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: penicillins attending: chief complaint: increased swelling major surgical or invasive procedure: none history of present illness: 84 year old man with hx of cad, prior mi, avr, niddm c/b cri, left cea, admitted to the with chf (ef 50%) today now transferred to for further managment. he describes that over the last month he has had slowly increasing edema and dyspnea on exertion. he reports being compliant with his medications and diet though he drinks around 8 16oz glasses of water a day. he denies any preceeding symptoms to this exacerbation including any recent chest pain, dietary indiscretion. in fact he just notes that he has had a slow increase in his weight that he thought was due to increasing caloric intake. he approximates that he has gained 13-15 lbs. . he was given 100 mg lasix prior to transfer and had 400 cc urine output on arrival. he had echo done prior to transfer. per dr. ef was 50%, with 4+ tr and avr gradient 30mmhg. past medical history: cardiac cad: inferior wall mi- rca stented at , requiring iabp. - (bioprosthetic) avr for as. cath: 40-50% lm stenosis, lcx with minimal disease. lad with a 70-80% lesion at the level of the d1. moderate disease in the ostium of the d2. rca widely patent in the site of the prior stenting. pa pressure 60/17, wedge 21 mmhg. started on plavix with plans to return to lab for pci. : direct stenting of the mid lad with a 3.5 x 18 mm cypher des. other vessels: 50% lmca, cx with mild luminal irregularities, rca not engaged. valvular: aortic valve replacement for aortic stenosis in ( ) rhythm: atrial fibrillation on coumadin s/p cardioversion in , htn hyperlipidemia thyroid disorder non insulin dependent diabetes c/b cri : left carotid endarterectomy : lap chole appendectomy chronic renal insufficiency bph shingles (started 4 mo ago) hypertension social history: social history is significant for the absence of current tobacco use (though has 60 pack year history). there is no alcohol abuse but has history of "drinking a lot". patient is married with 4 children. he is a retired recreation manager. he is the primary care taker for his wife who had a cva about 5 years ago. quit smoking 40-50 years ago. rare etoh, no recreational drug use. family history: (+) family history of sisters and a brother died from vascular complications in their 40's-50's physical exam: vs - t 95.6 hr 70 rr 18 02 98% ra bp 154/71 gen: elderly slightly obese male. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of > 14cm (~4cm above clavicle when sitting at 90 degrees). cv: pmi located in 5th intercostal space, midclavicular line. irreg irreg, with high pitched honking murmur heard best at rusb but radiates throughout precordium. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, obese with edema of lower abdominal skin. has slight erythema of lq. unable to assess for organomegaly given obesity. no abdominial bruits. ext: + edema of le to knee skin: with stasis dermatitis, with small left ulcers (reported to be draining last week) no xanthomas. guaiac + stool . pulses: right: carotid 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: wbc-9.9 rbc-3.53* hgb-10.1* hct-30.3* mcv-86 mch-28.8 mchc-33.5 rdw-18.4* plt ct-143* pt-17.9* ptt-32.8 inr(pt)-1.7* 04:26am pt-19.1* ptt-108.3* inr(pt)-1.8* 07:30pm glucose-70 urean-51* creat-2.8* na-138 k-3.5 cl-95* hco3-33* angap-14 07:30pm ck(cpk)-218* ck-mb-5 ctropnt-0.05* probnp-* 04:26am ck-mb-5 ctropnt-0.06* calcium-8.7 phos-3.8 mg-1.6 cxr: admission findings: there is status post sternotomy and the metallic components of porcine aortic valve prosthesis are identified in place. the heart is moderately enlarged with a clear prominence of the left ventricular contour to the left and posteriorly. the lateral view also demonstrates a prominence of the left atrium in posterior direction. the thoracic aorta is elongated and demonstrates extensive wall calcifications both in the aortic root, ascending portion and descending aorta. there is no evidence of any local aortic contour abnormality. the pulmonary vasculature demonstrates an upper zone redistribution pattern and some perivascular haze exists in the lower pulmonary vascular portions but there is no evidence for significant interstitial or alveolar edema. also, the lateral pleural sinuses are free but very mild blunting of the posterior pleural sinuses is recognized on the lateral view. acute parenchymal infiltrates are not present. available for comparison is a previous pa and lateral chest examination of . the heart size was significantly enlarged already on the previous study and findings concerning cardiac configuration and aortic valve prosthesis are unchanged. direct comparison of the frontal views suggests that the previously observed degree of interstitial edema resulting in perivascular haze has decreased slightly. as on the previous examination, there was no evidence of any acute infiltrate nor is there any pneumothorax or significant pleural effusion. impression: status post aortic valve replacement (porcine type) with cardiac enlargement and mild degree of chronic chf. no significant progression during latest four-month examination interval. cxr: 7/22impression: no evidence of pneumonia. no significant change