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: morphine sulfate attending: chief complaint: hypoxia major surgical or invasive procedure: 1. intubation 2. right radial arterial line history of present illness: this is an 87-year-old woman with an extensive pmh including cad 3 vessel, htn, chf, mod-severe as who presented with acute respiratory distress requiring intubation. ms. developed increasing dyspnea at home since yesterday with elevated blood pressure last evening (sbp > 200). no history of fever, chills, cough, increased sputum or chest pain. her daughter found her this morning in acute respiratory distress and consequently called ems. at the time she was ambulating to the bathroom. . in the ed, initial vs were: t 97 p 60 bp 203/97 r 30 o2 sat 74% bag mask. ms. was emergently intubated. she was given lasix 60 mg iv once, per records diuresised 1150 l. patient dropped pressure to 60 systolic with propofol, improved with 750 cc bolus and turning off propofol. the patient was additionally given versed and vecuronium. she received a total of 1.5 l ns, ceftriaxone, and levofloxacin (empiracally for pna). she was transferred to the icu. . patient intubated and sedated unable to give history. past medical history: 1. cad - 3 vessel, told to have stress test but refused several years ago, last catheterization about 12 years ago per patient's daughter. 2. htn 3. sick sinus syndrome s/p ppm , replaced 4. chf - last known echo ef >55% () 5. hypothyroidism 6. paced afib - not anticoagulated 7. chronic lung nodules 8. moderate-severe aortic stenosis social history: russian speaking. patient lives alone and is widowed. no h/o tobacco, etoh. patient has help for cleaning and bathing, does some cooking, daughter does shopping. walks without aid at baseline. has frequent visitors, daughter (health care proxy) lives nearby: . family history: cad mother died of appendicitis four brothers died in physical exam: on admission to ed t: 97 p: 60 bp: 203/97 r:30 spo2 sat 74% bag mask general appearance: intubated eyes / conjunctiva: perrl, no(t) pupils dilated head, ears, nose, throat: endotracheal tube cardiovascular: (pmi normal), (s1: normal), (s2: normal), (murmur: systolic) peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: diminished: throughout) abdominal: soft, non-tender, bowel sounds present, obese extremities: right lower extremity edema: 1+, left lower extremity edema: 1+ skin: not assessed neurologic: responds to: not assessed, movement: not assessed, sedated, tone: not assessed on discharge: tm: 98.2, hr: 59, bp: 136/59, sp02: 99 2l general: well appearing, sitting in chair eating breakfast neck: elevated jvp at about 7cm cardiac: regular rate and rhythm; 3/6 systolic ejection murmur lungs: crackles at bases bilaterally abdomen: +bs, soft, non-tender, non-distended peripheral vascular: + peripheral pulses extremities: trace edema bilaterally skin: warm and dry pertinent results: on admission: 08:00am blood wbc-22.7* rbc-4.80 hgb-14.7 hct-44.8 mcv-93 mch-30.5 mchc-32.8 rdw-14.3 plt ct-181 08:00am blood pt-12.9 ptt-24.6 inr(pt)-1.1 08:00am blood glucose-319* urean-17 creat-1.2* na-142 k-4.8 cl-107 hco3-21* angap-19 08:00am blood alt-32 ast-33 ld(ldh)-264* ck(cpk)-63 alkphos-95 totbili-0.6 08:00am blood calcium-8.6 phos-5.9* mg-2.4 08:43am blood type-art tidal v-550 fio2-60 po2-67* pco2-46* ph-7.28* caltco2-23 base xs--4 -assist/con intubat-intubated 08:09am blood glucose-289* lactate-5.9* k-4.6 . cardiac enzymes: 08:00am blood ctropnt-<0.01 08:00am blood ck-mb-notdone 02:49pm blood ck-mb-notdone ctropnt-<0.01 07:46pm blood ck-mb-notdone ctropnt-<0.01 09:31am blood probnp-1430* . cardiac echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size is normal. the aortic valve leaflets are moderately thickened. there is severe aortic valve stenosis (valve area 0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. . compared with the prior study (images reviewed) of , the severity of aortic stenosis has progressed. . cxr lung volumes are maintained following tracheal extubation. extensive bilateral pulmonary consolidation is heterogeneous and also has varied in radiodensity to different degrees in separate areas over the past two days. i suspect much of the abnormality is edema, but pulmonary hemorrhage and pneumonia could be making a contribution. moderate cardiomegaly is stable and small bilateral pleural effusions have developed since the earliest studies on . transvenous right atrial and right ventricular pacer leads in standard placements. no pneumothorax. . ekg : a-v sequentially paced rhythm with intrinsic a-v conduction and right bundle-branch block configuration. compared to the previous tracing of there is no diagnostic interim change. brief hospital course: ms. is a pleasant 87-year-old woman with cad, chf, htn, sick sinus syndrome s/p pacer, moderate-severe as who presented to on with acute respiratory distress. due to her poor respiratory status she was intubated in the emergency department and admitted to the medical intensive care unit. on , her respiratory status had improved and she was successfully extubated. on , she was transferred to the cardiology service. her brief hospital course was notable for: . # acute respiratory distress: acute pulmonary edema was suspected as the most likely etiology of the patient's acute respiratory distress, in setting of diastolic dysfunction and moderate-severe as. initially, there was concern for myocardial infarction however, she was ultimately ruled out with three sets of negative cardiac enzymes. there was also concern for pneumonia and initially ms. was put on antibiotics. however, due to lack of fever, leukocytosis, and marked clinical improvement, antibiotics were discontinued on . in the micu, ms. was diuresed with 60 iv lasix x 1, and on was restarted on her home regimen of 80 mg po lasix. an arterial line was placed on without incident, for close bp observation, and this was discontinued on , prior to transfer to the floor. she was successfully extubated on . . upon arrival on medicine floor, ms. was started on torsemide (eventually uptitrated to 40mg ) with good urine output