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: iodine attending: chief complaint: transfer for cath major surgical or invasive procedure: central venous line swan ganz catheter arterial line history of present illness: 76f w hx of cad s/p cabg (lima->lad), s/p multiple pcis, bioprosthetic avr w/ aortic root repair, s/p biv ppm, copd, dm2, presented to on with compaints of increasing dyspnea on exertion and progressive weakness x3-4 weeks. also had intermittent non-productive cough, denied fevers or increased peripheral edema. in the ed at osh, she complained of chest pressure and was noted to have tachycardia. chest pressure located on left upper chest in area of pacemaker, no radiation. was watching television at onset, no known exacerbating or alleviating factors, not associated with inspiration, did not get worse with walking, +/- was worse with moving arms. she was given nitro, asprin, oxygen and morphine. she continued to have progressive dyspnea and persistent chest discomfort with a warm/flushed feeling. due to concern for heart failure, she was given iv lasix 100mg and responded well. there was also concern for rapid afib hr 140s and she was given diltiazem 15mg iv with improvement of heart rate to 100bpm. however, her pacemaker was interrogated at caritas on by dr. , and only showed underlying sinus rhythm. . she was transferred to the icu during which time she had sbp 70s, asymptomatic, improved slowly to sbp 100s after stopping beta blocker and ?lisinopril. maintained oxygen with nasal canula 2-4l, had some tachypneic episodes that responded to cpap. . cardiac biomarkers positive at outside hospital, initially with trop 0.14 and ck-mb of 3.7, placed on heparin drip; trop peaked at 8.11 on . tte showed ef 20-25% with severe global hypokinesis. . at baseline, dyspnea at rest on exertion. at baseline was able to climb 3 stairs and walk around house with cane, able to go out to the restaurant once/week. starting 3-4 weeks ago, was unable to walk up the 3 stairs and could no longer go out, having trouble walking around her house as well. + orthopnea. no pnd. no increased peripheral swelling. no fevers/chills/rigors. intermittent non-productive cough. new urinary urgency and incontinence, but no dysuria. some nausea after eating "feels heavy", no vomitting, no change in stool pattern, no bloody stools. no leg pain. no history of stroke, ? tias. currently no cp or palpitations. continues to feel sob but able to talk in full sentences on 3l. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension . 2. cardiac history: -cabg: (lima->lad) -percutaneous coronary interventions: bms lcx, patent lcx, lad occuled, first dm jailed by lcx stent, patent lima, rca occluded -pacing/icd: . 3. other past medical history: ischemic cardiomyopathy, ef 20-25% by osh echo s/p avr (bioprosthetic) w aortic root repair pseudo-aortic stenosis first noted in history of tia copd anemia - history of gastrointestinal ectasias depression and anxiety arthritis in hands past surgical history cholecystectomy b/l carotid endarterectomy social history: lives with husband, stopped smoking 1 year ago, no etoh, no ivdu, see hpi for baseline status details. has 4 children, 3 of which live in the area, one lives in . family history: mother with heart disease, father died of throat cancer, one brother had a stroke, other brother healthy and well. physical exam: upon admission: vs: t=96.6 bp=117/55 hr 131 rr=20 o2 sat 97% on 3l nc general: wdwn in nad. oriented x3. mood, affect appropriate. slurred speech. skin is pale. heent: ncat. perrl, eomi. conjunctiva were pink. neck: supple with jvp at jaw. no carotid bruits. cardiac: tachy, normal s1, s2. early peaking systolic murmur no radiation to carotids best heart at lusb and llsb, also can hear it at rusb. no gallop or rub. no thrills, lifts. pacer site c/d/i. lungs: kyphosis. anterior wheezing, posterior wheezing cleared with coughing, crackles 2/3 up on right side (patient was lying dependently on right), no rhonchi. poor aeration mostly in area of crackles. abdomen: soft, ntnd. no tenderness. extremities: no c/c/e. cannot palplate le pulses, but feet warm. femoral cath site c/d/i no bruit, no hematoma, no bleeding. skin: various ecchymosis on ue b/l pulses: right: carotid 2+ radial 2+ left: carotid 2+ radial 2+ pertinent results: outside hospital results upon admission: . ekg at osh: rapid afib with intermittent pvcs and intermittent vpaced complexes . cxr at osh: cardiomegaly and chf . osh labs inr 1.2 glucose 190 bnp 912 trop 0.14 (initial) . 