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: no known allergies / adverse drug reactions attending: chief complaint: hypotension and poor uop major surgical or invasive procedure: s/p lead extraction and upgrade to biventricular icd history of present illness: briefly, this is a 71 m with a history of cad s/p cabg in complicated by vt in the early recovery period and systolic heart failure (ef ~10%), s/p icd and pacemaker placement who presented to for elective upgrade to a single biv-icd system. he underwent this procedure on which was complicated by bleeding at line insertion site in neck (hematoma at site). otherwise he tolerated the procedure well. he was originally planned to be d/c'd home, but was transferred to the service after becoming hypotensive with systolics in the 60s. he received a 250-cc bolus with ns with some improvement (sbp in 80s-90s). however, he has made very little uop over the next day (foley was removed at ~6:00 am and there was no further uop recorded). in addition, creatinine has increased from 1.3 to 1.9. a bedside echo was performed by the cardiology fellow to rule out effusion or tamponade (none present). given persistently low bps and possible need for vasopressors to maintain uop, he is being transferred to the ccu. . of note, he underwent placement of a ventack p icd in with 2 epicardial sensing leads and 2 epicardial patches. this was changed to a ventak mini- generator in with placement of an svc coil. the svc coil by cxr on is noted to be in the right atrium as opposed to the svc. he has not received any therapies from his icd in 20 years according to dr. note dated . in , the patient subsequently had a st. pacemaker placed in the right subclavian system. he was seen by dr. who recommended left-sided biventricular icd with extraction of the leads done under general anaethesia in the or. . on review of systems, he endorses right wrist pain since his sprain with limited range of motion. also has chest wall tenderness since his procedure. he had a recent syncopal episode after rising to get out of bed in . no recent lightheadedness. he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. no dysuria. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. he does sleep with two pillows at home but states this is to prevent neck discomfort. . on arrival to the icu, he reports that his thinking is clear. denies lightheadedness. denies pain other than with palpation of chest wall. no current sob or other complaints. past medical history: 1. coronary artery disease status post cabg in . 2. ventricular fibrillation 2 weeks postop from the patient's cabg in . 3. placement of ventak p icd in with two epicardial sensing leads and two epicardial patches. (abdominal) 4. replacement of icd with ventak mini-generator as well as an svc coil placed at that time. ; 5. right subclavian pacemaker (st. ). 6. decreased lvef noted to be 15% in . 7. paroxysmal atrial fibrillation. 8. hypothyroid. 9. psoriasis 10. remote kidney stones 11. right arm sprain , now healed social history: married and lives with his wife in , ma. 3 grown sons in the area. retired but formerly worked in refridgeration for . former heavy smoker (up to 2 packs per day) but quit in at time of his mi. no alcohol. no home services. family history: not obtained physical exam: admission exam: vitals: t 98.1, hr 77, bp 90/52, rr 15, 95% on 2l general: nad. oriented x3 (date, place ). mood, affect appropriate/pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink but slightly pale. neck: supple with jvp to 4 cm above the clavicle. has hematoma at right neck over catheter insertion site. cardiac: irregularly irregular rhtyhm, rate in 80s, low pitched systolic murmur loudest at lsb. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. bibasilar crackles present. abdomen: soft, ntnd. no hsm or tenderness. incision site left lower abdomen with no evidence of infection. extremities: no peripheral edema skin: bilateral stasis dermatitis. pulses: 2+ dp pulses bilaterally discharge exam vitals: tm 99.8, hr 73-78, bp 93-117/50-65 (110/65), rr 16-18 o2 sat 95% ra i/o: nr/960 uop since :30 general: nad. oriented x3. mood, affect appropriate/pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva pale. neck: supple. jvp flat. has hematoma at right neck over catheter insertion site. cardiac: rrr, low pitched ii/vi systolic murmur loudest at lsb. