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: azithromycin / gadopentetate dimeglumine / morphine sulfate / keflex / iodine-iodine containing attending: chief complaint: syncope major surgical or invasive procedure: cardiac catheterization central line placement and removal picc line placement history of present illness: mr. is a 48 year-old man with dilated cardiomyopathy (ef 25%) on coumadin, s/p icd in , htn, ckd (baseline cr 1.3-1.6) and asthma who presents with syncope. . the patient was recently discharged on for acute on chronic chf after receiving aggressive diuresis. he then continued to develop abdominal discomfort, nausea and vomitting, and he was unable to keep his medications down. he then developed worsening coughing spells, and it was in the setting of a severe coughing spell when he had a witnesssed syncopal event for about 7 seconds. per the patient's mother, the patient was pale and cyanotic. he quickly recovered and was sent to the er who admitted him to the cardiology service. . on the cardiology service his abdominal pain, nausea, vomitting was felt to be secondary to congestive hepatopathy, his cough due to chf vs asthma, and his syncope was felt to be secondary to a coughing spell leading to increased intra-abdominal pressures and therefore reduced preload in the setting of low-output state. his icd interrogation was negative for any events. he was aggressively diuresed with a net 10 liters negative since admission. he underwent rhc for milrinone trial, which proved to be successful. his mean pcw went from 30 to 22, and his fick c.i. went from 1.72 to 2.79. . on the floor he is complaining of a frontal headache. he denies weakness, speech/vision problems, seizures, nausea, vomitting, unilaterality, photophobia/phonophobia. he denies chest pain or shortness of breath. he also gives a several month history of significant brbpr. he had a colonoscopy for this in which showed polyps that were removed. he recently saw gi who felt his bleeding was likely due to internal hemorrhoids or a fissure and referred him to colorectal surgery, who he has not yet seen. . on review of systems, he 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. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, ankle edema, palpitations. past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, +hypertension 2. cardiac history: non-ischemic dilated cardiomyopathy; ef 20% (etiology takotsubo vs. alcohol-induced per omr review) --on coumadin for dilated lv -cabg: none -percutaneous coronary interventions: percutaneous coronary intervention, in without evidence of coronary disease -pacing/icd: aicd placement 3. other past medical history: - asthma - depression - gerd - chronic kidney disease, baseline creatinine 1.3 - s/p achilles repair social history: he lives with his children, not married. originally from pr, former correctional officer x 25 years, on disability x2 years since cardiomyopathy diagnosis. no etoh x 2 years. history of recreational cocaine, last used 3 years ago. no tobacco use. family history: father (74 years; valve replacement + cabg 8 months ago) mother (68 years; diabetes, hypertension). 3 brothers (hypertension, asthma). 5 children (5-23 years; asthma). colon cancer in maternal grandmother and 2 maternal aunts. physical exam: admission exam t: 98, 118/57, hr 77. rr 18 100% ra. 248kg. gen: obese male, appears tired, nad, aaox3 neck: jvp pulsatile at the mandible. heart: rr, nl s1 s2, s3. no murmurs. lungs: ctabl abd: obese, very ttp in right quadrant, rebound +, guarding +, left side not ttp. ext: 1+ lower extremity edema. . discharge exam s 97.9 114/70 (100-120/50-65) 74 18 100/ra wt 105.9 (106 <--109 orthostatic vs - hr & bp stable gen male lying in bed in nad, comfortable-appearing aaox3 heent: ncat mmm neck supple jvp 5 heart: rrr, nl s1 s2; no murmurs lungs: decreased rales, good aeration and expansion, no apparent respiratory distress abd: soft obese nontender nondistended nabs ext: no edema pertinent results: admission labs 01:30pm blood wbc-5.8 rbc-3.87* hgb-10.3* hct-31.1* mcv-80* mch-26.7* mchc-33.1 rdw-15.5 plt ct-172 01:30pm blood neuts-73.1* lymphs-18.2 monos-8.1 eos-0.2 baso-0.4 01:30pm blood pt-55.5* ptt-43.9* inr(pt)-5.5* 01:30pm blood glucose-135* urean-26* creat-1.6* na-125* k-4.1 cl-90* hco3-26 angap-13 01:30pm blood alt-101* ast-60* alkphos-108 totbili-1.1 01:30pm blood ctropnt-<0.01 09:43pm blood ctropnt-<0.01 09:43pm blood lipase-10 01:30pm blood calcium-9.3 phos-3.8 mg-2.1 . iron studies 06:47pm blood caltibc-363 ferritn-34 trf-279 iron-48 . discharge labs 05:00am blood wbc-4.3 rbc-3.96* hgb-10.3* hct-31.2* mcv-79* mch-26.2* mchc-33.2 rdw-15.6* plt ct-175 05:00am blood pt-12.6* ptt-25.5 inr(pt)-1.2* 05:00am blood glucose-98 urean-21* creat-1.2 na-129* k-4.6 cl-92* hco3-28 angap-14 05:00am blood calcium-9.0 phos-3.2 mg-1.9 . admission ekg - nsr 76 sinus rhythm with ventricular premature beats. borderline p-r interval prolongation. low limb lead voltage. there is somewhat late r wave progression. since the previous tracing probably no significant change. . admission cxr frontal and lateral chest radiograph: the lungs are clear. there is no focal consolidation or pneumothorax. there is no vascular congestion or pleural effusions. mediastinal and hilar contours are within normal limits. moderately severe cardiomegaly is unchanged compared to prior examination. an aicd generator overlies the left chest wall. the lead appears intact, terminating in the expected location of the right ventricle. impression: moderate-to-severe cardiomegaly consistent with history of known cardiomyopathy. no pulmonary edema, pleural effusion, or