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: norvasc / infed attending: chief complaint: burning chest pain and shortness of breath major surgical or invasive procedure: dialysis removal of tunneled dialysis catheter history of present illness: pt is a 61 yo f w/ cad s/p mi (in ) and previous 2 stents in rca and lad, scleroderma, htn, esrd on hd mwf ( scleroderma) s/p transplant x2 currently failing with initiation of dialysis since , and systolic hf (ef 20-25%) who comes in with substernal, burning chest pain that feels like "fire." she reports this pain has been ongoing and intermittent for months, and has been occuring every night for the past few weeks. she notes this pain only occurs at night and begins after she lays flat to sleep. she reports that it is exacerbated by food. she finds herself having to sit almost upright to help relieve her pain. she has tried antacids, maalox, and omeprazole with no relief. she has also tried nitroglycerin which will relieve her pain for about 1/2-1 hour, but then the pain returns. she has requested oxygen at her last two dialysis sessions which helps her and she usually feels better after her hd sessions. she also has associated dyspnea along with the pain that is much improved with oxygen and sitting in an upright position. . of note, she was admitted to last in w/ pulmonary edema and dyspnea, had a tunneled ij line placed and was initiated on dialysis in the setting of her renal transplant failure and volume overload. she was intubated for respiratory distress and had good relief with lasix gtt with return of adequate oxygen saturations on room air. she was discharged on furosemide 80mg but reports now that she does not make any urine, a few drops if any. . she was evaluated by pcp for this chest pain most recently 5 days ago. he noted that she hasn't had any weight changes nor increase swelling in her bles. he believes chest pain is gi in origin patient is scheduled for outpatient endoscopy for further evaluation this thursday along with treatment with omeprazole. . in the ed, vitals 97.1 104 118/65 22 97%. cxr with pulmonary edema, ekg with lad, ivcd without changes compared prior. patient started on cpap in ed given tachypnea was unable to wean off. vitals prior to transfer hr: 91, 100% on bipap, bp 107/66. pt arrived to the ccu floor on a nrb, but then slowly transitioned to 4l nc w/ oxygen saturations 92-95%. pt felt comfortable as long as she was sitting up straight and felt better with the oxygen. . 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 dyspnea on exertion, ankle edema, palpitations, syncope or presyncope. past medical history: -- multivessel cad, s/p anterior stemi 03/. s/p rca and lad stenting previously. -- ischemic cmp, lvef 30% -- htn -- dyslipidemia -- pvd s/p r to l fem-fem bypass, r external iliac stenting -- scleroderma -- esrd on hd, s/p renal transplant x2 in , now w/ rejection -- osteoporosis -- hx gi bleed social history: lives at home with husband - history: heavy ~ ppd for > 30 years, quit in - etoh: denies - illicit drugs: denies family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - mother: dm, passed away 4 years ago - father: cancer, died in his 30s physical exam: admission physical exam vs: afebrile, bp=118/65 hr= 95 rr=30 o2 sat= 93 general: in mild respiratory distress but calm. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. dry mucous membranes. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, jvd 8cm. 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 slightly labored. crackles on b/l lung fields mid-way up the lung. no wheezes/rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge physical exam vitals - tm/tc: 98.8/98.8 hr:85 bp:89-97/53-56 rr: 02 sat: 95% ra in/out: last 24h: 240/anuric last 8h: weight: 66.9( ) tele: sr, rate 60's-80's, few runs of wct, irregular, unclear if vt vs aberrency, asymptomatic general: 61 yo f in no acute distress, stitting in chair heent: perrla, no pharyngeal erythemia, mucous membs dry, no lymphadenopathy, jvp non elevated chest: crackles left base only, no rhonchi or wheezes cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. ext: wwp, no edema. dps, pts 2+. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. gait wnl. skin: no rash psych: a/o, pleasant and cooperative pertinent results: admission labs 11:00am blood wbc-5.0 rbc-2.91* hgb-8.7* hct-27.4* mcv-94 mch-29.8 mchc-31.7 rdw-15.3 plt ct-216 11:00am blood neuts-73.0* lymphs-15.2* monos-4.7 eos-6.4* baso-0.7 11:00am blood pt-13.7* ptt-28.1 inr(pt)-1.2* 11:00am blood glucose-159* urean-44* creat-6.6* na-137 k-4.8 cl-96 hco3-27 angap-19 11:00am blood ck-mb-4 probnp- > 11:00am blood ctropnt-0.16* 05:56pm blood ck-mb-10 mb indx-15.4* ctropnt-0.22* 04:00am blood ck-mb-23* mb indx-16.4* ctropnt-0.75* 12:10pm blood ck-mb-14* mb indx-12.1* ctropnt-0.82* 11:00am blood ck(cpk)-33 05:56pm blood ck(cpk)-65 04:00am blood ck(cpk)-140 12:10pm blood ck(cpk)-116 04:00am blood calcium-9.7 phos-5.2* mg-1.8 . discharge labs 07:01am blood wbc-5.0 rbc-2.85* hgb-8.7* hct-26.1* mcv-92 mch-30.5 mchc-33.2 rdw-15.1 plt ct-202 05:55am blood pt-13.2 ptt-32.2 inr(pt)-1.1 07:01am blood glucose-191* urean-44* creat-5.2*# na-134 k-4.5 cl-94* hco3-28 angap-17 07:01am blood calcium-10.1 phos-2.5* mg-1.8 04:00am blood tacrofk-4.7* 05:35am blood tacrofk-5.4 11:22am blood tacrofk-3.9* 07:01am blood tacrofk-4.9 11:22am blood fibrino-461* 11:22am blood ld(ldh)-236 totbili-0.7 dirbili-0.3 indbili-0.4 11:22am blood hapto-216** . microbiology mrsa screen: no mrsa isolated . imaging chest (portable ap): there is bilateral diffuse reticulonodular opacity in the lower lung fields and ground-glass haziness. these findings are compatible with pulmonary edema. dialysis catheter is in unchanged position with tip seen in the distal svc/cavoatrial junction. cluster of calcifications in the right mid lung are unchanged. the aorta is tortuous and calcified. there is mild cardiomegaly. no definite pleural effusions are seen. . tte: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with inferior akinesis and near akinesis of the distal half of the septum and anterior walls. the apex is aneurysmal and akinetic. the remaining segments contract well (lvef 30%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with normal cavity size and extensive regional systolic dysfunction c/w multivessel cad or other diffuse process. moderate mitral regurgitation. compared with the prior study (images reviewed) of , the severity of mitral regurgitation is increased and global left ventricular systolic function is improved with slight decrease in cavity size. regional left ventricular dysfunction is similar. . chest (portable ap): in comparison with the study of , there has been substantial decrease in the pulmonary congestion with the pulmonary vessels now only mildly engorged. minimal atelectatic change is seen at the left base and there may be blunting of the costophrenic angle. hemodialysis catheter remains in place. brief hospital course: 61 yo f w/ cad s/p mi (in ) and previous 2 stents in rca and lad, scleroderma, htn, esrd on hd s/p transplant x2, and systolic hf (ef 20-25%) who comes in with chronic burning chest pain and acute systolic heart failure. . # acute systolic chf: patient presented with increased dyspnea and chest x-ray showed pulmonary edema. physical exam demonstrated rales to mid lung fields. patient reports increased dyspnea prior to dialysis recently and may need change to dry weight. she had a session of ultrafiltration the night of admission and then a truncated 2-hour session of dialysis the following day. in keeping with her outpatient schedule, the pt went for a full session of dialysis on wednesday. echo showed an ef of 30% and so she was started on metoprolol succinate 25mg qhs, with lisinopril 2.5mg to possibly be started as an outpatient (and to be titrated up as her blood pressure will tolerate it and also to be held on her dialysis days). after her dialysis session, pt's symptoms improved, physical exam demonstrated clear lung fields, and chest xray showed interval improvement in pulmonary edema. . #. chest pain/burning: pts pain was atypical. her symptom has bothered her each evening for a very long time, and is exacerbated when she lies on her back. it is thought to be gi related per outpatient providers and will follow up with gi in one week. ekg was without changes, and discomfort resolved on arrival and with subsequent nitroglycerin. her cardiac enzymes were trended until they peaked. she was put on ppi and carafate, which seemed to provide relief of her pain. . #. esrd sp transplant on hd: pt had a session of ultrafiltration on the night of admission and was continued on her outpatient schedule of dialysis, monday, wednesday, friday. her graft is well-functioning and her tunneled catheter was pulled. she was continued on her home prednisone, cellcept, tacrolimus, and calcitriol. her tacrolimus levels were within target. the amount of fluid they were able to take off and the length of time spent on dialysis was limited by pt's low blood pressure. she will continue to have 4 hours of dialysis, three times a week, with the next session on monday and an estimated dry weight of 67.5kg. . # cad: pt was continued on her home statin and asa. . # rhythm: pt was in sinus rhythm, and had no active