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: heparin agents attending: chief complaint: shortness of breath major surgical or invasive procedure: ir-guided double lumen picc placement. tee cardioversion. history of present illness: 69 year old man with a history of endstage cardiomyopathy (nyha class 4) and severe chf with an ef of 15% (ef of 20% on milrinone drip) as well as severe mr p/w increasing shortness of breath an o2 requirements on increasing doses of lasix. on home scale the pt gained 6 lbs over the week, and was unable to stand prior to admission. his urine output also decreased from 600cc/24hrs on to 200cc/24hrs on day of admission. the pt's wife also noted increased abdominal girth and pedal edema. + orthopnea, + pnd. the patient was recently discharged from after an admission for ventricular tachycardia controlled on amiodarone. his course was complicated by episodes of acute pulmonary edema. on , the patient had a right heart catheterization which showed a cardiac index of 1.8 that improved to 2.6 after initiation of milrinone. appropriate fluid status was maintained with lasix 20 mg po daily, and patient was able to breathe comfortably on room air at discharge. following his discharge on , the patient was able to ambulate and breathe comfortably until , when he began to develop shortness of breath and developed an oxygen requirement that was increased from 2l to 4l on the day prior to admission. the pt has also been on spironolactone prior to discharge which was omitted from his discharge medications and then re-started on . the patient also reports that picc line for milrinone drip had been leaking. past medical history: cad, s/p cabg x 4 in ischemic cardiomyopathy s/p icd, nyha class 4, on home o2 atrial fibrillation with a h/o of being treated with dofetelide and coumadin x 1 month only hit with + ab screen, treated w/ argatroban in past depression / memory loss hyperlipidemia mitral regurgitation gib from gastric ulcer in h/o avms s/p injection in and rheumatoid arthritis h/o sacral ulcer-healed s/p right 5th toe amputation s/p right 4th toe ulcer s/p inguinal hernia repair relative adrenal insufficiency thrombocytopenia thought to be autoimmune, s/p bone marrow bx h/o c-diff anemia chronic renal insufficiency allergies: heparin agents (hit) social history: retired orthopedic surgeon, lives at home with wife, quit smoking 50 years ago, social drinker, no other drug use. family history: sister with dm, mother died of liver cancer, father has cad. physical exam: vs t 95.0, hr 90, bp 79/54, rr 22, pox 99% on 4l nc gen: nad, aox3 heent: +jvd to angle of jaw. no lad, supple card: rrr, diffuse pmi, holosystolic murmur at apex. no thrills, lifts. pulm: bibasilar rales, + accessory muscle use abd: soft, nt, distended, no masses or organomegaly, bs+ ext: multiple swan neck deformities r and l hands, 1+ pitting edema bilateral lower extremity, r>l, no cyanosis, clubbing, feet cool but bilateral dp pulses palpable pertinent results: labs on admission: wbc-5.6 rbc-3.59* hgb-9.3* hct-28.8* mcv-80* mch-25.9* mchc-32.4 rdw-17.8* plt ct-121* pt-16.0* ptt-33.4 inr(pt)-1.4* glucose-116* urean-61* creat-1.9* na-125* k-4.7 cl-91* hco3-21* angap-18 calcium-8.4 phos-4.2# mg-2.4 ck(cpk)-15* ck-mb-notdone labs on discharge: wbc-3.9* rbc-3.32* hgb-8.4* hct-26.1* mcv-79* mch-25.3* mchc-32.2 rdw-18.2* plt ct-78* pt-15.0* ptt-29.5 inr(pt)-1.3* glucose-96 urean-43* creat-1.1 na-124* k-4.6 cl-92* hco3-28 angap-9 calcium-7.8* phos-2.1* mg-2.3 ekg : sinus rhythm with demand ventricular pacing. compared to the previous tracing of the findings are similar. cxr : severe cardiomegaly is unchanged. the position of the pacemaker defibrillator leads in the right atrium and right ventricle is unchanged as well. multiple broken sternal wires are seen, with appearances different compared to the prior study being now divided into two parts. the vertical central lucency projecting over the mid of the thoracic spine suggests sternal dehiscence that may be worse compared to the prior film. bilateral pleural effusions are present, increased since the prior film as well as there is new worsening of the left lower lobe opacity consistent with atelectasis. the upper lungs are unremarkable. there is mild vascular engorgement consistent with mild failure, but unchanged since the prior study. tee : the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no thrombus is seen in the right atrial appendage the ascending aorta is mildly dilated. there are three aortic valve leaflets which are mildly thickened. aortic stenosis is present (not quantified). impression: no intra-atrial thrombus. brief hospital course: this is a 69 year old man with a history of end stage cardiomyopathy (nyha class 4) and severe chf with an ef of 