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: demerol / morphine / hydrocodone / codeine attending: chief complaint: s/p fall major surgical or invasive procedure: cardiac catheterization history of present illness: 85 yo f with htn, polymyalgia rheumatica, transferred from for cardiac catheterization. the patient was in her usual state of health until wednesday , when she developed black diarrhea, occuring 5 times daily. the patient attributes the black color to her iron supplements. along with diarrhea, the patient also experienced 2 episodes of vomiting (clear, no blood or coffee grounds). the patient also had fever to as high as 100.6 on friday and saturday . on sunday , the patient became lightheaded when getting up from the toilet and fell, hitting her head and right elbow. she presented to , where head and c-spine ct were negative. she developed chest pain after admission, relieved with metoprolol and nitroglycerin. she received 1 unit of rbcs for hct 27, and became short of breath. she was given 40mg iv lasix and diuresed 500cc. she ruled in for mi with third set of troponins peaking at 0.26. she was transferred to for cardiac catheterization on 100% non-rebreather and a heparin gtt. of note, pt was guaiac positive on admission. on arrival to , the patient was taken to the cardiac catherization lab, where she was found to have severe 3-vessel disease and an elevated lvedp (see below for details). she was transferred to the ccu on a non-rebreather for further management. in the ccu, the patient was weaned to a non-rebreather. she reported that her breathing was improved and had no other complaints. on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, cough, hemoptysis, or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. she denies sore throat, sinus congestion, dysuria. she denies weakness, tingling, or numbness. all of the other review of systems were negative. cardiac review of systems is notable for chest pain and lightheadedness as above and two pillow orthopnea. no syncope. the patient reports a recent decrease in exercise tolerance from 100 feet on a flat surface to 50 feet on a flat surface. past medical history: 1. cardiac risk factors: +hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: hypertension diastolic chf chronic kidney disease (baseline 1.5-1.7) right bbb mrsa in nares atrial fibrillation gout cellulitus polymyalgia rheumatica diverticulosis depression and anxiety s/p cholecystecomty/appendectomy s/p tonsillectomy s/p surgery for anal fissure social history: retired. worked as secretary. lives alone at . -tobacco history: quit 40 yrs ago; smoked 1 ppd x 30 years -etoh: denies -illicit drugs: denies family history: father with stroke at 68. mother with mi at 65. two brothers with htn. had 4 children (one died). physical exam: (per admitting resident) vs: t=97.5 bp=129/54 hr=69 rr=18 o2 sat=96%/6l general: wdwn in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. cardiac: rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. cta anteriorly (could not sit up due to recent cath). abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, or xanthomas. pulses: right: radial 2+ dp 2+ pt 2+ left: radial 2+ dp 2+ pt 2+ pertinent results: admission labs 05:30pm blood wbc-13.7* rbc-3.60* hgb-9.7* hct-29.4* mcv-82 mch-27.0 mchc-33.0 rdw-14.9 plt ct-311 05:30pm blood neuts-92.2* lymphs-5.4* monos-2.1 eos-0.3 baso-0 11:01pm blood pt-12.0 ptt-26.0 inr(pt)-1.0 11:01pm blood glucose-174* urean-31* creat-1.5* na-141 k-3.3 cl-105 hco3-22 angap-17 11:01pm blood ck(cpk)-110 11:01pm blood ck-mb-3 ctropnt-0.14* 11:01pm blood calcium-8.6 phos-4.3 mg-1.9 05:33pm blood type-art o2 flow-15 po2-75* pco2-34* ph-7.46* caltco2-25 base xs-0 intubat-not intuba discharge labs 05:42am blood wbc-14.9* rbc-3.43* hgb-9.8* hct-29.3* mcv-86 mch-28.4 mchc-33.2 rdw-15.2 plt ct-360 05:42am blood pt-12.1 ptt-25.7 inr(pt)-1.0 05:42am blood glucose-103* urean-36* creat-1.4* na-139 k-4.2 cl-98 hco3-32 angap-13 05:42am blood calcium-8.8 phos-2.2* mg-2.1 04:05am blood %hba1c-6.1* eag-128* cxr () - the size of the cardiac silhouette is at the upper range of normal, there is no evidence for overt pulmonary edema. in the right upper lobe as well as in the entire left lung, the interstitial markings are increased, there are patchy areas of opacities, that are ill-defined and distributed in a mainly peribronchial pattern. in addition, a small left basilar atelectasis and a small left pleural effusion is seen. overall, the morphology and distribution of the changes suggests multifocal pneumonia rather than pulmonary edema. no evidence of right basal changes, no evidence of right-sided pleural effusion. cxr () - in comparison with study of , there has been placement of left