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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: intubation - l-ij quinton line for temp hd - placement of r-ij cordis w/ pa catheter - picc line placement - cardiac catheterization history of present illness: mr 65 year old man with past medical history significant for hypertension, hyperlipidemia, coronary artery disease s/p cabg and recent ptca with bms to d1 , chf (ef 40%) presenting with worsening difficulty breathing for the past 3 days. . patient reports worsening difficulty breathing for the past 3 days. he has been residing in rehab facility after recent tma of right foot for non healing diabetic foot ulcer. patient describes shortness of breath with exertion (transfering to and from wheelchair) that was at its worse today, and was associated with chest burning which lasted one hour. patient denies any frank pain, arm / neck / jaw pain or tingling, did not experience palpitations or syncope / presyncope/ lightheadedness. . per transfer note, pt coplained of shortness of breath and chest pain at rehab facility. pt given sl nitro with good effect, however with new recurrent episode shortly thereafter ems was called and patient trasnferred to for evaluation. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope. . in the ed: 0 98.8 80 179/54 100% ? nc. patients ecg obtained and concerning given worsened st elevations in setting of lbbb. code stemi called, patient given 40mg lasix iv, 1 inch nitro paste, heparin bolus given only 6k, integrilin bolus 18, 600 plavix load, aspirin 324mg more given. he was guaiac negative. after evaluation by cardiology fellow, clinical presentation felt to be more suggestive of volume overload and hyperkalemia. code stemi cancelled, patient admitted to service for futher managment. . at time of transfer, vs hr 72 118/42 21 4l nc 95%. patient remained chest pain free while in the ed, no urine output was recorded. past medical history: cad s/p 4 mi's (, , ) diabetes mellitus type ii neuropathy retinopathy diabetic foot ulcer pvd hypertension hyperlipidemia gerd depression h/o alcoholism- stopped drinking 25 years ago ? ischemic colitis per omr right fem-dp, l fem- with stents bilaterally 3 vessel cabg, ? history of partial colectomy from ischemic colitis (looks like appendectomy on ct scan) s/p amputation of 2nd left toe social history: retired automechanic. no current alcohol or tobacco. prior smoker: 80 pack-years, quit in after first mi per omr. previous alcoholism- no alcohol for 25+ years. family history: mother with breast cancer at 54. father with alcohol abuse, multisystem organ failure at 77. physical exam: vs - 98.6 158/50 72 95% 3l nc gen: wdwn middle aged male in nad. 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 18 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, soft i/vi systolic crescendo murmur at rusb. no s3 or s4. chest: decrased air movement, bilateral crackles at bases. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: rle with dressing that is clean, dry, intact, 1+ pitting edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: labs on admission: 09:42pm ctropnt-0.05* 09:42pm ck-mb-3 micro: sputum gram stain-final; respiratory culture-final inpatient gram stain (final ): pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. smear reviewed; results confirmed. respiratory culture (final ): moderate growth commensal respiratory flora. imaging: c cath (): comments: 1. coronary angiography in this left-dominant system revealed diffuse coronary artery disease. the lmca was a small caliber vessel without disease. the lad had 60-70% calcified stenoses of the proximal section, as well as the diagonal branch, and was occluded after the mid-section. the lcx had sequential stenoses of the proximal and distal lcx, with occluded om1 and om2 branches, and total occlusion after the distal lcx. the rca was a non-dominant vessel with sequential 80% stenoses. 2. selective graft venography revealed a widely patent svg-pda and lpl graft. the svg-om1 graft had a 30-40% stenosis in the mid-svg, and was patent to the om1 branch. 3. selective graft arteriography revealed a widely patent lima-lad graft. 4. resting hemodynamics revealed elevated right- and left-sided filling pressures, with mean ra pressure of 15 mmhg, and mean pcw pressure of 30 mmhg. the wedge tracing was notable for a prominant v-wave with pressure of 51 mmhg, consistent with possible mitral regurgitation. there was mild pulmonary hypertension with mean pa pressure of 38 mmhg, and mild systemic hypertension, with sbp of 140mmhg. the cardiac output was normal at 5.1 l/min. there was no aortic stenosis detected by pullback technique. 