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: transfer from outside hospital for carotid stenosis major surgical or invasive procedure: carotid angiography carotid stenting electrophysiology study biventricular pacemaker and icd placement history of present illness: this is a 84 year-old male with a history of dilated cardiomyopathy with an ef of 15%, lbbb, and gi bleed who presented to on with syncope. he states that he was in his usual state of health at the drive-through for honey dew donut when he fainted and hit a wall. the event was not preceded by any symptoms including cp, sob, dizziness, nausea, or diaphoresis. he was initially going to be referred to for a biventricular icd but an mra of the carotids showed 55-60% stenosis in the left internal carotid. however, carotid ultrasound showed high velocities in the left internal carotid suggestive of an 80-95% stenosis. pt states that he had only fainted once before, about 1.5 years ago, when he was found to be in chf. he reports some increased doe over the past few months, becoming more sob after walking up 1.5 flight of stairs. he also denies chest pain, palpitations, orthopnea, or pnd. he denies any headaches, lightheadedness or vertigo, vision changes, difficulty speaking, or weakness. past medical history: systolic congestive heart failure with lvef of 15% gastrointestinal bleed hiatal hernia gerd social history: social history is significant for 70 pack-year history of tobacco use; patient stopped smoking 1.5 years ago when diagnosed with congestive heart failure. pt used to have 1 alcoholic drink every 1-2 days but has also stopped. there is no history of illicit drug use. pt used to do dry wall & plaster but is retired. he lives with wife (recovering from recent admission for sciatica), is able to perform activities of daily living. family history: he had two sons, but both passed away. one had lymphoma, other unknown. there is no family history of premature coronary artery disease or sudden death. physical exam: vs - t 97.4, bp 122/71, p 65, rr 16, o2 sat 95% ra gen: wdwn elderly gentleman in nad. oriented x3. mood, affect appropriate. heent: ncat. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, no carotid bruit. cv: rr, normal s1, s2 but quiet. no m/r/g. chest: ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: - right: carotid 2+ dp 2+ pt 2+ - left: carotid 2+ dp 2+ pt 2+ pertinent results: laboratory data at osh: bun 20, cr ranged from 1.3-1.6 trop 0.05, 0.05 wbc 9, hct 41, plt 198 urine positive for cannabinoids . admission labs- 05:25pm blood wbc-6.5 rbc-4.14* hgb-13.1* hct-38.5* mcv-93 mch-31.7 mchc-34.1 rdw-13.5 plt ct-189 05:25pm blood pt-12.8 ptt-26.3 inr(pt)-1.1 05:25pm blood plt ct-189 05:25pm blood glucose-95 urean-25* creat-1.4* na-140 k-3.7 cl-103 hco3-23 angap-18 06:13am blood ck(cpk)-158 06:13am blood ck-mb-4 ctropnt-0.02* 05:25pm blood calcium-9.0 phos-3.1 mg-2.2 . discharge labs- . 07:05am blood wbc-7.6 rbc-3.33* hgb-10.7* hct-31.2* mcv-94 mch-32.2* mchc-34.4 rdw-14.3 plt ct-137* 10:40am blood hct-32.0* 07:05am blood pt-13.0 ptt-29.2 inr(pt)-1.1 07:05am blood plt ct-137* 07:05am blood glucose-94 urean-20 creat-1.1 na-138 k-3.8 cl-106 hco3-23 angap-13 05:35am blood calcium-9.0 phos-3.2 mg-2.3 . studies- . . telemetry at osh in : no significant pauses, no vt. . 2d-echocardiogram at osh in : severe global hypokinesis with ef of 15%. mild mr and mild tr. carotid duplex at osh on : 1. severe heterogeneous calcified plaque in both carotid systems, right greater than left 2. flow velocities throughout the right ica and common carotid suggests an occlusion 3. flow velocities within the left ica suggest a high grade 80-95% stenosis. 4. vertebral flow is antegrade bilaterally mra at osh on : examination degraded by patient motion. occlusion of the right carotid arterial system with reconstitution primarily via the ophthalmic and right a1 segments. mri brain at osh on : examination degraded by patient motion. diffuse cerebral atrophy and scattered small old supra and infratentorial infarcts. focal encephalomalacia of the right frontoparietal region probably represents an old watershed infarct. . ekg (): sinus bradycardia. left atrial abnormality. left bundle-branch block. compared to the previous tracing of no diagnostic interim change. tracing #2 . ekg : rate of 54bpm sinus bradycardia. left atrial abnormality. left bundle-branch block. compared to the previous tracing of sinus rhythm has appeared. . carotid cath comments: 1. access: retro rfa with catheter selective to lcca. 2. thoracic aorta: type ii arch with noted occlusion of rcca. 3. carotid/vertebrals: the rcca is occluded. the right vertebral is patent. the lcca has mild orign disease without noted significant gradient. the ipsilateral cca fills the eca and ica with the ica filling the ipsilateral aca and mca with robust cross filling from a patent acom to the contralateral territories (right aca and mca). 4. successful pta/stent to left ica with a x40mm acculink stent posted with a 4.0mm balloon. excellent result with normal flow down vessel and 20% residual. patient remained neurologically intact. final diagnosis: 1. 