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: past medical history: 1. cad, status post mi in and . 2. ischemic cardiomyopathy with an ef of 30-40%. 3. high cholesterol. 4. hypertension. 5. hypothyroid. 6. djd. 7. hiatal hernia. medications on admission: 1. aspirin. 2. plavix. 3. synthroid. 4. toprol. 5. lisinopril. 6. lipitor. 7. colace. 8. dulcolax. 9. sublingual nitroglycerin. 10. motrin. allergies: the patient is allergic to penicillin. social history: the patient is widowed and lives alone in . physical examination on admission: vital signs: afebrile, pulse 118, blood pressure 124/84 with a map of 104, respiratory rate 14, pa pressure 40/25. foley was 1.7 liters in the bag. vent: ac 500/12, peep 5, fi02 100%, intubated, sedated, withdraws to stimulus. lungs: with wet dense crackles, right side, anteriorly and laterally, left fields clear with diffuse crackles. heart: regular rate and rhythm, s1, s2. abdomen: distended, soft, no rebound. no apparent bowel sounds. extremities: no edema. feet cool. dp pulse not palpable. balloon in place on left side. neurologic: withdraws to stimuli, moving hands and feet. laboratory data: hematocrit 36.9, white count 10.7, platelets 442,000. the u/a was negative. abg 7.37 42, 265 on an fi02 of 100%. impression: this is a -year-old female with known cad, status post mi in and again two weeks ago, status post st elevation mi, hypertension, high cholesterol admitted with shortness of breath, respiratory distress, and ew hypotensive, intubated, and on dopamine for blood pressure support. 1. coronary artery disease: catheterization on admission revealed a patent stent. a bedside echocardiogram with inferior posterior hypokinesis and an ef 35%. we decided to continue aspirin, plavix, lipitor, and heparin while the balloon pump was in place, holding beta blocker and ace while the patient was on dopamine and hypotensive. pump function: ef 30%, balloon pump at 1:2, attempted to discontinue balloon pump early. chest x-ray on presentation was consistent with pulmonary edema. the patient was diuresed almost 2 liters after 40 of lasix iv times three. the pad was followed to guide diuresis. 2. infectious disease: the patient was treated empirically for pneumonia with levo 250 q.d., vancomycin 1 gram q.d., to be dosed if trough less than 15, flagyl 500 t.i.d. it was considered to double coverage for possible pseudomonas given the recent hospitalization and rehabilitation stay with ceftazidime. this was not done initially as the patient has a history of a penicillin allergy and the reaction was uncertain by the family. blood cultures, urine, and sputum cultures were sent. 3. renal: creatinine 1.3, baseline 0.9 to 1.1. we decided to follow renal function and electrolytes as the patient was being administered lasix for diuresis. the patient was noted to have an anion gap and nonanion gap acidosis. 4. endocrine: tsh was checked in and was within normal limits. the patient was continued on her synthroid. hospital course: on hospital day number two, overnight the intra-aortic balloon pump was discontinued and the heparin was shut off. the patient was bolused times two in hope of weaning the dopa; however, it was left on overnight. on hospital day number three, the patient had been extubated overnight. she was delirious and agitated overnight and had to be administered haldol and ativan and she was transfused 1 unit of packed red cells. the nitro drip was off. the patient was lethargic but responded to painful stimuli. she was tachycardiac with a heart rate in the 118s. she was continued on vancomycin, levo, and flagyl empirically for suspicion for the aspiration pneumonia and possible sepsis. on , the patient was noted to be tachypneic to a rate of 30-32 with loud expiratory wheezes and paradoxical breathing, 02 saturation 90% on 5 liters, tachycardia to the 120s, agitated. the patient was given 02 via nasal cannula. an abg was obtained off of the nasal cannula that showed the following: 7.42, 36, 47, saturation 85% on room air, aa gradient around 49. face mask was applied. saturations went to the 90s. the patient was given 5 mg of iv lopressor times two, 40 mg of iv lasix times one. a chest x-ray was a poor quality film with no significant change from prior x-rays to suggest fulminant chf or new infiltrate or collapse. iv access in the right wrist was lost so a triple lumen was placed in the right groin. the patient was given nebulizer treatments. her 02 saturations improved to 96% on face mask. respiratory rate decreased to 16, heart rate decreased to 115. the patient was more comfortable on examination. it is unclear whether the patient went to pulmonary edema after receiving 1 units of packed red cells two hours prior or whether she became bronchospastic. it was also possible that the patient had pulmonary edema in the setting of tachycardia, i.e., demand ischemia. the patient was placed on dv prophylaxis and pneumoboots. on the evening of , the intern on-call in the ccu had a long discussion with the patient's granddaughter and daughter. it was decided that the patient should be made dnr/dni at this time as her relatives said that in the past the patient has said that she would not want to be on machines. on , the patient remained tachycardiac, heart rates in the 100s. she was continued on levo and flagyl but vancomycin was discontinued as there was no source of infection and all cultures were negative to date. the patient continued to be diuresed for chf. for her mental status changes, psychiatry was consulted to help manage her agitation. it was decided after consultation with psychiatry to control her agitation by using standing doses of haldol in addition to p.r.n. and risperdal 0.5 to 1 mg p.r.n. was also added to her medications. it was decided to avoid benzodiazepines. on , there was an event at 2:00 in the afternoon. the patient's oxygen saturation had decreased to the low 80s on 3 liters nasal cannula. again, her respiratory rate had increased to 40 with expiratory wheezing and her blood pressure was stable initially at 136/77. her heart rate was up to the 130s. ekg showed sinus tachycardia with no significant changes. the patient was given 80 of iv lasix with a good response. she was also given 2 mg of iv lopressor and her heart rate went to the 100s. the patient was afebrile. a chest x-ray was ordered that was consistent with chf and bilateral pleural effusions. an abg was done as follows: 7.35, 42, 73. the patient was placed on a nonrebreather. saturations increased to 97-98%. the patient stabilized. there was a discussion between the house staff, the attending, and the family on . in light of the patient's worsening respiratory and cardiac status it was decided by the family to make the patient comfort measures only. on , at 23:30, the patient was found to be without a pulse, without respirations, and was pronounced dead. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor insertion of endotracheal tube arterial catheterization implant of pulsation balloon nonoperative removal of heart assist system diagnoses: pneumonia, organism unspecified anemia, unspecified intermediate coronary syndrome congestive heart failure, unspecified acute respiratory failure hyperosmolality and/or hypernatremia mixed acid-base balance disorder acute myocardial infarction of other inferior wall, subsequent episode of care shock, unspecified 

Answer: The patient is high likely exposed to