definite. echo:la is mildly dilated. ra is moderately dilated. lv wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. rv chamber size is increased with free wall hypokinesis. a bioprosthetic av prosthesis is present with thin/mobile leaflets. the transaortic gradient is higher than expected for this type of prosthesis. trace aortic regurgitation is seen. mv leaflets are mildly thickened. mild (1+) mr is seen. there is moderate pa systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: normal global biventricular systolic function. well seated aortic bioprosthesis with mobile leaflets but increased gradient. moderate pa systolic hypertension. rv cavity enlargement with free wall hypokinesis. mild mr. right heart catheterization: 1. coronary angiography was deferred due to elevated creatinine. 2. resting hemodynamics revealed elevated right and elevated left sided filling pressures with rvedp of 21 mmhg and pcw of 25 mmhg. there was severe pulmonary arterial systolic hypertension with pasp of 78 mmhg. 3. left ventriculography was not performed due to elevated creatinine. final diagnosis: 1. elevated left sided filling pressures. 2. severe pulmonary hypertension. 3. succesful swan ganz catheter placement.on renal us: no hydronephrosis and no new mass is identified bilaterally. arterial flow identified in both kidneys but unable to obtain a full doppler study due to patient's condition. cxr:interval development of a retrocardiac density which may be secondary to atelectasis or pneumonia. brief hospital course: on the floor, diuresesis was attempted with lasix, metolazone, then nesiritide, without good results, and he was transitioned from coumadin to heparin, to lovenox (with a notable cr of 3.4, inr 2.2) to the cath lab for swan placement for tailored inotropic therapy for his severe right heart failure. initial pa pressures were ra 24, rv 76/16 pcwp 25 pa 78/24. on presentation to icu, was co was 2.43, started on 5mg of dobutamine and co went to 2.57 with some pvc ectopy, no increased urine output and was changed to lasix drip. echo consistent with systolic dysfunction with ef>55%. diruesed effectivly with a lasix drip and d/c weight was 96 kilograms (down form admit weight of 101kg). ischemia not felt to be cause of exacerbation. also had a febrile episode and was treated with a 7 day course for hospital acquired vs. aspiration pneumonia. he was afebrile on transfer from the unit. currently in atrial fibrillation s/p unsuccessful cardioversion x 2. continued on b-blocker with good rate control. d/c on lovenox bridge to restarting coumadin after invastive procedures. valves: has history of avr ( bioprosthetic). currently on anticoagulation and heparin while subtherapeutic. evaluated by echo prior to transfer. echo on shows trace ar, mod tr, 1+mr. he had acute renal failure but with improved forward flow following diuresis his cr improved to approx 2.9. his baseline is ~2.5. he was discharged to rehab with dr. follow up. medications on admission: synthroid 25 mcg daily colchicine 0.6 mg allopurinol 100mg tylenol 650 mg qid prn hydrocodone/apap 7.5/750 prn pain amaryl 2 mg coumadin 2.5 mg daily (has not taken in 1 week as supratherapeutic) crestor 10 mg daily ecotrin 81 mg daily flomax 0.4 mg daily potassium 40 mg lasix 80 mg daily lopressor 50 mg daily neurontin 300 mg tid niferex 150 mg daily nexium 40 mg daily discharge medications: 1. rosuvastatin 5 mg tablet sig: two (2) tablet po daily (daily). 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. polysaccharide iron complex 150 mg capsule sig: one (1) capsule po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 8. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 9. epoetin alfa 2,000 unit/ml solution sig: () units injection qmowefr (monday -wednesday-friday). 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 14. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). 15. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed. 16. enoxaparin 80 mg/0.8 ml syringe sig: one (1) syringe subcutaneous daily (daily). 17. insulin nph human recomb 100 unit/ml suspension sig: eight (8) units subcutaneous at bedtime: to be given at bedtime. 18. insulin regular human 100 unit/ml solution sig: 2-12 units injection four times a day: use as directed. discharge disposition: extended care facility: - discharge diagnosis: right heart failure . cad atrial fibrillation on coumadin s/p cardioversions hypertension hyperlipidemia thyroid disorder non insulin dependent diabetes chronic renal insufficiency (basline cre 2.0) gout bph shingles s/p left carotid endarterectomy () s/p laproscopic ccy () s/p appendectomy discharge condition: ambulating with assistance, deconditioned. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1200 cc/ day . you were admitted to the hospital with right heart failure. you had a cardiac cath and were placed in the intensive care unit for close monitoring. fluid was removed and you were discharged to rehab. followup instructions: please follow up with dr. in 2 weeks post discharge. his number is procedure: pulmonary artery wedge monitoring diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin long-term (current) use of anticoagulants heart valve replaced by transplant 

Answer: The patient is high likely exposed to