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: lisinopril attending: chief complaint: bradycardia and hypotension major surgical or invasive procedure: mechanical ventilation cardiac catheterization history of present illness: 64 year old female with cardiac history of type 2 dm on insulin, hypertension and dyslipidemia presents to the ed with two week history of generalized weakness and poor po intake. she reports having had nausea and vomiting for three days last week with subsequent improvement over the week. she had similar episode of nausea/vomiting yesterday which led her daughters to bring her to the the today. she reports no sick contacts, eating outside, fever, chills, change in bowel movement, chest pain, shortness of breath or dysuria. . in the ed, she was noted to have bradycardia in 50s, hypotensive to 69/54 and finger stick of 123. labs significant for acute kidney injury with creatinine of 3.3 (baseline of 1.1) and hematocrit of 25.5 (basline in mid 30s). she was given glucagon 5 mg bolus x 1 without change in her rate or blood pressure. she was subsequently transferred to ccu for further evaluation and management. . in the ccu, she reported no complaints. she was given iv atropine 1 mg x 1 which improved her heart rate and blood pressure. she was started on dopamine gtt at 5 mcg/kg/min which improved her heart rate but did not improve her blood pressure. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: - cabg: none - percutaneous coronary interventions: clean coronaries on cath at in - pacing/icd: none 3. other past medical history: osteopenia; gastritis in setting of nsaid use and extrinsic restrictive lung disease social history: she lives alone. her daughter lives on the above her with her husband and children. she works for the city of as an assistant city order. she has quit smoking recently and denies any alcohol use. notes her diet is okay. she is working on eating more sugarless products and working on exercise. family history: mother and grandfather had diabetes. one uncle had cancer in the leg. another aunt with throat cancer. another aunt with breast cancer. her grandfather had an mi at an older age as well. she does not know her dad well. physical exam: on admission: general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. dry mucosal membranes. neck: supple with flat jvp. left ij in place cardiac: rrr. no murmurs or gallops appreciated lungs: poor inspiratory effort. ctab otherwise abdomen: soft, ntnd. extremities: no edema. no rash neuro: cn 2-12 intact. on discharge: vitals: bp:150-170s/80s hr: 65-90 rr: 18 o2: 98%ra gen: alert, sitting in bed, nad heent: supple, no jvd cv: regular, no m/r/g, distant resp: clear lung fields abd: soft, nt, nd, obese, +bs extr: no lower extremity edema neuro: a/o, speech clear, no focal defects pertinent results: labs/results . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:30 5.5 3.62* 7.9* 25.3* 70* 21.9* 31.3 18.5* 345 04:11 6.9 3.36* 7.4* 23.7* 70* 22.0* 31.3 18.6* 323 05:41 7.6 3.60* 8.1* 25.5* 71* 22.5* 31.7 19.1* 352 03:37 11.5* 3.63* 7.9* 26.3* 72* 21.8* 30.2* 18.2* 337 21:10 6.8 3.53* 8.1* 25.5* 72* 23.1* 31.9 18.3* 339 12:35 6.9 4.69 10.6* 34.4* 73* 22.7* 31.0 18.6* 271 10:00 6.9 4.83 10.7* 34.3* 71* 22.2* 31.3 17.9* 320 12:30 4.5 5.22 11.8* 38.2 73* 22.6* 30.9* 17.2* 323 09:55 5.9 4.84 10.8* 34.7* 72* 22.3* 31.1 16.9* 439 . renal & glucose glucose urean creat na k cl hco3 angap 07:30 120*1 25* 0.9 141 3.9 109* 21* 15 19:10 1.1 141 3.4 109* 04:11 771 40* 1.3* 142 3.6 111* 20* 15 13:20 1.8* 141 4.0 111* 05:41 125*1 53* 2.0* 137 4.4 109* 17* 15 17:30 222*1 60* 2.6* 135 4.6 110* 16* 14 03:37 119*1 64* 3.5* 138 4.3 109* 16* 17 21:10 57*1 67* 3.3* 138 4.2 110* 20* 12 . enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 03:37 155 41 21:10 23 19 139 81 0.1 . cpk isoenzymes ck-mb ctropnt 03:37 2 <0.01 . chemistry totprot albumin globuln calcium phos mg uricacd iron cholest 07:30 8.6 2.6* 2.1 19:10 1.6 04:11 6.0* 8.5 3.9 1.9 9* 13:20 2.0 05:41 8.5 3.9 2.0 17:30 8.1* 5.5* 2.2 03:37 7.5* 5.7* 2.1 . hematologic caltibc folate hapto ferritn trf 04:11 246* 282* 189* 03:37 143 . pituitary tsh 03:37 2.1 other endocrine cortsol 03:37 35.2 . whole blood, miscellaneous chemistry lactate 05:47 0.8 03:24 0.9 23:59 0.7 03:42 0.9 . cxr: upright ap view of the chest: low lung volumes are noted. this accentuates the size of the cardiac silhouette which is likely mildly enlarged. the mediastinal and hilar contours are likely within normal limits. the lungs are clear without focal consolidation. no pleural effusion, pneumothorax, or pulmonary vascular congestion is present. no acute osseous findings are seen. impression: low lung volumes with mild cardiomegaly. no evidence for pneumonia. . tte: there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). doppler parameters are indeterminate for left ventricular diastolic function. there is a mild resting left ventricular outflow tract obstruction. