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: this is a 68-year-old man without significant past medical history who was brought to the emergency room from the with acute respiratory distress. per ems, the patient denied any chest pain, he did have rales and wheezing and a positive jugular venous distention. he was in sinus bradycardia when ems was called. in the emergency room, the patient's heart rate was 120 with a blood pressure of 180/90, which subsequently rose to 230/120. he was given nitroglycerin, albuterol nebulizers, 80 mg of intravenous lasix and intubated for respiratory distress. electrocardiogram showed sinus rhythm with st elevation in v1 through v3 of 1 to depressions in 2 with t-wave inversions in v4 and 5. the patient also had q waves in v1 through v3. he was taken to the catheter lab where he was found to have an ejection fraction of 35%, anterobasal hypokinesis and anterolateral and apical akinesis with elevated left and right heart pressures. his coronary anatomy revealed a proximal 40% rca lesion that was ulcerated, proximal 100% lesion of the lad and proximal left circumflex lesion that was 20% and it was thought that the rca was providing collateral circulation to the left side of the heart and had been transiently blocked. therefore, the rca was stented with 0% residual. the lad was resistant to multiple attempts at opening and was thought to be a chronic lesion. the patient was then transferred to the ccu intubated. past medical history: 1. known coronary artery disease. 2. known diabetes. allergies: no known drug allergies. medications: none social history: the patient is a resident of the . he works at . he reports one to two drinks a day of alcohol. he has about a 40 pack year tobacco history and currently smokes. he denies cocaine or intravenous drug use. his family contacts are his brother, , phone number . family history: unable to obtain. physical exam: vital signs: temperature 98.0??????, heart rate 76, respiratory rate 16, blood pressure 101/65, intubated on 100% oxygen saturating 100%. general: this is an elderly male intubated in no acute distress who answers questions by nodding appropriately. his head, ears, eyes, nose and throat showed extraocular movements intact. pupils equal, round and reactive to light. the jugular venous distention could not be assessed. heart: regular rate and rhythm with a normal s1 and s2, soft systolic murmur was heard at the apex. lungs: rancorous throughout to anterolateral exam. there were no wheezes. abdomen: soft, nontender, nondistended with normal bowel sounds. the patient had hepatomegaly to about 6 cm below the costophrenic angle. extremities: the patient had right groin sheath and all distal pulses were dopplerable. genitourinary: the patient had left scrotal swelling about 10 cm in diameter. it was nontender without erythema and there were no bowel sounds. neurologic: the patient was awake, alert, moved all limbs, answered questions, appropriate. laboratory exam: white blood cell count 16.3, hematocrit 35.4, platelets 353. chem-7: sodium 134, potassium 4.9, chloride 96, bicarbonate 23, bun 18, creatinine 1.2, blood sugar 268. pt and ptt were all within normal limits. the patient had liver function testing. his alt was 95, ast 156, alkaline phosphatase 222. total bilirubin was 0.4, albumin 3.8. initial ck was 207. ck later peaked at 604 with a troponin greater than 50. imaging: chest x-ray, ap, showed patchy diffuse infiltrates bilaterally consistent with pulmonary edema versus aspiration versus pneumonia. there is mild hyperinflation with small bilateral pleural effusion. ecc placement was acceptable. electrocardiogram on admission was sinus rhythm at 80 with a normal axis and st elevation of 1 to 5 mm in v1 through depressions in 2 with t-wave inversions in v4, 5 and l. post catheter, the patient's sinus rhythm was 75 with 1 to elevations in v1 through v3. t-wave inversions were resolving and lead 2 no longer had st depressions. right heart catheterization results showed a right atrial pressure of 17, right ventricular pressure of 48/12 to 20, p pressure of 44/24 with a mean of 32 and wedge was difficult to assess, but was estimated to be 26 to 30. hospital course: this is a 68-year-old gentleman without known coronary artery disease who presents with acute respiratory distress secondary to pulmonary edema and electrocardiogram changes suggestive of acute anterior myocardial infarction. in the catheterization lab, he had elevated filling pressures and a likely chronically occluded lad knot minimal to intervention and an ulcerated 40% rca lesion which was stented. 