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: horse/equine product derivatives / calcium channel blocking agents-benzothiazepines / metoprolol attending: chief complaint: dyspnea major surgical or invasive procedure: av nodal ablation with pacemaker placement--. history of present illness: the patient is an 83 yo m with esrd on hd (mwf), h/o a fib and pat, baseline av conduction delay, cad, moderate mr, moderate as who p/w dyspnea. he developed acute shortness of breath after lunch today and called the ems. he denied any syncope, chest pain, palpitations, nausea/vomiting, diaphoresis. he reports worsening orthopnea and couple of episodes of pnd in the past 2 nights. he has poor functional status due to excessive fatigue more than sob. his pedal edema is the same, and he denies any weight gain. he urinates 500 cc per day. he has not missed any dialysis days. he had half a hotdog and puts salt on his food but no more than usual. he takes all his medications as prescribed. he had a cough with clear sputum, no hemoptysis, in last day. no fever, chills, sick contacts. on arrival to the ed, vs were: t 97.4, p 117, bp 210/130, r40, 75% on ra. pt was not able to speak in full sentences. he was started on bipap with improvement and transitioned to nrb with o2 sats of 95-97. he was also started on nitro gtt with improved bp to 120/80s. he also received 20 mg iv lasix with ?response (unable to pass catheter bph). ekg showed atrial fibrillation, noted to be regular at rate of 120s with but no p waves. no ischemic changes on ekg. his shortness of breath has improved but he is unable to eat without desaturating. . on review of symptoms, he denies any deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery. he has back pain but no other myalgias or joint pains. he has some nausea on days off hd in the past week. no vomiting, abdominal pain, black stools or red stools. all of the other review of systems were negative. past medical history: - chronic renal failure on hd x 4 years (thought to be due to obstructive uropathy, kidney stones, bph) - hx moderate (2+) mr, moderate as, mild ai - hx mild lv dysfunction - hx atrial fibrillation and paroxysmal atrial tachycardia - baseline av conduction delay - hypertension - coronary artery disease with old posterior mi on ekg and pmibi in with ef44%, global hypokinesis, no reversible defects. - hx left 4-9th rib fx, left hemothorax - r kidney stone s/p lithotripsy (, complicated by klebsiella uti) - s/p stroke (cerebellar), found on mri, sxs of gait instability - hx gait d/o, hand paresthesias, polyneuropathy, c3/c4 spinal cord compression cerival spondylosis, l median nerve injury - anemia - benign prostatic hypertrophy - headaches - hx of positive ppd, never treated - hx squamous cell and basal cell ca - hsv keratouveitis - ventral hernia - s/p open cholecystectomy - s/p small bowel resection (80-90%) for mesenteric ischemia - s/p umbilical hernia repair - s/p cystocele repair - s/p laminectomy - c/b osteomyelitis - s/p turp social history: patient lives with his wife in . he is a former chief of psychiatry at the . social history is significant for the remote tobacco use, 3ppd x 40 years, quit 20 years ago. he drinks 1 every 2 weeks. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs: t 100.2, bp 127/74, hr 111, rr 30, o2 98% on nrb, wt 78.5 kg gen: older male in mild respiratory distress. alert and oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 7 cm. cv: pmi located in 5th intercostal space, midclavicular line. regular rhythm, tachycardic, systolic murmur best at llsb. no s4, no s3. chest: resp were mildly labored, no accessory muscle use. bilateral crackles way up, decreased breath sounds at l lower lung base. no wheezes. abd: well-healed scars. normoactive bowel sounds. ntnd, no hsm or tenderness. no abdominial bruits. ext: 1+ pitting edema bilaterally. l 3rd toe blue but with intact sensation. palpable thrill over left arm av fistula. skin: no stasis dermatitis, ulcers, scars, or xanthomas. petechial rash on lower extremities. ecchymoses on upper extremities. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: 04:40pm wbc-11.7*# rbc-3.87* hgb-13.7* hct-42.2 mcv-109* mch-35.3* mchc-32.4 rdw-20.9* neuts-89.1* bands-0 lymphs-6.5* monos-3.8 eos-0.3 basos-0.2 hypochrom-normal anisocyt-2+ poikilocy-1+ macrocyt-2+ microcyt-occasional polychrom-occasional ovalocyt-1+ burr-1+ glucose-213* urea n-66* creat-4.7*# sodium-140 potassium-5.8* chloride-99 total co2-22 anion gap-25* . 