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: history of present illness: this is a -year-old male with a history of hypertension, chronic obstructive pulmonary disease, and positive tobacco history who presents with one week of dyspnea on exertion. the shortness of breath is relieved with rest. the patient denies any recent illness, nausea, vomiting, cough, rhinorrhea, fevers, chills, sweats, chest pain, or abdominal pain. at the hospital the patient was found to be in congestive heart failure and was diuresed. he then went into atrial fibrillation was put on a diltiazem drip. he reconverted back into a normal sinus rhythm after seven hours. the patient was then given a digoxin load, but no beta blocker given the severe chronic obstructive pulmonary disease on his pulmonary function tests; which revealed fev1 of 0.5 (which is 29% of predicted), fvc of 1.05 (which is 45% of predicted), and fev1:fvc ratio of 62%. past medical history: 1. in , a motor vehicle accident with rib and collar bone fractures. 2. position vertigo. 3. hypertension. 4. peripheral edema. 5. status post appendectomy. 6. chronic obstructive pulmonary disease; with fev1 of 0.5 (which is 29% of predicted), fvc of 1.05 (which is 45% of predicted), and fev1:fvc ratio of 62%. 7. total hip replacement. medications on admission: medications at home included dyazide 37.5/25 one tablet p.o. q.d. medications on transfer: 1. combivent 2 puffs inhaled q.i.d. 2. advair 100/50 1 puff inhaled b.i.d. 3. lasix 20 mg intravenously q.d. 4. lisinopril 5 mg p.o. q.d. 5. digoxin 0.625 mg p.o. q.d. 6. diltiazem drip. 7. potassium chloride 20 meq p.o. q.d. 8. heparin intravenously. allergies: no known drug allergies. social history: the patient has a 40-pack-year smoking history with quitting 30 years ago. he occasionally drinks alcohol. family history: family history revealed no evidence of coronary artery disease. pertinent laboratory values at the outside hospital: laboratories revealed white blood cell count was 7.6, hematocrit was 41.2, mean cell volume was 103, and platelets were 289. sodium was 143, potassium was 4.8, chloride was 103, bicarbonate was 42.4, blood urea nitrogen was 27, creatinine was 1, and blood glucose was 105. calcium was 9.1. inr was 1.1. creatine kinases were 57 and 97. the creatine kinase of 97 had a ck/mb of 3.56 and a ck/mb index of 3.7. troponin was 0.2. clostridium difficile toxin assay was negative. radiology/imaging: a chest x-ray showed mild pulmonary edema with bilateral pleural effusion. echocardiogram at the outside hospital showed mild left atrial enlargement, mild concentric left ventricular hypertrophy, and ejection fraction of 55% to 60%, severe aortic stenosis, with a peak gradient of 114 mmhg, a mean gradient of 55 mmhg, an area of 0.7 cm2, trace aortic regurgitation, trace mitral regurgitation, moderate tricuspid regurgitation, and pulmonary aortic systolic hypertension (pasd of 40 mmhg plus rap). pertinent laboratory values at : laboratories revealed white blood cell count was 7.5 (with 76.8% neutrophils and 14.3% lymphocytes and 6.8% monocytes), hematocrit was 40.6, and platelets were 198. sodium was 140, potassium was 4.1, chloride was 98, bicarbonate was 35, blood urea nitrogen was 36, creatinine was 0.8, and blood glucose was 104. alt was 14 and ast was 17. inr was 1.1 and partial thromboplastin time was 70.6. magnesium was 1.9. radiology/imaging: electrocardiogram revealed a normal sinus rhythm at 74 beats per minute with normal axis. there was 0.5-mm st depressions in leads i and ii. there were t wave inversions and 4-mm st depressions in leads v3 through v6. there was evidence of left ventricular hypertrophy. hospital course: 1. aortic stenosis: a repeat echocardiogram showed an ejection fraction of greater than 55%, moderate left atrial enlargement, moderate right atrial enlargement, symmetric left ventricular hypertrophy, severe aortic stenosis (aortic valve are was 0.7 cm2, peak gradient of 98 mmhg, mean gradient of 60 mmhg, and peak velocity of 5 m/sec), trivial mitral regurgitation, 1 to 2+ tricuspid regurgitation, mild systolic pulmonary artery systolic hypertension, and trivial pericardial effusion. the patient was taken to catheterization which again showed several aortic stenosis with a gradient of 50 mmhg to 60 mmhg. also on catheterization, there was only 50% stenosis of the medial left anterior descending artery. cardiothoracic surgery was consulted for possible aortic valve replacement. however, that the patient had a pco2 in the 60s on arterial blood gas, it was felt that the patient was not a good candidate for aortic valve replacement. it is best that the patient be medically managed with lasix and controlling the atrial fibrillation. if this medical regimen is to fail, the patient may return for palliative valvuloplasty. however, it is advised that valvuloplasty in itself would carry a 5% mortality for this patient with lung disease. 