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: vancomycin attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: right heart catheterization history of present illness: 66m patient of dr. , who presented to the ed today c/o poor uop for 3 days. he states that his weight this morning was 192 which is high for him and he states that he has been as low as 172. weights in our system are difficult to follow, and the patient has readings of many he notes that he has had a normal bowel movement this morning and has never noticed red blood around stool, red blood in the toilet bowl, or black-tarry stools. he explicitly denies cp, or an increase in his baseline shortness of breath. he states this morning he was getting light-headed with changes in position, however this has resolved at this time. . of note he was changed from lasix to torsemide but the patient feels this didnt work as well as his lasix and that he has been gaining weight. he states he took two doses of his old lasix yesterday without effect. . in the ed his initial vitals were 97.6 70 88/52 16 100% and given his low maps, he received 2 units of prbcs, and 2l ivf. with that his systolics were noted to be in the low 100's. a foley cathter was placed and returned 50cc of uirne. rectal exam revealed bright red blood. 2 peripheral 18g ivs were placed. the patient briefly endorsed respiratory distress, and cxr was checked revealing a mild increase in interstitial edema and 160mg of iv lasix were given with 100cc of uop and resolution of symptoms. . for unclear reasons, the patient was given zosyn and vancomycin. durring the infusion of vancomycin he developed hives on his arm and the infusion was stopped. . on arrival to the floor the patient is clear, not complaining of any dyspnea, and feels very comfortable. past medical history: 1. severe cad s/p 4vcabg 2. v-fib arrest 4-days post-cabg s/p pacemaker/icd - generator change and pocket revision in to right side of chest secondary to pain 3. ischemic cardiomypoathy / systolic chf, ef 25% 4. peripheral vascular disease s/p bilateral femoral-popliteal bypass 5. multiple lower extremity catheterizations 6. diabetes type ii - followed at 7. obstructive sleep apnea 8. gout 9. asthma 10. mild sigmoid colonic thickening on recent ct-abd/plv, colonoscopy showing sessile polyps, biopsy will have to happen off plavix 11. esophagitis, gastritis, peptic ulcer disease 12. afib/flutter s/p tte cardioversion , ablation. social history: -tobacco history: quit , prior 70 pack year history -etoh: quit , prior heavy use -illicit drugs: denies any history married, lives at home with wife. to his admission to rehab he lived at home with his wife. walks with a cane. he does not drink or smoke. family history: there is no family history of premature coronary artery disease or sudden death. mother with kidney problems. father died of unknown causes. + h/o stomach cancer. diabetes is prevalent throughout the family. physical exam: admission physical exam: vs: t=96.2 bp=80/51(57) hr=69 rr=16 o2 sat=95% on 3l general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera mildly icteric. perrl, eomi. conjunctiva were pale, dry mucosa. no xanthalesma. neck: supple with jvp of 3 above the clavicle at 30 degrees. cardiac: midline scar, rr, normal at least two murmurs one early peaking heard best in the pulmonic area, one holosystolic heard best over the mitral area. no m/r/g. no thrills, lifts. no s3 or s4. lungs: mild crackles at the bases clearing with deeping breaths, diffuse inspiratory wheezes doing the same. abdomen: distended soft, ntnd. no hsm or tenderness. no fluid wave, abd aorta not enlarged by palpation. no abdominial bruits. extremities: stasis dermatitis, no pitting edema, bilateral scars of saphenous harvest. right: radial dp (-) pt : radial dp pt discharge physical exam: pertinent results: admission labs: wbc 5.6 hgb 7.4 hct 25.1 plts 269 pt 22.8 ptt 47.4 inr 2.1 na 133 k 4.6 cl 101 hco3 22 bun 76 cr 2.9 gluc 234 alt 18 ast 23 ldh 339 alk phos 161 t bili 0.3 albumin 3.0 lactate 1.6 trop-t 0.04 pro-bnp 2247 iron 21 ferritin 20 tibc 343 pertinent studies: ct abdomen/pelvis without contrast (): 1. trace perihepatic fluid noted tracking along the right paracolic gutter as well as trace retroperitoneal fluid and a small amount of simple pelvic fluid. overall this is nons-specfic and may be related to iv hydration status. 2. mesentery noted in the upper part of the abdomen, a nonspecific finding though new compared to prior studies. follow up in 6 months is advised. 3. bilateral small pleural effusions, right greater than left. 4. right lower lobe 5mm pulmonary nodule. recommend non-emergent chest ct to assess for other possible pulmonary nodules and establish frequency of surveillance. 5. extensive vascular calcifications. tte (): the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is severely depressed with global hypokinesis and akinesis of the interventricular septum and anterior wall (lvef= 20-25 %). the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are moderately thickened. the mitral valve leaflets are structurally normal. moderate (2+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a restrictive filling abnormality, with elevated left atrial pressure. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study dated (images reviewed), the degree of mitral regurgitation is slightly worse. pulmonary pressures are higher. lvef is similar. renal ultrasound (): findings: the right kidney measures 9.8 cm and the left kidney measures 10.1 cm. there is no hydronephrosis. no cyst or stone or solid mass is seen in either kidney. impression: no hydronephrosis. . cardiac catheterization (): response to inhaled no pvr 3.9 to 1.3 c/i 3.5 to 3.9 pcwp 34 to 42 discharge labs (): wbc 5.7 hgb 8.9 hct 28.2 plts 220 pt 14.6 ptt 30.5 inr 1.3 na 137 k 4.3 cl 100 hco3 25 bun 67 cr 2.0 gluc 116 brief hospital course: 66m with cad s/p cabg, vf arrest s/p aicd, ischemic cmp (ef 20-25%), af/flutter s/p ablation with recent admission for acute systolic chf with aggressive diuresis admitted with hypotension and . . # hypotension: suspect hypovolemic shock in the setting of gi bleeding vs. efficatious response to torsemide. the patient responded well to volume. symptoms not consistent with cardiogenic shock given his excellent oxygenation, very mild insterstitial marking, and baseline pro-bnp. in addition, echocardiogram performed on hd1 was not consistent with cardiogenic shock. the patient did not meet any sirs criteria currently as he was without fever, leukocytosis, tachycardia or tachypnea throughout admission. pt was fluid/volume responsive in the ed with pressures rising into the low 100's systolic after 2uprbc and 2l ivf. he received a total of 4uprbc and pressures improved. metoprolol, torsemide and flomax were held initially. metoprolol and torsemide were restarted on hd4 as blood pressures were stable and patient began to appear volume overloaded with increased weight, fluid wave in abdomen, elevated jvp and lower extremity edema. patient responded to po torsemide. he was discharged on torsemide 100mg in the am and 50mg in pm. his weight was 189 lbs at the time of discharge. patient's ideal weight is likely closer to 183 lbs. . #right>left heart failure- patient's ongoing signs of lower extremity edema, abdominal distension and elevated jvp on exam indicating right>left sided failure. on hd3, patient was taken for right heart catheterization to determine acute vasoreactivity to nitric oxide. the right heart catherization showed elevated pulmonary pressures with good response to no. the patient was therefore started on sildenafil. most likely etiology of pulmonary arterial hypertension is underlying obstructive sleep apnea. patient was continued on home cpap while sleeping. he was instructed to be compliant with cpap. patient was discharged on sildenafil. . # arf - low feurea reflected current clinical suspicion that patient had pre-renal azotemia, whether the etiology is poor forward flow or dehydration. following rehydration, creatinine remained elevated. urine sediment did not show signs of atn. renal ultrasound showed no signs of hydronephrosis. lisinopril and torsemide were held initially. creatinine began to trend downward. his home lisinopril was restarted and his torsemide was restarted. creatine continued to trend down and was 2.0 at the time of discharge. . # gi bleed - patient with no obvious predilection to bleeding on upper and lower endoscopy in '. he does have diverticulosis which is the most likely source of bleeding. it is unclear if this is his primary issue or a complication of decreased clearance of his dabigatran. on initial exam, patient had bright red blood per rectum on digital exam. he continued to have blood streaked stools intermittently, but hematocrit remained stable following initial transfuion. gi was consulted and felt that patient should be prepped for colonoscopy pending resolution of acute renal failure. however, as arf improved, patient became volume overloaded and the decision was made to diurese patient over hydrating for bowel prep. the patient will follow-up with gi for colonoscopy as an outpatient. his home pradaxa was not restarted given recent bleed. he was discharged on protonix. . #. chronic systolic chf: patient had no signs of volume overload at the time of admission. echocardiogram performed on hd1 showed higher pulmonary pressures and worse mr in comparison to prior tte performed in . torsemide was held initially, and restarted on hd4 as patient began to show signs of volume overload. patient diuresed well on po torsemide and was 189 lbs at the time of discharge. his ideal weight is likely 183lbs. patient was instructed to call dr. if he had a weight gain of >3lbs. . #. cad s/p 4v cabg: patient was without chest pain or ekg changes at the time of admission. he was continued on atorvastatin and aspirin. toprol and lisinopril were held initially as above in the setting of hypotension. these medications were restarted on hd 4 with maintenance of blood pressue. the patients diuretics were also initally held but restarted when the patients weight began to increase as above. . #. atrial fibrillation/flutter s/p ablation: hr control excellent. dabigatran was held in the setting of and gi bleed. at the time of discharge his ptt and inr