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: olanzapine attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 82m hx severe dementia, dm, chf, pvd (stent x2, most recent ), reported recent nstemi on , recent admission from for a fib with rvr and acute chf exacerbation who p/w shortness of breath. today, the patient was noted to have increased work of breathing starting around noon time with o2 sats in the 70s-80s. he was started on supplemental oxygen and given lasix 40mg iv x2, 80mg x2 with metolazone 5mg x2, however did not urinate well to these boluses, only putting out ~450cc over a 12 hour period. he continued to have shortness of breath and was started on bipap, then sent to the ed for further evaluation. of note, he has received 3 prbc transfusions over the past week, most recently 2 on wednesday - it is unclear what the reason for these transfusions is. per report, he was receiving heparin sc until at least wednesday. . in the ed, initial vitals were not recorded. he was continued on bipap, had a cxr which was essentially unchanged from previous, ekg without ischemic changes. labs showed elevated cr to 2.0, hct up to 31, trop of 0.08, and bnp of 23,000. blood cultures x2 were also drawn, a ua showed mod. leuks and few whites/bacteria. vitals on transfer were: 74 110/58 20 bipap 10/5 100% --> o2 sat 100%. . on the floor the patient is unable to answer questions or follow commands secondary to severe dementia. . ros unable to be obtained severe dementia. past medical history: pmh: - dementia - alzheimers - bipolar (hx of hypersexual behaviour) - type 2 dm - aka - cad, history of mi - chf (ef 30%) - hypertension - hyperlipidemia - pvd - hx of tia/cva (left frontal, right occipital, right basal ganglia - severe dysphagia s/p g-tube - recurrent aspiration pneumonia - andemia - chronic nausea - ulceration of right big toe - c diff, vre, mrsa psh: right lower extremity diagnostic angiography () left above knee amputation () cholecystectomy social history: born in , never married, 2 adult children with minimal involvement. history of 2ppd x 40 years, quit ~15-20 year ago. non-ambulatory, incontinent of bowel/bladder. dependent of all adls. sister is hcp ; . family history: noncontributory physical exam: admission physical exam: general: nad. oriented to name only. heent: ncat. sclera anicteric. perrl, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: jvp to middle of neck cardiac: regular rhythm with frequent pvcs, normal s1, s2, no m/r/g lungs: exam limited by patient cooperation - crackles noted up lung field on right on posterior exam abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . physical exam: vitals - tm/tc:98.8/97.4 hr:72-81 bp:122-139/65-70 rr:16-18 02 sat:95% 3l np weight: 87(88.1 ) tele: sr with freq pvc's. fs: general: 82 yo m in no acute distress, lying in bed. heent: mucous membs dry, no lymphadenopathy, jvp at 16 cm chest: ctabl anterior, no wheezes, no rales, no rhonchi cv: s1 s2 normal in quality and intensity, slightly irregular, no murmurs rubs or gallops abd: firm, mildly tender to palpation. non-distended, bs normoactive. ext: wwp, no edema. dps, pts trace neuro: 3/5 strength in u/l extremities. skin: no rash, mult ecchymoses, midline right ue psych: alert, calm. pertinent results: - ecg: sinus rhythm at 73 with pvcs. no acute ischemia. . - echo : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. there is mild (non-obstructive) focal hypertrophy of the basal septum. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. 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. the mitral valve leaflets are myxomatous. there is mild posterior leaflet mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the mitral and tricuspid regurgitation are increased. . cxr: findings: there is mild cardiomegaly. the aorta is tortuous and calcified. the mediastinal and hilar contours appear unchanged. there is a similar mild interstitial abnormality with prominence of central pulmonary vascularity, suggesting mild vascular congestion. in addition, patchy streaky opacities in the right mid and lower lung suggest a background of minor scarring or atelectasis. although evaluation is limited, there is no definite pleural effusion. no pneumothorax is demonstrated, although it is noted that the left lung apex is obscured by a flexed chin. impression: essentially stable findings suggesting mild pulmonary vascular congestion. . admission labs: 09:20pm blood wbc-9.0# rbc-3.64*# hgb-10.1*# hct-31.2*# mcv-86 mch-27.8 mchc-32.4 rdw-17.8* plt ct-135* 09:20pm blood neuts-74* bands-0 lymphs-12* monos-13* eos-0 baso-1 atyps-0 metas-0 myelos-0 09:20pm blood pt-10.8 ptt-30.2 inr(pt)-1.0 09:20pm blood glucose-157* urean-74* creat-2.0* na-139 k-4.4 cl-94* hco3-39* angap-10 09:20pm blood ld(ldh)-185 ck(cpk)-20* 09:20pm blood probnp-* 09:20pm blood ctropnt-0.08* 