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab. abdomen: soft, ntnd. no hsm or tenderness. incision site left lower abdomen with no evidence of infection. extremities: no peripheral edema. skin: bilateral stasis dermatitis. pulses: 2+ dp pulses bilaterally pertinent results: admission labs wbc-6.1 rbc-4.44* hgb-12.5* hct-38.1* mcv-86 mch-28.1 mchc-32.7 rdw-14.7 plt ct-91* neuts-85.1* lymphs-7.6* monos-6.4 eos-0.7 baso-0.2 07/07/11pt-15.2* inr(pt)-1.3* glucose-93 urean-23* creat-1.3* na-142 k-4.1 cl-101 hco3-33* angap-12 calcium-8.7 phos-3.7 mg-2.1 ck(cpk)-41* ck-mb-2 ctropnt-0.04* imaging/studies echo () the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is an inferobasal left ventricular aneurysm. there is severe global left ventricular hypokinesis (lvef = 10 %). with moderate global free wall hypokinesis. there are complex (>4mm) atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. there are filamentous strands on the aortic leaflets consistent with lambl's excresences (normal variant, but other etieologies can not be excluded owing to some thickening of strands and poor visibility). the study is inadequate to exclude significant aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. key findings discussed with procedural team at the time of the exam. echo () the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef <20%). right ventricular cavity size is normal with mild free wall hypokinesis. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. cxr () a single lead follow a normal course from a left-sided battery pack terminating in the region of the right ventricle. an abandoned lead terminating in the region of the right atrium is ligated in the chest wall adjacent to the new battery pack. epicardial pacing wires are unchanged. there is probable small left pleural effusion. there is no pneumothorax. severe cardiomegaly is unchanged. . labs on discharge: 06:45am blood wbc-5.8 rbc-3.16* hgb-9.1* hct-27.1* mcv-86 mch-28.6 mchc-33.4 rdw-14.7 plt ct-105* 06:45am blood glucose-98 urean-27* creat-1.1 na-141 k-3.4 cl-101 hco3-33* angap-10 06:45am blood calcium-8.8 phos-2.6* mg-1.8 brief hospital course: assessment and plan: 71 year old referred for lead extraction and biv icd implant. hypotensive with poor uop and creatinine bump post procedure so transferred to ccu for monitoring. . active issues: # hypotension: pt developed post-procedural hypotension with systolics in 60s. he received a 250-cc bolus with ns with some improvement (sbp in 80s-90s) on the floor but was transferred to ccu for possible pressor therapy. in the ccu, he required 250 cc ns bolus x 6 to maintain his blood pressure but never required pressors. his hypotension was most likely multifactorial due to a combination of blood loss during icd placement procedure, poor po intake, systolic heart failure with poor forward flow, and bp-lowering medications. mental status remained intact with clear thought processes. blood pressure remained 90-100s so his home antihypertensive medications were resumed gradually. at the time of discharege he was on dose of him home carvedilol, losartan, and imdur. he will likely need adjustment in his home medications given that he reports having systolics bp in 80s at home. . # acute renal failure: creatinine increased from 1.3 to 1.9 post-procedure in the setting of 8-point hct drop and hypotension to sbp in 60s at lowest. uop was poor immedicately post procedure with no output following foley removal at 6:00 am. renal failure is likely secondary to hypoperfusion and improved back to baseline within 48 hours. urine output increased appropriately, his cr is now at baseline and he was resumed on his home dose of bumex. . # s/p aicd placement: pt was admitted for elective upgrade to a single biv-icd system. he was treated empirically with vancomycin x 48 hours and will need to continue keflex for a total of 10 days post procedure. his pacemaker was interrogated and found to be working appropriately. he will need follow up in device clinic in 1 week. . # systolic chf: patient has low ef of ~10%. he initally had signs of volume overload with bibasilar rales on exam, likely secondary to the fluid boluses he recevied to maintain his map. he auto-diuresed well and was resumed on his home dose of bumex and 1/2 dose of home carvedilol, imdur and losartan. chronic issues: . # atrial fibrillation: pt remained ventricularly paced during hospitalization. his coumadin dose was increaed to 7.5 daily due to subtherapeutic inr; he will require daily inr checks after discharge until his inr is stable and therapeutic. . # htn: home meds were initally held in the setting of hypotension, were later restarted as above . # hld: continued on atorvastatin . # hypothyroidism: continued home dose levothyroxine . # allergies: