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: lasix attending: chief complaint: sob, cp major surgical or invasive procedure: central line placement history of present illness: mr. is a 76 year old male with a history of als, cad s/p cabg, chf (ef of 35 %) who initially presented from home with acute onset shortness of breath, epigastric pain and arm pain. of note the patient was recently admitted to this hospital between and for rectal pain. during that admission the patient was found to be impacted and also to have a urinary tract infection. he was disimpacted and started on stool softeners. he received a two week course of ciprofloxacin for his uti which was scheduled to end on . he was also started on digoxin for better rate control of his atrial fibrillation and imdur for recurrent chest pain. the patient reports that since that admission he was been experiencing cough and congestion for approximately 8 days. on this presentation he complained of acute worsening shortness of breath, epigastric pain and bilateral arm pain. the pain was described as dull and in his epigastrium without radiation. it was not associated with movement or eating. he has had similar pain before but it has not been persistent. the arm pain was described as going down both arms without an aching sensation. he denied chest pain, lightheadedness or syncope. he did report nasal and sinus congestion and cough since his last discharge. he denied fevers, chills, nausea, vomiting or fatigue. he was transported here by ems who noted that he was rhonchorous and diaphoretic. his epigastric pain and dyspnea did not improve with nitroglycerin. in the ed his vitals were 98.6, 135, 137/86, 26, 100% on nrb. he received 2mg iv morphine for chest pain. he was given 10mg iv diltiazem for afib w/ rvr with decrease in hr to 80s-90s. blood cultures were drawn and vanc/zosyn (for hap as he has recently been hospitalized) and ivf were given. the patient had a large bowel movement in the ed. labs were notable for lactate of 2.7, repeat k (first hemolyzed) of 4.7, wbc 10.9 with mild left shift, inr of 1.4, bnp 1376, troponin 0.04/ck 239 with negative mb. his o2 supplementation was weaned to face tent. a cxr was interpreted as chf. additionally he was given pr asa. a rij cvl was placed. cvp readings were . his sbp dropped to the 70s while hr was in the 60s-70s and dopamine and levophed were started. she received a partial dose of 0.5mg iv dilaudid for pain control. he received ~2.5l ns while in the ed. he was transferred to the micu for further management. in the micu he continued to have shortness of breath as well as atypical chest pain. his cxr was consistent with pulmonary edema nad he recieved lasix for diuresis. he had a repeat echocardiogram which showed 3+ mitral regurgatation and he was started on lisinopril for afterload reduction. he had a speech and swallow evaluation which was notable for moderate to severe dysphagia. a peg tube was discussed with the patient who declined, prefering to take pos despite the aspiration risk. goals of care were discussed with the patient and his sister . his unstable cardiac status, repeated hospitalizations and dysphagia the decision was made to focus on comfort measures. his dyspnea and chest pain improved with subsequent administration of prn morphine. per this discussion the patient would still prefer around the clock care in a rehab setting as opposed to hospice. he was transferred to the floor for further management. review of systems is difficult to obtain secondary to the patient's severe dysarthria. he complains of abdominal pain and consiptation but does not want any medications. he denies dyspnea or chest pain currently. past medical history: als htn chronic systolic chf (ef 35%-40%) cad s/p mi afib gout, currently inactive hyperlipidemia social history: resides in brookside home. sister lives with him and assists with some iadls. gets privately-hired hha as well as vna twice a week. has been seen by palliative care during previous admissions, but while he wants to focus on comfort, he also wants to be treated and hospitalized if necessary for acute illness. has considered rehab although has declined to go there during last admission in order to minimize spending. denies tobacco, etoh, illicit drug use. family history: father with stomach ca physical exam: vs: temp: 97.3 bp: 105/59 hr: 80 rr: 17 o2sat 97% on face tent, cvp 9 gen: pleasant, comfortable, nad, dysarthria (at baseline per hcp) : perrl, , anicteric, mmm, op without lesions neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: coarse breath sounds bilaterally cv: irreg irreg, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, cool extremities with chronic venous stasis changes skin: abrasions on left shin (from transfer via ambulance per hcp) neuro: aaox3 pertinent results: hematology: 02:25am wbc-10.9 rbc-4.50* hgb-13.5* hct-41.7 mcv-93 mch-29.9 mchc-32.3 rdw-17.0* plt count-260 05:50am wbc-14.1*# rbc-4.34* hgb-12.6* hct-39.3* mcv-91 mch-29.0 mchc-32.0 rdw-16.3* plt ct-269 . coags: 02:25am pt-15.6* ptt-41.9* inr(pt)-1.4* 05:50am pt-27.7* ptt-48.5* inr(pt)-2.8* . chemistries: 02:25am glucose-181* urea n-18 creat-1.0 sodium-135 potassium-10.0* chloride-102 total