower lobe atelectasis. 2. small ascites. 3. nonspecific stranding in the anterior and posterior right pararenal spaces. correlation with patient's amylase and lipase is recommended. **4. 3.2 cm abdominal aortic aneurysm. follow-up recommended. 5. right kidney small hyperdense lesion. evaluation with us recommended. . renal us renal ultrasound: the right kidney measures 8.3 cm. the left kidney measures 8.4 cm. there is no evidence of hydronephrosis, nephrolithiasis, or renal masses. there is bilateral cortical thinning. the urinary bladder is not visualized and the patient has a foley catheter in place. impression: no evidence of hydronephrosis, nephrolithiasis, or renal mass. . tte: : ef >55% 1. the left atrium is moderately dilated. the right atrium is moderately dilated. 2. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is difficult to assess but is probably normal (lvef>55%). 3. the right ventricular cavity is mildly dilated. 4. the aortic valve leaflets are mildly thickened. 5. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. 6. there is mild pulmonary artery systolic hypertension. . ecg: 51, sinus brady w/ junctional escape in the 40s. no st-t wave changes. . 136, nl axis, afib, std in v4-v6, i/l brief hospital course: assessment: 73 yo f w/ diastolic chf, gout, pe p/w bradycardia thought to be due to sick sinus syndrome, acute renal failure, gout flare, gi bleed. . 1. cv: pump: the patient has known diastolic dysfxn with last tte on demonstrating ef>55%. although there was no comment on e/a ratio, clinically this would indicate impaired relaxation as pt was clinically in flash pulmonary edema in the setting of hypertension. the clinical finding of flash pulmonary edema was confirmed with a cxr. the pt received one episode of hd to remove fluid but has since been able to diurese successfully. she was started on afterload reducing agents including hydralazine and nitrates. as her creatinine was elevated, she was not able to be started on acei or at the time of this admission. her hydralazine was increased to 75mg q6hours, and isorsorbide dinitrate was increased to 60mg tid. these medications were chosen over her previous outpt regimen which consisted of amlodipine (as this can cause side effect of fluid retention and le edema) and metoprolol (discontinued due to episodes of bradycardia and concern for sick sinus syndrome). she was aggressively diuresed on lasix 80mg iv bid and achieved neg 1l per day. she was subsequently converted to a po regimen which included lasix 80mg in am and lasix 40mg in pm. the pt was followed by the renal service for her renal failure and fluid overload who oversaw our management. at acute rehab, the pt should be continued on diuresis with po regimens consisting of lasix 80mg po qam and 40mg po qpm. she should have daily weights and ins and outs monitored to document appropriate diuresis (goal of neg 500cc/day). in addition, her renal function should be followed closely (electrolytes three times a week) to observe for worsening renal failure. she should follow up with the clinic in one to two weeks time to assess her renal function. . rhythm: the pt was initially admitted with bradycardia. this may have been secondary to a sick sinus syndrome vs. beta blocker overdose in setting of acute on chronic renal failure. the ep service was contact and believe the latter to be the case. therefore no plans were made for pm placement. since cessation of bb, the pt was without episodes of bradycardia and her metoprolol was discontinued all together. in addition to her bradycardia, the pt also had an episode of afib with rvr. the pt had episode of hr in the 150s on with isolated elevated bp (up to 180s systolic) and some ischemic changes on ekg, the etiology of which was unclear. tsh was wnl. she was started on esmolol and dilt drip on for sx control and was transitioned to dilt drip alone on . she was subsequently transitioned to po dilt 90 mg qid then lopressor 37.5mg po bid and hr has been stable. pt was cardioverted on , which was initially successful in keeping pt in nsr. however, pt reverted to afib with rvr on . patient responded well to dilt 10mg iv x 1 then 60mg po qid with excellent rate control. ep was notified, and per ep recs, patient also started on amiodarone 400mg qd. as on amiodarone, pt's metoprolol was d/c'ed and the diltiazem was titrated back to 30mg qid. at time of discharge, the pt was on amiodarone 400mg once daily which should be reduced to a maintenance dose of 200mg once daily upon evaluation by ep. she was also on diltiazem 150mg qid. in addition, the pt was anticoagulated with coumadin 5mg qhs with goal inr of . she should have routine inr checked and dose of her coumadin should be adjusted as necessary. she should follow up with dr. of the cardiology division for further management of her atrial fibrillation. . 3. acute renal failure: the pt initially presented with arf. this was thought to be secondary to nsaid overuse and hypovolemia/hypoperfusion. cr peaked at 6.8 at , then decreased to 2.9. however this subsequently increased again to mid 4s. the secondary elevation in creatinine was thought to be due to poor forward flow in decompensated chf. she was initially requiring hd on , but has been off since. she was diuresed as above with good success without significant change in her creatinine. she should received close monitoring of her electrolytes with three times a week chem7. she should follow up with the clinic to assess for further progression of her renal disease and necessity for possible hd in the future. . 