subclavian picc line extends to the mid portion of the svc. there has been some decrease in the bilateral patchy areas of opacification, most likely consistent with improving pneumonia. cardiac cath () - 1. coronary angiography in this right dominant system demonstrated severe three vessel cad. the lcx was the least stenosed and there was no obvious single culprit stenosis. the lmca had distal calcification with a hazy 30% stenosis. the lad was heavily calcified with diffuse disease throughout with serial 60% stenoses just before a major d4 with a distal 85% stenosis and an 80% apical stenosis. there was a high d1, functionally a large septal branch which was patent. a large d2 and d4 were also patent. the lcx was tortuous proximally with slow flow and mild diffuse disease in the av groove lcx. om branch had a proximal 50% stenosis with a tortuous upper pole and mild diffuse disease in the lower pole. the distal av groove lcx supplied collaterals to the distal rca system. the rca was heavily calcified with a 40% ostial stenosis without pressure dampening. there was proximal diffuse disease up to 75% and distal diffuse disease before the rpda up to 45%. there was moderate diffuse disease throughout the rpda with severe diffuse disease in the distal av groove rca supplying the rpls with slow flow (? severe disease vs. competitive flow from collaterals). septal collaterals from the lad fill the rpda. 2. limited resting hemodynamics revealed mildly elevated ra pressure with a mean rap of 9 mmhg. there was severely elevated left sided filling pressures with an lvedp of 29 mmhg. there was moderate systemic arterial systolic hypertension with an sbp of 160 mmhg. no cardiac index could be calculated as unable to float pwp catheter beyond ra. 3. modest hypoxemia (o2 sat 93% on 15l nrb mask) improved to 96% with the addition of 2l via nasal cannula arguing against significant shunt physiology. final diagnosis: 1. severe three vessel cad. 2. severe left ventricular diastolic dysfunction. brief hospital course: 85 yo f with htn, afib, dchf, ckd, h/o guaiac-positive stools, transferred from for cardiac catheterization in the setting of elevated cardiac enzymes, new focal wall motion abnormalities, and worsened mr. to have extensive 3-vessel disease. # coronary artery disease: pt noted to have a troponin leak at an osh, with peak of 0.26. was transferred to for cardiac catheterization, which revealed three-vessel disease. given this, pt is a poor candidate for pci. after much discussion, pt decided that she would not want cardiac surgery. medical management was pursued. during her hospitalization, she experienced episodes of chest discomfort, particularly at night. she did not exhibit any ecg changes during these episodes. her metoprolol was uptitrated, and she was started on a long-acting nitrate for further antianginal activity. by the time of discharge, she had been free of chest pain for several days. # acute on chronic diastolic hf / worsened ritral regurgitation: echo at osh showing new focal wall motion abnormalities and worsened mr, likely of ischemic etiology. on presentation, she was thought to be hypervolemic. metoprolol and amlodipine were tirated for optimum bp control / afterload reduction. the option of mitral valvular surgery was addressed, but the patient was not interested in cardiac surgery. she was diuresed with bolus iv lasix, which was converted to po lasix prior to discharge. # pneumonia: cxr performed on was suspicious for multifocal pneumonia. pt was initially started on broad-spectrum coverage with vancomycin, cefepime, levofloxacin. she was noted to spike a fever on the night of ; however, she remained afebrile after that. she did also have a leukocytosis throughout her hospitalization, which was improving at the time of discharge. on , her antibiotics were narrowed to levofloxacin, as she had no positive cultures and appeared improved clinically. of note, at the time of discharge, she did continue to have an oxygen requirement, which was likely multifactorial in etiology (see below). # gi bleeding: the patient was noted to have guaiac positive stools during her hospitalization. she did have one episode of a hematocrit drop, for which she received a unit of prbcs. her hematocrit remained stable after that. she also complained of some episodes of dysphagia, with food getting "stuck" in her throat. she states that this has been occuring for some time. she was seen by gi for both of these issues. further evaluation with a barium swallow was recommended as an outpatient. further work-up of her gi bleeding should also be pursued as an outpatient. of note, in the setting of this gi bleeding, her aspirin dose was decreased and her ppi dose was increased. her iron