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: percocet / cefaclor / monopril / ciprofloxacin / iodine / antihistamine / ambien attending: chief complaint: presented for upgrade to biventricular pacer, transferred to ccu for management of cardiogenic shock major surgical or invasive procedure: catherization for upgrade of biventricular pacer history of present illness: 85 yo m with hx of af & chb s/p ppm (), generator change (), cad s/p cabg () & multiple coronary/renal/peripheral stents, ischemic cm (ef 35%) who presented for resynchronization with upgrade to biventricular pacer given recently worsened ef and chf symptoms. during the procedure he underwent balloon venoplasty of his obstructed svc, and became increasingly agitated requiring more sedation. he was intubated, became hypotensive with bps droppng to systolic 60s, and started on multiple pressors. emergent echo showed no tamponade, but decreased cardiac function likely cardiogenic shock. per report, he went into pea and received cpr x 8 minutes, 1 of atropine, 2 of epi, and regained spontaneous circulation. given he had instrumentation of both the svc and pulmonary artery, with hemoptysis during intubation, there was concern for hypovolemia secondary to blood loss (? into mediastinum versus pulmonary hemorrhage). hct was checked and 25 (5 pt drop). he received two units prbc. he received 1g vanc in setting of getting multiple urgent lines. cxr was negative for ptx. he was placed on a ballon pump with subsequent improvement in his pressures (map 70s-80s) and transferred to the ccu on levophed and epinephrine. . in the ccu he was given 80 of iv lasix and started on a lasix gtt. hct's were checked q2hrs, and because they were stable he was started on a heparin gtt (given the balloon pump). he was hypothermic and had a lactate of 10. his abgs were monitored and vent settings optimized. he was weaned off epinephrine. family was updated. . unable to obtain ros clinical status- intubated and non-responsive. past medical history: cad, cabg in multiple stents - pvd renal and peripheral stents turp bilateral hernia repair carotid stenosis less than 60% on right ica, less than 40% left ica on pneumonia/bronchitis memory problems of hearing, cannot hear in left ear at all, hearing aide right ear social history: -unable to obtain family history: -unable to obtain physical exam: vs: 94, 80 (v paced), 112/40, 20, 92% general: intubated, not responding to verbal, tactile, noxious stimuli heent: atraumatic, per @ 7 mm, non-reactive (hx of b/l cataract ) cardiac: rrr (paced) unable to appreciate any murmurs, + pads lungs: diffuse rales abdomen: soft, unable to appreciate bs over iabp extremities: no edema, unable to palpate or doppler pulses pertinent results: tte poor image quality. the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is probably moderately depressed (lvef= 30 %). there is no ventricular septal defect. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . eeg impression: this long-term eeg showed an encephalopathic background throughout. the background was slow and of low voltage. there were no prominent focal abnormalities. there were no epileptiform features. . eeg impression: this long-term eeg showed an encephalopathic background throughout. the background was slow and of low voltage. there were no prominent focal abnormalities. there were no epileptiform features. . eeg this eeg telemetry with video showed a low voltage mildly slow background throughout, without any evidence of seizures or epileptiform discharges. the low voltage very regular background indicates a widespread encephalopathy. some of the more rhythmic features raise the possibility of medication effect. there were no focal abnormalities or epileptiform features. . eeg impression: this telemetry showed a markedly encephalopathic background throughout. there were no clearly epileptiform features or electrographic seizures. there was frequent movement artifact, and some of this appeared to be large amplitude movements, possibly as part of an abnormal respiratory pattern. also, there were some sudden jerks of the head to the left, possibly myoclonic, but without associated epileptiform features on the eeg, and at a frequency of under one every three seconds. there were no clear seizures. . eeg this telemetry captured no pushbutton activations. the background was slow throughout, with additional bursts of generalized slowing. these findings indicate a widespread encephalopathy affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there were no areas of prominent focal slowing. there were no clearly epileptiform features, and there were no electrographic seizures. . ct head without contrast impression: 1. no acute intracranial process on ct. 2. extensive subcortical white matter hypodensities; could be related to chronic small vessel ischemic changes. . ct head without contrast impression: 1. no acute intracranial process. 2. increased mucosal thickening within the sphenoid sinus could represent an ongoing inflammatory process. . right upper quadrant ultrasound 1. cholelithiasis, without specific son evidence of acute cholecystitis. no biliary ductal dilation. 2. extensive aortic atherosclerotic disease, with linear echogenic focus within the mid abdominal aorta possibly representing a dissection flap of indeterminate chronicity. 3. bilateral renal cysts. 