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: heparin agents / percocet attending: chief complaint: respiratory failure major surgical or invasive procedure: none at - arrived intubated. history of present illness: 67 f with cad s/p cabg, systolic chf, copd, recent trach with tracheocutaneous fistula closure one month ago, now transfer from sicu service. patient admit to osh around with resp distress at home requiring intubation in the field after a feeling of anxiety and urge for ativan. went to osh, extubated then reintubated later that day. per report, had vocal cord edema at reintubation. transferred to given tenuous condition and history of care by ent at past medical history: -coronary artery disease s/p cabg in and "recent" pci -chf, last tte ef 60% with mild lvh and some focal hypokinesis at base. -osa -dyslipidemia -htn -left total hip replacement-, elective. complicated postoperative course with post-operative atrial fibrillation wtih rvr requiring cardioversion, sepsis, pseudomonas vap, vre ut, and prolonged intubation leading to trach/peg. discharged to chronic wean facility but unable to decannulate. bronchoscopy revealed tracheomalacia of subglottic region. -supraglottic edema from gerd -bipolar disorder -depression -chronic atrial fibrillation, developed postop from thr, not anticoagulated -chronic constipation -hit during fragmin therapy social history: married. very supportive husband. when she is not hospitalized/in rehab, she lives with him. no etoh or current smoking. has 35 pack year smoking history, quit 13 years ago. family history: depression physical exam: vs: 130/80 80 21 95% on ra gen: nad heent: eomi, perrl, hoarse voice neck: supple cv: regaulr rate, distant hear sounds, no mrg pulm: coarse breath sounds through out with scattered expiratory wheeze, scattered rhonochi bilaterally abd: +bs, soft, ntnd ext: no edema neuro: no focal deficits psych: anxious, good insight into anxiety pertinent results: admission labs: 03:08am blood wbc-7.3 rbc-3.17* hgb-10.1* hct-30.1* mcv-95 mch-31.9 mchc-33.7 rdw-15.8* plt ct-217 03:08am blood pt-14.3* ptt-28.3 inr(pt)-1.2* 03:08am blood glucose-122* urean-19 creat-1.1 na-143 k-4.0 cl-108 hco3-26 angap-13 03:08am blood calcium-8.7 phos-3.0 mg-1.6 05:32am blood glucose-123* lactate-1.0 na-142 k-4.1 cl-103 discharge labs: 04:50am blood wbc-5.0 rbc-3.31* hgb-10.3* hct-30.6* mcv-93 mch-31.3 mchc-33.7 rdw-14.7 plt ct-316 04:50am blood glucose-105 urean-21* creat-1.0 na-137 k-3.9 cl-99 hco3-31 angap-11 imaging: ct chest: provisional findings impression: mlkb sun 2:55 pm no pe. consolidation in lung bases, associated with pleural effusion bilaterally. final report history: 67-year-old female with severe hypoxia, history of copd, pulmonary edema. rule out pulmonary embolism. technique: mdct of the chest was performed before and after administration of intravenous contrast. images were reformatted in the axial, coronal, sagittal, and oblique planes. findings: there is no filling defect within the main, right, left, lobar, or segmental branches of the pulmonary artery to suggest the presence of pulmonary embolism. bilateral lower lobe atelectasis can be seen, more extensive compared to prior study obtained on . within the posterior aspect of right upper and left upper lobes, there are patches of consolidation consistent with pneumonia. there is diffuse interstitial thickening, likely representing pulmonary edema. the amount of pleural effusion has also increased compared to prior study of . again noted is mediastinal and hilar lymphadenopathy. unchanged and stable calcified granuloma within the right upper lobe (series 3, image 51). endotracheal tube and nasogastric tube are in place. patient is status post cabg. there is thinning of myocardium associated with calcification at the apex of the heart, and could be result of prior myocardium infarction. osseous structures: degenerative changes in the spine are present. previously-described subcutaneous emphysema has been resolved. impression: 1. negative examination for pulmonary embolism. 