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: biaxin / erythromycin base / amiodarone attending: chief complaint: lethargy major surgical or invasive procedure: s/p r heart cardiac catheterization for trial of dobutamine. s/p picc line placement. history of present illness: 59 y/o female with pmh significant for severe ischemic cardiomyopathy with a lvef of 15%, cad, and pulmonary hypertension admitted through the ed with lethargy and severe laboratory abnormalities. pt is really unable to give any history. she simply reports that her girlfriend made her come in. she reports that she has been feeling fine and denies any pain. available notes, the pt's neightbor had called dr. and reported that the pt had been more lethargic over the last day or so. the neighbor called ems to bring the pt to the ed for further evaluation. . in the ed, the pt's initial vs were 96.5 127/50 80 18 100% 0.5l. her finger stick was 42 and the pt received 1 mg im glucagon. the pt was found to have multiple laboratory abnormalities including: bicarb of 7, creatinine of 1.9 (baseline 0.7 to 1.1), lactate of 15.7, and a inr of 13.8. she received levaquin, vancomycin, vitamin k 10 mg po x1, and vitamin k 5 mg iv x1. a cardiology consult was obtained. . past medical history: 1. advanced chf with a lvef of 15 to 20% secondary to ischemic cardiomyopathy 2. severe 4+ mr on 3. mild to moderate + tr by on 4. -v/icd in 5. cad s/p mi in and cabg in 6. pfts from with a mild restrictive ventilatory defect 7. hypothyroidism secondary to amiodarone toxicity 8. history of paroxysmal atrial fibrillation- pt is anticoagulated on coumadin and her inr from was 3.8. 9. s/p cholecystectomy . s/p tia x3 with slurred speech- this was transient and is currently resolved. . social history: smoked for 7 years, currently, not smoking. no alcohol use. the patient lives alone and is retired. family history: mother - non-alcoholic liver cirrhosis. father - dm. father deceased of mi at 50. sister with sle. physical exam: 97.8 116/74 80 18 98 ra gen- alert and oriented x2 ( and self). resting comfortably on strecher. very lethargic and not really able to given a history/answer extensive questions. heent- cardiac- rrr. iii/vi sem loudest at the left lower sternal border. pulm- ctab. no wheezes, rales, or rhonchi. abdomen- soft. nt. nd. positive bowel sounds. extremities- trace bilateral pedal edema. 1+ dp pulses bilaterally. . pertinent results: cxr- stable appearance of heart and lungs. . head ct (wet read)- no intracranial hemorrhage or mass effect. . liver us- no change from previous studies. no focal abnormalities of the liver. cbd same size at approximately 10 mm. . ecg- paced at 80 beats per minute. 05:57pm wbc-10.0 rbc-3.85* hgb-12.1 hct-41.1# mcv-107*# mch-31.6 mchc-29.6* rdw-17.7* 05:57pm plt count-199# 05:57pm neuts-84.8* lymphs-11.6* monos-3.4 eos-0.2 basos-0 05:57pm hypochrom-3+ anisocyt-1+ macrocyt-3+ 05:57pm glucose-162* urea n-31* creat-1.9*# sodium-133 potassium-5.9* chloride-94* total co2-7* anion gap-38* 05:57pm alt(sgpt)-41* ast(sgot)-119* ld(ldh)-604* ck(cpk)-77 alk phos-189* amylase-64 tot bili-2.0* 06:35pm lactate-15.7* 05:57pm lipase-22 05:57pm albumin-3.8 05:57pm tsh-6.4* 06:35pm lactate-15.7* 05:57pm digoxin-2.8* 05:57pm asa-neg ethanol-neg acetmnphn-6.8 bnzodzpn-neg barbitrt-neg tricyclic-neg 05:57pm urine bnzodzpn-pos barbitrt-pos opiates-neg cocaine-neg amphetmn-pos mthdone-neg 07:31pm type-art po2-152* pco2-20* ph-7.22* total co2-9* base xs--17 07:31pm glucose-142* lactate-15.1* k+-4.9 07:31pm freeca-1.16 . . . . . cardiology report c.cath study date of *** not signed out *** brief history: the patient is a 59 year old woman with an ischemic cardiomyopathy (ef 15%) and severe mitral regurgitation s/p biv-icd placement with paf, severe pulmonary hypertension, and hypothyroidism who is referred to the catheterization lab for evaluation of hemodynamic measurements with infusion of dopamine and dobutamine. indications for catheterization: class iv heart failure, pre-cardiac transplant evaluation. procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through a 8 french introducing sheath. cardiac output was measured by the fick method. a 5 french arterial sheath was placed for measurement of arterial pressure and for arterial blood draws. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 1.87 m2 hemoglobin: 10.4 gms % entry dopamine 5 dobutamine 10 **pressures right atrium {a/v/m} -/13/11 -/19/18 right ventricle {s/ed} 73/19 65/14 pulmonary artery {s/d/m} 73/32/47 80/40/55 65/24/38 pulmonary wedge {a/v/m} -/32/32 -/52/40 -/19/18 aorta {s/d/m} 124/70/82 131/74/93 120/52/73 **cardiac output heart rate {beats/min} 80 88 80 rhythm af af af o2 cons. ind {ml/min/m2} 125 125 125 a-v o2 difference {ml/ltr} 57 52 31 card. op/ind fick {l/mn/m2} 4.1/2.2 4.5/2.4 7.5/4.0 **resistances systemic vasc. resistance 1385 587 pulmonary vasc. resistance 293 267 213 **% saturation data (nl) pa main .56, .57, .52, .75, .75 ao .96, .92, .89, .97 **arterial blood gas inspired o2 concentr'n .24 other hemodynamic data: the oxygen consumption was assumed. technical factors: total time (lidocaine to test complete) = 1 hour 24 minutes. arterial time = 1 hour 24 minutes. fluoro time = 7.4 minutes. contrast: premedications: asa 81 mg p.o. fentanyl 25 mcg iv midazolam 0.5 mg iv anesthesia: 1% lidocaine subq. anticoagulation: other medication: dobutamine 1-10 mcg/kg/min iv dopamine 2.5-5 mcg/kg/min iv cardiac cath supplies used: 300 cm mallincrodt, optiray 100cc comments: resting hemodynamics upon entry revealed moderately elevated right and severely elevated left sided filling pressures, with a mean ra of 11, rvedp of 19, mean pcwp of 32 mm hg. severe pulmonary artery systolic hypertension was present, at 73/32 (mean 47 mm hg). central systemic arterial pressures were normal (124/70 mean 82 mm hg). the cardiac index as calculated from the fick equation was depressed, at 2.2 l/min/m2. the svr was elevated at 1385 dynes/sec/cm5. with infusion of dopamine (5 mcg/kg/min), there was no significant change in the pulmonary artery pressure (80/40/55 mm hg). the cardiac index was minimally higher (2.4 l/min/m2). the systemic arterial pressure was likewise unchanged (131/74/93 mm hg). after stopping dopamine infusion, initiating dobutamine, and titrating the dosage upwards to 10 mcg/kg/min, the patient's pulmonary arterial pressures decreased slightly to 65/24 with a mean of 38 mm hg. her mean pcwp decreased significantly to 18 mm hg (from baseline of 32 mm hg), and her systemic arterial pressure remained essentially unchanged (120/52/73 mm hg). her cardiac index also significantly improved, from a baseline of 2.2 to 4.0 l/min/m2 with dobutamine infusion. her svr also significantly decreased from baseline of 1385 to 587 dynes/s/cm2 with dobutamine infusion. the pa saturation at baseline was 56%, which increased to 75% after dobutamine infusion. final diagnosis: 1. severe systolic and diastolic ventricular dysfunction. 2. severe pulmonary artery sytolic hypertension. 3. marked improvement in hemodynamic measurements with dobutamine infusion. attending physician: , . referring physician: , . cardiology fellow: , s. attending staff: , j. brief hospital course: a/p: 59 y/o female with pmh significant for severe ischemic cardiomyopathy with a lvef of 15%, cad, and pulmonary hypertension admitted through the ed with lethargy and severe laboratory abnormalities. . 1. chf with lvef of 15 to 20%: pt does not appear to be in decompensated failure at this time. hydrated gently without dyspnea. -had swan ganz with dobutamine titration, showing that the patient had decreased svr and inceased cardiac output with dobutamine. started dobutamine 5mcg/kg/min after picc placed but titration up to 10 mcg/kg/min was limited by frequent pvc's 1 every 10 beats, so the patient was decreased to 5 mcg/kg/min. she will likely receive dobutamine 5mcg/kg/min at home when she is stable for discharge. quadruple concentrated dobutamine (1g/250cc d5w) because of hyponatremia. titrating up acei and transitioning to daily lisinopril. . 