4. right pleural effusion. . abdominal xray nonspecific bowel gas pattern with no evidence of obstruction . cxr persistent bilateral pneumonia, or resuscitation-related lung contusion. worsening pulmonary edema. . lower extremity non invasive ultraound impression: no evidence of dvt in both lower extremities. . upper extremity impression: cephalic vein thrombosis. the deep veins of the right upper extremity are patent. . cxr the patient is intubated, the tip of the endotracheal tube projects approximately 2 cm above the carina. right pectoral pacemaker, no evidence of pneumothorax. correctly positions. . cxr endotracheal tube is in standard placement. clear definition of the upper aspect of the cuff indicates pooled secretions above. heart size is top normal, decreased since . pulmonary vascular engorgement has also improved, indicating improved cardiac function. left lung is clear. right lung base is partially obscured by pleural effusion, but also appears to have cleared of pneumonia or asymmetric edema. small right pleural effusion persists. there is no pneumothorax. transvenous right atrial, right ventricular, and left ventricular pacer leads are in standard placements unchanged. left pic line tip is partially obscured by pacer leads, but is probably in the mid svc. brief hospital course: hospital course this is an 85 year old gentleman with a history of atrial fibrillation, complete heart block ppm, coronary artery disease cabg & multiple coronary/renal/peripheral stents, ischemic cardiomyopathy who presented for upgrade to biventricular pacer. his procedure was complicated by cardiogenic shock. post operative course was further complicated by pulmonary hemorrhage prolonged intubation and second arrest while having a doboff placed. while the patient never appeared to recover completely after inital cardiogenic shock, his neurological exam notably deteriorated after second arrest. concern for brain stem injury in the setting of absent spontaneous eye movements, and inablity to follow commands. after extensive neurologic work-up and medical management, the patient's family ultimately decided to make the patient comfotable. he passed within 24 hours of extubation with his family at his bedside. . active issues # goals of care: the patient was full code on admission to the cardiac intensive care unit. the patient's wife, step children and ultimately biologic children were present during hospital course. the patient's wife and team were in continual discourse regarding goals of care. ultimately after second arrest and deteriorating neurological status, the patient was made comfort measures only. he was extubated and expired with his family by his side. . # cardiogenic shock: unclear precipitant for intra-operative pea arrest, but likely related to baseline low ef and poor reserve and likely intra-operative complication of pulmonary hemorrhage secondary to pulmonary artery - left main stem fistula. cardiac biomarkers were not consistent with acute mi. an emergent echocardiogram was negative for tamponade and revealed severely depressed cardiac function. the patient was started on multiple pressors, and an iabp was placed with subsequent improvement in his pressures with maps in the 70s-80s. on time of transfer to the ccu he was on levophed and epinephrine for pressure support, which were slowly weaned during his hospital stay. he was started on a lasix gtt for diuresis with subsequent good urine output. tte revealed ef 30%, right ventricular cavity dilation and depressed free wall contractility, severe tricuspid regurgitation, and moderate pa systolic htn. his pressures improved and the iabp was discontinued. from a cardiac stand point the patient initially did well, was diuresed and off pressor support. several days post extubation, the patient traveled to interventional radiology for placement of dohboff for initiation tube feeds. procedure was complicated by arrest, the patient was reintubated, cpr was initiated, the patient received two rounds of epinephrine and levophed and dopamine were started. once stabilized, ionotropic support was quickly weaned off and the patient required intermittant pressor support for the duration of his hospital stay. . # pulmonary hemorhage: initially, there was concern for hypovolemic shock secondary to blood loss given instrumentation of svc and distal pulmonary arteries. additionally, he was noted to have hemoptysis during intubation. a repeat hct revealed a 5 point drop. he was given a total of 3 units of prbc, and serial hcts were monitored. once stable, the patient was started on a heparin gtt given his iabp. he continued to have gross blood suctioned from his et tube. his balloon pump was discontinued allowing heparin to be discontinued. pulmonary was consulted for bronchoscopy, which revealed a large amount of blood and active bleeding in the left mainstem, endotracheal tube was selectively placed into the right mainstem. ip was consulted for possible intervention. ir was consulted for possible angio embolization, who recommended cta chest and aortogram which were deferred given the patient was not stable. overnight, off heparin the patient did well, and only old blood was suctioned from et tube therafter. the endotracheal tube was replaced to proper position. . # fever: the patient was febrile to 102 a few hours after admission to the ccu. he was pan-cultured. he had received 1g of vancomycin in the cath lab given the mutiple emergent lines placed in non-optimal sterile technique. vancomycin was continued and cefepime/flagyl were added to cover for a possible aspiration event and he completed an 8 day course. after second arrest, the patient developed persistent fevers without localizing source of infection. etiology initially felt to be likely pulmonary hemorrhage. after several days of persistent fevers, and interval development of hypotension requiring intermittant pressor support, the patient was empirically started on vancomucin and zosyn. . # neurologic impairment: after inital arrest, the patient was followed by neurology. his neurologic exam continued to improve. eeg findings were significant for a slow background without any evidence of seizures or epileptiform discharges. indicates a widespread encephalopathy. a non contrast head ct was consistent with extensive subcortical white matter disease, unclear how much secondary to prior ischemia versus current event. post extubation, the patient demonstrated continued improvement, he was responsive to command, intermittantly arousable, with garbled speech and not oriented. after second arrest and re-intubation a repeat eeg demonstrated again slow low voltage background, with additional