15% (ef of 20% on milrinone drip) as well as severe mr p/w sob, doe, pnd, weight gain of 6lbs in a week, likely due to chf exacerbation. # chf/pump: on physical exam the patient appeared to be in volume overload with jvd to angle of the jaw, bibasilar rales, 1+ pitting edema in the lower extremities, and distended abdomen. this was consistent with symptoms of sob, pnd, doe and likely secondary to systolic and diastolic hf secondary to increased intravascular volume. he was diuresed with lasix bolus 20mg iv and lasix gtt at 2mg/hr. milrinone was increased to 0.75, and he was continued on spironolactone and his acei. # cad: he has a history of cad, ck negative on this admission with no chest pain and ekg that is unchanged. chf exacerbation unlikely to be secondary to acs in this setting. he was monitor on telemetry # rhythm: the patient was in paced rhythm on telemetry. he has a history of v-tach which responded to amiodarone. patient also has icd in place. # respiratory: sob and increased o2 requirement were likely secondary to chf exacerbation and resultant pulmonary edema. # rheumatoid arthritis: swan neck deformities were stable. he was continued on prednisone 5mg po daily for ra control. # anemia: his hct was stable. he was continued on ferrous sulfate for anemia. medications on admission: ferrous sulfate 325 mg daily escitalopram 10 mg daily aspirin 81 mg daily pantoprazole 40 mg q24h prednisone 5 mg daily amiodarone 200 mg once a day. captopril 12.5 tid milrinone 1 mg/ml infusion 0.5 mcg/kg/min intravenous continuously. carvedilol 25 mg twice a day. furosemide 20 mg once a day. spironolactone 25 daily discharge medications: 1. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. pt has heparin allergy- no heparin flushes 2. lasix 20 mg tablet sig: one (1) tablet po as directed as needed. disp:*30 tablet(s)* refills:*0* 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 4. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 7. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 8. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). disp:*30 tablet(s)* refills:*2* 9. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 10. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 11. picc picc care per protocol 12. milrinone 1 mg/ml solution sig: 0.75mcg/kg/min intravenous continuous infusion. disp:*qs qs* refills:*5* discharge disposition: home with service facility: vna discharge diagnosis: primary: - ischemic cardiomyopathy, status-post icd, nyha class 4, on home o2 - coronoary artery disease, status-post cabg x 4 in - atrial fibrillation with a history of being treated with dofetelide and coumadin x 1 month secondary: - hit with + ab screen, treated w/ argatroban in past - depression / memory loss - hyperlipidemia - mitral regurgitation - gib from gastric ulcer in - history of avms, status-post injection in and - rheumatoid arthritis - relative adrenal insufficiency - thrombocytopenia thought to be autoimmune, s/p bone marrow bx - anemia - chronic renal insufficiency discharge condition: stable. afebrile. discharge instructions: you were admitted for increasing shortness of breath and oxygen requirements on increasing doses of lasix. while you were here, you received a 2 lumen picc line which you are being discharged with. while you were here, you were diuresed with lasix and received a cardioversion for an arrythmia. please take your medications as written. these include the home milrinone. your aspirin was stopped. your amiodarone was increased to 400mg daily. you were started on a medication called digoxin which you will take every other day. please adhere to your follow-up appointments. please weigh yourself every morning, and call you doctor if your weight increases by more than 3 lbs. please adhere to a 2 gm sodium diet. please limit your fluid intake to 1.5l. please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, or any other symptoms that you are concerned about. followup instructions: cardiology follow-up: please see dr. on , at 2:30pm. his office can be reached at . please see dr. on , at 10:00am. his office can be reached at . renal: please see dr. , md and 2:30pm. his office can be reached at . procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart automatic implantable cardioverter/defibrillator (aicd) check diagnoses: mitral valve disorders congestive heart failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status depressive disorder, not elsewhere classified chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other specified cardiac dysrhythmias automatic implantable cardiac defibrillator in situ rheumatoid arthritis gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction combined systolic and diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to