70% stenosis of left ica. 2. occluded right ica. 3. successful pta/stent to left ica with a 6-8x40mm self-expanding stent and posted with a 4.5mm balloon. . cxr frontal chest radiograph: the pacemaker/aicd is seen overlying the left chest wall, with one lead residing in the right atrium and two overlying the expected location of the right ventricle. the heart size is top normal. the pulmonary vasculature is normal. mild pleural thickening is seen, particularly along the right lateral chest wall. there is no focal consolidation or pneumothorax. . cxr findings: in comparison with the study of , there is no interval change. the cardiac silhouette remains at the upper limits of normal in size. there is no change in the appearance of the pacemaker lead. no acute pneumonia. . brief hospital course: #carotid stenosis: pt gently hydrated with normal saline and then given bicarb prior to carotid angiography, also given mucomyst for renal protection. behavioral neurology evaluated patient, reported no focal neurological findings before or after the procedure. during the procedure patient had stenting of left internal carotid artery. pt tolerated the procedure well and was observed overnight in the ccu. pt is now on plavix and aspirin. . # syncope possibly secondary to dysrhythmia due to bradycardia and a recent syncopal episode, the patient had an electophysiology study on . as a result it was thought that the pt would benefit from biventricular implantable cardioverter and defibrillator (biicd) placement to prevent bradycardia and future syncope. pt had a known history of lbbb, and atrial fibrillation, and while in the hospital he has had sinus bradycardia into the 30's, rare pvcs and pacs. in the ep lab atrial fibrillation was induced, the patient had unsuccessful conversion with ibutelide, and later the patient had 5 seconds of tachycardia to 120's. on , patient had a biv/icd via cephalic and axillary, and before the procedure had converted spontaneously into sinus rhythm. the pacemaker's inferior lead briefly intermittently simulated the phrenic nerve, but it was adjusted to resolve this issue. pt had a small hematoma in the area of the procedure, a pressure dressing was applied and the pt was observed overnight. pacemaker was interrogated and was functioning appropriately the day after insertion. pt was not able to be anticoagulated due to gi bleed. pt received one dose of vancomycin and one dose of levaquin for infection prevention after placement. on the morning of discharge dr. found a small right femoral bruit on exam which he wants the patient to have followed by dr. at his next appointment. dr. informed dr. about this issue for follow up care. . # pump: pt has dilated cardiomyopathy with class ii chronic systolic chf, echo from an outside hospital showed that the patient had an ef of 20%. pt was restarted on lasix during his stay and his congestive heart failure symptoms were well controlled. . # cad/ischemia: pt has a left bundle branch block and an old inferior infarct thus presumed coronary artery disease. pt is on full dose aspirin, lipitor, but not on a beta blocker due to bradycardia. it was unclear why the pt was not on an , and due to the impaired renal function it was not started after his icd placement was completed. pt was also placed on plavix for his internal carotid stent. it was recommended to dr. to consider adding an ace-i as an out patient if his renal function improves, unless there are other reasons the patient is not able to tolerate the medication. . #possible chronic renal failure- creatinine was 1.5 on admission, pt received gentle iv fluids and it dropped to 1.3. renal function was closely monitored before restarting the patient's ace-inhibitor, and should be followed after discharge. . # prophylaxis/hx of gi bleed: pt was placed on pantoprazole 40mg per day, and pt was not anticoagulated. pt had pneumoboots for dvt prophylaxis. . pt was discharged hemodynamically stable, afebrile, and able to ambulate. medications on admission: lasix 20 mg daily kcl 20 meq every other day lipitor 80 mg daily* aspirin 325 mg daily feosol 325 mg daily omeprazole 40 mg daily discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily): for your cholesterol. 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): to pervent clots in your stent. disp:*30 tablet(s)* refills:*2* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 5. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 6. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 7. lasix 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: primary: 1. carotid stenosis status post angiography and stenting 2. sinus bradycardia status post biventricular icd placement secondary: 1. congestive heart failure due to dilated cardiomyopathy, chronic systolic heart failure, ef 15% 2. gi bleed 3. hiatal hernia 4. gerd discharge condition: asymptomatic and hemodynamically stable. discharge instructions: you were admitted to and treatment of your critical carotid stenosis. you underwent carotid angiography, and a stent was placed in your left internal carotid artery. you tolerated the procedure well, with no worsening of your kidney function. you had an irregular rhythm in your heart, and after testing it was determined you would benefit from a pacemaker with icd (defibrillator). this device was implanted in you, and you tolerated the procedure well. you were started on the following medications: plavix (for your stent), toprolol xl (for your heart). please take all medications as prescribed. please follow up with your doctors for further . you will need to see the device clinic to check on your pacemaker/icd, and your cardiologist and pcp. if you experience chest pain, dizziness, weakness, vision loss, difficulty speaking, please call 911 or come to the er. followup instructions: caridology: dr. monday at 3:15 --please discuss starting ace inhibitors with him. --please ask him to evaluate your right femoral artery for a small systolic bruit which was found on exam primary care provider: . (who works with dr. ) on 12pm. please discuss your stay here during this visit. pacemaker follow up: provider: clinic phone: date/time: 11:30 procedure: catheter based invasive electrophysiologic testing arteriography of cerebral arteries aortography implantation of cardiac resynchronization defibrillator, total system [crt-d] percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: other primary cardiomyopathies esophageal reflux congestive heart failure, unspecified diaphragmatic hernia without mention of obstruction or gangrene occlusion and stenosis of carotid artery without mention of cerebral infarction other specified cardiac dysrhythmias chronic systolic heart failure 

Answer: The patient is high likely exposed to