2. atrial fibrillation: upon admission, the patient was in a normal sinus rhythm. however, on hospital day four, the patient went into atrial fibrillation with the following vital signs: heart rate was 124, blood pressure was 123/64, oxygen saturation was 97% on 5 liters nasal cannula. he was cardioverted with 200 joules, and the patient went back into a normal sinus rhythm. however, three hours later, the patient did return back to atrial fibrillation with the following vital signs: heart rate was 125, blood pressure was 191/53, and oxygen saturation was 97% on 5 liters nasal cannula oxygen. he was cardioverted with 200 joules, and then 3 of the 360-joule shocks. after the fourth shock, the patient did return to a normal sinus rhythm. at that time, he was then restarted on an amiodarone drip which required a unit stay. after the amiodarone drip was finished, the patient was started on 200 mg of amiodarone p.o. t.i.d. for one week; then to be decreased to 200 mg p.o. b.i.d. for another week; and then finally to 200 mg p.o. q.d. the patient did remain in a normal sinus rhythm except for two and a half hours on the day after transfer back to the medical floor. he then reverted back into a normal sinus rhythm by himself. his combivent inhaler was discontinued so that he would not convert back to atrial fibrillation by becoming tachycardic with the albuterol component. he was then started on diltiazem 30 mg p.o. q.i.d. for rate control. also, he was anticoagulated with coumadin with an inr goal of 2 to 2.5. 3. coronary artery disease: the patient was given an aspirin as a primary prevention of coronary artery disease. his lipid panel was checked and revealed that his cholesterol was 128, triglycerides were 100, high-density lipoprotein was 48, and low-density lipoprotein was 60. on cardiac catheterization for the aortic stenosis, he only had 50% stenosis of the left anterior descending artery without any intervention. at this time, he has no significant coronary artery disease. 4. congestive heart failure: congestive heart failure secondary to atrial fibrillation and aortic stenosis. the patient was aggressively diuresed with lasix. it is best to control his atrial fibrillation in terms of rhythm and rate for better management of the congestive heart failure. if the patient's congestive heart failure is not improved with medical management, then it is advised that he undergo a palliative angioplasty for his aortic stenosis. 5. restrictive pulmonary function: the patient had acute decompensation in his pulmonary function. he suddenly required requiring oxygen both at rest and with ambulation. arterial blood gases were checked sequentially, and showed that his ph ranged from 7.33 to 7.41, and pco2 ranged from 62 to 66. a pulmonary service consultation was obtained, and they felt that his elevated pco2 was likely multifactorial. his elevated pco2 may be due to compensation for a metabolic alkalosis, affect from pao2, restriction from pulmonary edema, or increased vdvt related to congestive heart failure. pulmonary function tests were obtained showing that he had an fev1 of 1.11 (which is 69% of the predicted), fvc of 1.59 (which is 55% of the predicted), and fev1:fvc ratio of 70 (which is 125% of the predicted), and dl/va of 3.23 (which is 91% of the predicted). given this restrictive pattern on his pulmonary function tests, it was most likely that his congestive heart failure and pulmonary edema were contributing to his poor pulmonary status. also, given the fact that his current fev1 is 69% of the predicted, and that he was quite robust prior to his decompensation, severe underlying pulmonary etiology was unlikely. given that he does not have any evidence of chronic obstructive pulmonary disease on his pulmonary function tests, it is recommended that all of his inhalers (including salmeterol, flovent, and atrovent) be discontinued. he was to follow up with a pulmonologist in one month. the patient was also to have pulmonary function tests every six months given that he is on amiodarone. the patient was saturating at 91% on 2 liters nasal cannula at rest and 87% to 89% on 3 liters nasal cannula while ambulating, so it is recommended that he be on 4 liters of oxygen with exertion and 2 liters of oxygen at rest. discharge diagnoses: 1. aortic stenosis. 2. atrial fibrillation. 3. congestive heart failure. 4. no evidence of coronary artery disease. 5. restrictive pulmonary function. medications on discharge: 1. coumadin 5 mg p.o. q.h.s. 2. lovenox (until inr of 2 to 2.5 is reached). 3. diltiazem 30 mg p.o. q.i.d. 4. atorvastatin 10 mg p.o. q.d. 5. amiodarone 200 mg p.o. t.i.d. from to ; then 200 mg p.o. b.i.d. from to ; and then 200 mg p.o. q.d. thereafter. 6. aspirin 325 mg p.o. q.d. 7. lasix 40 mg p.o. q.d. condition at discharge: condition on discharge was stable. discharge status: discharge status was to a rehabilitation center. discharge instructions/followup: 1. the patient was to follow up with his primary care provider in one week. 2. the patient was also to follow up with cardiology after rehabilitation stay. 3. the patient was also to follow up with a pulmonologist in one month. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization other electric countershock of heart diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases bacteremia 

Answer: The patient is high likely exposed to