1. cardiovascular: pump function: the patient had an ejection fraction in the catheterization lab of 35% with increased filling pressures and pulmonary edema. follow up echocardiogram which was suboptimal in nature showed an enlarged la, concentric left ventricular hypertrophy with severe global hypo to akinesis and an ejection fraction of 20%. given that the patient presented in florid congestive heart failure, he was aggressively diuresed with lasix. he was maintained on intravenous t&g for preload reduction and started on captopril for afterload reduction. the nitrates were gradually converted to po and captopril was increased. the patient's heart failure improved after a total of approximately 5 liters diuresis. his optimal estimated dry weight is 181 pounds. he was started on a standing dose of po lasix 40 mg q day and ace inhibitors were eventually changed to lisinopril 15 mg q day. further, he was started on imdur 30 mg q day. rate and rhythm: the patient presented in sinus with occasional pvcs. he had no malignant arrhythmias while on telemetry. he was started on low level beta blockers which were gently titrated to atenolol 25 mg q day. 2. ischemia: the patient is status post stent of the rca for the lad remains totally occluded. it was felt that since this chronic lad lesion is not amenable to intervention and that the rca is providing right to left shunt, but any further occlusion of the rca would represent left main equivalent. therefore, it was recommended that the patient be medically optimized for the time being and followed with repeat angiogram in approximately three months for any evidence of stent re-occlusion. for the time being, he is maintained on aspirin, plavix x1 month. he received integrilin for 48 hours ad was kept on heparin until his coumadin was therapeutic. cholesterol was checked and he was found to have a total cholesterol of 173, triglycerides 71, hdl 47 and ldl 112. therefore, he was started on lipitor. cks were cycled with a peak of 604 and troponin of greater than 50, but these gradually declined. the patient will need follow up for his anticoagulation which he was started on for anterior wall akinesis and high likelihood of lv thrombus formation. 4. pulmonary: the patient presented in acute pulmonary edema with bilateral infiltrates which required intubation. he was weaned off the vent on day #2 of intensive care unit, but required reintubation for respiratory distress in the setting of tachycardia, hypertension and the patient's attempt to get out of bed. he was further diuresed and was successfully extubated on day #4 of his micu stay. given his smoking history, he may have an element of chronic obstructive pulmonary disease and will need pulmonary function testing as an outpatient. 5. renal: the patient had a creatinine of 1.2 which bumped slightly to 1.6 in the setting of aggressive diuresis and at the time of this dictation, the patient's creatinine was back down to his baseline of 1.3. 6. hem/onc: the patient's hematocrit remained relatively stable during his hospital stay. he did not require any blood transfusions. he was maintained on heparin during his hospital stay for thrombus prophylaxis and his platelets also remained stable. he was started on coumadin and will require follow up for his inr checks. he will stay on heparin until his coumadin is therapeutic. at the time of this dictation, his inr was 1.1. 7. genitourinary: the patient had left scrotal swelling which he initially reported was new. scrotal ultrasound was performed and showed left hydrocele without evidence of epididymitis. on repeat questioning, the patient reported the left scrotal swelling is of longstanding, was stable during hospital stay. 8. toxicology screen: the patient's urine and urine toxicology screens were nasogastric. 9. disposition: the patient was evaluated by the physical therapy service, who felt that a rehabilitation would be appropriate. in addition, the patient's heparin would need to be maintained until his coumadin was therapeutic. therefore, the plan is to screen the patient for a rehabilitation stay prior to discharge home where he lives alone. 10. infectious disease: the patient had a temperature of 101?????? and elevation in his white blood cell count while he was in-house. he was therefore started on levofloxacin and flagyl. flagyl was discontinued after three days of treatment. levofloxacin will continued for a total of seven days for tracheobronchitis. 11. gastrointestinal: the patient does have a chronic alcohol intake with some hepatomegaly and elevated alt, ast and alkaline phosphatase on admission. these were rechecked and had decreased to alt of 60, ast of 64 and alkaline phosphatase of 129, however these may need to be followed as an outpatient. the patient, at no point, complained of any abdominal or right upper quadrant pain. discharge condition: stable discharge status: cardiac rehabilitation. discharge diagnoses: 1. coronary artery disease, status post acute anterior myocardial infarction with percutaneous transluminal coronary angioplasty and stent of rca and residual total occlusion of lad. 2. congestive heart failure. 3. left hydrocele. 4. tracheobronchitis. discharge medications: 1. coumadin 5 mg po q hs. 2. lasix 40 mg po q day. 3. imdur 30 mg po q day. 4. lisinopril 15 mg q day. 5. atenolol 25 mg q day. 6. isordil 30 mg q hs. 7. enteric coated aspirin 325 mg q day. 8. plavix 75 mg q day x1 month. 9. heparin continuous infusion 1450 units q hour. 10. levofloxacin 500 mg q day through . follow up: 1. the patient will follow up with his primary care physician, . , at . 2. the patient should follow up with cardiology at either or per dr. referral in two to four weeks. he should also have repeat angiogram in three months to assess for stent reocclusion. , m.d. dictated by: medquist36 d: 12:23 t: 12:57 job#: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified acute myocardial infarction of other anterior wall, initial episode of care pneumonitis due to inhalation of food or vomitus 

Answer: The patient is high likely exposed to