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: penicillins attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: cardiac catheterization and history of present illness: the patient is a year old male with cad s/p mi in and , ppm implanted in , chf, pvd, and htn who presented to clinic to transfer his medical care to . he reported 6 weeks of increasing leg swelling, worsening dyspnea with minimal exertion, pnd, orthopnea, and occasional lightheadedness. he denied any recent cp, palpitations, nausea, vomiting, diaphoresis, or syncope. labs reviewed from on showed k 5.2, bun 84, creatinine 3.5, and tsh 6.9. he was directly admitted to the service for management of his acute on chronic chf and acute renal failure. . he reports that his symptoms began shortly before . he has never had a similar episode in the past. prior to then, he was quite active, climbing stairs without problems, walking regularly, and using a stationary bike for 30 minutes daily. he has become progressively more fatigued and now becomes sob with minimal activity such as standing up from a chair. he has also had difficulty sleeping due to sob when lying down. he has been unable to lie down flat. he has developed le edema and scotal swelling. he also has a new foot lesion overlying his right great toe which has been painful. he says that he feels thirsty constantly but has decreased appetite. his family also noted that his weight has increased from 124 lbs several weeks ago to 142 lbs now. . on review of systems, 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. all of the other review of systems were negative. past medical history: # cad -- never developed typical chest pain with mis -- describes "heavy breathing" -- s/p mi and ptcax2 in ny without stents -- s/p mi with chf # ppm with icd -- first placed in after syncopal episode -- st. 3207-36, implanted -- biv paced and pacemaker dependent per records -- needing replacement soon at last interrogation # pvd -- vascular surgery to left leg in past # hypertension # home o2 at 2l -- for comfort # ckd -- patient told he had mild kidney disease in past social history: # alcohol -- none # tobacco -- none # drugs -- none family history: parents died in holocaust, family medical history unknown. physical exam: physical exam on admission: vs: t 95.4, bp 100/51, hr 65, rr 20, spo2 98% on ra gen: elderly male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. palpebral conjunctiva red bilaterally with some evidence of bleeding. does not extend to globe itself. nonpainful and nonpruritic. perrl, eomi. mmm, op benign. neck: supple, full rom. jvp of ~ 12 cm. no cervical lymphadenopathy. no carotid bruits noted. cv: rrr with normal s1, s2. no m/r/g. somewhat distant heart sounds. chest: respiration unlabored. decreased breath sounds and dullness to percussion at right base. no crackles, wheezes or rhonchi. abd: normal bowel sounds. soft, nt, nd. no organomegaly. abdominal aorta not enlarged by palpation. ext: left leg cooler than right. venous stasis changes bilaterally. le edema left > right extending to groin and scrotum. skin: dry skin. dorsum of right hand red but not warm or tender. soft pustular lesion ~1.5 cm on right first mtp joint with some surrounding erythema. does not seem to involve the joint itself. neuro: cn ii-xii grossly intact. no focal weakness or loss of sensation. pertinent results: lab results on admission: 05:20pm blood wbc-5.6 rbc-4.50* hgb-13.6* hct-41.7 mcv-93 mch-30.1 mchc-32.5 rdw-16.2* plt ct-113* 05:20pm blood neuts-75.9* lymphs-15.3* monos-5.1 eos-2.3 baso-1.5 05:20pm blood pt-40.5* ptt-38.3* inr(pt)-4.3* 05:20pm blood glucose-113* urean-96* creat-3.7* na-135 k-4.9 cl-103 hco3-21* angap-16 05:20pm blood alt-35 ast-40 ld(ldh)-256* alkphos-177* totbili-0.7 05:20pm blood albumin-3.5 calcium-8.9 phos-4.1 mg-2.4 05:20pm blood tsh-5.6* . 10:36pm urine type-random color-yellow appear-clear sp -1.010 10:36pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 10:36pm urine rbc-0-2 wbc-0-2 bacteri-none yeast-none epi-0-2 10:36pm urine hours-random urean-585 creat-57 na-43 k-45 cl-70 10:36pm urine osmolal-405 . . lab results on transfer to ccu: 06:15am blood wbc-5.7 rbc-4.23* hgb-12.4* hct-38.5* mcv-91 mch-29.3 mchc-32.3 rdw-15.8* plt ct-103* 06:15am blood pt-31.3* ptt-37.8* inr(pt)-3.1* 06:15am blood glucose-99 urean-126* creat-4.2* na-136 k-4.0 cl-99 hco3-25 angap-16 06:15am blood calcium-8.5 phos-5.1* mg-2.2 . . radiology report chest (pa & lat) study date of 5:52 pm findings: there is a left icd pacemaker with leads in the right atrium, right ventricle, and coronary sinus. there are looped leads in the left brachiocephalic vein. there is a moderate right pleural effusion and no left pleural effusion. there is right basilar atelectasis. no pneumothorax is identified. there is severe cardiomegaly with a large right atrium. the mediastinal contours are normal. impression: 1. moderate right pleural effusion. 2. severe cardiomegaly with right atrial enlargement. 3. right basilar atelectasis. . . brief hospital course: the patient is a year old male with cad s/p mi in and , ppm implanted in , chf, pvd, and htn who presents with acute on chronic chf and acute renal failure. . # pump: he has a history of chf secondary to his mi in , but reports never having an episode similar to this. he is not aware of any preceding trigger or dietary changes. he was taking lasix 20 mg po daily at home, but over the last 6 weeks developed worsening volume overload with anasarca and sob. his pulmonary exam and cxr show a right sided pleural effusion. his echo on showed lvef 20%, inferior posterior akinesis, and hypokinesis of the remaining left ventricle. he was started on a lasix drip at 10 mg/hr on admission. he was placed on a low sodium diet with 1.5 l daily fluid restriction. his lasix dose was increased the next day to 12 mg/hr with the addition of metolazone 2.5 mg po bid. he had fair urine output with this regimen and reported improvement in his sob and le edema, but will need significantly more diuresis to reach euvolemia. he