chlorpheniramine prn . transitional issues: pt was full code. he will need close follow up wtih cardiology and device clinic in 1 week. he will need to continue taking keflex until . he will need to have his inr checked daily until he is stable and therapeutic. medications on admission: - atorvastatin 20 mg by mouth once a day - bumetanide 2 mg tablet by mouth twice a day - carvedilol 25 mg tablet by mouth twice a day - isosorbide mononitrate 60 mg er 24 hr by mouth once a day - levothyroxine 112 mcg by mouth once a day - losartan 25 mg tablet by mouth twice a day - potassium chloride 20 meq by mouth once a day - warfarin 5 mg by mouth as directed: last dose pre procedure . - chlorpheniramine maleate 4 mg by mouth q 4 hours prn for allergies discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 112 mcg capsule sig: one (1) capsule po daily (daily). 3. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po daily (daily). 4. chlorpheniramine maleate 4 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for allergies. 5. keflex 500 mg capsule sig: one (1) capsule po every six (6) hours for 4 days. 6. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day): hols sbp < 90. 7. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 8. losartan 25 mg tablet sig: 0.5 tablet po at bedtime. 9. bumetanide 2 mg tablet sig: one (1) tablet po bid (2 times a day). 10. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever, pain. 11. docusate sodium 100 mg capsule sig: two (2) capsule po once a day as needed for constipation. 12. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 13. warfarin 2.5 mg tablet sig: two (2) tablet po once daily at 4 pm: mon, wed, fri, sat, sun. 14. warfarin 2.5 mg tablet sig: three (3) tablet po once a day: tues and thurs. 15. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. discharge disposition: extended care facility: health care center discharge diagnosis: s/p lead extraction s/p new biventricular intracardiac defibrillator chronic systolic chf coronary artery disease acute on chronic kidney injury discharge condition: vs: 99.8 tmax, 98.6 t current, bp 93-109/63-67, hr 70's paced, 18, 96% ra cv: rrr, nl s1s2, no m/g/r resp: ls clear anteriorly abd: soft, nontender, + bs ext: right and left chest dressings c/d/i, right incision with moderate ecchymosis noted extending to right axilla and lateral chest wall, no increase from demarcations. both sites tender, no bleeding or hematoma noted. 2+ radial pulses bilaterally, + csm bilateral hands. abdominal steristrips intact, no bleeding or ecchymosis noted. 2+ dp/pt, no pedal edema discharge instructions: it was a pleasure taking care of you at . you had one lead removed and a new biventricular implantable cardiac defibrillator (icd) placed. your blood pressure was low and you needed intravenous fluid boluses to keep your blood pressure up. we have decreased some of your blood pressure medicines, this can be increased again once your blood pressure is higher. no lifting your right arm over your head or lifting more than 5 pounds with that hand for 6 weeks. . we made the following changes to your medicines: 1. you will be on keflex 500 mg every 6 hours for 4 more days to prevent infection at the incision sites. 2. you should decrease your coreg to 12.5mg every 12 hours because your blood pressure was running low while you were in the hospital. 3. decrease imdur to 30 mg and losartan to 12.5 mg because of low blood pressures 4. start senna and colace to prevent constipation 5. start tylenol and oxycodone as needed for pain at the icd site you may have discomfort and bruising at the incision sites, this is normal. if the pain gets worse, if you have fevers, chills or shortness of breath, call dr. or dr. . followup instructions: cardiology: department: cardiac services when: thursday at 9:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 11:00 am with: , np building: campus: east best parking: garage dr. () thurs 1:15 (primary cardiologist) primary care: name: , j address: , , phone: when: monday, :45am procedure: implantation of cardiac resynchronization defibrillator, total system [crt-d] diagnoses: other iatrogenic hypotension congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status hematoma complicating a procedure chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mechanical complication of automatic implantable cardiac defibrillator chronic systolic heart failure surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation personal history of sudden cardiac arrest pain in joint, forearm 

Answer: The patient is high likely exposed to