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: hydrochlorothiazide / demerol / ambien / strawberry / wheat bran / hydrochlorothiazide / aldactone / inspra attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation history of present illness: 63m with cad s/p cabg (), severe ischemic cardiomyopathy (ef 20%), s/p biv/icd, dm2, htn, osa, recently started on coumadin for l apical thrombus during recent hospitalization at (/09), sent in from vascular clinic to ed with increased sob, n/v, and fatigue, dry cough x 2 days. had dyspnea overnight more than baseline orthopnea ( pillows at home). wife notes likely dietary indiscretion 2 days prior. . patient had recent admission to /09 for fatigue, body aches, and dyspnea. found to have worsening ef by echo, and apical thrombus for which he was started on coumadin. discharged on increased dose of and 5 day course of levofloxacin for empiric tx of bronchitis/pna. . today in ed, initial vitals were t99.8, hr91, bp174/113, rr30s, o2 sat 88% -> mid 90s on nrb. diaphoretic, found to be in respiratory distress, worried about persistent tachypnea -> intubated with etomidate/succ/midazolam. denied chest pain at this time. cxr consistent with fluid overload. ecg showed v pacing, unchanged from prior. given rectal asa, sl nitro, started on nitro gtt. bedside echo showed mild left ventricular hypertrophy with marked ventricular dilation and severe global hypokinesis. mild to moderate mr, mild pulm htn. no obvious lv clot but cannot be excluded. 1st set enzymes negative, bnp 1095. cards consult called, plan for admit to ccu for likely decompensated heart failure. planned for , but not given due to low bp. foley placed, 100cc urine output on own. vitals on transfer were hr60, 97/53, rr20, o2 100%, vent settings cmv, tv 500, fio2 80, peep 5. . on arrival to ccu, patient sedated, but able to respond to questions appropriately, denied chest pain. able to recognize family. . full ros unable to be obtained as patient intubated with sedation but denies any chest pain, hemoptysis, changes in bowel movements. had 1 day of cough without sputum. . cardiac review of systems is notable for absence of chest pain, palpitations, syncope or presyncope. past medical history: . cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: -cabg: cad, s/p cabg (4 vessel cabg on (lima to lad, svg to om, ramus, rca); ischemic cardiomyopathy (ef 15-25%) -pacing/icd: biv pacer for ventricular arrhythmias 3. other past medical history: 1. htn 2. prostatitis 3. melanoma s/p excisions 4. dm2 5. afib in past, prior to biv pacer 6. gerd 7. gout 8. sleep apnea 9. s/p hemorrhoidectomy 10. bilateral iliac artery aneurysm s/p repair (), infrarenal aaa of 3 cm s/p repair 11. hypertensive cardiomyopathy 12. hypercholesterolemia 13. cervical radiculopathy 14. recurrent pna social history: he lives with his wife in . -tobacco history: ex-smoker, with 40 pack-year smoking history -etoh: none, with no history -illicit drugs: none family history: father with mi in 50s physical exam: vs: t= 98.9 bp= 114/53 hr= 65 rr= 16 o2 sat= 100% on cmv tv 500, fio2 100, peep 5 general: middle aged man intubated, sedated, able to wake up with verbal stimulation and answer questions by nodding appropriately heent: ncat. sclera anicteric. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 15 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 heard lungs: rhonchorous anteriorly abdomen: soft, obese, possible fluid wave, nt. no abdominial bruits. extremities: 1+ pitting edema to knee, r>l skin: old venous stasis changes bilaterally pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: tte (): the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis (lvef = 20-25 %). the left ventricular apex is heavily trabeculated, and a left ventricular mass/thrombus cannot be excluded. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened. the study is inadequate to exclude significant aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric jet of mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild left ventricular hypertrophy with marked ventricular dilation and severe global hypokinesis. mild to moderate mitral regurgitation. mild pulmonary hypertension. compared with the report of the prior study (images unavailable for review) of , a left ventricular apical thrombus is not definitively seen. a supravalvular aortic membrane is not clearly identified. ekg (): sinus rhythm with ventricular demand pacing. pacemaker rhythm - no further analysis. since previous tracing of , the heart rate has increased. cxr 1v (): in comparison with study of , there is huge enlargement of the cardiac silhouette consistent with cardiomyopathy. however, there has been substantial increase engorgement of pulmonary vascularity consistent with the clinical impression of superimposed congestive failure. pacemaker device remains in place. cxr 1v (): significant interval improvement in pulmonary edema has been demonstrated which is almost completely resolved. left retrocardiac opacities are most likely due to atelectasis rather than residual pulmonary edema. cardiomegaly is severe and unchanged. the position of the biventricular pacemaker leads is unchanged. there is small most likely bilateral pleural effusion, decreased since the prior study. tte (): there is an apical left ventricular aneurysm. there is severe global left ventricular hypokinesis (lvef = 20 %). no masses or thrombi are seen in the left ventricle. there is no pericardial effusion. impression: no apical thrombus. wbc-6.9 hgb-10.9* hct-34.6* mcv-82 plt ct-121* neuts-79.5* lymphs-13.4* monos-4.4 eos-2.3 baso-0.4 pt-22.5* ptt-35.5* inr(pt)-2.2* glucose-78 urean-39* creat-2.2* na-145 k-3.3 cl-102 hco3-33* alt-41* ast-40 ld(ldh)-278* ck(cpk)-138 alkphos-126* totbili-0.9 lipase-79* ctropnt-0.01 > 0.04* > 0.04* probnp-1095* digoxin-1.0 ck(cpk)-138 > 105 > 102 brief hospital course: 63 year-old male with coronary artery disease, dilated cardiomyopathy (ef 20%) status-post biv/icd, diabetes mellitus type ii, hypertension, obstructive sleep apnea, recently started on coumadin for left apical thrombus admitted with respiratory distress secondary to decompensated heart failure. hospital course was as follows. 