5. nonselective left subclavian injection revealed a 70% stenosis of the proximal left subclavian artery, with a 45 mmhg pressure drop across the stenotic lesion. final diagnosis: 1. diffuse coronary artery disease. 2. elevated left- and right-sided filling pressures. 3. mild pulmonary and systemic hypertension. 4. subclavian stenosis. cxr (): impression: cardiomegaly, bilateral airspace opacity, right greater than left, concerning for pulmonary edema with bilateral pleural effusions, also greater on the right. echo (): the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. lv systolic function appears moderately-to-severelydepressed (ejection fraction 30 percent) secondary to akinesis of the posterior wall and hypokinesis of the inferior septum, anterior free wall, and apex. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. a possible discontinuity in the myocardium between the inferior and posterior wall at the basal level is seen. the discontinuity occurs where normal inferior wall meets akinetic posterior wall. this could represent a contained pseudoaneurysm of the left ventricle. this finding was present on the prior study. compared with the findings of the prior study (images reviewed) of , the mitral regurgitation is increased. ct chest (): impression: 1. severe coronary artery atherosclerosis. anemia. 2. likely asymmetric pulmonary edema. contribution of drug reaction, for example amiodarone toxicity, pulmonary hemorrhage or aspiration cannot be assessed in the setting of cardiac decompensation. 3. asbestos-related pleural plaques. basal rounded atelectasis, greater on the right, stable for three years. 4. mild-to-moderate emphysema apical predominant. abd ultrasound (): impression: 1. no hydronephrosis. 2. normal liver doppler. 3. no extra- or intra-hepatic biliary duct dilatation. ct a/p (): 1. no evidence of retroperitoneal hemorrhage or hemorrhage in the left groin (the site of recent catheterization). 2. new bilateral basal consolidations, likely relate to aspiration. 3. small amount of simple ascites, new since prior study. 4. extensive atherosclerotic disease. gallbladder u/s (): 1. no evidence of acute cholecystitis or intra- or extra-hepatic biliary ductal dilation. 2. a echogenic focus in the gallbladder neck measuring 1.2 cm, could either represent a polyp, adherent sludge or a non-calcified stone. follow-up evaluation upon resolution of acute symptoms is recommended. cxr (): ap single view of the chest has been obtained with patient sitting semi-upright position. available for comparison is a preceding similar study dated . during the two days examination interval, the patient has been extubated. comparison of heart size obtained in portable ap position suggests mild regression of cardiac enlargement. this is also supported by the less marked perivascular haze previously noted in the pulmonary circulation. although the diaphragmatic contours are now again visible, although blunting of the lateral pleural sinuses persists, indicating some remaining pleural effusion. previously described left internal jugular approach central venous line as well as a similar right-sided line persist. the latter still carrying the swan-ganz catheter seen to reach the central portion of the right pa. no evidence of pneumothorax or newly developed discrete pulmonary parenchymal infiltrates that would indicate the presence of pneumonia in this patient with leukocytosis. brief hospital course: ** patient was discharged against medical advice on ** mr. is a 65 year-old man with cad s/p previous cabg who was admitted w/ shortness of breath, transferred to the ccu for sob and hypoxia. 1. hypoxic respiratory failure- this was likely exacerbated in the setting of pulmonary edema with possible superimposed infection. volume overload and newly diagnosed mitral regurgitation also contributed to difficulty breathing. pt was intubated on for increasing respiratory distress. he was treated with an 8-day course of vanc/cefepime for aspiration pneumonia. he was initially diuresed with lasix boluses and lasix drip, but due to poor urine output and increasing creatinine, drip was discontinued. on , diurses with lasix boluses and metolazone was initiated and renal was consulted, who recommended starting cvvh. on , pt started diuresis with cvvhd for pulmonary edema in setting of worsening mr. cvvh was continued until . pt was extubated on , without complications. in the setting of aggressive diuresis, pt's respiratory status continued to improved and he was called-out to the floor on . pt was comfortable on room air, prior to discharge when he chose to be released against medical advice on . 