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are not well seen. no mitral regurgitation is seen. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with hyperdynamic left ventricular function. right ventricular dilation and dysfunction. . cardiac catheterization 1. moderate pulmonary hypertension (pas 50-55 mean 30) 2. preserved cardiac output 3. elevated right and left sided filling pressures without hemodynamic evidence supporting constriction. 4. no evidence of valvular stenosis. 5. no angiographically-apparent cad. . brief hospital course: 64f dmii on insulin, htn and hl admitted with junctional rhythm, hypotension and acute kidney injury in the setting of likely beta-blocker toxicity. pt had an episode of acute respiratory distress during admission requiring intubation. . active issues # junctional rhythm: the patient presented to the ed with hr in the 50s and bp of 69/54. ekg showed junctional rhythm. she was given glucagon 5 mg iv x 1 out of concern for beta-blocker toxicity. in the ccu, 1 mg atropine was administered with good response and improvement in hr. she was started on an epinephrine gtt with improvement in hr, dripp was d/c'ed on . echo revealed mild symmetric left ventricular hypertrophy with hyperdynamic left ventricular function and right ventricular dilation and dysfunction. . # hypotension: likely mixed cardiogenic and hypovolemic. she received ~ 3l of ivf in the ed and additional 1l on presentation to the ccu. epinephrine gtt was started with improvement in bp so d/c'ed on . am cortisol and tsh were normal. tte showed hyperdynamic lv function, dilated and depressed contractility of the rv. following bp normalization the pt became hypertensive (see below). . # cmp: pt underwent cardiac cath as part of work-up for admission with junctional rhythm, hypotension and abnormal echo with rv dilation. cath revealed moderate pulmonary hypertension and elevated right and left sided filling pressures without hemodynamic evidence supporting constriction. ddx included restrictive process vs dchf and pulmonary htn. no evidence of valvular stenosis or angiographically-apparent cad was noted. thus, the pt was not placed on asa. pt to f/u with dr. within the next two weeks. also, the pt was instructed to reschedule pulm f/u as she missed her appointment with pulm while in-patient. . # : cr was 3.3, up from baseline of 1.1 in . k was 4.2, bun 67. likely prerenal from volume depletion given history of nausea/vomiting x 1 week. cr stabilized over the course of the hospitalization. appropriate medications were renally dosed. was discontinued during hospitalization with plans for further discussion as outpatient for restarting given pt with hx of dmii. . # acute hypoxemic respiratory failure: likely due to a combination of flash pulmonary edema and anxiety. in the afternoon of , pt became acutely dyspneic and tachypneic. she had bilateral diffuse crackles and cxr showing diffuse bilateral infiltrates. she was given morphine 2mg iv x2, lasix 40mg iv x1 and started on a nitro gtt. pt was also placed on cpap however had difficulty tolerating and began to tire with an abg 7.23/42/89/18/-9. anesthesia attempted intubation but had initial difficulty and pt desatted, briefly became hypotensive to the 60s, and had junctional rhythm in the 20s. she was given atropine x1 with increase of hr to 110s and sbp to the 160s. pt was successfully intubated. after aggressive diuresis (out 3l), pt was successfully extubated in the pm of with no further episodes of distress. the pt will be calling to schedule f/u up with pulm in 2 weeks time. . # hypertension: after d/c of epi gtt, pt's bps elevated to the 160s. after starting pt on 25mg hctz (home dose), 10mg amlodipine, metoprolol 25 mg po bid, and aggressive diuresis, bps improved although still elevated. losartan was held to simplify home regimen and decrease risk of future incidence of renal failure in setting of vomitting and diarrhea. . # microcytic anemia: hct was 25.5 on admission. iron