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 / nsaids / percocet / verapamil / neurontin / ultram / mysoline / / codeine / darvon attending: chief complaint: dyspnea major surgical or invasive procedure: cardioversion, defibrillation history of present illness: 81 yo f with a history of chf (ef 30%), afib on coumadin, s/p cabg presents with dyspnea. last night she began feeling chest pain that felt "like a in my chest" and noticed her heart beating quickly. she felt short of breath, weak, nauseaous, with abdominal pain and "like i was dying". the chest pain and sob continued overnight, but the patient is unclear when it started; she states she has had chest pain at baseline for months. the pt's nurse called her in the morning to check in and decided to call 911. ems found pt hypotensive, with pulse in 170s, gave pt 150mg amiodarone and aspirin in the field. . in ed, initial vital signs were: 98.8 61/39, 168, 23, 100% on nrb. in ed appeared uncomfortable, minimally tender in the epigastrium, found to have maroon guaiac positive stools, 2+ non-pitting edema bilaterally. on ekg appeared to be in aflutter, given midazolam, cardioverted with 100j initially, then appeared to go into vtach, defibrillated with 200j, converted to nsr. labs significant for hypoperfusion, cxr appears to be c/w chf, pulmonary edema. ctab showed equivocal colitis. covered with vanco/flagyl, got levoflox then developed a rash so levoflox was stopped. got 150mg iv amiodarone after cardioversion, now on amiodarone gtt. surgery consult for increased lactate. cardiology, ep looked at ekg, rhythm strip, no reccommendations. on transfer, vs were 102/49, p 60, 19, 100% 3.5l. now has 2 pivs. had gotten 1750 cc ivf, 200 cc in foley, prior to transfer. . on the floor, vitals hr 56, bp 86/47, spo2 99% on 2l nc. pt felt tired and had some continued chest pain. on ros, the patient denied fever, cough, vomiting, melena, blood in stools. she did endorse weight loss over the past few months, anorexia x months, chronic le edema, constipation (no bm x 5-6 days), a history of diarrhea with abdominal pain (unclear time course), and a feeling of increased pressure in her head. most recent weights in clinic about 145 lb. in clinic c/o decreased urination, not found to be volume overloaded on exam, bp 80/40 (near baseline per note). was found to have elevated cr and k from labs, refused medical intervention and so was treated with stopping ace-i and spironolactone and took kayexalate. . pt had extensive discussion concerning code status with pcp . (see note in omr). briefly, pt has been dnr/dni for years and expressed wish to be dead, wants to pass in her sleep. she clearly does not want any futile aggressive interventions (e.g. long term supportive care, or intervention if she is "very sick") but is equivocal about temporary less aggressive measures; she should remain dnr/dni per her goals of care. full acls resuscitation with cpr / intubation would not be consistent with her wishes. past medical history: #) coronary artery disease: (followed by dr. -- wide complex tacchycardia, ep: inducable sustained monomorphic vt; most of arrythmia felt to be atrial fibrillation. on/off multiple antiarrhythmics. -- acute lateral mi (). 100% ramus lesion, ef 45% mod mr, lateral hypokinesis -> treated medically. -- history of chf () requiring intubation, found to have found severe mr. -- nuclear stress test with reversible defect but cath ok. -- had mvr (porcine), cabg lima-->ramus. some complications including cardiogenic shock, prolonged on pump. -- ef 35-40%, well functinoing mitral valve. -- resumed coumadin, amio discontinued #) pulmonary: history of copd, pulmonary hypertension. stopped smoking . #) chronic renal insufficiency. baseline creatinine approx 1.1. #) left knee pain, s/p tkr, now functionally impaired with dislocation after replacement. #) history of left hip replacement with revision , #) allergic rhinitis. on fluticasone, atrovent. #) history of basal cell carcinoma. lesion removed from nose . #) history of tremor. #) osteoporosis. history of t6 compression fracture. fosamax. #) history of headaches. #) history of low back pain. rx neurontin, prozac. #) gerd. s/p hiatal hernia repair . barrett's esophagus. #) history of abnormal mammogram, thought not to require