2. atelectasis in lower lobes associated with pleural effusion bilaterally. patchy opacities suspicious of pneumonia. stress mibi: radiopharmaceutical data: 9.2 mci tc-m tetrofosmin rest (); 30.2 mci tc-99m tetrofosmin stress (); history: 67 year old woman with cad and chf, admitted for recurrent episodes of pulmonary edema, evaluate for perfusion defects. summary from the exercise lab: dipyridamole was infused intravenously for 4 minutes at a dose of 0.142 mg/kg/min. imaging method: resting perfusion images were obtained with tc-m tetrofosmin. tracer was injected approximately 30 minutes prior to obtaining the resting images. following resting images and two minutes following intravenous dipyridamole, approximately three times the resting dose of tc-99m tetrofosmin was administered intravenously. stress images were obtained approximately 30 minutes following tracer injection. imaging protocol: gated spect. this study was interpreted using the 17-segment myocardial perfusion model. interpretation: left ventricular cavity size is moderately enlarged. there are moderate fixed perfusion defect in the basal inferior wall, the apex, and the inferolateral wall. gated images reveal hypokinesis of the basal inferior, apex, and inferolateral wall. the calculated left ventricular ejection fraction is 36%. no previous study to compare. impression: 1. moderate fixed perfusion defect in the basal inferior wall , the apex, and the inferolateral wall with associated hypokinesis. 2. moderately enlarged left ventricule with calculated ef of 36%. stress ekg: resting data ekg: sinus, t wave flattening inferiorlaterally heart rate: 74 blood pressure: 112/56 protocol / stage time speed elevation heart blood rpp (min) (mph) (%) rate pressure 1 0-4 0.142mg/ kg/min 80 96/46 7680 total exercise time: 4 % max hrt rate achieved: 52 interpretation: ms. is a 67 year old woman with coronary artery disease s/p cabg in and pci, copd who presented with worsening dyspnea. the patient was infused with 0.142mg/kg/min of dipyridamole over 4 mintues. the patient reported a headache during the infusion. however, she had no chest, arm, back, or neck pain during infusion or in recovery. the baseline t wave abnormalities did not change during exercise or recovery. the rhythm was sinus with frequent apc's. there was appropriate hemodynamic response. the dipyridamole was reversed with 125mg of aminophylline. impression: no anginal type symptoms and no significant st segment changes from baseline. nuclear report to be sent separately. spirometry: pulmonary report spirometry, lung volumes, dlco study date of 12:57 pm spirometry 12:57 pm pre drug post drug actual pred %pred actual %pred %chg fvc 2.17 2.21 98 fev1 1.59 1.55 103 mmf 1.18 2.02 59 fev1/fvc 74 70 105 lung volumes 12:57 pm pre drug post drug actual pred %pred actual %pred tlc 3.33 3.63 92 frc 1.93 2.06 94 rv 1.38 1.42 98 vc 2.01 2.21 91 ic 1.40 1.57 89 erv 0.54 0.64 85 rv/tlc 42 39 106 he mix time 0.00 dlco 12:57 pm actual pred %pred dsb 7.03 16.35 43 va(sb) 2.45 3.63 68 hb 10.90 dsb(hb) 7.69 16.35 47 dl/va 3.14 4.50 70 notes: no online pulmonary notes available. brief hospital course: 67 yo f with pmh significant for recent trach with tracheocutaneous fistula closure trasnferred to from osh, intubated after suspected flash pulmonary edema brought on by severe anxiety. initially admitted to sicu, subsequently extubated and transferred to floor after aggressive diuresis. on floor patient was managed with anti-anxiety medications, further diuresis and oxygen therapy (patient uses cpap at baseline at night). ent evaluated for revision of fistula but surgical intervention was deemed unnecessary at this time. patient was weaned from day time cpap and was discharged in stable condition home with services. . respiratory distress: admitted to sicu from osh initially intubated. was diuresed and successfully extubated. initial concern for new cardiac cause of flash pulmonary edema, particularly given hx of chf, however stress mibi showed no change from study done earlier this month at with several fixed areas of hypoperfusion (see earlier section for complete result). other possibilities that were considered were severe anxiety leading to increased in bp causing flash. patient was managed with further diuresis, nebs and eventually weaned to room air with night time cpap which is her baseline. ent evaluated for fistula revision which was deemed unnecessary at this time. . chf: stress mibi indicated ef 30-35% which is slightly decreased from