and diminishment of rales on lung exam. (patient was diuresed with caution in light of mod-severe as). sp02 continued to be 92-95% on 2l nasal cannula. she was also started on lisinopril 20mg qd for better bp control and afterload reduction. better bp control will help with pulmonary edema, but without valvular repair, this issue cannot be entirely corrected. both the family and the patient are aware of this. . # hypertension: during her hospitalization, the patient was noted to have labile blood pressures ranging from hypo to hypertensive. hypotensive episodes occured in the setting of getting propofol for sedation while intubated, and hypertensive episodes occured primarily in the settings of anxiety, and after extubation. in the micu, ms. was initially started on captopril, but this was changed to lisinopril on the medicine floor. her home clonadine was stopped; home lopressor was switched to carvedilol for better alpha blockage. torsemide 40mg was started as above. ms. was also given lorazepam prn anxiety. . # : creatinine increased to 1.2 from baseline 0.9 in the setting of diuresis. it trended down to 1.0 on day of discharge. . # cad: patient with known 3 vessel disease. no history of chest pain and cardiac biomarkers were present. ekg did not reveal any st wave changes, though it did show some pacing irregularities. asa and simvastatin were continued. ms. was discharged on asa, simvastatin, and ace-i. . # moderate-severe aortic stenosis: ms. had increasing dyspnea prior to admission, but no known history of chest pain or syncope. and echo from shows an lvef of 55% and an aortic valve area of 0.8cm2. ms. prefers medical management of as and does not want surgery. her imdur was stopped during admission and she was diuresis cautiously as as makes her preload dependent. . # hypothyroidism: levothyroxine was continued at 50mcg daily. . # rate: ms. has a history of afib and sick sinus syndrome s/p ppm. pacemaker was interrogated by ep during admission and some changes were made. ms. should follow up with device clinic in 1 month and dr. on . she was discharged on amiodarone and carvedilol. . #gout: after aggressive diuresis, ms. complained of symptoms consistent with gouty flare in left big toe. colchicine was started at 0.6mg qd and pain begam to subside. colchicine was continued on discharge. outpatient management of gout is deferred to pcp. medications on admission: meclizine 12.5mg simvastatin 20 mg daily levothyroxine 50 mcg daily lopressor 50 mg , imdur 60 mg daily at noon amiodarone 200 mg daily aspirin 81 mg daily lasix 80 mg daily c clonidine 0.1 mg, 2 tablets in am and 1 tablet in pm. discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 6. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 7. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 8. torsemide 20 mg tablet sig: two (2) tablet po bid (2 times a day). 9. meclizine 12.5 mg tablet sig: one (1) tablet po twice a day. 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 11. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 12. senna 8.6 mg capsule sig: one (1) capsule po twice a day. 13. colace 100 mg capsule sig: one (1) capsule po twice a day. 14. oxygen continue oxygen by nasal cannula (1-6l) as needed. call your doctor worsens or your oxygen requirement increases. discharge disposition: extended care facility: of discharge diagnosis: primary 1. acute pulmonary edema in the setting of high blood pressure secondary 1. coronary artery disease 2. diastolic heart failure 3. sick sinus syndrome s/p pace maker 4. hypothyroidism 6. atrial fibrillation 7. moderate-severe aortic stenosis discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid (walker or cane) discharge instructions: dear ms. , it was a pleasure taking care of you on this admission. you came to the hospital because you were having shortness of breath. in the emergency department your oxygen level was found to be very low and your blood pressure very high. you were intubated (put on a ventilator) and sent to the intensive care unit. we think that you had trouble because your blood pressure was high which, in relation to your other cardiac issues, ultimately caused fluid to accumulate in your lungs. . the following changes were made to your medications in order to ensure better control of your blood pressure in the setting of your aortic stenosis. we also started a medication to help with your gout. 1. stop taking imdur 60mg daily 2. stop taking lopressor 50 mg twice a day 3. stop taking lasix 80mg daily 4. stop taking clonidine 5. start taking carvedilol 12.5mg twice a day 6. start taking lisinopril 20mg daily 7. start colchicine 0.6mg daily (for gout) 8. start torsemide 40mg twice a day . at the rehab facility you will also receive colace and senna (to help you move your bowels), tylenol as needed for pain, oxygen, and heparin three times daily to prevent blood clots. . you will need to have your chemistry (electrolytes) checked in one week because of some of the medications we are starting. . please keep all of your doctors' appointments. please take all of your medications as prescribed. . weigh yourself every day and call your doctor if you gain more than 3 pounds. . call your doctor or return to the hospital if you develop shortness of breath, chest pain, severe headache, bright red blood in your stool, abdominal pain, nausea, vomiting, diarrhea, fever or any other concerning symptoms. followup instructions: please call your pcp . at to make an appointment in weeks after you are discharged from the rehabilitation facility. you will be called by the device clinic for an outpatient interrogation of your pacemaker one month after discharge. cardiology, dr. : 09:20a , cc7 cardiology (sb) procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube artificial pacemaker rate check diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders acute respiratory failure cardiac pacemaker in situ other diseases of lung, not elsewhere classified acute diastolic heart failure sinoatrial node dysfunction unspecified hypertensive heart disease with heart failure 

Answer: The patient is high likely exposed to