02:38am blood triglyc-57 hdl-69 chol/hd-2.1 ldlcalc-66 06:20am blood vitb12-816 folate-16.6 . discharge labs: 07:20am blood wbc-8.9 rbc-3.43* hgb-12.1* hct-37.4* mcv-109* mch-35.4* mchc-32.4 rdw-20.0* plt ct-245 glucose-102 urean-28* creat-3.7* na-142 k-4.9 cl-102 hco3-31 angap-14 calcium-9.0 phos-2.7 mg-1.7 . ecg study date of 2:45:08 pm sinus tachycardia. prolonged p-r interval. left axis deviation. probable left anterior fascicular block. possible inferior myocardial infarction, age undetermined. compared to the previous tracing of p waves are now visible, right bundle-branch block has resolved and the rate has increased somewhat. otherwise, no significant difference. . portable tte (focused views) done at 3:43:34 pm there is mild symmetric left ventricular hypertrophy with normal cavity size. overall left ventricular systolic function is severely depressed (lvef= 25-30 %). the inferolateral segments are akinetic. the number of aortic valve leaflets cannot be determined. the aortic valve is not well seen. there is moderate aortic valve stenosis (area 1.0-1.2cm2). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. moderate to severe (3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. . compared with the prior study (images reviewed) of , overall lv systolic function is probably slightly worse. the degrees of aortic stenosis and mitral regurgitation are similar. . ecg study date of 2:33:46 pm atrial sensed and ventricular paced rhythm with left bundle-branch block pattern. compared to the previous tracing of there is now one hundred percent atrial sensing and ventricular pacing. brief hospital course: patient is an 83 yo m with esrd on hd (mwf), h/o a fib and pat, baseline av conduction delay, cad, moderate mr, moderate as who presented with acute shortness of breath on and found to be in chf. . # pump/acute congestive heart failure: the patient appeared to have acute on chronic congestive heart failure with ef of 35% on last echo from . repeat echo this admission demonstrated a ef of 25-30%. he was clinically volume-overloaded on exam and cxr on presentation was consistent with flash pulmonary edema. it was felt that these symptoms were from his elevated blood pressure and prolonged tachycardia. the patient's dyspnea improved on an non-rebreather mask. given his volume overloaded status, the patient underwent urgent hemodialysis with marked improvement on exam as well as his oxygen requirements. the patient was able to demonstrate good oxygen saturation at rest, but during evaluations with physical therapy, the patient consistantly desaturated to the low 80's with ambulation. pt recommended that the patient go to rehab, but the patient disagreed and wished to return home. he was discharged home with a plan for home vna/pt/ot services as well as home oxygen. . # rhythm/atrial tachycardia: the patient and was known to have a history of atrial fibrillation with rvr as well as paroxysmal atrial tachycardia, and he presented with a hr of 117. the patient was previously scheduled for pacemaker placement with av nodal ablation prior to his admission. given the patient's chf symptoms, however, it was felt that the patient would benefit from undergoing the procedure earlier than planned. the patient's home coumadin regimen was held to prepare for the procedure and the patient underwent the ablation and pacer implantation without complications on . post procedure x-ray demonstrated correct lead placement. the patient was noted to be entirely atrial paced per ecg. amiodarone was discontinued. following the procedure, the patient was restarted on his home doses of coumadin. his last documented inr prior to discharge was 1.6. the patient was scheduled for follow-up with his primary cardiologist as well as the device clinic. he was also instructed to have his inr followed by the . . # valves: the patient had a history of moderate (2+) mr, moderate as, mild ai. a repeat echo this admission showed little change in valvular disease. no interventions were made during this hospitalization. . # htn: the patient was noted to be hypertensive 210/130 on presentation to the ed. according to the patient, he was not taking anti-hypertensives at home due to significant drug side effects. he was initially started on a nitro drip for blood pressure control, but this was discontinued following dialysis, which resolved his volume status issues and returned the patient to a normotensive state 130's/50's. . # esrd on hd: the patient initially underwent several rounds of dialysis within the first 3 days of admission after which he resumed his normal 3 day per week hemodialysis