biopsy. #) chronic dizziness. #) history of mild anemia. #) history of tia with atypical hand numbness. #) history of peripheral edema (presumed venous insufficiency +/- cardiac component) #) history of abnormal lft's (?amio related) #) history of shoulder pain, moderate-severe oa, history bursitis #) history of hand pain #) fibromyalgia #) depression #) dnr/dni status social history: she was born in , . she denies tobacco (quit at the time of her open bypass surgery), alcohol, and other drugs. she has lived in both and prior to living in the united states (). she speaks several languages. her medications are delivered to her from a local pharmacy. family history: non-contributory physical exam: general: some increased work of breathing. looks stated age. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. very poor dentition without upper teeth. neck: supple with jvp to mandible. cardiac: pmi enlarged. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: some kyphosis. resp were slightly labored, no accessory muscle use. very poor air entry, with no breath sounds at bases. wheezes and ronchi above. abdomen: slightly distended. no hsm. mildly tender, particularly periumbilically. extremities: very severe lower extremity edema. cool extremities. skin: mild statis dermatitis, no ulcers, scars, or xanthomas. neurologic: alert and oriented to person and place. cnii - xii intact. neurologically limited right leg movement since stroke after cabg, pain limited movement of left leg (s/p redone hip and 'dislocated' knee per patient). pertinent results: labs on admission: 11:00am blood wbc-10.5# rbc-4.18* hgb-11.3* hct-36.6 mcv-88 mch-27.0 mchc-30.8* rdw-15.2 plt ct-248 11:00am blood neuts-84.6* lymphs-11.0* monos-4.1 eos-0.2 baso-0.1 11:00am blood pt-34.3* ptt-37.2* inr(pt)-3.5* 11:00am blood urean-54* creat-3.2* na-141 k-3.5 cl-100 hco3-15* angap-30* 11:00am blood alt-199* ast-219* ld(ldh)-673* ck(cpk)-267* alkphos-106* totbili-1.0 11:00am blood lipase-66* 11:00am blood ck-mb-24* mb indx-9.0* 11:00am blood ctropnt-0.50* 11:00am blood calcium-8.5 phos-4.5 mg-2.1 05:59pm blood caltibc-289 ferritn-1480* trf-222 11:09am blood glucose-163* lactate-7.1* na-142 k-3.6 cl-104 calhco3-15* . imaging: . ct abdomen: metallic clips at the ge junction are again noted with extensive streak artifact which somewhat limits the evaluation of the adjacent anatomy. the non-contrast appearance of the liver is unremarkable. the gallbladder is surgically absent, with clips in the gallbladder fossa. there is dilation of the common bile duct which measures up to 23 mm in diameter, series 301b, image 19, which is increased from previous measurement of 18 mm at a similar level. possibility of a retained stone cannot be excluded. correlate clinically and if needed ultrasound may be obtained to further assess. the pancreas is atrophic. the spleen is grossly unremarkable along with both adrenal glands. the kidneys demonstrate no hydronephrosis or stones. the abdominal aorta contains atherosclerotic calcification and appears normal in course and caliber. there is an unremarkable appearance of the stomach and duodenum. . there is a fat-containing umbilical hernia, which appear stable. the hernia also contains a small amount of fluid, though there is no bowel entering the hernia. haziness is seen along the inferior edge of the liver and along the right paracolic gutter, best seen on series 2, image 29 and 30, which is new and reflect the presence of mild colitis. small bowel is unremarkable without evidence of ileus or obstruction. pelvis: there is equivocal thickening along the transverse colon, which may reflect colitis. as mentioned above, there is mild stranding along the hepatic flexure, which could also reflect inflammation. there is no free air or evidence of abscess. large amount of fecal loading of the rectum is noted. there is no evidence of diverticulitis. the appendix is not definitively identified, though there is no secondary sign of appendicitis. the uterus and adnexa appear unremarkable. trace free fluid is seen in the deep pelvis. urinary bladder contains a foley catheter. streak artifact from a left hip prosthesis limits evaluation through the pelvis. . bones: degenerative changes are noted in the included portion of the thoracolumbar spine with an s-shaped scoliosis. hardware related to left hip arthroplasty is noted. . impression: 1. mild thickening along the transverse colon with associated stranding in the region of the hepatic flexure may represent colitis. etiology could be inflammatory, infectious, or ischemic. 