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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: cardiac catheterization with no intervention history of present illness: the patient is an 82 y.o f with a past medical history significant for cad s/p cabg (lima->lad, svg->om, pda with anastomoses to d1, pda), copd, and paf who was transferred from lrgh in in the setting of nstemi with cardiogenic shock. the patient was originally admitted in w/pna+chf, treated w/abx, ruled in w/nsstw changes, tte at that time: ef 60%, mod mr, pt offered cath-refused. soon after, readmitted w/ recurrent pneumonia, treated w/abx/steroids/for 7 days. her stay was complicated by c. difficile with wbc of 80,000 as well as hypotension. she was treated with flagyl po which she failed. vanco was added, abdominal ct did not show surgical abdomen with bowel wall edema c/w c. difficile enterocolitis. she ruled out for an mi. she was treated with vanco for 2 weeks. at that time, c. difficile was negative x 2 and antibiotics were discontinued. she then developed paroxysmal atrial fibrillation with nsvt and started on coumadin. at the same time, she developed acute renal failure with a creatinine peak of 3.8 with a negative renal ultrasound. her urine cultures grew pseudomonas x 2 as well as klebsiella. she was given tobramycin for a total of 4 doses. after the last dose, she developed diarrhea once again as well as wheezing and hypoxia with o2 sats of 88% with a cxr suspicious for lll pma. her antibiotics were changed to zosyn iv flagyl in addition to po vanco. 24 hours prior to transfer, the patient developed afib with rvr to 130 and given beta-blockers and placed on a cardizem drip. her troponin was 9 and peaked at 11 with ekg with afib and lateral st depressions. tte on showed: focal posterior and basal inferior hk, ef 55-60%, moderate mr, mild tr however, repeat tte on day of transfer showed ef 30% with severe tr. she developed hypotension and transferred to the icu. dccv was attempted and failed. a swan was placed with co of 2.5, ci 1.8, svr on neo with a wedge of 40. she then developed progressive dyspnea and was intubated prior to transfer. during intubation, she vomited rusty-colored sputum concerning for coffee-grounds. post-intubation cxr showed lll infiltrate with pleural effusion and chf. during her stay, she was also followed by vascular for severe peripheral edema. the patient is on high-dose steroids for ?adrenal insufficiency. the patient has not tolerated an ace or in the past secondary to arf. she was transferred to for cath in the setting of cardiogenic shock and nstemi. cath : lmca distal 60% lad small, 90% prox, occluded mid lima patent lcx 60-70% prox, before om 50% om graft patent w/ 50% at anastomosis rca dominant, occluded mid rca graft patent, pda 90% lv normal function with mild anterolateral hk, no mr past medical history: cad s/p cabg (lima->lad, svg->pda, om1) paroxysmal atrial fibrillation c. difficile diarrhea - failed flagyl, on vanco x 2 weeks gerd with ?coffee ground emesis copd nstemi in carotid stenosis bilaterally s/p bilateral cea social history: not attainable. family history: not attainable. physical exam: tc= p=101 (afib) bp=103/62 intubated gen- alert, responsive, able to follow commands, intubated heent - perla, eomi, intubated, no carotid bruits heart - rrr lungs - mechanical breath sounds bilaterally with decreased breath sounds at the bases abdomen - soft, nt, nd, + bs, no hepatosplenomegaly ext - +2 p. edema to knees bilaterally pertinent results: cardiac cath 1. selective coronary angiography revealed 30% disease in the lmca. the lad was 100% occluded in the mid vessel. there was a 80% diagonal lesion. the lcx was totally occluded. the rca was known occluded. 2. graft angiography revealed a patent svg to om graft and a patient lima to lad graft. the svg to rca was ectatic with multiple aneurysm and seial 50 and 70% stensoses in the rca and pda distal to the touchdown. 3. limited hemodynamics showed normal central pressure while the patient was on milrinone, levofed, and vasopressin. final diagnosis: 1. three vessel coronary artery disease. 2. patent svg to om, svg to rca, and lima to lad. echo: the left atrium is elongated. the right atrium is moderately dilated. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction. overall left ventricular systolic function is mildly depressed. resting regional wall motion abnormalities include basal to mid inferolateral/inferior akinesis/hypokinesis. the basal to mid inferior/inferolateral region is aneurysmal. right ventricular systolic function is normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. severe (4+) mitral regurgitation is seen. the mitral regurgitation jet is eccentric. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cxr: endotracheal tube and nasogastric tube are in satisfactory position. enteric tube remains in stable, satisfactory position. as before, the swan-ganz catheter terminates within the right interlobar pulmonary artery. there is a persistent congestive heart failure pattern, unchanged. a small-to-moderate left pleural effusion is noted with collapse/consolidation of the left lower lobe. impression: 1) persistent congestive heart failure pattern. 2) small-to-moderate left pleural effusion with associated left lower lobe atelectasis or consolidation. 