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: xanax / ativan attending: chief complaint: tachycardia, feeling unwell major surgical or invasive procedure: none history of present illness: m with pacemaker admitted for rapid afib. in , he had a dual chamber st. pacemaker placed for symptomatic bradycardia and chronitropic incompetence and has been doing fairly well. he walks his dog 1.5 miles daily. this morning, he woke up feeling lousy and tried to walk the dog but could only make it down the block and had to turn back. did not have enough energy and felt some lightheadedness. no chest pain or shortness of breath. he called clinic who interogatted the pacer over the phone and found him tachycardic. he was told to go to the ed. otherwise he feels well. on review of systems, denies fevers, chills, nausea, vomit, abd pain, diarrhea. on cardiac review of systems, denies orthopnea, pnd or increase in peripheral edema. in the ed, vitals were: 98.6, 128, 144/85, 24, 100%ra. because of his fast heart rates, he was given dilt 10 iv x 3 and dilt 30 mg po followed by 60 mg po. past medical history: # chronic renal failure - followed by dr. . on epogen. - baseline creatinine is 2.0 - 2.4. # claudication - walks 1.5 miles daily but has to stop and rest. # aortic stenosis - mean gradient 60 on last echo - declined avr or valvuloplasty # b12 deficiency # htn # gerd # pvd # h/o stomach cancer - s/p total gastrectomy and roux-en-y in late # left renal artery stenosis - s/p stenting # type 2 dm # hyperkalemia in the past attributed to dietary supplements # paroxysmal atrial fib - reported after gastrectomy but no h/o recurrence # copd # tia # abdominal aortic aneurysm repair # right ica 50% occluded, 90% occluded social history: lives at home with his wife. is a ed physician in . phone numbers are and . patient is a retired jazz musician--- played the clarinet and sax. no etoh or drugs. smoked ppd for 30 years but quit approximately 20 years ago. family history: no fam hx or early cad. physical exam: vitals: 97.1, 143/62, 76, 20, 100%2lnc gen: a+ox3, nad, pleasant heent: perrl, eomi, op clear, mmm neck: no jvd cv: soft heart sounds, irregular and tachy, iii/vi sem, no rubs or gallops pulm: distant breath sounds, no wheezes, rhonchi rales. abd: soft, nd, nt, +bs, murmur radiates to abdomen ext: trace ankle edema pertinent results: cxr (): left-sided pacer is again seen with leads overlying the right atrium and ventricle. cardiac and mediastinal contours appear stable. pulmonary vascularity appears within normal limits. there is persistent eventration of the right hemidiaphragm and mild hyperexpansion, not significantly changed in appearance from prior. there are no focal consolidations or large pleural effusions. ct head (): findings: there is no intracranial hemorrhage, mass effect, or shift of normally midline structures. the ventricles, cisterns, and sulci are enlarged secondary to involutional change, unchanged from . periventricular white matter hypodensities are the sequelae of chronic small vessel infarction. -white matter differentiation, however, is preserved. the osseous structures are unremarkable. the visualized paranasal sinuses and mastoid air cells are clear. cxr (): a new interstitial edema has developed in both lungs more predominantly at the bases. the heart is enlarged. small subtle left pleural effusion might be present. a left-sided pacer is again noted with leads overlying the right atrium and right ventricle. persistent eventration the right hemidiaphragm. echo: the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. there is mild global left ventricular hypokinesis (lvef = 40-50 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , there is now moderate concentric left ventricular hypertrophy with a small cavity, reduced ejection fraction, and evidence of severe diastolic dysfunction. the cardiac rhythm is now atrial fibrillation. renal us: impression: 1. cortical atrophy of the right kidney and absence of diastolic flow in the segmental arteries indicative of an intrinsic vascular abnormality. the limited doppler study on the right does not allow for evaluation of renal artery stenosis. 2. multiple simple bilateral renal cysts, unchanged from , . brief hospital course: year old male with a st. pacemaker placed for symptomatic bradycardia in who presented with new onset afib with rvr. the patient was initially anticoagulated with heparin for new onset atrial fibrillation with rvr with initiation of coumadin. two of his home antihypertensives were held (amlodipine and losartan) to leave room to uptitrate beta-blockade for improved rate control. he was seen by ep who decided to attempt chemical cardioversion which was successful. on the day of cardioversion the patient became acutely hypertensive to 270 systolic. he also had difficulty breathing in this setting. he was treated with 30 of iv hydralazine, 25 mg of iv lopressor, 25 mg po captopril and 20 iv lasix. his blood pressure was fairly refractory to these interventions and the patient was transferred to the cardiac intensive care unit for closer monitoring. he also received 2 mg iv ativan for agitation. upon arrival in the unit, the patient became somewhat unresponsive with minimally reactive pupils. given his hypertensive emergency, there was suspicion for stroke. the patient had a negative head ct scan. he was unable to have mri given his pacer. his mental status improved to baseline overnight. according to his wife, he has had similar episodes in the past with benzodiazapines and it was thought his mental status change was most likely secondary to a medication effect. the patient returned to the floor with difficult to control blood pressure. he was treated aggressively with anti-hypertensives. the patient experienced dizziness with both blood pressure highs and when his blood pressure was too low. per his pcp, patient generally has a blood pressure between 140-160. per his wife, the patient has had transient elevations in his blood pressure over 200 in the past. from prior notes, it appears the patient has some element of autonomic dysfunction in addition to known left renal artery stenosis s/p stent and critical aortic stenosis. as he became