2. post-cholecystectomy with increasing diameter of the common bile duct compared with prior exam. recommend clinical correlation and if needed ultrasound may be obtained to further assess. 3. moderate fecal loading of the rectum. 4. fat and fluid-containing periumbilical hernia, stable. . . transthoracic echo (): the left atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %) with apical akinesis. there is no ventricular septal defect. the right ventricular cavity is dilated with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the transmitral gradient is normal for this prosthesis. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . compared with the findings of the prior study (images reviewed) of , the mitral regurgitation may be increased (may have been underestimated due to shadowing), and the left ventricular ejection fraction is further reduced. . renal us: impression: 1. no hydronephrosis. 2. arterial and venous flow identified within the hilum of each kidney, but no further characterization can be made. . heel x-ray: the patient is status post orif of distal fibular fracture, not fully evaluated on these views. small inferior calcaneal spur is present. no fracture or dislocation is detected on the available views. no focal lytic or sclerotic lesion is identified. brief hospital course: 81 y/o female with coronary artery disease, s/p cabg/mvr, atrial fibrillation on coumadin, chf (ef 30%), copd, and chronic renal insufficiency, admitted with dyspnea, found to have wide complex tachycardia s/p dccv and amiodarone complicated by development of a different wide complex tachycardia for which she was defibrillated, subsequently transferred to ccu for volume overload/diuresis, now s/p -7l diuresis, with hospital course complicated by infection/septic shock. . initial medical floor course: . # hypotension: most likely developed cardiogenic shock in the setting of tachyarrhythmia, however there also may be component of hypovolemia, given dehydration and nausea. she was given gentle ivf boluses to maintain good urine output. there was also some concern for a distributive process with elevated white count with evidence of colitis on imaging so she was started on broad spectrum antibiotics (vanc, flagyl, ceftriaxone), which were discontinued when infectious etiology was felt to be unlikely. . # tachyarrhythmia: it was felt that she most likely was in svt with aberrancy on initial presentation to the emergency department. when cardioversion was attempted she developed a wide complex tachycardia consistent with ventricular tachycardia, which broke with dccv. she was started on an amiodarone drip. the cardiology service was consulted. amiodarone was transitioned to po on hd #2. . # colitis: patient complained of abdominal pain, benign exam but questionable colitis on imaging. the general surgery service was consulted. she had an elevated lactate in the setting of renal failiure and shock, which could be due to ischemic colitis but also could be due to tachyarrhythmia. she was started on broad spectrum antibiotics, which were discontinued when abdominal exam improved and infectious etiology was felt to be unlikely. . # nstemi: elevated cardiac biomarkers with anterior twi on ekg likely demand ischemia in the setting of tachyarrhythmia. she was monitored on telemetry and continued on aspirin, statin. etiology not felt to be acs/ua/plaque rupture. . # schf: initially intravascularly volume depleted in the setting of her cardiogenic shock, with elevated lactate and hypotension. subsequently volume overloaded and was eventually transitioned to ccu for diuresis (see below). patient felt to be euvolemic (after 7l diuresis in the ccu). . # subacute renal failure: likely from chronic chf with intravascular depletion. on final days prior to passing away, patient developed arf likely from infection/septic shock (see below). . # elevated lfts: elevated lfts in the setting of hypotension likely due to shock liver, which improved throughout hospital