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: inderal la / codeine / morphine attending: chief complaint: shortness of breath, worsening fatigue major surgical or invasive procedure: s/p biventricular pacing/defibrillator system. history of present illness: 61 year old man with a pmh notable for ischemic cardiomyopathy. he has had two prior myocardial infarctions, the first in and the second in . he also has undergone multiple pci??????s, the most recent being an angioplasty at and women??????s hospital in . he does complain of chest discomfort. he does get significant shortness of breath with mild to moderate exertion. this can occur with activities like emptying the garbage. given his degree of cardiomyopathy with an ejection fraction of 26%, he has been referred for lv lead placement with biventricular upgrade. past medical history: past medical history - coronary artery disease/ischemic cardiomyopahty - history of myocardial infarctions - prior pci's( and women??????s) - hypertension - hyperlipidemia - diet controlled diabetes - gerd - history of rheumatic fever as a child, heart murmur past surgical history s/p ppm/aicd ( virtuoso dr) s/p resection of skin cancer on his face s/p back surgery s/p appendectomy social history: patient is married and lives with his wife. occupation: recently unable to work. previously worked in auto parts delivery. etoh: occasional tobacco: quit in , 45+pyh family history: notable for premature coronary disease on his paternal side. paternal uncles died in their 40's of "heart disease". physical exam: physical exam pulse: 94 resp: 16 o2 sat: 97% ra b/p right: 86/52 left: 81/52 general: middle ages male in nad skin: dry intact heent: perrla eomi neck: supple full rom no jvd chest: lungs clear bilaterally heart: rrr irregular murmur - soft sem abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema: none varicosities: none neuro: grossly intact pulses: femoral right: 1 left: 1 radial right: 2 left: 2 carotid bruit right: none left: possible pertinent results: 05:20am blood wbc-6.8 rbc-3.04* hgb-10.0* hct-28.8* mcv-95 mch-32.8* mchc-34.6 rdw-14.3 plt ct-157 04:50pm blood wbc-10.9 rbc-3.86* hgb-12.2* hct-35.9* mcv-93 mch-31.7 mchc-34.1 rdw-14.4 plt ct-295 02:08am blood pt-12.9 ptt-27.3 inr(pt)-1.1 05:20am blood glucose-106* urean-25* creat-1.0 na-137 k-4.4 cl-99 hco3-31 angap-11 04:50pm blood glucose-144* urean-26* creat-1.0 na-134 k-4.2 cl-101 hco3-25 angap-12 echocardiography report , portable tte (complete) done at 3:36:27 pm final referring physician information , c. , status: inpatient dob: age (years): 61 m hgt (in): 64 bp (mm hg): 85/55 wgt (lb): 116 hr (bpm): 92 bsa (m2): 1.55 m2 indication: left ventricular function. dilated cardiomyopathy. icd-9 codes: 425.4, 414.8, 424.0, 424.2 test information date/time: at 15:36 interpret md: , md test type: portable tte (complete) son: , rdcs doppler: full doppler and color doppler test location: / 6 contrast: none tech quality: adequate tape #: 2010w007-1:32 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: 3.1 cm <= 4.0 cm left atrium - four chamber length: 4.6 cm <= 5.2 cm left atrium - peak pulm vein s: 0.4 m/s left atrium - peak pulm vein d: 0.8 m/s right atrium - four chamber length: 4.3 cm <= 5.0 cm left ventricle - septal wall thickness: *0.5 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.6 cm <= 5.6 cm left ventricle - systolic dimension: 5.0 cm left ventricle - fractional shortening: *0.11 >= 0.29 left ventricle - ejection fraction: <= 20% >= 55% left ventricle - stroke volume: 41 ml/beat left ventricle - cardiac output: 3.75 l/min left ventricle - cardiac index: 2.42 >= 2.0 l/min/m2 left ventricle - lateral peak e': *0.07 m/s > 0.08 m/s left ventricle - septal peak e': *0.05 m/s > 0.08 m/s left ventricle - ratio e/e': 12 < 15 aorta - sinus level: 3.0 cm <= 3.6 cm aorta - ascending: 2.4 cm <= 3.4 cm aortic valve - peak velocity: 1.2 m/sec <= 2.0 m/sec aortic valve - lvot vti: 16 aortic valve - lvot diam: 1.8 cm mitral valve - e wave: 0.7 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 1.00 mitral valve - e wave deceleration time: *92 ms 140-250 ms tr gradient (+ ra = pasp): *36 to 42 mm hg <= 25 mm hg findings left atrium: normal la and ra cavity sizes. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. normal ivc diameter (<2.1cm) with <35% decrease during respiration (estimated ra pressure indeterminate). left ventricle: normal lv wall thickness and cavity size. severe global lv hypokinesis. no lv mass/thrombus. no resting lvot gradient. right ventricle: normal rv chamber size. focal apical hypokinesis of rv free wall. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: left pleural effusion. conclusions the left atrium and right atrium are normal in cavity size. the right atrial pressure is indeterminate. left ventricular wall thicknesses and cavity size are normal. there is severe global left ventricular hypokinesis (lvef <20 %). the basal inferolateral wall contracts best. no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal. with focal severe hypokinesis of the apical half of the free wall. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe global left ventricular systolic dysfunction. mild-moderate mitral regurgitation. moderate pulmonary artery systolic hypertension. right ventricular apical free wall hypokinesis. clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibotor or . based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. electronically signed by , md, interpreting physician 16:03 ?????? caregroup is. all rights reserved. brief hospital course: mr. went to the operating room and underwent left epicardial ventricular lead placement for biventricular upgrade via a left thoracotomy. he tolerated the procedure well. after recovery in the post anesthesia unit he was transferred to the cvicu for further monitoring. chest tube inserted intraop secondary to entering the left pleural space. pod#1 he was transferred to the step down unit. an episode of vtach on triggered his aicd and he was defibrillated x 1. ep was called. the remainder of his admission he remained hemodynamically stable with 1 further episode of vtach (without triggering a shock.) ep recommended follow up with dr. in 1 week following discharge. on pod#5 he was cleared for discharge to home by dr. . all follow up appointments were advised. medications on admission: medications at home: lisinopril 5mg daily every morning isosorbide mononitrate 60mg daily every morning coreg 12.5mg twice a day aspirin 325mg daily every morning mvi one daily every morning omeprazole 20mg daily every evening ranexa 500mg twice daily turosemide 100mg tabs, 0.5 tabs prn simvastatin 40mg daily every evening sl nitroglycerin as needed discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. torsemide 100 mg tablet sig: 0.5 tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 5. ranolazine 500 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po bid (). disp:*60 tablet sustained release 12 hr(s)* refills:*2* 6. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 8. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 9. ibuprofen 400 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. disp:*120 tablet(s)* refills:*1* 10. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: home with service facility: discharge diagnosis: s/p biventricular pacing/defibrillator system. past medical history is remarkable for: 1. coronary artery disease. 2. ischemic cardiomyopathy. 3. history of multiple myocardial infarctions. 4. prior history of multiple percutaneous coronary angioplasties/stents. 5. hypertension. 6. hyperlipidemia. 7. diet-controlled diabetes. 8. gastroesophageal reflux disease. 9. history of rheumatic fever as a child. past surgical history: 1. status post permanent pacemaker/aicd in ( virtuoso dr). 2. status post resection of skin cancer on his face. 3. status post back surgery. 4. status post appendectomy. discharge condition: alert and oriented ambulatory pain controlled with motrin and tylenol discharge instructions: each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving until cleared by dr. lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: please call for appointment in weeks after discharge: pcp: . please call for appointment in 1 week with ep/cardiologist: dr. cardiac surgeon: dr at 1:30 pm procedure: implantation of cardiac resynchronization defibrillator, total system [crt-d] diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other and unspecified angina pectoris other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction other left bundle branch block chronic systolic heart failure 

Answer: The patient is high likely exposed to