1. respiratory failure: patient was intubated in emergency department for tachypnea, hypoxia. decompensated heart failure was most likely underlying etiology given exam consistent with fluid overload, fluid congestion on chest radiograph, elevated bnp, and recent history of dietary noncompliance. patient was diuresed and extubated within hours of admission to ccu. 2. decompensated systolic heart failure: patient with known hypertensive cardiomyopathy followed by dr. in heart failure service. s/p biv/icd interrogated in with no problems. ef 15-20% from recent echo in . exam consistent with volume overload including jvd, crackles, and lower extremity edema. effusions were seen on chest radiograph. recent diet and fluid restriction noncompliance as inciting factor for decompensated heart failure. as above, patient was intubated in ed for hypoxia. nitro gtt was started, and rapidly weaned off in ccu. patient was diuresed successfully with 100mg iv, then downtitrated to 60mg iv and finally 100mg po qam and 60mg po qpm. he was continued on digoxin, lisinopril, beta-blocker. he was given a low-salt diet and fluid restricted, and was counseled on the importance of sodium and fluid restriction. 3. coronaries: known cad s/p cabg. no chest pain or indications of acs. troponin was elevated but ck flat. ecg paced and without evidence of ischemia. he was continued on asa, beta-blocker, ace inhibitor, and statin. 4. rhythm: atrial and ventricular paced (underlying rhythm is sinus brady). on amiodarone for afib in past. patient was continued on amiodarone. he reported having been on coumadin several years ago particularly for atrial fibrillation but had been stopped for an unknown reason. as below, he recently had been restarted on coumadin for a separate reason. 5. recent possible left apical clot: noted on tte at . repeat tte with definity showed no evidence of a clot. coumadin was thus held. 6. diabetes mellitus, type ii: continued home lantus and humalog sliding scale. 7. chronic kidney disease: stable from discharge on . likely related to diabetes, hypertension. 8. dyslipidemia: continued lipitor per home regimen. 9. depression: continued escitalopram per home regimen. **communication: (wife), ( medications on admission: - 60-100 mg daily (discharged on with 100mg daily x 3 days then 80mg daily) -coumadin 5mg, then inr to be checked -s/p 5 day course of levofloxacin (500 mg daily for 5 days on for empiric treatment for bronchitis and pneumonia) -folic acid 1 mg daily -lexapro 20 mg daily, -lisinopril 10 mg daily -allopurinol 200 mg b.i.d. -amiodarone 200 mg daily -aspirin 81 daily -carvedilol 25mg b.i.d. -digoxin 0.125 mcg every other day -lipitor 80 mg at bedtime -klonopin 0.5 mg t.i.d. p.r.n. -flexeril 10 mg p.r.n. -protonix 40 mg b.i.d. -zantac 300 daily -zetia 10 mg at bedtime -lantus 70 units subcutaneous b.i.d. -humalog sliding scale -asa 81mg daily -advair daily -flomax .4mg daily -lexapro 20mg daily discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 2. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 3. escitalopram 20 mg tablet sig: one (1) tablet po once a day. 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 11. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety. 12. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 13. advair diskus 100-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 14. lantus 100 unit/ml solution sig: seventy (70) units subcutaneous twice a day. 15. omega-3 fish oil 1,000-5 mg-unit capsule sig: one (1) capsule po once a day. 16. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. disp:*30 tab sust.rel. particle/crystal(s)* refills:*2* 17. humalog mix 75-25 100 unit/ml (75-25) suspension sig: as per sliding scale units subcutaneous three times a day: before meals. 18. allopurinol 100 mg tablet sig: 1.5 tablets po daily (daily). 19. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 20. furosemide 20 mg tablet sig: five (5) tablet po once a day: early in the morning. disp:*150 tablet(s)* refills:*2* 21. furosemide 20 mg tablet sig: three (3) tablet po once a day: at 1-2pm. 22. omega-3 fish oil 1,000-5 mg-unit capsule sig: one (1) capsule po once a day. discharge disposition: home discharge diagnosis: acute on chronic systolic congestive heart failure diabetes mellitus type 2 transaminitis hypertension discharge condition: hemodynamically stable. maintaining o2 saturation with ambulation, on room air. continues to diurese well. discharge instructions: you had an episode of congestive heart failure where fluid filled up your lungs causing you to be intubated. we aggressively diuresed you with intravenous and transitioned you to oral before discharge. your current weight is 233 pounds. you goal weight is likely around 220-225 pounds or when you are able to lie almost flat to sleep and you have no swelling in your legs. it is very important to follow your low sodium diet and limit your fluid intake to 1500cc per day or about 6 cups of fluid. please also be sure to count the fluid from a popsicle in the daily total. please take your first dose of early in the morning and the second dose about 1-2pm. if you limit your fluids, you should not be up at night to urinate. . medicine changes: 1. warfarin (coumadin): you do not have to continue this as the echocardiogram did not show a clot. 2. furosemide: 100mg in the morning, 60 mg at night 3. please talk to dr. about whether to continue your inhalers . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500cc or 3 poland spring liter bottles followup instructions: primary care: , r. phone: date/time: tuesday at 3:30pm. cardiology heart failure: provider: . phone: date/time: 1:00 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) acute respiratory failure long-term (current) use of insulin automatic implantable cardiac defibrillator in situ acute on chronic systolic heart failure nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to