course. . # obstructive lung disease / allergic rhinitis: patient met with the pulmonary team to optimize her regimen. she was started on fluticasone nasal spray as well as fluticasone inhalers. advair was avoided given the salmeterol component. . # anxiety: continued on fluoxetine, and started on low dose ativan prn . ccu course: . patient was admitted to the ccu for failure to diurese on the cardiology floor on lasix gtt. the patient was started on milrinone, lasix gtt which was discontinued secondary to hypotension. milrinone was switched to renally dosed dopamine with lasix gtt and metolazone and the patient started to produce urine. patient's dyspnea and perepheral edema markedly improved and patient was 7 liters net negative during her length of stay in the ccu. the patient was then transitioned to po torsemide 40mg po bid plus metolazone 2.5mg po daily. . on the medical floor, tosemide was changed to 40 mg daily and metolazone was continued at 2.5 mg daily to maintain euvolemia. . subsequent medical floor course/palliative care/goals of care: . # infection/hypotension/sirs/septic shock: on date of anticipated discharge, patient developed likely infection, with high grade fever to 102 degrees. extensive conversations with patient and family took place, and empiric antibiotics were started. however, over the next 48 hours, patient's clinical course did not improve. no source of organism was identified, as blood culture, urine culture, and cxr were without overt source. given patient's goals of care and after discussion with family and health care proxy, care was transitioned initially to "do not escalate care" and subsequently "comfort measures" when her condition did not improve. . # goals of care: extensive conversations with patient, family, patient's primary care physician and palliative service took place during this admission. patient was informed that her chronic medical conditions are end stage, including her end stage systolic heart failure. she has also become severely deconditioned after her icu and subsequent ccu stay. patient always stated her goals of care to be consistent with do not resuscitate/do not intubate, and subsequently, transitioned her care to do not escalate care, and finally, comfort measures when her clinical course precipitously declined from likely sepsis complicated by her underlying co-morbidities. she passed away with family at bedside on medications on admission: albuterol sulfate atorvastatin 40 mg daily fluoxetine 40 mg every morning fluticasone 50 mcg spray, 2 sprays(s) fluticasone 220 mcg 2 puffs inhaled twice daily folic acid 1 mg tablet furosemide 80 mg tablet 2 tablet(s) by mouth once daily dose isosorbide mononitrate 30 mg tablet sustained release 24 hr lisinopril 5 mg tablet (stopped 3/19 per clinic note) metoprolol succinate 12.5 nitroglycerin 300 mcg (1/200 gr) tablet oxybutynin chloride 5 mg tab,sust rel osmotic push 24hr sodium polystyrene sulfonate spironolactone (stopped 3/19 per clinic note) trazodone 300 qhs warfarin 1 mg qd acetaminophen aspirin 81 mg tablet, delayed release (e.c.) colace 100mg capsule cromolyn 40 mg/ml spray, non-aerosol cyanocobalamin mcg tablet diphenhydramine hcl 25 mg capsule 2 capsule(s) by mouth daily at bedtime (otc) sennosides vitamin a-vit c-vit e-zinc-cu kayexelate per clinic note discharge medications: expired discharge disposition: expired discharge diagnosis: primary: 1. septic shock 2. cardiogenic shock 3. acute on chronic, end stage, systolic heart failure 4. acute renal failure . secondary: 1. atrial fibrillation 2. asthma 3. dilated cardiomyopathy discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified other electric countershock of heart diagnoses: other primary cardiomyopathies subendocardial infarction, initial episode of care congestive heart failure, unspecified acute and subacute necrosis of liver acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status paroxysmal ventricular tachycardia anxiety state, unspecified septic shock old myocardial infarction long-term (current) use of anticoagulants encounter for palliative care heart valve replaced by transplant acute on chronic systolic heart failure paroxysmal supraventricular tachycardia extrinsic asthma, unspecified 

Answer: The patient is high likely exposed to