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: history of present illness: the patient is an 89-year-old female with a history of coronary artery disease, congestive heart failure, status post pacer, who presented acutely with shortness of breath. the patient has notably six admissions for chf in the last eight months, but most recently she was admitted from for chf exacerbation and stay was complicated by a non-q wave mi. she received stent to the lad, left circumflex and had episodes of bradycardia to the 30s which required placement of a dual-chamber pacer, as well as rapid afib. which was treated with amiodarone. during the course of that hospital stay, the patient underwent hypoxic ventilatory failure secondary to flash pulmonary edema requiring intubation x 3. the patient eventually recovered and was discharged to rehabilitation on . the patient was transferred home from on . at home, the patient was largely bedridden with no shortness of breath, stable orthopnea, no pnd or lower extremity edema. the patient did note cough x a week that was nonproductive and then was subjectively febrile the night prior to admission. on the morning of admission, the patient became increasingly short of breath with nausea and diaphoresis. no chest pain and no arm pain. on arrival in the ed, the patient had a pulse of 75, blood pressure 91/61, respiratory rate 25, satting at 100% on a nonrebreather face . it should be noted that the patient's room air sats were not checked. the patient became acutely hypotensive with systolic blood pressure in the 70s and was placed on a dopamine drip. chest x-ray at that time was consistent with pulmonary edema. the patient got 100 of iv lasix with 230 cc of urine output. ecg showed a paced rhythm at 75 with a question of st elevations in ii, iii and f, as well as a question of newly positive axis in v1 and v2 that had previously been negative. the patient was started on heparin due to concern of acute coronary syndrome. past medical history: remarkable for coronary artery disease, two-vessel disease, status post stents to the lad and left circumflex in of this year, congestive heart failure with a known ejection fraction of less than 20%, moderate-severe mitral regurg, severe global left ventricular hypokinesis. the patient also has a history of hypertension, hypercholesterolemia, hypothyroidism, gout, diabetes mellitus. social history: no tobacco. no alcohol. no drugs. family history: noncontributory. allergies: no known drug allergies. medications on admission: amiodarone 200 mg po qd, aspirin 325 mg po qd, lisinopril 5 mg po qd, metoprolol 12.5 mg po tid, lipitor 5 mg po qd, lasix 60 mg po bid, synthroid 100 mcg po qd, zantac 150 mg po bid, celexa 20 mg po qd, ambien 5 mg po q hs prn and b12 sc q month. vitals on arrival in the unit: the patient had a temperature of 99.8, blood pressure of 108/57 on 5 mcg of dopamine, pulse was 95. the patient was breathing at 19, satting 98% on a nonrebreather face and 98% on 2 liters nasal cannula. generally, the patient was alert and oriented, in no apparent distress. pupils were equal, round and reactive to light. oropharynx was clear with dry mucous membranes. neck - the patient had no obvious jugulovenous distention at 30??????. chest - the patient had bilateral crackles in a quarter of the lung field. cardiovascular exam - the patient had a paced rhythm, normal s1, split s2, no murmur, gallops or rubs, and a diffuse, anteriorly displaced pmi. extremities - the patient had trace ankle edema bilaterally and dopplerable dp and pt pulses bilaterally. neurologically, the patient was alert and oriented x 3. chest x-ray on admission showed no obvious pacer migration with mild cephalization of vessels, a small right pleural effusion and was read as being consistent with mild congestive heart failure. ecg showed a paced rhythm at 75 with a wide qrs, positive axis in v1 and v2 that was previously negative, and a question of st elevations in leads ii, iii and f. the patient's white count on admission was 17.1 with a differential of 55 neutrophils, 0 bands, 40 lymphocytes. hematocrit was 32.8, platelets 382. the patient's sodium on admission was 125, k 3.8, bun and creatine 34 and 1.5, respectively. the patient's lfts were all within normal limits. the patient had three sets of cardiac enzymes in the emergency department. her highest ck was 20 and her troponins remained less than 0.3. she had a urinalysis that was clear and unremarkable. no evidence of uti. she also had urine cultures and blood cultures drawn. impression: in short, this is an 89-year-old female with cad, chf, admitted