2. hyponatremia: pt presented with severely decreased oral intake over 1-2weeks. she then was volume repleted partially with saline, but also to a great degree with oral free water. her sodium worsened further on initiation of dobutamine gtt, which is suspended in free water. -dobutamine has since been concentrated 4x. -free water restriction, 1l orally. -continue 2g/day sodium restriction given severe chf. -encourage oral intake up to 1l/day as above. . 3. thrombocytopenia: plt 522, upon last check before this admission. admitted with plt 199 on , trending down to 94 on but up at 115 on . heparin flushes d/c'd although hit ab negative. dic labs negative as well. . 4. dysuria: foley discontinued. le and wbc in urine with no epithelial cells and + bacteria. past micro data shows multiple pan-sensitive e.coli infections. will treat with levofloxacin x 10 days. since foley removed, due to void at 6pm. if no void by then and bladder scan >200cc, straight cath x 1 for residual. . 5. lactic acidosis: lactic acidosis- unclear etiology of pt's lactic acidosis. does not appear to be septic in nature as afebrile, not tachycardic, not tachypnic. pt denied taking any new medications or any that don't belong to her. as her lactic acid has quickly improved in the few hours since arrival, could be due to a seizure as this would improve relatively quickly, or to severe dehydration with diarrhea and poor nutrition over 1.5 weeks ("i stopped eating for 12 days") as she received rapid volume resuscitation. - improved with gentle volume resuscitation, starting with 250 cc ns bolus and gentle maitnance fluids at 75 cc/hr, monitoring carefully given severely depressed lvef. - also improved with dobutamine but limited by ectopy on higher doses as below. . 6. psych: pt's toxin screen widely positive and there is concern for the patient being suicidal. psychiatry consult pending to assess for suicidality. patient's prior history of refusing transplant, her current history of ingestion, and her management as bridge to future transplant make determining her suicidality important. however, pt had hx of taking fioricet (has barbituates); also known to be on benzodiazepines chronically at home. on further history, pt refused transplant due to no social support at home. psychiatry felt that her changing mental status was delirium. mental status has since stabilized and no acute concern for si. . 7. atrial fibrillation: pt with a elevated inr on admission. initially, was concerned about severe hepatic failure/dysfunction causing synthetic dysfunction and other abnormalities. however, does not appear that her liver is dysfunctional, but this may be due to volume resuscitation in the setting of dehydration. pt denied taking large doses of her coumadin. got vitamin k in the ed and continued to monitor inr. started enoxaparin and prior dose of warfarin (2mg0 qhs) on as transition back to home regimen. . 8. diarrhea: possibly secondary to refeeding. no recent antibiotics. pt was taking oral neutraphos and was not eating for days, which both may have resulted in diarrhea on refeeding. . 9. dehydration: pt was extremely dry, now close to euvolemic. unclear if she became dehydrated for some reason and this led to her current state or she developed the acidosis, etc then became dehydrated. will rehydrate very gently given severely depressed lvef. urine output continues to be low at 20cc/hr. given 250cc bolus without much response and over a period of days, she received multiple small boluses and returned to euvolemic status with improved urine output. from r heart cardiac cath, her ra pressure was depending on dobutamine dose, but it may be possible that pt may need relatively high ra filling pressures if rhf severe. . 10.fen- initially npo until the pt became more alert. agressive electrolyte replacement. had self-limited episodes of lightheadedness and nausea despite stable vitals and bps in 120s. possibly secondary to refeeding or dehydration. checked albumin, most recently 3.3 from 3.8 on admission; prealbumin pending. started supplements tid c/w nutrition consultation recommendations. . 