focal consolidation to suggest pneumonia. . admission ct head non-contrast head ct: there is no hemorrhage, mass, mass effect, or acute large territorial infarction. there is no shift of the usually midline structures. the suprasellar and basilar cisterns are widely patent. the ventricles and sulci are normal in size and configuration. -white matter differentiation is preserved throughout. there is a moderate soft tissue thickening in the subcutaneous tissues of the left occiput, which is unchanged from prior examination. no acute hematoma or skull fracture is identified. the visualized paranasal sinuses and mastoid air cells are well aerated. impression: no acute intracranial process. . ct abd/pelvis abdomen: the lung bases are clear without focal lesion. there is moderate cardiomegaly. a pacemaker wire terminates in the right ventricle, unchanged. the heart is otherwise unremarkable. the pleura and pericardium are intact without effusion. evaluation of intra-abdominal organs is limited by lack of iv contrast. within these limitations, the liver appears unremarkable without focal or diffuse abnormality. the gallbladder is normal. no intra- or extra-hepatic bile duct dilatation. the pancreas appears within normal limits. the spleen appears unremarkable. bilateral adrenal glands are normal. bilateral kidneys are unremarkable. the esophagus and stomach are normal. the small and large bowel are normal in course and caliber. oral contrast reaches the rectum. colonic diverticulosis is present without evidence of diverticulitis. the appendix is normal and filled with air. a small amount of fluid is present in perisplenic and perihepatic regions. mild thickening of bilateral gerota's fascia, bilateral lateral conal fascia, and mesentery are present. no pathologically enlarged retroperitoneal or mesenteric lymph nodes. no pneumoperitoneum or abdominal wall hernia. small scattered calcifications are present of bilateral common iliac arteries. pelvis: the bladder is normal. dystrophic calcifications of the prostate are present. no pathologically enlarged pelvic wall or inguinal lymph nodes. a small amount of pelvic fluid is present. osseous structures: mild degenerative changes are present at several levels of the thoracolumbar spine with osteophytosis. no focal lytic or sclerotic lesions concerning for malignancy. no acute fractures. impression: 1. within the limitations of this non-contrast study, no acute abdominal organ pathology is appreciated. no evidence of bowel ischemia or obstruction. 2. small amount of intraabdominal and pelvic fluid with mild fat and mesenteric stranding may be due to fluid overload. 3. moderate cardiomegaly. 4. colonic diverticulosis without diverticulitis. . cardiac catheterization comments: 1. limited resting hemodynamics revealed significantly elevated biventricular filling pressures (rvedp 22mmhg and mean pcw 30mmhg). there was moderate pulmonary artery hypertension at rest with mild elevation in pvr (58/11mmhg with 211 dynes*sec*cm-5). the cardiac output and index were depressed (3.8 l/min and 1.7 l/min/m2). after a milrinone bolus the pcw dropped to 22mmhg mean and mean pa dropped to 36mmhg. the cardiac output and index improved significantly (6.2 l/min and 2.8 l/min/m2). final diagnosis: 1. moderate systolic and diastolic ventricular dysfunction. 2. moderate secondary pulmonary venous hypertension. 3. marked improvement in systolic function with milrinone. . fluoroscopy-guided picc line placement impression: uncomplicated ultrasound and fluoroscopically guided double-lumen picc line placement via the right brachial vein. final internal length is 40 cm, with the tip positioned in the distal svc. the line is ready to use. brief hospital course: 48m with idiopathic dilated cardiomyopathy (ef 25%, on coumadin & s/p icd placement), htn, ckd (baseline cr 1.3-1.6) & asthma who presents with syncope, found to be in acute-on-chronic heart failure. . #) acute-on-chronic systolic heart failure underlying exacerbation of chronic heart failure known idiopathic cardiomyopathy likely explanation for numerous presenting symptoms including syncope, abdominal pain, and dyspnea. last echo showed lvef = 25%. he was admitted in the setting of low output heart failure, leading to increased intra-abdominal pressures causing congestive hepatopathy/abdominal pain/ruq tenderness. abdominal distension also thought to contribute to syncope. cardiac output and wedge pressure significantly improved after milrinone infusion. in the icu he was maintained on milrinone at a rate of 0.5 mcg/hr and transferred to the floor on this stable dose. torsemide 80mg daily was restarted; he was discharged on milrinone and torsemide. heart failure specialists had honest discussions with the patient about his long-term prognosis; he will continue to be followed closely in heart failure clinic at and will continue work-up for potential heart transplant at /. . #) congestive hepatopathy patient presented w/a tender enlarged liver, most likely secondary to vascular congestion. team initially consider portal venous thrombosis (exonerated by negative ruq u/s on ), alcoholic hepatitis, viral hepatitis (but negative viral screen), and/or hemachromatosis (iron studies negative). ultrasound demonstrated some fatty infiltration suggestive of either alcoholic hepatitis or nash. tender hepatomegaly resolved after initiation of milrinone and diuresis for 3 kg. . #) chronic microcytic anemia mcv 80 suggestive of anemia iron-deficiency and/or chronic inflammation. iron studies wnl. . #) anticoagulation patient on coumadin 5 mg qd for lifelong prevention of atrial thrombus, given his dilated cardiomyopathy. his inr was initially elevated (likely in the setting of worsening heart failure/inflammation) so coumadin was decreased to 3 mg qd. given total of 7 mg vitamin k on and to reverse inr prior to cardiac catheterization (for milrinone trial); thereafter, his coumadin was restarted but inr continued to be low due to persistent effects of large dose vitamin k. discharged on coumadin 5 mg qd. expect gradual rise in inr even without coumadin dose increase. . transitional issues 1. follow-up heart failure symptoms, dr. to modify medical management prn 2. heart transplant workup at (needs pfts, not able to obtain here) 3. follow-up any issues surrounding home milrinone infusion, any ectopy 4. trend hct. medications on admission: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheezing. 2. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 3. esomeprazole magnesium 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. hydrocortisone acetate 25 mg suppository sig: one (1) suppository rectal at bedtime: please take under direction of your pcp. 6. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 7. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 8. montelukast 4 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 9. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: take as directed by the coumadin clinic. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. torsemide 20 mg tablet sig: four (4) tablet po once a day. 13. potassium chloride 20 meq tablet, er particles/crystals sig: two (2) tablet, er particles/crystals po once a day: please take with breakfast. 14. spironolactone 25 mg tablet sig: one (1) tablet po once a day. 15. codeine sulfate 15 mg tablet sig: one (1) tablet po at bedtime as needed for cough. disp:*15 tablet(s)* refills:*0* 16. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*60 capsule(s)* refills:*0* 17. anecream 4 % cream sig: one (1) application topical twice a day as needed for pain: apply to affected area twice daily as needed. 8. multivitamin tablet sig: one (1) tablet po once a day. discharge medications: 1. milrinone in d5w 200 mcg/ml piggyback sig: 0.5 mcg/kg/min intravenous infusion (continuous infusion): weight 106kg. disp:*qs mcg/kg/min* refills:*2* 2. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 3. esomeprazole magnesium 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 5. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 6. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 9. torsemide 20 mg tablet sig: four (4) tablet po once a day. disp:*120 tablet(s)* refills:*2* 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). disp:*1 disc* refills:*2* 11. singulair 4 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 12. warfarin 5 mg tablet sig: one (1) tablet po once a day. 13. hydrocortisone acetate 25 mg suppository sig: one (1) suppository rectal at bedtime: under direction of your pcp. 14. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation four times a day. discharge disposition: home with service facility: discharge diagnosis: diabetes dyslipidemia hypertension non-ischemic dilated cardiomyopathy chronic systolic heart failure chronic kidney disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital with worsening heart failure. you had a cardiac catheterization that showed you would benefit from milrinone. you were started on a milrinone drip, with improvement in your heart's pump function. you were also diuresed for 6 liters of fluid. you will continue to receive milrinone at home - an infusion company will continue to instruct you and your family on home use of milrinone. we made the following changes to your medications: stopped flovent inhaler stopped potassium supplements . started advair inhaler, 1 puff daily . you should continue to take: torsemide 80 mg daily spironolactone 25 mg daily losartan 25 mg daily toprol xl 50 mg daily singulair 4 mg daily albuterol inhaler as before 5 mg coumadin daily until instructed by clinic celexa 40 mg daily esomeprazole 20 mg daily colace 100 mg daily multivitamin rectal suppositories please review the attached medication list with your doctor at your next appointment. followup instructions: department: when: wednesday at 10:30 am with: , md. post clinic building: sc clinical ctr campus: east best parking: garage *this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. you should have labs checked (chem7) at this pcp appointment next week. department: cardiac services when: monday at 9:30 am with: dr. building: sc clinical ctr campus: east best parking: garage you will be contact by medical center's heart transplant program with an appointment in the near future. if you do not hear from them, please call dr. office or discuss this issue with him at your follow-up appointment. will arrange for pfts. procedure: combined right and left heart cardiac catheterization automatic implantable cardioverter/defibrillator (aicd) check central venous catheter placement with guidance diagnoses: other primary cardiomyopathies abnormal coagulation profile anemia, unspecified esophageal reflux congestive heart failure, unspecified acute and subacute necrosis of liver hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified asthma, unspecified type, unspecified other chronic pulmonary heart diseases depressive disorder, not elsewhere classified chronic kidney disease, unspecified blood in stool long-term (current) use of anticoagulants acute on chronic systolic heart failure syncope and collapse other specified disorders of liver fitting and adjustment of automatic implantable cardiac defibrillator 

Answer: The patient is high likely exposed to