with subacute shortness of breath, and presented with hypotension requiring a dopamine drip. hospital course by system - 1) cardiovascular - coronary artery disease: the patient on admission was on aspirin, lipitor, beta blocker, ace inhibitor. ruled out for mi by enzymes. ekg, although there were st elevations, they were not considered to be consistent with an ischemic event. the patient remained chest pain-free throughout the course of her stay. pump function: the patient had a known left ventricular ejection fraction of approximately 20%. she had a repeat echo shortly after admission which showed no significant changes from the previous echo which was done on the . the patient appeared to be clinically dry. she was not hypoxic, had trace crackles only, and trace edema with a flat jvp. she was bolused with fluid and was able to be weaned from the dopamine drip overnight the first night. the patient remained hemodynamically stable with blood pressures largely in the high-80s to low-100s throughout the course of her stay. the patient became acutely short of breath two nights after admission and hypoxic to 90% on 2 liters nasal cannula. she was given lasix and diuresed with symptomatic relief. a chest x-ray at that time showed congestive heart failure. the patient had no further episodes of respiratory distress throughout the course of her stay. rhythm: the patient's ecg showed an extremely wide qrs and a change from left bundle to right bundle morphology in v1 and v2 which was felt to be more consistent with the patient's native complex. given the question of pacer migration and hypotension, perforation was ruled out with echo. interrogation by ep showed the pacer to be pacing appropriately without significant migration. 2) infectious disease: the patient presented with a low-grade fever and an increased white blood cell count, and an infiltrate versus chf on chest x-ray. she was covered initially with vancomycin and levofloxacin empirically and pancultured. the patient remained afebrile throughout the course of her stay after the night of admission. vancomycin was discontinued. all cultures remained negative throughout admission. nevertheless, on her chest x-ray there was also a question of left lower lobe pneumonia versus atelectasis with a left-sided pleural effusion. thus, the patient was continued on levofloxacin. pleural effusion was tapped on the day prior to discharged; results are still pending at the time of this dictation, but the fluid was clear and serous appearing. 3) pulmonary: after the one hypoxic episode the night after admission, the patient remained comfortable on room air with oxygen saturations greater than 95%. 4) renal: the patient presented with a creatinine that was slightly elevated above her baseline of 0.9-1.2. urine electrolytes were sent suggesting the patient was prerenal. urine culture was sent which remained negative throughout the course of the patient's stay. the patient had excellent urine output greater than 30 cc/hr throughout the course of her stay and responded well to diuresis. at the time of discharge, her creatinine had returned to baseline. 5) endocrine: the patient was continued on her synthroid. thyroid function tests were sent which showed her tsh to be elevated, her t4 and free-t4 to be normal, and her t3 to be low. this was felt to be consistent with the patient being started on amiodarone a month prior to this admission for her afib. and will need follow-up at a later date. final discharge diagnoses: 1) congestive heart failure. 2) hypotension likely secondary to hypovolemia. 3) coronary artery disease. 4) hypertension. 5) hypercholesterolemia. 6) hypothyroidism. medications on discharge: levofloxacin 500 mg po qd for 9 days, plavix 75 mg po qd, aspirin 325 mg po qd, digoxin 0.125 mg po qd, captopril 6.25 mg po tid, lasix 60 mg po bid, ranitidine 150 mg po bid, atorvastatin 5 mg po qd, celexa 20 mg po qd, amiodarone 200 mg po qd and ambien 5 mg po q hs prn, as well as synthroid 100 mcg po qd. the patient was discharged on the ninth. as of the time of this dictation, the patient is still deciding whether she will go home with services or go to acute rehab care. the patient should follow-up with her primary care physician, . , within the next week or so to consider restarting her beta blocker as an outpatient. , m.d. dictated by: medquist36 procedure: thoracentesis diagnoses: pneumonia, organism unspecified mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation fall from other slipping, tripping, or stumbling pain in joint, shoulder region 

Answer: The patient is high likely exposed to