04:04am blood wbc-25.9* rbc-4.13* hgb-11.4* hct-33.8* mcv-82 mch-27.6 mchc-33.7 rdw-17.3* plt ct-401 09:00am blood neuts-85* bands-8* lymphs-3* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 04:44am blood glucose-99 urean-48* creat-2.0* na-123* k-4.0 cl-89* hco3-22 angap-16 04:44am blood alt-46* ast-48* ld(ldh)-485* alkphos-71 amylase-185* totbili-0.4 12:03am blood lipase-43 ggt-49* 09:00am blood ck-mb-notdone ctropnt-1.32* 04:44am blood albumin-2.2* calcium-7.6* phos-4.7* mg-1.8 12:03am blood triglyc-65 hdl-41 chol/hd-2.1 ldlcalc-32 12:03am blood tsh-3.4 brief hospital course: the patient is an 82 year old female with a history of cad s/p cabg, cri, chf ef 20%, copd now with cardiogenic shock s/p nstemi with c. difficile colitis on vancomycin and ?lll pneumonia on zosyn/flagyl who was transferred from lrgh for cath 1. chf, ef 20% - normal lv function per cath in 11-99, echo on with ef 55% now with ef 20% in setting of rising troponins, shortness of breath, and hypotension likely secondary to cardiogenic shock and nstemi - the patient was transferred to on neo with an index of 1.8 and svr of . we decided to wean the neo to off and start milrinone for ionotropic support as well as vasopressin. - her swan was misplaced on admission with likely position in the rv which was refloated to wedge position with the following pressure readings: cvp 14 rv 32/12 pap 35/23 (28) wedge 17 - the patient's goal wedge is 16-17. on , the patient's sodium dropped and she appeared to have anasarca. our goal for diuresis was 1.5 liters out and we gave 80 mg iv lasix. our co on admission was 3.1, ci 1.67 and svr of 1265 on 0.7 on neo. - her final co was 5 with an index of 3 and svr 980 on milrinone and vasopressin. 2. cad - the patient is on heparin gtt, asa, no beta-blocker at present given her cardiogenic shock and a statin was held due to her elevated lfts. - the patient's family was insistent on a cardiac catheterization which was discussed with dr. and the patient's primary cardiologist who referred the patient here to have a cardiac cath. the family understood that a cardiac catheterization in the setting of acute renal failure and possible sepsis is very high risk but the family wanted to abide by the patient's wishes. - a cath on showed : comments: 1. selective coronary angiography revealed 30% disease in the lmca. the lad was 100% occluded in the mid vessel. there was a 80% diagonal lesion. the lcx was totally occluded. the rca was known occluded. 2. graft angiography revealed a patent svg to om graft and a patient lima to lad graft. the svg to rca was ectatic with multiple aneurysm and seial 50 and 70% stensoses in the rca and pda distal to the touchdown. 3. limited hemodynamics showed normal central pressure while the patient was on milrinone, levofed, and vasopressin. final diagnosis: 1. three vessel coronary artery disease. 2. patent svg to om, svg to rca, and lima to lad. - no intervention was made. 3. ?sepsis - the patient's lactate on admission was 3.2 with a 13% bandemia, wbc of 17. she has a history of marked leukocytosis in the setting of c. difficile colitis although this was negative during this admission. we drew blood cultures on admission and obtained a cxr that was unimpressive for pulmonary infiltrate. we rechecked pan-cultures to confirm previously diagnosed infections. - we continued the patient on zosyn in the setting of her known pseudomonal uti, po vanco for her c. difficile and iv flagyl in the setting of her c. diff and ?pma. we added iv vanco as well to cover for possible line sepsis as she has a swan. 4. paroxysmal atrial fibrillation - failed to respond to dccv at osh, now on amio gtt. we will monitor a daily ekg for pr, qt prolongation. the patient went into spontaneous sinus rhythm on amiodarone on the morning of admission. - we will also continue heparin gtt. 5. hypotension - the patient was started on iv steroids for ?adrenal insufficiency which seems highly unlikely in the setting of known nstemi with cardiogenic shock. - we, however, cannot abruptly discontinue iv salumedrol and thus will continue to wean her off of steroids checking her bs qid with a sliding scale insulin for elevated blood sugars. 6. acute renal failure - the patient's baseline cr is 0.9 and is now 1.6 with a normal renal ultrasound at the osh. renal lytes may be unhelpful given her recent diuresis. - etiologies may include decreased perfusion in setting of cardiogenic shock, pre-renal azotemia, or iatrogenic (check all medications for nephrotoxicity). 7. copd/respiratory - the patient is currently intubated with normal gas. we will continue her albuterol/atrovent. 8. after many efforts, the patient's family decided to make the patient comfort measures only and withdraw all aggressive measures including pressor support and intubation. the patient's family remained with the patient until the time of her death. discharge medications: none. discharge disposition: expired discharge diagnosis: death. discharge condition: death. discharge instructions: death. followup instructions: none. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more coronary arteriography using two catheters other endoscopy of small intestine left heart cardiac catheterization enteral infusion of concentrated nutritional substances diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified septicemia iron deficiency anemia secondary to blood loss (chronic) severe sepsis acute respiratory failure cardiogenic shock septic shock encounter for palliative care hemorrhage of gastrointestinal tract, unspecified gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to