2d-echocardiogram at osh (): ef 20-25% w severe global hypokinesis. av peak gradient was 34mmhg, aortic valve mean gradient 18mmhg w trace aortic regurg and a bioprosthetic valve . osh leni: no dvt b/l . labs upon admission . 05:38pm blood wbc-7.9 rbc-3.33* hgb-10.2* hct-32.2* mcv-97# mch-30.7# mchc-31.8 rdw-15.3 plt ct-248 05:38pm blood neuts-95.6* lymphs-2.8* monos-0.8* eos-0.5 baso-0.3 05:38pm blood pt-13.7* ptt-22.9 inr(pt)-1.2* 05:38pm blood glucose-149* urean-42* creat-0.9 na-141 k-4.1 cl-99 hco3-25 angap-21* 05:38pm blood alt-41* ast-43* ld(ldh)-349* ck(cpk)-55 alkphos-159* totbili-0.6 05:38pm blood ck-mb-6 ctropnt-0.26* 04:53am blood ck-mb-38* mb indx-14.8* ctropnt-0.65* 04:14pm blood ck-mb-85* mb indx-14.6* ctropnt-1.42* 05:38pm blood calcium-9.5 phos-4.1 mg-2.2 03:12pm blood type-art po2-70* pco2-37 ph-7.45 caltco2-27 base xs-1 intubat-not intuba 03:12pm blood glucose-154* lactate-2.0 k-4.0 03:12pm blood hgb-10.0* calchct-30 o2 sat-93 . last labs available . 04:48pm blood wbc-12.4*# rbc-2.99* hgb-9.1* hct-28.4* mcv-95 mch-30.3 mchc-31.9 rdw-15.2 plt ct-263 04:53am blood pt-14.9* ptt-25.3 inr(pt)-1.3* 04:14pm blood glucose-164* urean-60* creat-1.7* na-137 k-4.3 cl-99 hco3-21* angap-21* 04:53am blood alt-34 ast-65* ld(ldh)-343* ck(cpk)-257* alkphos-127* totbili-0.6 04:14pm blood ck(cpk)-584* 04:14pm blood calcium-9.0 phos-4.8* mg-2.1 04:17pm blood o2 sat-96 06:12pm blood o2 sat-37 07:41pm blood o2 sat-35 . echo at : the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated with severe global hypokinesis. the basal inferolateral wall contracts best (lvef = 20-25 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal with borderline normal free wall function. a well-seated bioprosthetic aortic valve prosthesis is present. the transaortic gradient is higher than expected for this type of prosthesis. there is critical aortic valve stenosis (valve area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: critical aortic valve prosthesis stenosis. left ventricular cavity enlargement with severe globa hypokinesis. moderate to severe mitral regurgitation. pulmonary artery systolic hypertension. compared with the report of the prior study (images unavailable for review) of , the aortic valve gradient andf pulmonary artery systolic hypertension have progressed. left ventricular cavity size is slightly larger. . cardiac catheterization: at . comments: 1. coronary angiography of this right dominant system demonastrated no new obstructrive coronary artery disease. the lmca has stents present without any obstructive disease. the lad has a total occlusion to the middle portion of the vessel which is then patent with competitive flow filling the vessel. the lcx has stents present that are patent. there is mild disease throughout the vessel, but no obstructive disease. the rca is known to be occluded and wasn't engaged. the right side had collateral flow provided from the left system. 2. graft angiography demonstrated a widely patent lima to mid lad. 3. resting hemodynamics revealed elevated right sided filling pressures with an rvedp of 25 mmhg. pulmonary capillary wedge pressure was severely elevated with a mean pressure of 37mm hg. there was severe pulmonary hypertension present at 76/37 mmhg with a low cardiac index of 2 l/min/m2. final diagnosis: 1. markedly elevated pulmonary capillary wedge pressure, markedly elevated right heart pressures, low cardiac output. 