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: dyspnea major surgical or invasive procedure: tee cardioversion intubation extubation picc line placement history of present illness: 89 y/o f chinese-speaking female with severe diastolic heart failure, atrial fibrillation not on anticoagulation, diabetes, hypertension, hyperlipidemia who presents with worsening doe/sob for past 3 days. patient was seen for worsening dyspnea and shortness of breath by dr. in heart failure clinic and at that time the patient's was started on lasix 20mg daily and increased toprol dose. per family, patient's lower extremity edema improved, but dyspnea persisted. also intermittant cp, lasts >5min, occurring several times a day, no current pain and no pain in ed. . in ed, temp 97.5, hr 75 bp 123/91 rr 26 pox 98 on 3 lnc. cxr showed retrocardiac opacity and new bilateral pleural effusions. no n/v, abd pain, f/c, cough, chest pain. in ed, he received levofloxacin 750 mg iv, and nitro sl. she initially had some relief with better dyspnea after getting nitro. got 250 ml bolus and then had respiratory distress and was intuabted. lactate 3.4. . on the floor, patient is intubated and sedated. family is at the bedside. she is in atrial fibrillation and her bp is stable. past medical history: -severe diastolic congestive heart failure -pulm htn -mod to severe mitral regurgitation -diabetes mellitus -hypertension -hyperlipidemia -osteoporosis -glaucoma -h/o gout () -h/o appendicitis last year with septic shock () -h/o atrial fibrillation (during hospitalization one year ago, not on coumadin, and discussed at last cards visit and daughter wanted to not initiate coumadin) - h/o tee electrocardioversion during hospitalization; has not had atrial fibrillation until past few weeks social history: the patient is originally from . she lives in with her daughter currently. tobacco use, no alcohol use, no drug use. functional status is poor, but does get around the house and has normal mental capacity, no known dementia. family history: circulatory disorders in her father and uncle, otherwise noncontributory. physical exam: pe on admission: vitals: t: 96.6, bp: 118/75, p: 93 (afib), r: 16, o2: 100% ac 100%/5/450/16 with abg 7.45/29/506 general: thin, eldery, intubated and sedated heent: sclera anicteric, mmm, oropharynx clear, pupils 3mm and reactive neck: supple, jvp not elevated, no lad lungs: coarse lung sounds bilaterally, crackles at the bases, no wheezes, referred ventilator sounds cv: irregularly irregular, 2/6 systolic murmur best heard at llsb abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: cool, palp pulses, no clubbing, no edema pertinent results: laboratories: 04:18pm blood wbc-8.4 rbc-4.11* hgb-13.1 hct-41.9 mcv-102* mch-32.0 mchc-31.4 rdw-13.9 plt ct-232 06:02am blood wbc-7.6 rbc-3.32* hgb-10.9* hct-33.0* mcv-99* mch-32.9* mchc-33.1 rdw-14.4 plt ct-225 04:18pm blood pt-14.7* ptt-37.2* inr(pt)-1.3* 06:02am blood pt-32.8* ptt-50.4* inr(pt)-3.3* 04:18pm blood glucose-144* urean-37* creat-1.0 na-143 k-4.2 cl-107 hco3-21* angap-19 06:02am blood glucose-101 urean-23* creat-0.9 na-142 k-3.6 cl-104 hco3-29 angap-13 04:38am blood alt-39 ast-51* ld(ldh)-295* ck(cpk)-59 alkphos-85 totbili-1.2 04:18pm blood ck(cpk)-58 09:30pm blood ck(cpk)-62 09:08pm blood ctropnt-0.02* 09:30pm blood ck-mb-notdone ctropnt-0.02* 04:38am blood ck-mb-notdone ctropnt-0.01 probnp-8079* 04:38am blood calcium-7.5* phos-3.6 mg-1.8 05:42am blood calcium-8.5 phos-3.7 mg-1.8 11:42pm blood type-art po2-506* pco2-29* ph-7.45 caltco2-21 base xs--1 03:21pm blood type-art tidal v-300 peep-5 fio2-40 po2-139* pco2-30* ph-7.43 caltco2-21 base xs--2 intubat-intubated 12:38am blood type-art temp-36.8 po2-163* pco2-34* ph-7.42 caltco2-23 base xs--1 intubat-intubated 04:27pm blood lactate-3.4* 09:30pm blood lactate-3.8* 11:42pm blood lactate-1.9 . ====================== imaging: tee: : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). the right atrial appendage ejection velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. there is symmetric left ventricular hypertrophy with normal cavity size. lv systolic function appears depressed. there are simple atheroma in the aortic arch and descending thoracic aorta to 47cm from the incisors. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. there is a small pericardial effusion. impression: no spontaneous echo contrast or thrombus in the la/laa/ra/raa. moderate to severe mitral regurgitation. mild aortic regurgitation. . tte : the atria are moderately dilated. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). transmitral doppler and tissue velocity imaging are consistent with grade iii/iv (severe) lv diastolic dysfunction. the right ventricular free wall is hypertrophied. right ventricular chamber size is normal with normal free wall contractility. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild aortic regurgitation. moderate to severe mitral regurgitation. moderate to severe tricuspid regurgitation. severe pulmonary hypertension. compared with the prior study (images reviewed) of , pulmonary pressures are higher. the other findings are simlar. . cxr : cardiac silhouette remains moderately enlarged. there are bilateral pleural effusions, which appear new from the prior study. the aorta remains tortuous with mural calcifications present. pulmonary ascularity is normal. the osseous structures are unchanged. a retrocardiac opacity is nonspecific, which may represent atelectasis, but infection is excluded. impression: 1. small bilateral pleural effusions. 2. retrocardiac opacity, which could represent atelectasis, but infection not excluded. 3. no evidence of pulmonary edema. brief hospital course: 89f c diastolic dysfunction with worsening heart failure, atrial fibrillation not on anticoagulation and mod-severe mr+tr who presents with acute on chronic worsening of dyspnea. . # dyspnea / respiratory failure: differential diagnosis includes chf vs pna vs mi. given rapid decompensation with small fluid bolus, and history of lack of fever, cough, no wbc, non-impressive cxr, the most likely cause of her dyspnea was acute on chronic diastolic heart failure, likely worsened recently by afib. mi was ruled out with unremarkable ekg and negative cardiac enzymes. in the micu, patient was intially intubated and sedated. after a tee ruled out thrombus in the heart, patient was cardioverted for persistent afib c rvr. she was on heparin gtt during tee and cardioversion. she was successfully extubated and transferred to cardiology service. after patient was transferred to cardiology floor, she was diuresed with 20mg po lasix daily, initially supplemented by another dose of iv 10mg lasix in the afternoon. patient responded to lasix well, and her lung exams improved with diuresis. . # acute on chronic diastolic heart failure: likely exacerbated by afib. after patient was transferred to cardiology floor, she was diuresed with 20mg po lasix daily, with another dose of iv 10mg lasix in the afternoon. patient responded to lasix well, and her lung exams improved with diuresis. patient was discharged with 20mg po lasix daily. . # mr: likely contributing to her fragile fluid balance and heart failure. she was hypertensive on admission. we innitially were able to decrease her afterload with intubation and peep, but after extubation, her bps were around 150s. we restarted a low dose acei for her. blood pressure was in the 110s to 120s afterwards. . # afib: patient was initially found to have afib when she had appendicitis a year ago. she was not anticoagulated. patient was in persistent afib with rvr in micu, so heparin drip was started, and patient had a cardioversion after tee showed no thrombus. she was started on coumadin for bridging. she was very sensitive to coumadin, inr was supratherapeutic after only 3 doses of coumadin (3mg, 3mg, 1mg), so coumadin was held. the plan is to re-start the patient's coumadin once inr < 3. she was also loaded with amiodarone 400mg for 7 days, followed by 200mg for 7 days (), and will start to take 200mg daily from . after patient was transferred to cardiology service on , she was started on low dose 12.5mg metoprolol tid after she had 2 episodes of atrial tachycardia. she was doing better in the next few days. however, she was noted to be in junctional rhythm with a heart rate of 30s-40s, and sbp in the 80s on . it is likely that after 6 days of amiodarone on board, she was finally seeing the effect of amiodarone. in the mean time, she was on beta blocker. both amio and bb had a suppressive effect on the sinus node, and probably she has some intrinsic nodal disease and the combination of all three caused her to go into junctional rhythm. she had some retrograde p waves on ekg, rp interval was prolonged, suggesting she not only has sinus nodal disease but also has av block. because of this bradycardia and hypotension, she was obseved overnight at ccu off beta blocker, and was doing well, so was transferred back to cardiology. patient was off beta blocker during the rest of her hospital stay. . # diabetes mellitus ii: metformin was held when patient was in the hospital, as patient needed imaging and metformin can cause elevated lactate. she was put on sliding scale humalong, and her blood glucose was well controlled. . # hypertension: low dose lisinopril was restared after extubation. patient's blood pressure was stable during this hospital stay. . # hyperlipidemia: home statin was continued. . # lactate: in the ed, lactate was 3.4. it was most likely due to poor tissue perfusion as a result of decompensated heart failure vs metformin effect. unlikely due to infection as patient had no sign of infection. metformin was held during this hospital stay. lactate returned to with 3l ns ivfs in ed. . # postive blood culture: blood culture from the emergency room grew coagulase negative staphylococcus in tubes, however patient had no sign of , this was thought most likely to be contamination. patient was on vanc initially which was discontinued. patient was afebrile and had no sign of during this hospital stay. . # anemia: hct was around 33-35, stable during this hospital stay. patient was found to have coffee grounds in ngt in micu, question tee esophageal trauma. patient was put on pantoprazole 40 mg iv q12h, then was on po pantoprazole. as a precaution, active type and screen were maintained, but patient did not require any blood transfusion. . # hypokalemia: patient had k of 3.0 after being transferred to floor. question lasix effect. beta-blocker could also decrease extracelluar k. patient was not vomiting, so unlikely losing k from gi tract. k was repleted with appropriate bump. . # osteoporosis: patient is on weekly fosamax. . # h/o gout: patient had no gout symptoms during this hospital stay. . patient had picc line in place as she had very difficult iv access. her code status was full after discussion with her daughter. medications on admission: alendronate 35 mg tablet weekly (friday) atorvastatin 10 mg daily furosemide 20 mg tablet daily lisinopril 10 mg tablet daily metformin 500 mg tablet sustained release 24 hr daily metoprolol succinate 50 mg daily polyethylene glycol 17 gm daily aspirin 81 mg tablet daily calcium 500 mg tablet daily multivitamin daily discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 2. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*28 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days: day 1: day 7: . disp:*14 tablet(s)* refills:*0* 5. amiodarone 200 mg tablet sig: one (1) tablet po once a day: starting on . disp:*30 tablet(s)* refills:*2* 6. metformin 500 mg tablet sig: one (1) tablet po once a day. 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed for constipation. 9. calcium 500 mg tablet sig: one (1) tablet po once a day. 10. multivitamin tablet sig: one (1) tablet po once a day. 11. fosamax 35 mg tablet sig: one (1) tablet po once a week: on fridays. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 14. coumadin 1 mg tablet sig: one (1) tablet po at bedtime: please start once inr < 3. 15. outpatient lab work inr check. please check inr daily. once < 3, restart coumadin discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: - acute on chronic diastolic heart failure - atrial fibrillation treated with cardioversion secondary diagnosis: - hypertension - hyperlipidemia - mod-to-severe mr - mod-to-severe tr discharge condition: stable, afebrile. discharge instructions: it was a pleasure to be involved in your care, ms. . you were hospitalized to because of shortness of breath. you have a diagnosis of heart failure that caused you to have too much fluid in your lungs. you were treated with a medicine called "lasix" which removed fluids from your lungs. your symptom significantly improved on this medication. you were also found to have an abnormal heart rhythm called "atrial fibrillation", and you underwent a procedure called "cardioversion" which stopped the bad rhythm. your medications have been changed. -- please discontinue metoprolol succinate -- please take 5mg lisinopril daily instead of 10mg daily -- please take amiodarone 200mg twice a day from to , thereafter take amiodarone 200mg once a day -- please continue to take lasix 20mg daily please follow up with your doctors below. if you develop worsening shortness of breath, chest pain, palpitations, leg swelling, dizziness or any other symptom that concerns you, please call your doctor or come back to the emergency department immediately. followup instructions: you have an appointment with your cardiologist dr. on at 10:30am. please make an appointment to see your primary care doctor dr. , . md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart diagnoses: other primary cardiomyopathies other iatrogenic hypotension anemia, unspecified mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled gout, unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases unspecified glaucoma atrial flutter hypopotassemia other and unspecified hyperlipidemia acute respiratory failure osteoporosis, unspecified other postprocedural status dehydration tricuspid valve disorders, specified as nonrheumatic 

Answer: The patient is high likely exposed to