last lvef of 45-50% with evidence of systolic failure and moderate mr. chf thought to be ischemic in nature. . cad: stress ekg showed no ischemic changes. managed on home medications. . copd: managed with home medications . diabetes: managed on home insulin regimen, asa, statin and ace-i . depression/anxiety: likely contributing to flashes, managed aggressively with ativan, and home medications of lamictal, seroquel, and sertraline. patient discharged with additional ativan and recommended to follow up with her out-patient psychiatrist. medications on admission: pantoprazole 40 mg senna 8.6 mg 2 tabs qd mvi asa 81 mg po qd quetiapine 100 mg qhs quetiapine 25 mg tablet tid metoprolol tartrate 25 mg qd sertraline 50 mg qd lisinopril 5 mg qd lipitor 40mg qd lamotrigine 25 mg lactulose 1tsp q6 prn furosemide 40 mg qd potassium discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twelve (12) hours. 2. senna 8.6 mg tablet sig: two (2) tablet po once a day. 3. multivitamin tablet sig: one (1) tablet po once a day. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 6. quetiapine 25 mg tablet sig: one (1) tablet po tid (3 times a day). 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*15 tablet(s)* refills:*0* 8. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 9. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 10. lipitor oral 11. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. lamotrigine 25 mg tablet sig: one (1) tablet po twice a day. 13. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*1* 14. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 15. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 16. lorazepam 1 mg tablet sig: one (1) tablet po every four (4) hours as needed for anxiety. disp:*45 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: respiratory failure pulmonary edema . congestive heart failure, chronic, systolic dysfunction anxiety bipolar disorder coronary artery disease obstructive sleep apnea discharge condition: stable discharge instructions: you were admitted from another hospital for respiratory difficulties requiring a breathing tube. you were evaluated for need for possible tracheostomy, but you care providers have felt that this is not necessary urgently. you have done very well after the breathing tube was removed. we have treated your anxiety and heart failure in addition. . please return to the hospital or call your doctor if you have recurrence of shortness of breath, chest pain or jaw pain, severe anxiety, or any new symptoms that you are concerned about. . please weigh yourself daily. please call your primary care physician if you gain or lose more than 2 pounds in one week, as this may be a sign that your lasix dose need adjustment. . since you were admitted, we have made the following medication changes: * we have increased your lasix to 40 mg twice daily. * we have added another water pill called spironolactone. * please stop taking your potassium pill for now (you should have your potassium level checked at your next pcp ). * we have increased metoprolol to twice daily. * we have given you an inhaler to be used if needed for wheezing or shortness of breath. * we have given you ativan tablets to be taken if needed for anxiety. please see your psychiatrist within one week to discuss your continued use of this medication. followup instructions: we have scheduled a primary care followup appointment with dr. at for at 11:30 am. you should have your potassium checked at that time. . please schedule a followup appointment with your psychiatrist for further management of your anxiety within one week. . please schedule a followup appointment with your cardiologist, dr. at , within 2-3 weeks. . we have scheduled a followup appointment with dr. for you (phone () on at 9am. . we have scheduled a followup appointment with dr. for tuesday at 11am (after your appointment with dr. . the phone number is ( if you need to reschedule. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation aortocoronary bypass status anxiety state, unspecified acute respiratory failure other constipation acute on chronic systolic heart failure hip joint replacement bipolar i disorder, most recent episode (or current) depressed, unspecified 

Answer: The patient is high likely exposed to