co2-24 anion gap-19 02:33am lactate-2.4* k+-4.7 12:20pm digoxin-0.4* 05:50am glucose-112* urean-26* creat-0.7 na-148* k-3.0* cl-107 hco3-33* angap-11 . urinalysis: 02:54pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-tr bilirubin-neg urobilngn-4* ph-5.0 leuk-neg 02:54pm urine rbc-* wbc-* bacteria-none yeast-none epi-0 trans epi-0-2 02:54pm urine color-amber appear-hazy sp -1.029 cardiac enzymes: 02:25am blood ck(cpk)-239* ck-mb-6 ctropnt-0.04* probnp-1376* 12:20pm blood ck(cpk)-148 ck-mb-25* mb indx-16.9* ctropnt-0.30* 12:13am blood ck(cpk)-104 ck-mb-13* mb indx-12.5* ctropnt-0.19* . admission ekg: probable atrial flutter with rapid ventricular response. left ventricular hypertrophy and intraventricular conduction delay. compared to the previous tracing of ventricular response has increased. there is left axis deviation. no diagnostic interim change. imaging: . echocardiogram: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly to moderately depressed (lvef= 40 %) with inferior and inferolateral akinesis. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . ap upright chest: tip of a right ij central venous catheter terminates at the cavoatrial junction. the patient is status post median sternotomy and cabg. mild cardiomegaly is stable. the aorta is unfolded. there is unchanged moderate pulmonary edema. new airspace abnormality within the right upper and right infrahilar regions is concerning for aspiration or evolving pneumonia. there are small bilateral effusions, right greater than left. left basilar atelectasis with accompanying elevation of the hemidiaphragm is again seen. visualized osseous structures are unremarkable. . cxr impression: persistent pulmonary edema with no focal opacities to suggest pneumonia. . microbiology: blood cultures x 2 - final no growth urine culture - final (yeast) brief hospital course: a/p: mr. is a 76 year old male with a history of als, cad s/p cabg, chf (ef of 35 %) who initially presented from home with acute onset shortness of breath, epigastric pain and arm pain. found to have had an nstemi with resultant pulonary edema. initially admitted to transferred to floor to focus on comfort care. . acute on chronic systolic heart failure: felt to be secondary to severe ischemic heart disease and exacerbated by his heart attack. repeat echocardiogram on this admission revealed an ef of < than 40%, as well as 3+ mitral regurgitation. given the mr, his ef is likely overestimated, and thus he was felt to have very poor forward flow. for his chf, he was started on lasix 10 mg iv daily, then switched to 20mg po daily, which he tolerated well. of note the patient has a reported allergy to lasix (hypotension and gout flares) but it was felt that the benefits of continued diuresis for his pulmonary status outweighed this risk. he was also started on lisinopril 10 mg daily for afterload reduction. finally, he was maintained on metoprolol for additional treatment of heart failure. on this regimen he had improvement in his cardiopulmonary status. shortness of breath: dyspnea likely secondary to congestive heart failure exacerbation as above with component of cardiac ischemia. during this hospitalization goals of care were discussed extensively and the patient decided to focus on comfort measures including using morphine for his dyspnea and ativan for his anxiety. he was started on standing atrovent for bronchospasm in the setting of likely recurrent aspiration events and was started on standing lorazepam and prn morphine for comfort and anxiety. his chf was managed as above. nstemi: on presentation the patient complained of atypical chest pain which was thought to be his anginal equivalent. his troponins peaked at 0.3 with an elevated mb-index, consistent with a heart attack. the decision was made to continued to medically manage his cardiac disease with aspirin, plavix, metoprolol, and lisinopril. a statin was not felt to be of any benefit given his poor short term prognosis. his atrial fibrillation was aggressively rate controlled to reduce myocardial demand. he was continued on sl nitroglycerin and morphine prn for chest pain. atrial fibrillation/flutter: the patient appeared to have increased tachycardia with agitation and discomfort. it was felt that anxiety was contributing to his tachycardia. he was continued on digoxin and metoprolol for rate control. given change in goals of care his coumadin was discontinued. we attempted to aggressively control exertional and adrenergic stimuli with bowel medications, mouth care and ativan for anxiety. constipation: the patient was recently hospitalized for fecal impaction. he was continued on an aggressive bowel regimen which he often opted not to take. he should be encouraged to take his bowel medications to avoid severe constipation. benign prostatic hypertropy: these medications were discontinued for comfort. he remains with a foley catheter in place. gout: no active inpatient issues. given goals fo care, allopurinol was discontinued. should his gout recur this could be reinstituted. als: the patient's als has reached end stage. per his primary neurologist dr. his prognosis is quite poor. during this admission he had a swallowing evaluation which demonstrated moderate to