bursts of additional slowing indicative of widespread encephalopathy affecting both cortical and subcortical structures. off sedation for several days, his exam was notable for intact brainstem reflexes and purposeful movements of his extremities. however the patient was no longer responsive to commands and appeared to have no spontaneous eye movements with eyes in slight upgaze. a repeat non contrast head ct was unchanged. however, in the setting of eye exam and inability to respond to commands several days off sedation there was significant concern for brainstem injury not visualized on ct. . # coronary artery disease / peripheral vascular disease: history of multiple stents in coronary, renal, peripheral arteries. cardiac biomarkers show mildly elevated trop, but flat ck and ckmb making an ischemic event unlikely. he was continued on aspirin and plavix which were discontinued in the setting of pulmonary hemorrhage. . # systolic congestive heart failyre: ischemic cardiomyopathy. last echo with ef of 35%, echo performed during cath showed severely depressed global function. most likely etiology for hypotension is cardiogenic shock. a repeat echo demonstrated an ef of 30%, right ventricular cavity dilation and depressed free wall contractility, severe tricuspid regurgitation, and moderate pa systolic htn. his pressures improved and the iabp was discontinued. . # rhythm: underlying rhythm is atrial fibrillation and complete heart block with evidence of ventricular pacing. the qrs complexes on ekg are not consistent with biventricular pacing. it is likely that the leads became displaced during his acute decompensation (described in hpi). he was monitored on telemetry. as an outpatient he had been on asa and plavix for anticoagulation. we continued his aspirin which was discontinued in setting of pulmonary hemorrhage. . # chronic renal insufficiency: creatinine on presentation was 2.4 with unclear baseline. the patient likely experienced insult to his kidneys during hypotension; however, his creatinine remained relatively stable at 2.0 in the setting of intial diuresis and then second arrest. . # metabolic acidosis: the patient initially presented with an anion gap acidosis in the setting of elevated lactate (10 on admission) from cardiogenic shock. the acidosic improved with bicarbonate and increased ventilation. he later developed a hyperchloremic non anion gap metabolic acidosis with acidemia from mixed respiratory acidosis in the setting of multiple normal saline based gtts (midazolam and precedex) and normal saline boluses during second arrest. he was given lactate ringers with resolution of his acidemia. . # hypertension: outpatient antihypertensive medications held in setting of cardiogenic shock. . # hyperlipidemia: held in setting of cardiogenic shock. . # elevated blood glucose: the elevated blood glucose levels: the patient was started on an insulin sliding scale. no history of diabetes. . # nutrition: the patient was started on total parenteral nutrition in the setting of prolonged intubation. after extubation, a dobhoff was attempted to be placed by both the ccu team and ir which was complicated by arrest. tpn was restarted post arrest and re-intubation. general surgery was consulted for placement of peg tube, however procedure never performed as patient persistently febrile and unstable. . transition of care the patient expired. medications on admission: acetaminophen-codeine - 300 mg-30 mg tablet - 1 tablet(s) by mouth as needed for arthritis pain allopurinol - 100 mg tablet - 1 tablet(s) by mouth once a day alprazolam - 0.25 mg tablet - 1 tablet(s) by mouth at bedtime amlodipine -10 mg tablet -1 tablet(s) by mouth once daily (to be held) atenolol - 50 mg tablet - 1 tablet(s) by mouth twice a day bumetanide - 2 mg tablet - 1 tablet(s) by mouth daily clopidogrel - 75 mg tablet - 1 tablet(s) by mouth daily isosorbide mononitrate - 120 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day nitroglycerin 0.4 mg tablet, sublingual - 1 tablet(s) sublingually as needed for chest pain pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day ranolazine - 500 mg tablet sustained release 12 hr - 1 tablet(s) by mouth twice a day rosuvastatin - 20 mg tablet - 1 tablet(s) by mouth once a day sertraline - 50 mg tablet - 1 tablet(s) by mouth once a day spironolactone 50 mg tablet -1 tablet(s) by mouth daily . medications - otc aspirin - 81 mg tablet - 1 tablet(s) by mouth once a day ferrous sulfate - - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth daily magnesium hydroxide - 400 mg/5 ml suspension - 1 by mouth at bedtime discharge medications: the patient expired. discharge disposition: expired discharge diagnosis: the patient expired. discharge condition: the patient expired. discharge instructions: the patient expired. followup instructions: the patient expired. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) other bronchoscopy other intubation of respiratory tract implant of pulsation balloon cardiopulmonary resuscitation, not otherwise specified implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system procedure on single vessel diagnoses: other primary cardiomyopathies congestive heart failure, unspecified acute posthemorrhagic anemia cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status accidental puncture or laceration during a procedure, not elsewhere classified chronic kidney disease, unspecified other nervous system complications other and unspecified hyperlipidemia hemorrhage complicating a procedure acute respiratory failure atrioventricular block, complete cardiac arrest anoxic brain damage cardiogenic shock compression of vein cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other encephalopathy do not resuscitate status hyperosmolality and/or hypernatremia ventilator associated pneumonia acute on chronic systolic heart failure chronic lymphoid leukemia, without mention of having achieved remission mixed acid-base balance disorder acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to