issues with her rhythm during the admission. she was monitored on telemetry . #. normocytic anemia: at recent baseline. secondary to esrd. she was continued on aranesp with dialysis per her outpatient regimen and given 1 unit prbc with an appropriate increase in her hematocrit. . # htn: blood pressure was well controlled on presentation. she was started on metoprolol succinate 25mg qhs, with lisinopril to possibly be started as an outpatient as long as her blood pressure can tolerate it. her lisinopril should be held on hemodialysis days due to low blood pressures. . # hld: pt was continued on her home lipitor. . transitional issues # recommend initiating lisinopril 2.5mg daily as an outpatient as long as her blood pressures can tolerate it. this medication should be held on hemodialysis days. stop taking calcitriol start nephrocaps as a vitamin for your kidneys start pantoprazole twice daily for your heartburn start carafate up to four times per day for your heartburn, do not take this within 1 hour of your other medications start taking maalox (calcium and simethicone) as needed for your heartburn start metoprolol at night to lower your heart rate and avoid chest pain. medications on admission: - lipitor 80 mg daily - aspirin 81 mg daily, - nitroglycerin sublingual p.r.n. - calcitriol 0.25 mcg daily - aranesp - albuterol mdi p.r.n. - prednisone 2 mg daily, - tacrolimus 1 mg b.i.d. - cellcept mg b.i.d. discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual as directed as needed for chest pain. 4. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 5. prednisone 1 mg tablet sig: two (2) tablet po daily (daily). 6. tacrolimus 1 mg capsule sig: one (1) capsule po twice a day. 7. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. maalox max quick dissolve 1,000-60 mg tablet, chewable sig: one (1) tab po three times a day as needed for heartburn. tab 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day): do not take within 1 hour of your other medications. disp:*120 tablet(s)* refills:*2* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 12. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po qhs (once a day (at bedtime)). disp:*30 tablet extended release 24 hr(s)* refills:*2* 13. aranesp (polysorbate) injection discharge disposition: home with service facility: family & services discharge diagnosis: acute on chronic systolic congestive heart failure ends stage renal disease coronary artery disease hypertension 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 . you had some chest discomfort that brought you into the hospital. we think that some of this discomfort is because of your stomach and have started you on a new medicine and scheduled an appt with a gastroenterologist on tuesday . at the same time, you had too much fluid in your lungs and we removed a little more fluid with dialysis and adjusted your dialysis medications. your weight this morning is 150 pounds. this should be considered your new dry weight. weigh yourself every morning, call your nephrologist if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. you were also anemic and received one unit of blood. please call dr. or np have chest pain/burning at home that is worse than the mild chest burning you have experienced for the last few months. you may take calcium carbonate for this burning, sit up straight in a chair and avoid spicy or acidic foods. . we made the following changes to your medicines: 1. stop taking calcitriol 2. start nephrocaps as a vitamin for your kidneys 3. start pantoprazole twice daily for your heartburn 4. start carafate up to four times per day for your heartburn, do not take this within 1 hour of your other medications 5. start taking maalox (calcium and simethicone) as needed for your heartburn 6. start metoprolol at night to lower your heart rate and avoid chest pain. followup instructions: department: cardiac services when: tuesday at 1:30 pm with: , np building: sc clinical ctr campus: east best parking: garage department: gastroenterology when: tuesday at 1:30 pm with: , md building: lm bldg () campus: west best parking: garage department: when: tuesday at 10:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis incision with removal of foreign body or device from skin and subcutaneous tissue diagnoses: anemia in chronic kidney disease end stage renal disease congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia osteoporosis, unspecified old myocardial infarction surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute on chronic systolic heart failure complications of transplanted kidney systemic sclerosis 

Answer: The patient is high likely exposed to