2. no epicardial disease to treat. . ekg : rate 100, sinus tach with ventricular pacing and frequent pvcs. brief hospital course: was a 76 year old female with cad, s/p cabg in , h/o bioprosthetic av replacement, htn, hld, chronic systolic chf, prediabetes, who initially presented to an oustide hopsital on with worsening dypsnea for 3-4 weeks and new onset chest pressure. she was found to have acute on chronic systolic heart failure, sinus tachycardia, hypotension and new nstemi. she was transferred to on for a cardiac catheterization that showed no interval change in her coronary anatomy (no new ischemic lesions), but very elevated left and right sided filling pressures, pulmonary hypertension and decreased cardiac output (pulmonary capillary wedge pressure 45, ra pressure 22, pa pressure 75/7, ci 1.8). an echocardiogram was completed which showed worsened critical aortic valve prosthesis stenosis (she has a history of known pseudoaortic stenosis diagnosed with dobutamine stress at ), progressive left ventricular cavity enlargement with severe global hypokinesis, moderate to severe mitral regurgitation and worsened pulmonary artery systolic hypertension. . due to elevated filling pressures on cardiac catheterization, sob and elevated jvp, it was presumed the patient was in florid heart failure with volume overload. she was given 80mg iv lasix in the cath lab and diuresed approximately 720cc. she was then started on a lasix gtt in the ccu, after which she dropped urine output to <30cc/hr. due to concern for cardiac output and flow to her kidneys, she was started on milrinone for ionotropic support. upon uptitrating the milrinone to achieve better urine output, her systolic blood pressures dropped to the 80-90s, she developed chest pain and nausea and her cardiac enzymes spiked. she was started on dopamine for pressure support. however, her chest pain continued and she was tachycardic with rates 120-140bpm. she was given morphine for pain which caused her pressures to drop further. out of concern for preload dependence at that time, the lasix drip was discontinued, the milrinone and dopamine were stopped, and she was given a fluid 500cc bolus after which time her maps returned >60. however, over the next few hours her pressures declined again, she was started on norepinephrine. a swan ganz catheter was placed which showed declining cardiac output and elevated pcwp 38. she continued in tachycardia and her pacer was interrogated by the ep team who determined she was in sinus tachycardia and the pacer was functioning correctly. various different combinations of ionotropic support were then tried including phenylephrine, norepinephrine and milrinone. she was given boluses with lasix with minimal urine output. . cvvh was considered to help remove volume, however her pressures were too unstable to attempt dialysis. an intra-aortic balloon pump was also considered, however, her ultimate prognosis was so poor that weaning of the balloon pump would be next to impossible. . a family meeting was then held with dr. in consultation with dr. and the ccu team regarding the patient's very poor prognosis and diagnosis of end-stage congestive heart failure and lack of current options for intervention. in considering the patient's wishes, she was made comfort measures only. she continued on her current regimen of pressure support and was given morphine due to progressive shortness of breath and work of breathing. her blood pressure slowly declined and she passed away at 1:48 am with her family at the bedside. medications on admission: home meds: 81mg daily mirtazipine 15mg qhs atorvastatin 80mg daily ferrous gluconate 325mg daily lisinopril 5mg daily ranitidine 150mg daily furosemide 120mg daily metoprolol 25mg plavix 75mg daily . meds on transfer: . zocor 80mg daily nitroglycerin 1inch topically q6hr morphine 2mg q2hr prn mirtazipine 15mg qhs milk of mag 10ml qhs metoprolol 25mg lisinopril 5mg dialy famotidine 20mg daily weight based heparin gtt protocol insulin aspart sliding scale qachs docusate 100mg prn plavix 75mg daily 325mg daily acetaminophen 650mg q4hr prn discharge medications: patient expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters arterial catheterization diagnoses: subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified aortocoronary bypass status dysthymic disorder cardiogenic shock primary pulmonary hypertension automatic implantable cardiac defibrillator in situ heart valve replaced by transplant acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to