was transfered to the ccu in order to initiate milrinone for more aggressive diuresis. in the ccu, patient briefly required phenylepherine while on milrone gtt but was eventually weaned off. he will be discharged on milrinone drip and torsemide 20 mg with sbp in the 70-80s range, with good mental status and stabilized renal function. . # rhythm: he first received an icd in after a syncopal episode. he had a st. 3207-36 ppm with icd implanted on . he is anticoagulated with coumadin for underlying afib, but is unaware of this diagnosis. he is biventricular paced and pacemaker dependent per records. his device was recently interrogated and will need to be replaced soon per records. inr was suprtherapeutic at 4.3 on admission, coumadin was stopped. patient will continue aspirin after discharge. . # coronaries: he has a significant history of cad with several past mis. he denies any recent cp or other symptoms suggesting an acute coronary event, but his prior mis were also atypical in presentation. his recent chf exacerbation is concerning for an acute decrease in systolic function from such an event. his echo on is highly suggestive of ischemic cardiomyopathy. viability study showed fixed perfusion defect of the inferolateral wall. intervention by catheterization was attempted but could not advance past the right brachial vein, and eventually aborted when there was sign of right femoral vein extravasation. ultrasound later showed hematoma but no dissection or fistula. patient transfused with ffp and prbc and remained hemodynamically stable. decision was made to medically manage patient. . # acute renal failure: his cr was elevated to 3.5 on recent labs at . his cr was 3.7 on admission and remained stable at 3.5 to 3.7 for several days despite aggressive diuresis. urine electrolytes were unrevealing with feurea 39.56%. his cr increased to 4.0 on evening and 4.2 on am, but eventually trended down to 3.0 at the time of discharge on . . # foot lesion: he had a superficial abscess overlying his right first mtp joint which was soft with surrounding mild erythema. it did not seem to involve the joint itself. the lesion was lanced on with expression of significant amounts of white purulent material. more pus was expressed from the lesion on exam yesterday. exploration of the lesion on showed that it was superficial. a minimal amount of pus was expressed on , and the lesion is much improved. cultures from the lesion showed no growth. cephalexin 250 mg po q8h was started afternoon. he was monitored for signs of new rash given his known penicillin allergy. the wound was cared for with regular dressing changes and topical antibiotics. repeat i&d was conducted on , again with negative swab gram stain and no visible pus. patient was not discharged on antibiotics. . # hand cellulitis: the dorsum of his right hand was erythematous on admission, but not warm or tender. it became slightly tender on subsequent days with slight soft tissue swelling overlying the third mcp joint. there was no tenderness with active or passive movement of the joint. prednisone and a brief course of antibiotics was given. at the time of discharge the symptoms had resolved. . medications on admission: aspirin 81 mg po daily metoprolol tartrate 25 mg po bid irbesartan 75 mg tab po daily atorvastatin 40 mg po daily imdur 60 mg po daily lasix 20 mg po daily coumadin 1.25 mg po daily vitamin d 1000 units daily discharge medications: 1. hospital bed 2. one wheelchair 3. milrinone 1 mg/ml solution sig: 0.25 mcg/kg/min intravenous continuous. disp:*10 bags* refills:*2* 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*30 tablet(s)* refills:*2* 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*30 capsule(s)* refills:*2* 8. trazodone 50 mg tablet sig: tablet po qhs as needed for insomnia: at bedtime. disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: critical care systems discharge diagnosis: primary: congestive heart failure coronary artery disease secondary: peripheral vascular disease hypertension chronic kidney disease 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: mr. , you were admitted to the hospital because of worsening of your heart failure. we started you on a medication called milrinone to help with your heart function. you also had a cardiac catheterization to assess your heart arteries but we did not find any blockages to fix. we have sent you home with milrinone drip and home nursing to monitor you while on this medication. we have made the following changes to your medications: started milrinone drip started torsemide 20mg by mouth daily started colace 100mg twice daily as needed for constipation started senna 1 tab twice daily as needed for constipation started trazadone as needed at night for sleep stopped metoprolol tartrate stopped irbesartan stopped atorvastatin stopped imdur stopped lasix stopped coumadin your complete medication list is attached. followup instructions: name: , l. location: center address: , , phone: appt: at 11am department: cardiac services when: monday at 4:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization other incision with drainage of skin and subcutaneous tissue central venous catheter placement with guidance diagnoses: other primary cardiomyopathies other iatrogenic hypotension anemia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified peripheral vascular disease, unspecified accidental puncture or laceration during a procedure, not elsewhere classified paroxysmal ventricular tachycardia ulcer of other part of foot old myocardial infarction cardiac pacemaker in situ accidents occurring in residential institution acute on chronic systolic heart failure diseases of tricuspid valve acute gouty arthropathy cellulitis and abscess of foot, except toes cellulitis and abscess of hand, except fingers and thumb other dependence on machines, supplemental oxygen chronic kidney disease, stage ii (mild) edema accidental cut, puncture, perforation or hemorrhage during heart catheterization 

Answer: The patient is high likely exposed to