was also discontinued. # oxygen requirment: likely multifactorial in the setting of the patient's pneumonia and severe mr. treatment as above. # positive blood cx: one blood cx positive for gpr's. likely a contaminant. speciation pending and not further cultures positive at the time of d/c. # pre-diabets: pt was noted to have elevated blood sugars in the ccu. a1c was 6.1, consistent with pre-diabetic state. this should be further followed as an outpatient. # chronic kidney disease: baseline creatinine 1.5 to 1.7. the patient remained at her baseline throughout the hospitalization. ace inhibitors was held in the setting of her kidney disease. # diarrhea: pt presented with some recent diarrhea in the setting of recent fever and chills. stool cultures were sent, including c.diff, and were negative. her diarrhea improved. # vitamin d repletion: pt's previous vitamin d regimen was not entirely clear. she is being discharged on 1000 units of vitamin d3 daily. this may be adjusted as an outpatient if more significant vitamin supplementation is desired. # polymyalgia rheumatica: continued on home prednisone dose. # anxiety/depression: continued on nortriptyline and zyprexa at home dose. medications on admission: ativan 0.5 mg daily prn tylenol 650 mg q4h prn prochlorperidzine 10 mg q6h prn lidoderm 5% patch apply to left hip for 12 hours on 12 hours off norvasc 5 mg daily prilosec 20 mg daily nortriptyline 10 mg daily metoprolol er 100 mg daily vitamin d 50,000 units weekly for 4 weeks, then monthy prednisone 10 mg daily drisdol once a month ferrous sulfate 325 mg tylenol 1000 mg po bid calcium carbonate 500 mg tid acidophilus 1 capsule zyprexa 5 mg daily trazodone 12.5 mg po qhs senna 1 tab discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 4. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for nausea . 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) topical once a day: to right hip, 12 hrs on, 12 hrs off. 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 8. nortriptyline 10 mg capsule sig: one (1) capsule po hs (at bedtime). 9. metoprolol succinate 200 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: total dose = 225mg/day. 10. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: total dose = 225mg/day. 11. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 12. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 13. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 14. acidophilus capsule sig: one (1) capsule po twice a day. 15. olanzapine 5 mg tablet sig: one (1) tablet po once a day. 16. trazodone 50 mg tablet sig: 0.25 tablet po hs (at bedtime) as needed for insomnia. 17. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 18. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual x3 as needed for cp : up to three doses separated by 5 min. if not resolved after three, call physician. 19. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days: start am. 20. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for reflux. 21. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). 22. aspirin 81 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). 23. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: of discharge diagnosis: primary: acute on chronic diastolic heart failure pneumonia coronary artery disease secondary: chronic kidney disease guaiac positive stool discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: out of bed with assistance discharge instructions: you were admitted to for a heart catheterization to evaluate for coronary disease. we found disease in all 3 blood vessels as well as a leaky mitral valve. you declined to have heart surgery to repair these problems. we removed extra fluid with medications called diuretics and treated you for a pneumonia. please take all medications as prescribed. we have made the following medication changes: stopped: lorazepam (ativan) ferrous sulfate (iron) changed: increased metoprolol succinate to 225mg daily vitamin d to 1000 units daily started: atorvastatin for cholesterol levofloxacin for 4 days (antibiotic for pneumonia) isosorbide mononitrate for chest pain aspirin for blood thinning furosemide to prevent fluid buildup weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please follow up with the physician at your nursing facility. please call on monday to set up a follow up appointment for 2-3 weeks with one of our cardiologists. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery polymyalgia rheumatica mitral valve disorders congestive heart failure, unspecified long-term (current) use of steroids acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, unspecified blood in stool diarrhea unspecified vitamin d deficiency 

Answer: The patient is high likely exposed to