schedule. the patient was maintained on his home doses of phoslo, sevelemar, and nephrocaps. . # low grade fever: the patient presented with a cough and low grade fever of 100.2. he otherwise denied any recent symptoms of infection. he was noted to have a mild leukocytosis with neutrophil predominate. chest xray was without obvious infiltrate. urine analysis/culture were notable only for urine cultures positive for >3 species of bacteria, consistent with contamination. blood culture were also negative. other than his initial presentation, the patient was afebrile throughout his hospitalization. medications on admission: pantoprazole 40 mg tablet po q24h aspirin 81 mg po daily calcium acetate 667 mg two (2) capsule po tid w/meals b complex-vitamin c-folic acid 1 mg po daily sevelamer hcl 400 mg po daily lotemax 0.5 % drops one (1) ophthalmic qid trifluridine 1 % drops one (1) drop ophthalmic q4h amiodarone 100 mg po once a day acyclovir 200 mg one (1) capsule po q12h warfarin 2/4 mg po once a day. discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) capsule po once a day. 5. sevelamer hcl 400 mg tablet sig: one (1) tablet po once a day. 6. lotemax 0.5 % drops, suspension sig: one (1) drop ophthalmic twice a day. 7. trifluridine 1 % drops sig: one (1) drop ophthalmic twice a day. 8. acyclovir 200 mg capsule sig: capsule po daily (daily). 9. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 11. warfarin 2 mg tablet sig: two (2) tablet po f,sa,. 12. warfarin 2 mg tablet sig: one (1) tablet po mtwth. 13. oxygen home oxygen 2-4l via np to keep o2 sat> 90% with ambulation. o2 sat in hospital 82% with ambulation on room air. 14. oxygen oximeter to monitor o2 saturations at home. 15. tylenol ex str arthritis pain 500 mg tablet sig: two (2) tablet po four times a day as needed for pain. 16. outpatient lab work please check your inr on friday and call results to dr. , office: , secretary discharge disposition: home with service facility: vna discharge diagnosis: primary: acute on chronic systolic heart failure hypertension atrial fibrillation/atrial tachycardia secondary: end stage renal disease on hemodialysis fever discharge condition: patient is in good condition. his vital signs are stable. discharge instructions: you were admitted to the hospital because you were very short of breath. you had a very fast heart rate (atrial tachycardia), which we believe is the cause of your acute congestive heart failure. you experienced hypertension during this hospital stay, which required a nitroglycerin drip and aggressive dialysis to remove fluid. on , you underwent a procedure where we ablated your av node. we then put in a pacemaker to make your heart continue to beat at a normal rate. . while you were here, we made the following changes to your medications: 1. we discontinued your amiodarone 200 mg daily 2. we started you on tylenol, extra strength, for pain at the pacer site. please take all medications as prescribed. please check your inr tomorrow, and call results to dr. , office: , secretary please keep all previously scheduled appointments. please return to the ed or your healthcare provider immediately if you experience increased shortness of breath, chest pain, nausea, excessive fatigue, chills, fevers, swelling of your legs or feet, or difficulty lying flat. . please adhere to a low-sodium (2 gm/day), low protein, low-fluid (1200 cc) diet, of which information was given to you on discharge. please weight yourself daily in the morning before breakfast and call dr. if you have a weight gain of more than 3 pounds in 1 day or 6 pounds in 3 days. . no lifting more than 5 pounds for six weeks. avoid extreme movements of your right arm such as reaching for objects or tucking your shirt in. please refer to the booklet we gave you on discharge regarding post pacemaker care. no showers for one week. followup instructions: primary care: provider: , md phone: date/time: 3:30 cardiology: provider: , md phone: date/time: at 4:30pm. office will call you with an earlier appt. neurology: provider: , m.d. phone: date/time: 10:30 . device clinic: at 9:30 am. center, . procedure: hemodialysis excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified atrial fibrillation aortic valve disorders personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease personal history of other malignant neoplasm of skin old myocardial infarction personal history of urinary calculi acute on chronic systolic heart failure other late effects of cerebrovascular disease, ataxia 

Answer: The patient is high likely exposed to