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: cephalosporins / ceclor / keflex / flagyl attending: chief complaint: shortness of breath major surgical or invasive procedure: cardiac catherization cvvh history of present illness: 65 yo male with ckd, dm, recent hospitalization for chf exacerbation/pulm edema, found to have new lbbb, transferred for cardiac cath. he was recently admitted with decompensation in heart failure 10 d ago and opted for medical management at that time. echo done then showed ef 25-30% with apical and anterior hypokinesis. he presented again on friday with pulmonary edema and was treated with lasix, zaroxylyn and dialysis on saturday with improvement. he normally gets dialysis in on a mon- wed fri. he was transferred from to for cardiac cath. at time of transfer, lungs were clear, sats hight 90s on r/a. vital signs on transfer: temp 97.9, hr 88 sinus with lbbb, rr 14, bp 114/67. of note, he was recently started on 75/25 for diabetes d/t high sugars. sugar today 138, npo since mn, no coverage prior to transfer. . he underwent cardiac cath which showed extensive 3 vessel disease. currently, he reports no complaints. no pain. would like to eat immediately. past medical history: cri: newly started dialysis, has an hd cath right chest wall. wants future peritoneal dialysis- s/p peritoneal catheter placed 2 weeks ago, not yet using it. diabetes on sliding scale regular at home, cad with new lbbb, severe cardiomyopathy, anxiety, pad s/p right bka with prosthesis, htn, lipids, hypokalemia, anemia social history: lives at home with his wife who was just d/c'd from hospital on saturday d/t leg injury no smoking, occasional alcohol family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: on admission general: nad. oriented x3. mood, affect appropriate. heent: sclera anicteric. eomi. cardiac: rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. . on discharge: vs: 99 90-102/50-60s 70-80s 97%ra wt: 107.8kg general: nad. oriented x3. mood, affect appropriate. heent: sclera anicteric. eomi, op clear without exudates, lesions. cardiac: rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. bibasilar crackles, no wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness, pd catheter in place: locked extremities: wwp, trace pretibial edema. pertinent results: on admission: 03:30pm blood wbc-9.6 rbc-3.36*# hgb-10.3*# hct-31.7*# mcv-94 mch-30.5 mchc-32.4 rdw-16.9* plt ct-280 03:30pm blood pt-16.2* inr(pt)-1.4* 03:30pm blood glucose-244* urean-61* creat-5.4*# na-137 k-4.2 cl-96 hco3-22 angap-23* 03:30pm blood albumin-3.4* calcium-8.1* phos-5.5* mg-1.7 potassium 08:53pm blood k-4.9 04:00am blood k-4.8 10:47pm blood k-5.9* 02:30pm blood k-6.6* 11:26am blood k-4.6 02:48am blood k-4.2 . on discharge: 06:00 wbc rbc hgb hct mcv mch mchc rdw plt ct 8.8 3.05* 8.9* 28.5* 93 29.3 31.4 16.8* 254 . glucose urean creat na k cl hco3 angap 134 46* 5.4* 138 4.1 96 30 16 . hga1c: 7.6 . cholest triglyc hdl chol/hd ldlcalc 112 83 35 3.2 60 . inr: 2.4 . microbiology: urine culture: ngtd blood culture: ngtd peritoneal culture: ngtd c. diff toxin x2: negative imaging: cardiac cath: comments: 1. selelctive coronary angiography in this left dominant system revealed 3 vessel coronary artery disease. the lm had a ostial 35% stenosis. the lad was heavily calcified; proximal-mid diffuse 50% involving d3 and s1, followed by 70% at s2; mild-moderate origin stenoses of modest caliber diffusely diseased d1-d3; mid 40-50% at tiny d4 after s2; mid 90% after large d5; diffuse disease in distal lad which wraps around the apex. the lcx was heavily calcified; proximal 55%; major om1 proximal 80% after om2; lpda proximal 90% (after lpls). rca was non-dominant; proximal diffuse disease to 70%. 2. limited resting hemodynamics revealed severely elevated left sided filling pressures with an lvedp of 38mmhg. there was severe pulmonary artery hypertension with a pasp of 64mmhg. there was a preserved cardiac index of 2.36l/min/m2. there was normal systemic arterial pressure of 118/81mmhg. final diagnosis: 1. severe diffuse three vessel cad in a left dominant system. 2. severe left ventricular diastolic heart failure in setting of newly diagnosed severe left ventricular systolic heart failure. 3. severe pulmonary arterial hypertension. 4. succesful removal of lue arterial and venous sheaths with good hemostasis. 5. urgent dialysis today given left-sided filling pressures approaching 40mmhg. 6. cardiac surgery evaluation for suitability for cabg. 7. d/c plavix. no prasugrel. 8. reinforce secondary preventative measures against cad, mi, severe lv systolic and diastolic heart failure. vein mapping: impression: small thickened bilateral greater saphenous and left short saphenous veins. viability study (fdg-pet): impression: 1. no activity in the lv apex. 2. greatly diminished activity in the mid and apical inferior wall. 3. preserved activity in the anterior wall. 4. diminished, but present activity in the septum and lateral wall. tte (s/p diuresis and cvvh): left ventricular wall thicknesses and cavity size are normal. there is severe global left ventricular hypokinesis (lvef <20 %). the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the aortic valve leaflets are moderately thickened. no aortic regurgitation is seen. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , the left ventricular cavity size is slightly smaller with similar systolic function. the estimated pulmonary artery systolic pressure is slightly lower. brief hospital course: 66-year-old male with cad, systolic and diastolic chf (ef 20-25 %), diabetes, ckd stage v recently initiated on hd, pad, hl with recent silent nstemi vs. demand ischemia leading to acute heart failure and resultant fluid overload transferred to for c. cath showing severe three vessel disease. # coronary artery disease: patient with known cad with elevated troponin in setting of heart failure exacerbation who presented recently to with two heart failure episodes with dyspnea likely in setting of ischemia given elevated troponin, new lbbb on ekg, and severe cardiomyopathy on echo. c. cath showing severe three vessel disease with subsequent cardiac surgery consult. echo at showed lvef 15% with dilated left ventricle with severe global systolic dysfunction most consistent with multivessel cad. decision was made to obtain a pet ct viability study. the interpretation of the study is as follows: normal tracer uptake is seen in the basal and mid anterior left ventricular myocardium. fdg avidity is mildly diminished in the septum and lateral wall compared to the anterior wall.no fdg avidity is seen in the apex. activity is greatly diminished in the mid and apical inferior wall, with preservation of the basal inferior wall. the lv cavity is enlarged. small bilateral pleural effusions are present. diffuse coronary artery calcifications are seen. impression: 1. no activity in the lv apex. 2. greatly diminished activity in the mid and apical inferior wall. 3. preserved activity in the anterior wall. 4. diminished, but present activity in the septum and lateral wall. the ct surgery service at did not feel that he was an appropriate surgical candidate and potential risks outweighed potential benefits. with the assistance of dr. , contact was made with the medical center cardiology service (dr. ) for consideration of cabg or high-risk revascularization with vad placement and a second opinion. however, pt will need to see dr. at first before referral is scheduled. regarding medications he was re-started on plavix 75 mg po qd; continued on metoprolol and aspirin. he was also placed on anticoagulation for new apical akinesis for a duration of 3 months. at discharge, inr was 2.4 on 3mg warfarin. outpatient issues: -- monitor bp with plan to start acei if blood pressure allows. -- continue close monitoring of inr as outpatient with coumadin dose adjusted as needed. # acute severe left ventricular diastolic heart failure in setting of newly diagnosed severe left ventricular systolic heart failure (ef 25-30%): patient with echo showing 15% with markedly dilated left ventricular with concentric lvh, regional wall motion abnormalities including akinetic segments. given left-sided filling pressures approaching 40 mm hg, transferred to ccu for rrt in setting of borderline hypotension and fluid overload. etiology of failure likely in setting of recent ischemia as above with long-standing hypertension and diabetes. no infection, apparent alcohol abuse, major anemia, or other precipitants causing destabilization. cvvh performed in the ccu, and the patient was net negative 6 l and no longer requiring supplemental oxygen. he was continued on metoprolol tartrate 12.5 mg po bid. acei was held during acute heart failure and was not started at discharge because of mild orthostasis. weight at discharge was 107.8kg. outpatient issues: -- monitor bp with plan to start acei if blood pressure allows for afterload reduction and cardiac remodeling. -- fluid management per nephrology . # fever. patient had tm 100.5 on that appears to have occurred while cvvh was stopped secondary to line clot. no localizing symptoms except sore throat. cxr possibility suggested pneumonia but not definitive. peritoneal dialysate cell count and differential showing increased wbc 155 with 75 % polys but patient has not received peritoneal dialysis. however, the peritoneal culture was not drawn properly as there was no dwell. other cultures including blood and urine showed no growth. wbc initially trended to maximum of 15.5 and downtrended. he did not appear systemically ill, and empiric antibiotics were not started. infectious disease was consulted with impression of no obvious source. ua mildly positive however culture with no growth. additional infectious work-up: c.difficile negative x2, blood cultures on discharge with no growth. patient afebrile prior to discharge with white blood count within normal limits. . # mild pulmonary artery hypertension: likely secondary to left ventricular failure (who class ii) and heart failure. advise outpatient work-up for secondary etiologies such as sleep apnea given habitus. he would benefit from sleep study as apneic as multiple desaturations on pulse oximetry in icu while sleeping. . # esrd (ckd stage v): patient recently initiated on dialysis secondary to recurrent episodes of volume overload refractory to medical management. he has an hd catheter placed until pd access matures in . he is on m-w-f schedule at . he underwent cvvh in the ccu as above and was transitioned to intermittent hemodialysis once blood pressures tolerated. he will need once weekly infusion of dialysate through pd catheter, this was done on (see page 1). . # diabetes (last a1c 7.6): patient on 75/25 insulin regimen at home, taking from 15-40 units three times a day. he had labile blood glucose during icu stay. he was switched to glargine insulin during hospital stay with poor glucose control despite increasing glargine and humalog sliding scale. after discussion with pharmacy and concern that 75/25 might not be available at rehab, his glargine was increased to 45 units and humalog sliding scale was increased. his a1c was 7.6 on admission indicating his glucose