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: iron dextran complex / bupropion attending: chief complaint: syncope/ hypotension major surgical or invasive procedure: central line placement history of present illness: for full details please see full admission note from micu. in brief, the patient is a 59 year old male with history of esrd on hd< dm, cad who was in his usoh until when he experienced dizziness and lightheadedness with standing with some resolution by the next morning. when walking the next day he experienced some dyspnea and chest pressure. on arrival to that day for a planned appointment he syncopized in the lobby. at that time the patient was found to he hypotensive to 70/30 for which he was taken to the e.d. immediately. there is no report of aura prior to this episode, seizure, or post-ictal state. . on arrival to the ed the patient was with following vitals: t97.0, hr55, bp 84/53, o2 95%ra with ecg revealing a junctional rhythm. ij was placed and cardiology consulted with impression that this was secondary to nodal effect of both toprol and dilt, recommendation to monitor overnight holding bb and ccb. in the icu the patient regained sinus rhythm and pressure improved to 104/70 without other intervention. cxr unremarkable and lactate wnl. the patient was monitored overnight and has remained hemodynamically stable, had hd today. the patient had metoprolol tartrate 37.5 po tid started today and tolerating well thus far. the patient is now transferred to the medical floor for ongoing care. . on arrival to floor the patient feels well. he denies currently chest pain, dyspnea, dizziness. he reports stable symptoms of chest pressure with exertion, particularly climbing stairs, that have stable over 1 year. past medical history: # esrd - on hd (since ') tu/th/sat; failed kidney attempted from hep c positive donor but aborted hypoxia. c/b wound dehiscence. # diabetes - followed by # hep c - genotype 1 c hepatitis c viral load of 18,400,000 i.u. followed by dr. # diastolic chf - last echo : dilated, ra moderately dilated; lvef>55% # gerd # former substance abuse - alcohol, cocaine, heroine; clean since ', 1 relapse with cocaine in '; attends and na # renal cell carcinoma s/p removal followed w/o recurrence # pericardial effusion , presumed viral; required pericardiocentesis for tamponade physiology # depression- no suicide attempts, +passive thoughts about suicide with no plan # barrett's esophagus (from omr)c/b anemia # carpal tunnel syndrome - used wrist splints # sleep apnea social history: mr. previously worked at sheraton hotel, retired in . currently lives with his sister : 80 pack-year history, quit etoh: history of 1 pint per week, quit illicits: previous crack cocaine use, quit . previous heroin use, quite 5-6 years ago. member of na, in therapy for substance abuse. family history: father-died at age 52 from stroke mother-died in her 50s from cirrhosis dm addict at unknown age, due to problems with kidney and pancreas physical exam: vitals: t- 98.9 lying: bp- 140/60 hr- 80 standing: bp 120/60 hr 80 rr-18 o2- 97% on ra . general: patient is a well appearing african american male, pleasant, in nad heent: ncat, eomi, sclera muddy brown, conjunctiva wnl. op: mmm, no lesions neck: obese, jvp difficult to assess body habitus chest: relatively clear to auscultation anterior and posterior, few end expiratory course wheezes cor: rrr, normal s1/s2. no murmurs appreciated. + s4 abdomen: obese, mod distended. soft, non-tender. + well healed rlq surgical scar ext: trace lower extremity edema pertinent results: trop: .02 - .03 wbc: 12.1 imaging: cxr - no acute process, line in place micro: blood - pending upon discharge urine - pending upon discharge catheter tip culture: pending upon discharge ecg: sinus brady, lad. qs iii, avf. no acute st/tw changes 03:13pm lactate-1.4 12:45pm k+-4.5 12:35pm glucose-100 urea n-44* creat-8.3*# sodium-139 potassium-4.7 chloride-97 total co2-27 anion gap-20 12:35pm ck(cpk)-119 12:35pm ctropnt-0.02* 12:35pm ck-mb-3 12:35pm wbc-11.6* rbc-3.99* hgb-11.2* hct-35.6* mcv-89 mch-28.0 mchc-31.5 rdw-20.7* 12:35pm neuts-58 bands-0 lymphs-23 monos-12* eos-5* basos-1 atyps-1* metas-0 myelos-0 nuc rbcs-2* 12:35pm hypochrom-occasional anisocyt-1+ poikilocy-occasional macrocyt-1+ microcyt-occasional polychrom-1+ teardrop-occasional 12:35pm plt smr-normal plt count-374 brief hospital course: bradycardia / hypotension - likely related to bradycardia with possible contribution from volume depletion. no evidence by labs or exam for infectious etiology. patient was on dilt 360mg po daily and toprol 100mg po daily. his ekg showed marked sinus bradycardia with a rate in the 20s and a junctional escape rhythm with a rate in the high 50s. he was hypotensive and fluid resuscitated, his hypotension resolved and his rhythm returned to sinus. his medications were adjusted to toprol 50mg daily. diltiazem was discontinued. ep was consulted and helped direct the plan. the patient's primary cardiologist was notified of the changes. diabetes - blood glucoses well controlled as inpatient. esrd- on hd, rec'd hd as inpatient on saturday . hep c - no active issues. outpatient follow up. medications on admission: asa 81mg daily citalopram 20mg daily dilt sr 360 daily valsartan 320 daily (patient not taking) gabapentin 100mg tid lantus 30 units reglan 10mg daily prilosec 20 mg daily vit b vit c folic acid cinacalcet 30mg daily toprol xl 100 daily allopurinol 100 daily calcium acetate sevelamer 800 tid with meals mirapex 0.25 qhs discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 4. pramipexole 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 9. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 10. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 11. insulin glargine subcutaneous 12. toprol xl 50 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:*2* 13. neurontin 100 mg capsule sig: three (3) capsule po as directed: take 3 pills after dialysis sessions. discharge disposition: home discharge diagnosis: primary diagnosis: syncope sinus bradycardia with junctional escape rhythm secondary diagnosis: esrd on hd htn dm ii discharge condition: sinus rhythm, not symptomatically orthostatic, stable discharge instructions: you were admitted for a fall probably related to your medications. please note the following medication changes: please stop taking your diltiazem. also, decrease your toprol xl dose to 50mg daily. please call your doctor or go to the emergency room if you fall, if you have lightheadedness, shortness of breath, chest pain, or any other symptoms that concern you. followup instructions: please follow up with your primary care physician and your kidney doctors 4 weeks of your discharge. you have the following appointments: 1. , md phone: date/time: 5:00 2. , md phone: date/time: 8:00 3. , center - non billing phone: date/time: 9:30 procedure: hemodialysis diagnoses: end stage renal disease esophageal reflux congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma other specified cardiac dysrhythmias personal history of malignant neoplasm of kidney diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure sympatholytics [antiadrenergics] causing adverse effects in therapeutic use coronary vasodilators causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to