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: lipitor / lisinopril / iodine / paper tape attending: chief complaint: foot pain major surgical or invasive procedure: none history of present illness: 68y/o f with pmh of cad s/p 4 vessel cabg and recent stent to graft, ischemic cardiomyopathy ef 20-30, s/p icdm just discharged from service for chf exacerbation (in ccu on dopa and lasix gtt) now presenting with chest pain. since discharge, patient has been seen by vna at home and today was noted to be hypotensive to sbp of 70s with lightheadedness and dizziness. shortly thereafter she experienced fleeting chest pain, lasting approximately one minute and then resolved. she denies worsening of baseline sob, palpitations, f/c, n/v/d, dysuria/hematuria. patient was mostly concerned with left foot pain that started the night prior to admission. patient denies any injury to her foot and likewise denies swelling or redness. she reports that the foot was extremely painful to touch and even bedsheets hurt her. she denies and history of foot or joint problems, specifically gout. given the continued pain, she presented to the ed for further evaluation. . in the ed, vitals were notable for a sbp in the 70s with arm cuff and patient was given a 250 cc bolus. her blood pressure was rechecked in the thigh and found to be 122/57. patient was chest pain free and reportedly even denied ever having chest pain. ekg was unchanged from prior and cxr showed stable cardiomegaly without pulmonary edema. given the foot pain, foot films were obtained and were unremarkable. patient was also noted to have acute on chronic renal failure with creatinine of 2.1, up from 1.6 and down trending, but positive troponin of .55 (1.09 on ). patient was then admitted for further management of chronic cardiac disease. . upon arrival to the floor, patient was sleeping comfortably, denying chest pain or foot pain. . on review of systems, she 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. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of ankle edema, syncope or presyncope. past medical history: 1. cad s/p 4v cabg in with lima-lad, svg-diag (known occluded), svg-om1, and svg-rca; non-sustained vt on tele s/p cabg, had intervention to the lima-lad anastamosis in with cypher stent at the anastomosis; cath'd most recently in with instent restenosis of lima-lad prior cypher stent that was successfully treated with taxus stent. 2. dm2 since 3. hypercholesterolemia 4. osteoarthritis: b/l shoulder, knee arthritis with intermittent effusions, rf +; also djd of both knees and l thumb, s/p tkr of l knee 5. dyspnea on exertion x years, followed by cardiology and pulmonology, thought to be most likely related to ischemic cardiomyopathy and cad 6. chf (ef 20-30%) . 1+ mr, 1+tr. small atrial secundum defect 7. hypertension 8. asthma 9. uterine fibroids, has had peri-menopausal spotting, received hrt 10. history of occult blood positive stool 11. myelodysplastic syndrome 12. cataracts 13. icd social history: social history is significant for the absence of current tobacco use. she previously smoked ~1 ppd but quit 10 years ago. she drinks alcohol rarely, about once every two weeks. she lives with her husband. they previously owned a restaurant called pit stop bbq. she has four children, one of whom is deceased. family history: mother had dm and cad, but died at 79 from lung ca. father died of an accidental death, but had a h/o cad. physical exam: vs: t - 98.5, bp - 122/70 (thigh), hr - 53, rr - 18, o2 - 100% ra general: wdwn, african-american female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, no jvd cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c; trace edema. no overlying erythema of bilateral feet. nontender, full rom of toes and feet. no asymmetry skin: multiple areas of hyperpigmentation involving entire body pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: ankle/foot films (r/l) - no acute fractures, effusions. l foot films: impression: 1. no fracture. 2. hallux valgus/metatarsus varus deformity with bunion formation. r foot films: findings: three views show no evidence of acute bone or joint space abnormality. there is a small inferior and moderate posterior calcaneal spurring. bl ankle films: findings: no evidence of acute bone or joint space abnormality. small calcifications and soft tissues could be within phlebolith. abdominal ultrasound: findings: the liver is normal in echotexture. no focal lesion is identified. there is no intrahepatic biliary dilatation. the gallbladder wall is again mildly thickened. son sign is absent. in comparisons with ultrasound of , there is no significant interval change. the main portal vein is patent with appropriate direction of flow. the spleen is unremarkable and normal in size. a tiny amount of perihepatic free fluid is visualized. impression: no hepatosplenomegaly. tiny amount of perihepatic ascites, unchanged. 