relatively hypotensive (sbp of 90) on labetolol as well as hydralazine, both of these agents were discontinued. the patient experienced acute on chronic renal failure, most likely secondary to kidney hypoperfusion while hypotensive. his creatinine had leveled off at discharge. he was discharged with services and scheduled to have electrolytes checked the wednesday after discharge with results to be faxed to both his pcp and nephrologist. the patient was eventually discharged on his original home medication regimen with uptitration of his amlodipine while his losartan was being held. the patient had a troponin leak consistent with nstemi in the setting of his hypertensive emergency. he was medically managed with beta-blockade and low dose aspirin as well as high dose statin. he was already anticoagulated on heparin at the time. he had an echo while in the hospital which showed moderate concentric left ventricular hypertrophy with a small cavity, reduced ejection fraction, and evidence of severe diastolic dysfunction. the patient was continued on his home plavix regimen for his left renal artery stenosis s/p stent by dr. . he also has known carotid disease. the patient was noted to have a urinary tract infection during this admission. cultures grew out klebsiella sensitive to cipro. the patient was treated with cipro and discharged to complete a course of antibiotics. he also had a left hand thrombophlebitis from an iv. the iv was removed and the thrombophlebitis resolved with no further intervention. he was discharged with home vna for assessment of his cardiopulmonary status, inr draws for his anticoagulation, which should be maintained between two and three until decided otherwise by his pcp and cardiologist as well as home chf monitoring, which the patient has had in the past. he should be restarted on his losartan as an outpatient once his renal function starts to return to his baseline ~2-2.5. medications on admission: norvasc 5 mg--1.5 (one and a half) tablet(s) by mouth once a day metoprolol tartrate 25 mg--0.5 tablet(s) by mouth twice a day plavix 75 mg--1 tablet(s) by mouth once a day ursodiol 300 mg--1 capsule(s) by mouth twice a day zantac 300 mg--1 tablet(s) by mouth daily protonix 40 mg--1 (one) tablet(s) by mouth daily hydrochlorothiazide 25 mg--1 tablet(s) by mouth daily lipitor 10 mg--1 tablet(s) by mouth once a day cozaar 25 mg--1 tablet(s) by mouth twice a day senokot 8.6 mg--1 (one) tablet(s) by mouth twice a day as needed for constipation discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ranitidine hcl 150 mg tablet sig: two (2) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 8. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. plavix 75 mg tablet sig: one (1) tablet po once a day. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 12. percocet 5-325 mg tablet sig: one (1) tablet po once a day as needed for headache. disp:*10 tablet(s)* refills:*0* 13. warfarin 2 mg tablet sig: one (1) tablet po at bedtime: please start this medication on saturday, . disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary: #atrial fibrillation with rapid ventricular response #hypertensive emergency secondary: #chronic renal insufficiency on epogen #claudication #aortic stenosis #gerd #copd #peripheral vascular disease #left renal artery stenosis #type ii diabetes mellitus #tia discharge condition: stable discharge instructions: you were admitted to the hospital because your heart rate was very fast. while in the hospital you underwent chemical conversion with medication to change your heart rate to sinus. your heart rate has been controlled since the conversion. we started you on a blood thinner which you will need to take until you are instructed otherwise. if you have any bleeding from your nose or blood in your stool, please notify your doctor immediately. please do not take your warfarin tonight (the blood thinner). please take the warfarin tomorrow night (saturday) and sunday night. the vna will check your inr levels on sunday. you also had an episode of extremely high blood pressure. we treated your blood pressure with medications. we are sending you home on a slightly different medication regimen. we increased your dose of amlodipine to 10 mg daily. we would like you to hold your losartan (cozaar) until instructed otherwise by your primary care physician. we will check your kidney function on wednesday, . your outpatient doctors when you may restart your losartan. we did not change your dose of beta-blocker or hydrochlorothiazide. we increased your cholesterol medication. please take all your other medications as prescribed. please call your doctor or come to the emergency room with any chest pain, shortness of breath, increasing headaches or other symptoms you find concerning. followup instructions: you have the following appointments scheduled: provider: , md phone: date/time: 3:00 pm. provider: , m.d. phone: date/time: 11:00 am. provider: , m.d. phone: date/time: 3:00 pm. provider: call transmissions phone: date/time: 9:00 am. you have an appointment with dr. on at 11 am to follow up for your cardioversion. please call (. procedure: diagnostic ultrasound of heart injection or infusion of other therapeutic or prophylactic substance other conversion of cardiac rhythm diagnoses: acidosis subendocardial infarction, initial episode of care esophageal reflux urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders personal history of tobacco use chronic kidney disease, unspecified other b-complex deficiencies occlusion and stenosis of carotid artery without mention of cerebral infarction other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure atherosclerosis of renal artery cardiac pacemaker in situ personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits altered mental status other vascular complications of medical care, not elsewhere classified accidents occurring in residential institution occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction phlebitis and thrombophlebitis of upper extremities, unspecified heart disease, unspecified personal history of malignant neoplasm of stomach benzodiazepine-based tranquilizers causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to