severe dysphagia. peg tube placement was discussed with the patient who opted to continued po intake despite aspiration risks. he was given hyoscyamine and ipratropium nebs for secretion management. he was given ativan tid for anxiety management, without which he would become agitated. due to his chronically bedbound status, he was noted to have multiple sacral pressure ulcers which were cared for locally, and were stage 1 at discharge. fen: he was placed on a pureed, thin liquid diet to minimize aspiration risk. aspiration precautions were taken. code status: dnr/dni, clarified with pt and family. he would not want to be admitted to an icu nor have a central line inserted again. goals of care: extensive discussions took place with the patient, his family and the medical staff. he would prefer to focus on comfort measures over life prolonging measures but would also prefer to maintain his currently level of care. his coumadin was discontinued. labs were not checked regularly and only significant abnormalities were treated. he was started on prn morphine and standing ativan for comfort. he will be transferred to rehab for further care. contact: and sister , hcp and primary caretaker (. medications on admission: colace lactulose 30ml po tid prn lisinopril 10 mg qdaily aspirin 325 mg po daily allopurinol 100 mg clopidogrel 75 mg po daily finasteride 5 mg po daily pantoprazole 40 mg qdaily tamsulosin 0.4 mg qhs warfarin 2 mg po hs hydrocortisone acetate 1 % ointment (hemorrhoids) bisacodyl 10mg prn atorvastatin 80 mg qdaily nasal spray miralax digoxin 125 mcg po qod. senna 8.6 mg po tid hydrocortisone 2.5 % cream : one (1) appl rectal (2 times a day). metoprolol tartrate 25 mg tablet tid hyoscyamine sulfate 0.125 mg, sublingual tid isosorbide mononitrate 30 mg qdaily sl ntg prn discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po bid (2 times a day). 2. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 3. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 4. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day). 5. aspirin 325 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily). 6. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 7. sodium chloride 0.65 % aerosol, spray : sprays nasal (2 times a day) as needed. 8. polyethylene glycol 3350 17 gram (100 %) powder in packet : one (1) powder in packet po bid (). 9. hydrocortisone 2.5 % cream : one (1) appl rectal (2 times a day). 10. hyoscyamine sulfate 0.125 mg tablet, sublingual : one (1) tablet, sublingual sublingual tid (3 times a day). 11. lisinopril 10 mg tablet : one (1) tablet po daily (daily). 12. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 13. digoxin 125 mcg tablet : one (1) tablet po daily (daily). 14. nitroglycerin 0.3 mg tablet, sublingual : one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 15. metoprolol tartrate 25 mg tablet : one (1) tablet po bid (2 times a day). 16. furosemide 20 mg tablet : one (1) tablet po daily (daily). 17. simethicone 80 mg tablet, chewable : tablet, chewables po qid (4 times a day) as needed. 18. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 19. morphine concentrate 20 mg/ml solution : 5-10 mg po q3h (every 3 hours) as needed for pain. 20. guaifenesin 100 mg/5 ml syrup : 5-10 mls po q6h (every 6 hours) as needed. 21. lorazepam 0.5 mg tablet : one (1) tablet po three times a day. discharge disposition: extended care facility: & retirement home - discharge diagnosis: primary: als, end-stage . secondary: hypertension acute on chronic systolic heart failure atrial fibrillation nstemi coronary artery disease hyperlipidemia discharge condition: fair. able to make sounds but having difficulty communicating. incontinent. requiring significant nursing care. discharge instructions: you were seen and evaluated for your epigastric pain and shortness of breath. your symptoms were due to worsening of your heart failure as well as a heart attack. you were treated with diuretics and medications for your heart. a number of conversations took place between you and your familiy and the physicians here and it was decided that your medical care would focus on comfort measures. you will receive lasix and ativan to make sure that you remain comfortable in your rehba institution. . the following changes were made to your medication regimen: 1. your coumadin was discontinued 2. your isosorbide mononitrate was discontinued . please take all medicines as prescribed. please call your doctor if you are experiencing pain or any other symptoms which disturb you. followup instructions: please follow up with your primary care physician . if you have any concerns about your medical care. his office phone number is . . you have an appointment with your neurologist as below: provider: , m.d. phone: date/time: 12:00 procedure: venous catheterization, not elsewhere classified diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other chronic pulmonary heart diseases atrial flutter constipation, unspecified other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) amyotrophic lateral sclerosis pressure ulcer, lower back surgical or other procedure not carried out because of patient's decision acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to