09:10pm glucose-159* urea n-88* creat-2.1* sodium-134 potassium-4.4 chloride-92* total co2-27 anion gap-19 09:10pm ck(cpk)-33 09:10pm ctropnt-0.55* 09:10pm ck-mb-notdone probnp-* 09:10pm uric acid-21.0* 09:10pm wbc-2.1* hct-30.0* 09:10pm neuts-60 bands-0 lymphs-29 monos-9 eos-0 basos-0 atyps-0 metas-0 myelos-0 blasts-2* nuc rbcs-124* 09:10pm plt smr-low plt count-86* 05:30am glucose-114* urea n-85* creat-1.6* sodium-135 potassium-3.4 chloride-93* total co2-29 anion gap-16 05:30am magnesium-2.0 05:30am wbc-1.8* hct-29.0* 05:30am plt count-83* brief hospital course: a/p: 68 yo m w/ cad, ischemic cardiomyopathy, and oa and multiple admissions for chf exacerbation with multiple diuretic changes/increases including hctz who presents with bilateral ankle pain and developed acute on chronic chf. . # cardio/pulmonary arrest: pt had end-stage chf. pt's wishes and prognosis were discussed at a family meeting with dr , palliative care, and . decided to be dnr/dni, goal to be comfortable at home. pt was transitioned to cmo, and pt's icd was turned off on . pt became hypotensive overnight down to 80s/60s and a fluid bolus was given overnight. in the am it was clarified that vitals were to be discontinued and to only to be given bolus if symptomatic. plan was to transfer to home hospice tomorrow, but today at about 12:00 pt became more sob and then apneic and died of cardio-pulmonary arrest. # acute on chronic systolic hf: (ef 20%) in the pt was hypotensive in 70s, and given a 250ml bolus and responded to 122/57. pt was initially euvolemic and w/o orthopnea, pnd, or doe on the floor, but later to become volume overloaded. pt was treansferred to the ccu for milrinone since unable to tolerate fluid challenge for renal failure. pt continued to devleop hypotension chf. started milrinone and lasix gtt which was increased to 20mg/hr and 0.75mcg/kg/min, and given 2 doses diuril. on pt was diuresed enough to stop the milrinone drip and was switched to po lasix and was euvolemic in the ccu. pt was transferred back to the floor, and became slightly overloaded and went up to lasix to 80mg , goal was to keep pt even. when pt became cmo this was changed to 30mg iv bid. # acute on chronic renal failure: pt's baseline cre usually 1.6-1.8. prerenal chf possibly leading to intrarenal atn. no contrast administered recently. pt's cr was trended and intially her diruetics were held, these were restarted once her improved. on transfer back from the ccu her cr was still elevated at 2.3. # hypotension: initially thought to be in the setting of overdiuresis. no evidence of sepsis, but in the end thought to be end-stage chf, managed with fluid bolueses and above. # cad: s/p cabg with recent stent of lima to lad. no chest pain or palpitations currently. ekg unchanged from previous w/o acute ischemic changes. trops were elevated renal disease and remained flat. continued asa, plavix, statin, bb until pt became cmo. # rhythm: pt occasionally had nsvt, but would remain asymptomatic. pt's aicd was eventually turned off on . . # asthma: cont albuterol, spiriva, fluticasone # myelodysplastic syndrome: pt's hct ~30 at baseline. u/s requested by heme-onc shows no interval change in hsm. stop danazol. pt received epo while in house (3000 u 3x/week), and transfused 1 unit on . # dm: diet controlled at home. hiss while in house. # ankle pain: likely gout in setting of new onset hctz use. (uric acid 21.0) atypical joint for gout (ankles). no evidence of fracture on l foot films taken in ed. unlikely infection (no fevers, leukocytosis, or open ulcers.) bilateral ankle films to assess for effusions, but no signficant effusion was found. pt's hctz was held. tylenol/tramadol was given for pain medications on admission: 1. digoxin 125 mcg po q mwf 2. torsemide 40 mg po bid 3. metoprolol succinate 25 mg po qd 4. aspirin 325 mg po qd 5. clopidogrel 75 mg po qd 6. spiriva 7. fluticasone 110 mcg 2 puffs 8. isosorbide mononitrate sr 30 mg po qd 9. pravastatin 40 mg po qhs 10. albuterol 90 mcg 2 puffs prn 11. multivitamin 12. nitroglycerin 0.3 mg sl prn 13. trazodone 25 mg po qhs prn: insomnia 14. epoetin alfa injection 15. docusate sodium 100 mg po bid prn 16. aranesp sureclick -polysorbate 25 mcg qweek per outpatient hematologist discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po 3x/week (mo,we,fr). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for foot pain. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. aranesp sureclick -polysorbate 25 mcg/0.42 ml pen injector sig: one (1) injection subcutaneous once a week: to be administered by hematologist. 9. nitroglycerin 0.3 mg tablet, sublingual sig: tablet, sublinguals sublingual prn (as needed) as needed for chest pain: if chest pain does not resolve with tablets, please call 911. 10. torsemide 20 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* 11. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*0* 12. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 13. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed for shortness of breath/wheezing. 14. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 15. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. discharge disposition: home with service facility: hospice discharge diagnosis: gout acute on chronic renal failure chronic systolic heart failure cad ischemic cardiomyopathy myelofibrosis discharge condition: pt died on around 12:00 discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified diagnoses: other primary cardiomyopathies pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status asthma, unspecified type, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified myelodysplastic syndrome, unspecified hypotension, unspecified cardiac arrest automatic implantable cardiac defibrillator in situ encounter for palliative care acute on chronic systolic heart failure osteoarthrosis, unspecified whether generalized or localized, lower leg osteoarthrosis, unspecified whether generalized or localized, shoulder region 

Answer: The patient is high likely exposed to