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: no known allergies / adverse drug reactions attending: chief complaint: suicidal ideation major surgical or invasive procedure: none history of present illness: ms. is a 69f with a history of end stage hocm with fluid sensitivity, copd (baseline 02 4l), chronic depression/anxiety, schizoaffective disorder who was seen by dr yesterday in clinic and was noted to make statements suggestive of suicidal ideation. she was referred from the ed for safety evaluation. . in the ed, initial vs were t 96.8, hr 59, bp 119/82, rr 18, o2 sat 97% 4l. she was seen by psychiatry who performed an evaluation and felt she was safe for discharge back to . apparently got 2 mg iv ativan, then 1 mg iv ativan for anxiety (no nursing documentation of meds given on dash or in chart, but these pulled from pharmacy). labs sent from ed were notable for na 147, wbc 7.0, hct of 25.4 (baseline low 30s) so she was started on 1l ivf; after about ~170cc, she became acutely sob. cxr showed mild pulmonary edema, and she was admitted to medicine for further management. vitals on admission hr: 98.1. hr: 77. rr: 25-36. o2: 94% 4lnc. bp: 123/94. . overnight, she reported feeling slightly sob. she stated that she felt her sob was from panic and endorsed a panic attack in the ed. she denied chest pain, cough, other pain or active complaints. overnight she triggered for ams, possibly ativan administration in the ed. however, she remained vitally stable and returned to baseline ms. . review of systems: denies fever, chills, night sweats, headache, vision changes (wears glasses at baseline and left them at ), does have mild congestion (this is chronic), sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. she has tremors in her hands and mouth occasionally at baseline. has occasional fecal incontinence. . past medical history: hocm - sensitive to fluid balance chf, with hx of acute flares after fluid adminsitration copd, baseline o2 4l htn breast ca major depression schizoaffective d/o osteoporosis anemia constipation s/p tah/bso s/p l hip orif social history: currently a resident at newbridge on the . sees a psychiatrist there and has assistance with medications. uses a wheelchair at baseline for her hip problems. non-. rare social alcohol. family history: non-contributory physical exam: physical exam: admission vs - 98.1 111-139/77-88 22-28 95 4l general - alert, aox3, patient appears depressed heent - sclerae anicteric, mm slightly dry, op clear neck - supple, no thyromegaly, +jvd to angle of jaw lungs - poor air entry bilaterally and has crackles bilaterally. unable to complete sentences. heart - rrr, 4/6 systolic murmur throughout precordium, loudest at rusb and llsb. abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - awake and alert, has tremor of mouth and tongue which disappears with speech. no current tremors in hands. discharge: pertinent results: labs on admission: 06:20pm blood wbc-7.0 rbc-2.68* hgb-8.3* hct-25.4* mcv-95 mch-30.9 mchc-32.6 rdw-13.7 plt ct-167 06:20pm blood neuts-81.9* lymphs-9.5* monos-5.2 eos-2.6 baso-0.8 06:20pm blood glucose-96 urean-27* creat-1.2* na-147* k-3.9 cl-103 hco3-37* angap-11 07:40am blood albumin-3.7 calcium-9.5 phos-3.1 mg-2.2 06:20pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 03:18am blood type-art po2-73* pco2-62* ph-7.43 caltco2-43* base xs-13 03:18am blood lactate-0.5 05:42am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 06:20pm urine casthy-2* 06:20pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-indetermin mthdone-neg cxr: mild cardiomegaly and mild pulmonary edema. pertinent results: echo pre-ablation: the left atrium is elongated. there is severe symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). there is a severe resting left ventricular outflow tract obstruction that increases with valsalva. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. there is systolic anterior motion of the mitral valve leaflets. an eccentric, anteriorly directed jet of moderate (2+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect).the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: left ventricular hypertrophy with valvular and resting lvot gradient. eccentric jet of at least moderate mitral regurgitation. compared with the prior study (images reviewed) of , the severity of mitral regurgitation has increased. echo immediately post-ablation: imaging performed immediately prior to, during and following ethanol septal abaltion. there was a severe resting left ventricular outflow gradient at baseline (peak gradient of 123 mm hg) and marked systolic anterior motion of the mitral leaflets (). optison injections in the selected septal perforators demonstrated enhancement in the proximal septum. sequential ethanol injections resulted in enhancement in the same region. following completion of the procedure, there was reduction in and the peak left ventricular outflow gradient was 36 mmhg. a lead is seen in the right ventricle. echo the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is a moderate (36mmhg peak) resting left ventricular outflow tract obstruction. right ventricular chamber size is normal. with borderline normal free wall function. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. there is systolic anterior motion of the mitral valve leaflets. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small circumferential pericardial effusion. impression: prominent symmetric left ventricular hypertrophy with normal regional and normal global (not hyperdynamic) systolic function. resting lvot gradient. pulmonary artery hypertension. mild aortic regurgitation. dilated ascending aorta. increased pcwp. compared with the prior study (images reviewed) of , left ventricular systolic function is less dynamic, the severity of aortic regurgitation is slightly increased, and moderate pa systolic hypertension is now identified. the resting lvot gradient is lower. echo there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is small. there is a severe resting left ventricular outflow tract obstruction. the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated with depressed free wall contractility. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is systolic anterior motion of the mitral valve leaflets. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , the interventricular septum is now akinetic, the left ventricular outflow tract obstruction is worse, the pulmonary artery pressure is higher, and the right ventricle is now dilated and hypokinetic. 11:17pm blood type-art temp-37 po2-121* pco2-49* ph-7.15* caltco2-18* base xs--11 05:56am blood type-art peep-5 fio2-80 po2-107* pco2-32* ph-7.32* caltco2-17* base xs--8 aado2-432 req o2-75 intubat-intubated 11:31am blood type-art temp-36.9 rates-28/ tidal v-400 peep-5 fio2-60 po2-64* pco2-28* ph-7.35 caltco2-16* base xs--8 intubat-intubated 04:00am blood ck-mb-117* mb indx-16.5* 12:35pm blood ck-mb-63* mb indx-15.0* ctropnt-7.84* 06:03am blood ck-mb-4 ctropnt-2.94* brief hospital course: hospital course: 69f with schizoaffective d/o, depression, anxiety, hocm, copd who was referred to ed by outpt cardiologist for safety eval after making comments suggsetive of si. had sob in the ed adn was admitted to . ethanol ablation for hocm occurred on with resultant rbbb and conduction block requiring ppm placement. ms. passed on from hypotension related to hocm after she was made cmo. # hocm: last echo showed moderate symmetric lvh with severe lvot obstruction and mild-moderate mr. we avoided ivf as likely to cause worsening pulmonary edema and diuresed as necessary with lasix. patient went for ethanol ablation on . she was observed in the ccu from with a transvenous pacer in place. a post-operative rbbb was noted. as expected, there occurred an mb leak to a peak of 114. diltiazem was uptitrated to 240 q8h while in the ccu. on , after no evidence of pacer wire necessity, the pacer wire was pulled and ms. was transferred to the floor. while on the floor, ms. experienced an asystolic arrest was coded x2, intubated, and a temporary transvenous pacer wire was placed. diltiazem was discontinued. given concern for continued conduction abnormalities a dual chamber pacemaker was placed on . immediately following return to the ccu from pacemaker placement, ms. became hypotensive to bp of 40s/20s. levophed and neosynephrine were initiated, ms. was bolused with 3l ns and sbps improved to 110s. a stat bedside echo demonstrated rv underfilling. broad spectrum antibiotics were empirically started. despite max doses of 2 pressors and aggressive iv hydration, ms. bp remained quite volatile with any changes in position causing hypotension to 40s/20s. after consultation with ms. healthcare proxy, it was decided that she would be made cmo. she was extubated on and later that day. # shortness of breath: prior to admission, patient had increasing weight in rehab and was getting extra doses of lasix. she also had a recent aspiration pna and was on cefpodoxime and flagyl at the time of admission. sob is likely mulitfactorial in the setting of chf d/t worsening hocm, fluid overload, pneumonia, and agitation in the ed. now back to baseline on 4l. we gave her 20 mg iv furosemide and started her on home 40 mg lasix. we continued duonebs and 4l 02, advair/spiriva for copd, cefpodoxime and flagyl for aspiration pna diagnosed prior to admission. inhaled bronchodilators were continued until ms. was made cmo on . # anemia: hct 25 on admission from baseline low 30s. normocytic. recent iron, b12 and folate studies have been normal. guaiac negative in the past and no evidence of active bleeding. ms. was transfused 1 unit prbc during her hypotensive episode on as an attempt to fluid resuscitate. # depression/anxiety: cleared by psychiatry following evaluation in the ed for discharge back to . we continued mirtazapine, bupropion until ms. on . medications on admission: medications (per hospice notes as of ): bupropion 75 mg po bid mirtazapine 15 mg po/ng hs lorazepam 0.5 mg po/ng hs:prn insomnia and q6h;prn for anxiety omeprazole 40 mg po daily metoprolol succinate xl 100 mg po daily tiotropium bromide 1 cap ih daily aspirin 81 mg po/ng daily milk of magnesia 30 ml po/ng q6h:prn constipation fluticasone-salmeterol diskus (250/50) 1 inh ih senna 1 tab po/ng :prn constipation docusate sodium 100 mg po qd ipratropium bromide neb 1 neb ih q2h:prn sob albuterol 0.083% neb soln 1 neb ih q2h:prn sob oxycodone 5mg tid clonazepam 0.5mg po lasix 40 po daily and 20 prn for >3lb weight gain discharge medications: discharge disposition: discharge diagnosis: schizoaffective disorder hypertrophic cardiomyopathy discharge condition: discharge instructions: followup instructions: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle arterial catheterization combined right and left heart angiocardiography other conversion of cardiac rhythm other conversion of cardiac rhythm cardiac mapping cardiopulmonary resuscitation, not otherwise specified diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified anemia, unspecified esophageal reflux mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified acute on chronic diastolic heart failure other chronic pulmonary heart diseases personal history of malignant neoplasm of breast constipation, unspecified atrioventricular block, complete pneumonitis due to inhalation of food or vomitus cardiac arrest cardiogenic shock osteoporosis, unspecified major depressive affective disorder, single episode, unspecified encounter for palliative care do not resuscitate status hyperosmolality and/or hypernatremia leukocytosis, unspecified other alteration of consciousness schizoaffective disorder, unspecified other dependence on machines, supplemental oxygen benzodiazepine-based tranquilizers causing adverse effects in therapeutic use unspecified hypertensive heart disease with heart failure abnormal involuntary movements panic disorder without agoraphobia suicidal ideation personal history of traumatic fracture wheelchair dependence full incontinence of feces 

Answer: The patient is high likely exposed to