was moderately well controlled at home. he should return to his previous insulin regimen once he returns home. . # pad: no abi or other data to evaluate extent. he was continued on above anti-platelet . . # hyperlipidemia: lipid panel at goal. he was continued on atorvastatin 80 mg po qd. . # normocytic anemia: patient with mild anemia. likely secondary to esrd. iron studies not suggestive of iron deficiency. epo was started during hd sessions on . . emergency contacts: wife , (h). (c); son (c), (h) . his code status was confirmed to be full. . arrangements were made for outpatient follow-up with dr. who specializes in heart failure. he will continue with outpatient dialysis per previous arrangements. medications on admission: home medications: updated from home list atorvastatin 80 mg qday allopurinol 200 mg po daily fibercon one tablet twice daily imodium as needed florajen3 probiotic 2 once a day omeprazole 20 mg po daily hydralazine 50 mg po ? bid isosorbide dinitrate 10 tid metoprolol succinate 25 daily lispro/protam 75/25 - between 15-40 units 3 times per day. plavix 75 daily (last dose unknown) aspirin 81 daily nitrostat sl as needed discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. allopurinol 100 mg tablet sig: one (1) tablet po once a day. 3. psyllium packet sig: one (1) packet po bid (2 times a day). 4. lactobacillus acidophilus oral 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. heparin (porcine) 1,000 unit/ml solution sig: 4,000-11,000 units injection prn (as needed) as needed for line flush: withdraw 4 ml prior to flushing with 10 ml ns followed by heparin as above according to volume per lumen. . 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 10. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 12. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 13. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 14. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 15. insulin lispro 100 unit/ml solution sig: 0-14 units subcutaneous four times a day: before meals and at hs per sliding scale. 16. insulin glargine 100 unit/ml solution sig: forty six (46) units subcutaneous at bedtime. 17. coumadin 3 mg tablet sig: one (1) tablet po once a day: please have inr checked weekly with coumadin adjusted accordingly. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: coronary artery disease chronic renal disease on hemodialysis secondary: hypertension diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to for cardiac catherization. you underwent a diagnostic cardiac catherization which showed extensive blockages in the arteries that lead to your heart. we performed a test called a viability study that evaluated whether clearing the blockages in your arteries would improve your heart function. this study was negative so you would not be helped by a bypass operation. your heart is now weak so we have started you on a medicine regimen that will help to maximize the heart function. your weak heart meant that fluid is not pumped well through the heart and backed up in your lungs. you underwent a blood filtering process to remove fluid from your body and you were started on hemodialysis to continue to remove excess fluid. your dialysis catheter was sluggish so the radiologist changed it on . we have arranged for you to see the following physicians after you go to rehab. 1. dr.: heart failure specialist. you have an appt in but we are working on an earlier appt, hopefully later this month 2. dr. : a general cardiologist who will see you in . 3. please make an appt to see dr. when you get out of rehabilitation . we made the following changes to your medicines: 1. stop taking hydralazine and isordil 2. start taking tylenol for pain 3. start taking lorazepam as needed for anxiety 4. start taking loperamide as needed for diarrhea 5. start taking sevelamer to lower your phosphate 6. start taking nephrocap vitamins 7. decrease allopurinol to 100 mg daily 8. take metamucil instead of fibercon for diarrhea 9. change 75/25 insulin to glargine while you are at rehab. humalog sliding scale as noted to be given before meals and at bedtime. 10. start taking coumadin to prevent clot formation . please continue your other home medications as prescribed. followup instructions: the following appointments have been made for you: name: , md location: internal medicine associates address: , , , phone: appointment: wednesday 11:00am department: cardiac services when: monday at 9:00 am with: dr. building: sc clinical ctr campus: east best parking: garage . please make an appt to see dr. when you get out of rehab. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters hemodialysis venous catheterization for renal dialysis arteriography of other specified sites diagnoses: other primary cardiomyopathies hyperpotassemia anemia in chronic kidney disease end stage renal disease renal dialysis status subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia mitral valve disorders congestive heart failure, unspecified gout, unspecified other chronic pulmonary heart diseases peripheral vascular disease, unspecified personal history of tobacco use occlusion and stenosis of carotid artery without mention of cerebral infarction hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease anxiety state, unspecified hypotension, unspecified long-term (current) use of insulin other left bundle branch block fever, unspecified diarrhea obesity, unspecified occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled below knee amputation status irritable bowel syndrome acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to