studies consistent with aocd. egd in showed gastritis which could represent mixed iron deficiency and aocd. guiaic negative in the ed. retic count was depressed at 1.6%. hemolysis labs were negative. hct remained stable. **the etiology of the patients aocd remained unclear at the time of discharge and should be further pursed as an outpatient** . chronic issues: # type 2 dm: blood sugars were initially low normal. her sugars were well-controlled on an insulin sliding scale. home dose of nph was held due to episode of hypoglycemia (bg=59). pt discharged on humalin regimen. . # hld: continued simvastatin 20 mg po qdaily . # depression: continued on sertraline 150mg po daily. desipramine 100 mg was held during hospitalization but resumed on discharge. . # chronic back pain: percocet 1-2 tabs po q6 prn pain while in house. pt continued on oxycontin 10mg on d/c. (pt on contract). . transitional issues: full code. pt was given phone numbers for cardiology and pulmonary and must call to make f/u appointments. a medication list (and actual bottles) were reviewed with pt and her daughter prior to discharge. pt will have visiting nursing care for medication management post hospitalization. medications on admission: albuterol prn atenolol 100 mg po qdaily desipramime 100 mg po qdaily vitamin d2 50,000 units po qweekly fluticasone 50 mcg 2 puff daily gabapentin 300 mg po qdaily losartan 100 mg po qdaily metformin 500 mg po qdaily oxycontin 10 mg po bid sertraline 150 mg po qdaily simvastatin 20 mg po qdaily triamterene/hctz 37.5/25 mg po qdaily nph 54 units qam and 60 units qpm discharge medications: 1. triamterene-hydrochlorothiazid 37.5-25 mg tablet sig: one (1) tablet po once a day. 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. sertraline 50 mg tablet sig: three (3) tablet po daily (daily). 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for wheeze. 5. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. insulin humalog insulin 55 units every morning 60 units every evening 7. desipramine 100 mg tablet sig: one (1) tablet po once a day. 8. metformin 500 mg tablet sig: one (1) tablet po once a day. 9. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 10. guaifenesin dm oral 11. iron 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 12. gabapentin 100 mg capsule sig: three (3) capsule po three times a day. 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 14. oxycontin 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po twice a day. 15. metoprolol tartrate 25 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 16. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnoses -junctional rhythm induced by beta-blocker toxicity -acute hypoxemic respiratory failure -acute kidney injury due to volume depletion -microcytic anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure caring for you at the . your blood pressure and heart rate were low because you had too much atenolol (a beta-blocker) in your system in the setting of decreased blood flow to your kidney potentially caused by another medication (valsartan or losartan). you subsequently had trouble breathing and needed to to be intubated. you had a cardiac catheterization which showed no evidence of coronary artery disease. . we made the following changes to your medications: 1) stop taking atenolol and instead start taking metoprolol tartrate 50mg by mouth twice a day to better control your blood pressure. 2) stop taking losartan and valsartan 3) start taking amlodipine 10 mg by mouth once daily to help control your blood pressure. . **your follow-up information is listed below. followup instructions: - please call dr. (cardiology) ( for a follow-up appointment in 2 weeks time. - please call for a pulmonology appointment ( in the next two weeks. department: podiatry when: friday at 2:20 pm with: , dpm building: ba ( complex) campus: west best parking: garage department: health center when: tuesday at 9:00 am with: , md, mph building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization combined right and left heart angiocardiography insertion of nasopharyngeal airway diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other chronic pulmonary heart diseases depressive disorder, not elsewhere classified other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified long-term (current) use of insulin iron deficiency anemia, unspecified chronic diastolic heart failure other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to