09:20pm blood calcium-9.1 mg-2.5 09:20pm blood hcg-<5 brief hospital course: 82m hx severe dementia, dm, chf, pvd, recent nstemi, af/rvr and chf admitted with chf exacerbation. . # acute on chronic diastolic chf- patient appeared mildly clinically volume overloaded on admission, with crackles, mildly elevated jvp (although does have tr), mild hip edema. cxr showed mild pulmonary congestion, and bnp elevated supporting congestive etiology. also considered aspiration pneumonitis (although no new x-ray findings), pe (although was on heparin until wednesday per report, not tachycardic, and responded to bipap), and acs (although negative ekg and enzymes). etiology of chf exacerbation unclear given no e/o infection, acs, tachycardia, htn, diet/med noncompliance. patient required bipap in ed, which was successfully discontinued 20 minutes after arrival in ccu. called out of ccu once weaned off bipap. patient initially started on lasix gtt and metolazone, then switched to iv lasix. his home meds (isosorbide, hydralazine) were continued for afterload reduction given mr. , he was started on torsemide 20mg po daily. weight 88 kg. . # cad: stable and without signs of acs on ekg/enzymes. patient is not on plavix, it seems that this is gi bleeds in the past. continued home asa and metoprolol. . # dm: continued glargine and sliding scale per rehab recs. . # severe dementia: aspiration and fall precautions. continued home sertraline. . ==================================== transition of care: -patient will need continued diuresis in rehab -goals of care discussion should occur in outpatient setting asap medications on admission: 1. aspirin 81mg daily 2. chlorhexidine 15ml 3. insulin lantus 28units qhs, 13 units qam 4. insulin regular sliding scale 5. isosorbide dinitrate 10mg tid 6. metoprolol tartrate 50mg 7. miconazole nitrate 2%pwd 8. omeprazole 40mg daily 9. sertraline 150mg daily 10. hydralazine 20mg tid 11. albuterol nebs q6prn 12. atrovent nebs q6prn 13. lactulose 15gm 14. ondansetron 4mg q8hrs prn nausea 15. furosemide 20mg po medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. chlorhexidine gluconate 0.12 % mouthwash sig: fifteen (15) ml mucous membrane (2 times a day). 3. insulin glargine 100 unit/ml solution sig: twenty eight (28) units subcutaneous at bedtime: 13 units before breakfast. 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for sob, wheeze. 5. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. isosorbide dinitrate 20 mg tablet sig: one (1) tablet po tid (3 times a day): hold sbp < 100. 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold sbp < 100, hr < 60. 8. miconazole nitrate 2 % powder sig: one (1) application topical twice a day. 9. omeprazole 2 mg/ml suspension for reconstitution sig: forty (40) mg po once a day. 10. sertraline 50 mg tablet sig: three (3) tablet po daily (daily). 11. hydralazine 10 mg tablet sig: two (2) tablet po tid (3 times a day): hold sbp < 100. 12. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po bid (2 times a day). 13. ondansetron 4 mg iv q8h:prn nausea please give with tube feeds 14. ciprofloxacin 250 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 9 days: total of 10 days ofr complicated uti. tablet(s) 15. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. normal saline flush 0.9 % syringe sig: three (3) cc injection every eight (8) hours. 17. furosemide 10 mg/ml solution sig: 20-40 mg injection twice a day as needed for for weight gain or sob. disposition: extended care facility: for the aged - macu diagnosis: acute on chronic diastolic congestive heart failure diabetes mellitus type 2 demientia dysphagia s/p g tube condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. instructions: you were admitted for an acute exacerbation of congestive heart failure and required intravenous lasix to get rid of the extra fluid. your medicines were changed from furosemide to torsemide for better absorption. daily weights are needed. please report weight gain of more than 3 pounds in 1 day or 5 pounds in 3 days. . 1. increase isosorbide dinitrate to 20 mg tid 2. change furosemide to torsemide for diuresis. 3. start ciprofloxacin for a 10 day course to treat urinary tract infection 4. saline flushes for midline. followup instructions: pcp after pt leaves the macu procedure: enteral infusion of concentrated nutritional substances diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute on chronic diastolic heart failure percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance bipolar disorder, unspecified atherosclerosis of native arteries of the extremities, unspecified subendocardial infarction, subsequent episode of care gastrostomy status above knee amputation status other late effects of cerebrovascular disease, dysphagia dysphagia, unspecified 

Answer: The patient is high likely exposed to