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: penicillins attending: chief complaint: fatigue major surgical or invasive procedure: i&d of r anterior leg hematoma transesophageal echocardiogram history of present illness: 82 year-old woman with hypertrophic obstructive cardiomyopathy (hocm) and end-stage renal disease on hemodialysis, complaining of increasing fatigue over the last 10 days. she was noted to have increasing pedal edema at this week's dialysis, and an additional 3# of fluid was removed the day prior to admission. she denies chest pain, worsening doe, pnd, or orthopnea. she does note occasional palpitations over this interval. per report, she has a 90% ostial rca blockage, and 50% om2 blockage on cath, that was not intervened on. she had a normal ef of 70% on tte, with moderate as (peak gradient 61, mean gradient 32, 1.1-1.2cm2), 2+ mr. she had a ppm placed in the mid- for hocm, originally a thera 7960 dual chamber ppm, that was changed to a sdr303 in . she recently had imdur 30mg po qd added to her regimen for cp control during a recent admission for chest pain/sob in context of two missed hd appointments, during which she was ruled out, noted to have no ecg changes, and did not have further cad w/u done due to clean coronaries on cath. . ms. saw her cardiologist on the day of admission with her complaints of fatigue. per report, she appeared somewhat lethargic and weak. blood pressure was 86/60mmhg left arm standing. pulse was 110 and irregularly irregular. she was reported to have little evidence of volume overload. ecg demonstrated new afib with rate 120, with evidence of lvh with extensive st-t changes c/w left heart strain. her pacer was interrogated, which indicates af since and likely chronic since . of note, however, ecgs from - demonstrated af on ecg, and not on previous ecg. she was sent to the ed for admission for tee/cv. in the ed, she was placed on heparin, and admitted to the cardiology service under ccu housestaff. . of note, ms. also has been experiencing diffuse abdominal pain over the last 2-3 months. during a recent admission at -, a kub, ct and mesenteric dopplers were unremarkable. she has never had a colonoscopy, and was recommended to have a colonoscopy done in the near future. she denies fever, chills, nausea, hematemesis, melena or hematochezia. she has experienced a significant weight loss, from 141lb to 106lb over the last year. past medical history: 1) hocm: s/p ppm placement. no ablation done, as pt asymptomatic. on carvedilol. lvot gradient 50mmhg at rest, 120mmhg after pvc. 2) esrd: unclear etiology. apparently had arf from acyclovir given for shingles, along with possible contrast nephropathy. has been receiving hd in through hickman catheter for last six months. anuric, has atrophic kidney. 3) htn 4) dmii (diet controlled) social history: no h/o tobacco or etoh. lives with son and daughter-in-law. died last year. family history: nc physical exam: t: f bp: 123/80 hr: 110 rr: 16 sao2: 98% ra gen: lying flat in bed comfortably, nad heent: perrl, mmm neck: supple, brisk carotid upstroke, no lad, no thyromegaly cv: irregularly irregular, ii/vi harsh sem radiating to carotids. could not get pt to valsalva. no s3 or s4. jvp 8cm chest: ctab, no w/r/r abd: diffusely mildly tender throughout, nondistended, +bs throughout, no hsm extr: 2+ le edema bilaterally neuro: a&ox3, no focal deficits pertinent results: admission cxr: the heart size is slightly increased. there is bilateral mild to moderate pleural effusions as well as bilateral pulmonary edema. the right hemithorax pacemaker is inserted with the leads in right atrium and right ventricle. area of linear calcification is demonstrated, the location of which could indicate mitral ring deposits. impression: pulmonary edema and bilateral pleural effusions. . tee report: general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. the patient was sedated for the tee. medications and dosages are listed above (see test information section). local anesthesia was provided by benzocaine topical spray. no tee related complications. 0.1 mg of iv glycopyrrolate was given as an antisialogogue prior to tee probe insertion. the rhythm appears to be atrial fibrillation. echocardiographic results were reviewed by telephone with the houseofficer caring echocardiographic results by e-mail. results were reviewed with the cardiology fellow involved with the patient's care. conclusions: the left atrium is dilated. the left atrial appendage emptying velocity is extremely depressed (<0.1 m/s). multiple large definite thrombi are seen in the left atrial appendage. there is symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch and in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is at lease moderate aortic valve stenosis, although the peak velocity across the aortic valve could not be assessed. trace aortic regurgitation is seen. the mitral valve leaflets are moderate-to-severely thickened and myxomatous. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. pulmonary pressures could not be assessed. there is no pericardial effusion. impression: thrombus with associated low emptying velocities in the left atrial appendage. . ct rle: findings: there is a large hematoma involving the anterior and lateral aspect of the right lower extremity. this large hematoma appears to extend from the level of just below the knee to the distal tibia, several centimeters above the ankle. there is no evidence of acute fracture impression: very large hematoma involving the anterior aspect of the right lower extremity extending from below the level of the knee towards the distal tibia. findings were discussed with dr. on . . tte: conclusions: the left atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate global left ventricular hypokinesis. no resting lvot gradient is identified. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is at least moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral leaflets and supporting structures are thickened. mild to moderate (+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the rhythm is now atrial fibrillation and global left ventricular systolic function is now depressed. the aortic valve gradient is reduced (likely related to impaired lv systolic function). . arterial dopplers: the exam was limited. wound in the right calf drained large amounts of bright red blood. doppler interrogation of the posterior tibial and dorsalis pedis arteries bilaterally demonstrated monophasic waveform. impression: markedly limited exam. monophasic waveform was demonstrated symmetrically in the bilateral tibial and dorsalis pedis arteries. these findings could be due to arterial insufficiency, therefore compartment syndrome cannot be diagnosed or excluded by this test. . head ct: findings: the study is slightly limited by the fact that the patient is obliqued in the scanner. no intra- or extra-axial hemorrhage is identified. there is no mass effect or shift of normally midline structures. the ventricles and sulci are slightly prominent consistent with age-related involutional change. the basal cisterns are well visualized. there is a periventricular white matter hypodensity consistent with chronic small vessel infarction. no fractures are identified. the visualized paranasal sinuses and mastoid air cells are clear apart from a small calcification in the left frontal air cell. the orbits appear unremarkable. impression: no evidence of intracranial hemorrhage or mass effect. . 09:45am blood wbc-8.9 rbc-3.92* hgb-12.5 hct-39.0 mcv-100* mch-31.8 mchc-32.0 rdw-21.5* plt ct-303 10:45am blood pt-41.5* ptt-pnd inr(pt)-4.7* 09:45am blood glucose-137* urean-23* creat-3.1* na-139 k-4.7 cl-100 hco3-24 angap-20 09:45am blood albumin-3.1* calcium-8.9 phos-4.0 mg-1.9 uricacd-5.9* 09:00am blood vitb12-1179* folate->20.0 01:10pm blood caltibc-146* ferritn-1113* trf-112* 09:15am blood %hba1c-6.0* -done -done 02:00pm blood tsh-1.0 01:10pm blood pth-202* brief hospital course: 1) ischemia: no evidence of active ischemia. 90% non-dominant ostial rca lesion on previous cath, by report. not active issue during this hospitalization. . 2) pump: evidence of some volume overload on initial exam and cxr, most likely diastolic dysfunction in context of new af, tachycardia, and loss of atrial kick. kept generally euvolemic, as borderline low bps did not allow for aggressive diuresis, and extra fluid was taken off during hemodialysis, which was continued while in-house. switched bb to toprol xl, and continued diltiazem sr for hocm and diastolic dysfunction while in-house. imdur held, so as to minimize unnecessary lowering of bp in this setting. . 3) rhythm: new onset af, dangerous in setting of hocm. had tee, which demonstrated large clot in , cardioversion not done. kept on heparin to coumadin bridge for anticipated anticoagulation for minimum 4 weeks before repeat tee to reconsider cardioversion. course complicated by spontaneous r anterior compartment lower leg bleed while on heparin. plastic surgery performed i&d, and evacuated large hematoma, which had intermittent bleeding while bridging to coumadin. coumadin was held prior to discharge for supratherapeutic inr (4.7 on am of discharge). inr should be checked every day, and coumadin restarted at 2mg po qhs once inr falls below 3.5. goal inr . . 4) abdominal pain: concerning for malignancy, given significant weight loss. denies f/c/ns or bowel symptoms, but will be very important to have colonoscopy as outpatient to r/o colon ca. per osh records, recent kub, ct abdomen, and mesenteric doppler u/s were unrevealing. pain control was provided as needed . 5) esrd: unclear etiology, possibly hypertensive nephropathy, exacerbated by episode of iatrogenic arf during previous hospital admission. hd continued while in-house on mwf schedule. continued nephrocaps, renal diet. . 6) s/p fall: ms. fell while ambulating in her room, hitting her head 3 days prior to discharge. this was in the setting of supratherapeutic inr. a head ct was obtained, which demonstrated no evidence of hemorrhage. she had no neurological findings, and had no adverse sequelae from the event. medications on admission: carvedilol 25mg po bid diltiazem sr 240mg po qd imdur 30mg po qd asa 325mg po qd lipitor 10mg po qd renalcaps qd discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*20 tablet(s)* refills:*0* 4. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical qd (): should be applied to leg with each dressing change. disp:*1 large tube* refills:*0* 5. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po once a day. 7. lipitor 10 mg tablet sig: one (1) tablet po once a day. 8. clindamycin hcl 150 mg capsule sig: two (2) capsule po q8h (every 8 hours). 9. metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). discharge disposition: extended care facility: - parkview discharge diagnosis: atrial fibrillation r lower extremity hematoma which developed in the setting of anticoagulation esrd hocm aortic stenosis dm ii discharge condition: stable discharge instructions: you are being transferred to a rehabilitation facility for further care. . you should have your dressing changed every day, as described below. you should keep your leg elevated at all times. followup instructions: please follow-up in the plastic surgery clinic on . you should call ( to make this appointment. they will examine your leg and decide if any further surgery needs to be done to promote healing of the affected area. you should continue your clindamycin as instructed. procedure: diagnostic ultrasound of heart hemodialysis excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue transfusion of packed cells diagnoses: end stage renal disease abdominal pain, unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation hematoma complicating a procedure unspecified fall hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease loss of weight cardiac pacemaker in situ diastolic heart failure, unspecified other malaise and fatigue contusion of face, scalp, and neck except eye(s) other specified disorders of skin acute myocardial infarction of unspecified site, episode of care unspecified 

Answer: The patient is high likely exposed to