11.proph: anticoagulated on lovenox-->warfarin; pneumoboots; h2 blocker. . 12.code: full. confirmed with pt's pcp. . 13.dispo: the patient was discharged in stable condition on dobutamine, lisinopril, amiodarone, aspirin, and her home coumadin dose for atrial fibrillation as her cardiac regimen. she was also discharged on 10 days of ciprofloxacin for uti and history of pan-sensitive e.coli urinary tract infections. patient was set up for home dobutamine infusions and was cleared by pt after a number of physical therapy sessions resulted in the patient returning to her baseline functional ability. . 14.follow-up: the patient will receive vna at home for nursing needs and to follow her inr until it reaches 2.0. additionally, she will take daily weights and call her cardiologist for a weight change of 3 lbs. she has a follow-up appointment with dr. scheduled for . medications on admission: allergies: 1. biaxin 2. erythromycin base 3. amiodarone . medications (as pt not able to give, these are from most recent dc summary): 1. asa 81 mg daily 2. levothyroxine 137 mcg daily 3. famotidine 40 mg daily 4. clonazepam 0.5 mg tid 5. digoxin 125 mcg daily 6. spironolactone 25 mg daily 7. mg oxide 400 mg 8. lorazepam 1 mg tid 9. sertraline 100 mg qhs 10. tylenol 325 mg tab q4-6h 11. amiodarone 400 mg daily 12. warfarin 2 mg daily- was supposed to hold dose today. discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 2. levothyroxine sodium 137 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. amiodarone hcl 200 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. sertraline hcl 100 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed): call your doctor if you have more than 10 minutes of chest pain. disp:*75 tablet, sublingual(s)* refills:*2* 6. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. disp:*30 tablet(s)* refills:*0* 7. warfarin sodium 2 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 8. dobutamine in d5w 4,000 mcg/ml parenteral solution sig: five (5) mcg/kg/minute intravenous continuous infusion: via portable infusion pump. please maximally concentrate. hold for chest pain, lightheadedness or arrhythmia. weight is 77kg. disp:*qs x 6 months qs x 6 months* refills:*5* 9. heparin sodium lock flush 100 unit/ml solution sig: three (3) ml intravenous once a day: to unsused picc lumen. disp:*90 ml* refills:*2* 10. famotidine 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. lisinopril 5 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 12. ciprofloxacin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 10 days. disp:*40 tablet(s)* refills:*0* discharge disposition: home with service facility: physician discharge diagnosis: congestive heart failure discharge condition: stable and improved. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet strictly, but be sure to eat regularly. fluid restriction: 1 liter of combined juice, water, soda per day. please follow up with dr. at your appointment noted below. please call your doctor or return to the emergency department with difficulty breathing, shortness of breath, lightheadedness, increased leg swelling, weight change of 3 pounds, or other concern. followup instructions: provider: , m.d. where: cardiac services phone: date/time: 3:00 provider: clinic where: cardiac services phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified coronary arteriography using a single catheter right heart cardiac catheterization infusion of vasopressor agent diagnoses: acidosis thrombocytopenia, unspecified mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation aortocoronary bypass status other chronic pulmonary heart diseases other specified forms of chronic ischemic heart disease old myocardial infarction long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ awaiting organ transplant status diseases of tricuspid valve cardiac rhythm regulators causing adverse effects in therapeutic use chronic combined systolic and diastolic heart failure other iatrogenic hypothyroidism 

Answer: The patient is high likely exposed to