were trending downward. . #iddm: patient's blood sugar was well controlled with insulin sliding scale throughout admission. . # neuropathy: patient was continued on home pregabalin 75 mg po bid throughout admission. . #. gout: no acute flare during admission. allopurinol and colchicine were held initially in the setting of . allopurinol was restarted at half home dose. colchicine was restarted at home dose. . #transitional issues: - ct abd/pelvis revealed rll 5mm pulmonary nodule. recommend non-emergent chest ct to assess for other possible pulmonary nodules and establish frequency of surveillance. also mesentery noted in the upper part of the abdomen, a nonspecific finding though new compared to prior studies. follow up in 6 months is advised. - close gi follow-up for colonoscopy. pt did not have a date for the colonoscopy at discharge but will be contact at home by the gastroenterology department. - patient was full code throughout admission. medications on admission: allopurinol - 300 mg daily atorvastatin - 40 mg tablet by mouth once a day colchicine - 0.6 mg every other day dabigatran etexilate 75 mg capsule torsemide - 100 mg tablet daily hydrocodone-acetaminophen - 5 mg-500 mg tablet - 1 tablet(s) by mouth 4 times a day as needed insulin glargine 60 units sc once a day am insulin lispro 15 units three times a day metoprolol succinate - 50 mg tablet extended release 24 hr prednisone - 5 mg tablet - 1 tablet(s) by mouth daily pregabalin - 75 mg capsule - one capsule(s) by mouth twice a day tamsulosin 0.4 lisinopril 5mg daily discharge medications: 1. outpatient lab work please check chem-7 and cbc on thursday with results to dr. at 2. sildenafil 20 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 3. torsemide 100 mg tablet sig: one (1) tablet po once a day: please take one half tablet at 1600. . disp:*60 tablet(s)* refills:*2* 4. prednisone 5 mg tablet sig: 0.5 tablet po daily (daily). 5. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 6. pregabalin 75 mg capsule sig: one (1) capsule po bid (2 times a day). 7. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 9. insulin glargine 100 unit/ml solution sig: sixty (60) units subcutaneous once a day. 10. insulin lispro 100 unit/ml solution sig: fifteen (15) units subcutaneous three times a day: 10 minutes before meals. . 11. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 12. moviprep 100-7.5-2.691 gram powder in packet sig: one (1) packet po as directed the evening before your colonoscopy for 1 doses. disp:*1 packet* refills:*0* 13. colchicine 0.6 mg tablet sig: one (1) tablet po every other day. 14. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 15. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. discharge disposition: home with service facility: multicultural vna discharge diagnosis: acute on chronic systolic congestive heart failure lower gastrointestinal bleed acute on chronic kidney failure pulmonary hypertension 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: you had bleeding from your lower intestines, likely this is due to hemorrhoids. we were unable to do a colonoscopy to check the site of the bleeding so a colonoscopy will be scheduled in weeks to check this. your blood counts have been stable and the bleeding seems to have stopped. you had an acute exacerbation of your congestive heart failure and needed high doses of diuretics to take off the extra fluid. we are sending you home on an increased dose of the diuretics. your weight at discharge is 189 pounds. your ideal weight is probably about 183 pounds. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. it is very important that you follow a low sodium diet at home as well. your kidney function had worsened when you were admitted to the hospital, they are better now but need to be followed closely after you go home. we have scheduled your follow up appointments close together after you go home. . we made the following changes to your medicines: 1. increase the torsemide to 100 mg in the morning and 50 mg in the afternoon 2. start taking sildenafil to lower the pressures in your lungs and help your heart work better 3. discontinue pradaxa 4. decrease allopurinol to 150 mg once a day 5. decrease prednisone to 2.5 mg daily 6. start taking protonix to prevent bleeding in your stomach followup instructions: you will be contact by the gastroenterology department to schedule a colonoscopy in about 3 weeks. . department: rheumatology when: wednesday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage department: when: friday at 2:00 pm with: , md building: campus: east best parking: garage . department: when: friday at 1:45 pm with: , md , ma procedure: diagnostic ultrasound of heart right heart cardiac catheterization diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other shock without mention of trauma automatic implantable cardiac defibrillator in situ hemorrhage of gastrointestinal tract, unspecified dehydration unspecified hereditary and idiopathic peripheral neuropathy acute on chronic systolic heart failure diseases of tricuspid valve chronic pulmonary heart disease, unspecified 

Answer: The patient is high likely exposed to