4. id: pt spiked fever to 100.9 on . cultures from (earlier) grew gpc in pairs and clusters, however, pt did not appear bacteremic clinically. u/a from was however positive for a uti. therefore the pt was started on levofloxacin for tx of uti. the pt was continued on levoflox 250mg q48hours due to renal function. she should receive her last dose of levoflox on . the pt was clinically stable throughout the admission from an infectious standpoint. . 5. gib: the pt was noted at osh to have a hct of 24 with guiaic positive stool, and was also noted to have g+ stools on admission here. this was thought to be secondary to nsaid gastritis. she received 1 unit prbc at osh and 3 units prbc here on and . hct has been stable since that time. pt also on epo for renal failure briefly and may require epo again at the discretion of the renal staff. we recommend further work up this as an outpatient. . 6. hx of pe: the pt had a pe dx'd in fall, . she was anticoagulated as an outpt. leni were neg, for dvt. the pt was started on anticoagulation with heparin followed by coumadin for afib as above which would also ppx again further dvt/pe events. . 7. gout: patient had been taking increasing doses of colchicine prior to initial presentation, this was thought likely to be the cause of her acute on chronic renal failure and her gib. therefore her colchicine and nsaids were stopped on admission to hospital. . 8. aaa: the pt was noted to have a 3.2cm aaa on ct abd during hospital course. she will follow up as an outpt to monitor development of the aaa. . 9. fen: cardiac low salt diet, moniter and replete lytes carefully prn. . 10. ppx: the pt was continued on dvt ppx during this admission with either heparin sub q, hep gtt or coumadin. in addition, the pt was continued on gi ppx with ppi and a bowel regimen. . 11. communication: with pt, family, pcp is . in . . 12. code status: full code medications on admission: meds - does not know her meds exactly: 1. norvasc 10 mg qd. 2. lopressor 100 . 3. hctz 25 qd. 4. coumadin 5 during week, 2.5 on weekend. 5. zocor 80 qd. 6. lopid 600 . 7. colchicine. 8. vicodin. (augmentin several weeks ago for "cold/pharyngitis"). discharge medications: 1. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 5. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 6. albuterol sulfate 0.083 % solution sig: inhalation q4h (every 4 hours) as needed. 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, chewable po daily (daily). 8. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 9. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. isosorbide dinitrate 20 mg tablet sig: three (3) tablet po tid (3 times a day). 12. hydralazine 25 mg tablet sig: three (3) tablet po q6h (every 6 hours). 13. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 14. diltiazem hcl 60 mg tablet sig: 2.5 tablets po qid (4 times a day). 15. epoetin alfa 10,000 unit/ml solution sig: as per renal. injection asdir (as directed). 16. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 1 days. 17. lorazepam 2 mg/ml syringe sig: 0.5 mg injection q4h (every 4 hours) as needed. 18. lasix 80 mg tablet sig: one (1) tablet po qam. 19. lasix 40 mg tablet sig: one (1) tablet po qpm. 20. coumadin 5 mg tablet sig: one (1) tablet po at bedtime. discharge disposition: extended care facility: - discharge diagnosis: 1. chf 2. atrial fibrillation with rapid ventricular response 3. flash pulmonary edema 4. acute on chronic renal failure 5. uti discharge condition: good discharge instructions: please take all of your medications as prescribed. several changes have been made in your medication regimen. please follow up with all of your doctors. please weigh yourself daily. if your weight is increased by more than 3lbs, please call your pcp to have your furosemide (lasix) dose increased. in addition, you should have your labs checked three times a week to evaluate your kidney function (chem7) and your coumadin dose (inr). if you experience any chest pain, palpitations, shortness of breath, dyspnea on exertion, worsening swelling in your legs, fevers, chills, abdominal pain, nausea, vomiting, diarrhea, please call your pcp or come directly to the ed. followup instructions: please follow up with your pcp within two weeks of discharge. please follow up with dr. of the cardiology department within one month of discharge. his office can be reached by calling . please follow up with the nephrology clinic within one to two weeks of discharge. an appointment can be scheduled by calling . md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis transfusion of packed cells diagnoses: acidosis hyperpotassemia urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified iron deficiency anemia secondary to blood loss (chronic) chronic kidney disease, stage iv (severe) gout, unspecified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease personal history of venous thrombosis and embolism abdominal aneurysm without mention of rupture sinoatrial node dysfunction hemorrhage of gastrointestinal tract, unspecified diastolic heart failure, unspecified volume depletion, unspecified unspecified analgesic and antipyretic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to