2. acute on chronic systolic heart failure: patient was clinically volume overloaded and cardiac catheterization showed evidence of new mr (but patent grafts). patient had little diuresis with iv lasix on the general medical floors, and was transfered to the ccu due to increasing oxygen requirement. he required intubation in the setting of aspiration while on facemask, with desaturation to 70%. while intubated, he had little output to lasix, and required cvvh for a net of liters off. as he approached the euvolemic state, he was successfully extubated. he was maintained on beta blocker, plavix, and statin. acei was not started given arf, but should be considered in future. optimized afterload reduction in setting of new mr . 3. acute on chronic renal failure: this was likely in setting of poor forward flow (fe urea 16%) s/p cvvh. electrolytes acceptable, volume status much improved and appeared to be euvolemic on exam. pt's urine output improved. cvvh continued until and pt underwent hemodialysis on . his creatinine trended downwards without the need for regular hemodyalysis. patient left against medical advice on before further parameters could be discussed. 4. atrial flutter: patient demonstrated new slow aflutter in the ccu. he underwent bedside cardioversion on and converted to normal sinus rhythm. for rate control, beta blocker and amiodarone were initiated. initially he was maintained on heparin gtt which was later transitioned to coumadin. 5. hypertension: pt was continued on / metoprolol. optimized with goal sbp??????s 100-110??????s and hr 60??????s. of note, patient had left-sided subclavian stenosis (proximal lima) with disparate blood pressure in upper extremities. consider intervention for subclavian stenosis as outpatient (not done as inpatient in cath given the dye load and renal failure) 6. transaminitis: pt's lfts were consistent with cholestatic picture- he had a negative ruq u/s and ct initially, but repeat ruq showed a questionable stone in the gallbladder neck vs echogenic focus, but this was non- obstructing. there could be some component of congestion, but could be also medication effect from statin or zosyn. atorvastatin was decreased from 80mg to 40mg daily and initial zosyn for hospital-acquired pneumonia coverage was changed to cefepime. lft's were carefully monitored throughout hospital course and trended downward. 7. anemia: unclear etiology. there were no signs of active bleeding on exam. his hct increased appropriately after 4 units prbc transfusion. pt underwent abdominal ct on to rule-out retroperitoneal bleed given recent catheterization on . there was no evidence of rp bleed on ct. his hemolysis labs were negative. his blood pressures and hcts remained stable throughout the remainder of his hospital course and he did not require further blood transfusions. 8. diabetes mellitus type ii: insulin was continued per outpatient regimen 9. diabetic foot ulcer: s/p r- tma. incision was clean, no evidence of infection at this time, sutures intact. seen by vascular surgery as inpatient, who recommended outpatient follow-up. medications on admission: # atorvastatin 40 mg tablet daily. # clopidogrel 75 mg tablet daily. # aspirin 325 mg tablet daily. # 10 mg daily. # metoprolol tartrate 50 mg 2 times a day. . # lorazepam 0.5 mg every 4 hours as needed for anxiety. # sertraline 100 mg daily. # temazepam 15 mg capsule po hs as needed for insomnia. . # heparin (porcine) 5,000 tid (3 times a day). # acetaminophen 325 mg for pain, fever. # oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. # ranitidine hcl 150 mg tablet . # humalog sliding scale # nph insulin - 20 units am, and 24 units pm # humalog - 10 units with breakfast, 12 units with dinner discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 4. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. 5. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 7. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 8. outpatient lab work please check lft's, inr on tuesday with results to dr. 9. lisinopril 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 11. amiodarone 200 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. nph insulin human recomb 100 unit/ml suspension sig: as directed units subcutaneous twice a day: 20 units in the morning and 24 units in the evening. 13. insulin lispro 100 unit/ml solution sig: as directed units subcutaneous twice a day: 10 units with breakfast, 12 units with dinner. discharge disposition: home with service discharge diagnosis: acute on chronic systolic congestive heart failure acute renal failure diabetes mellitus type 2 aflutter discharge condition: level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you had trouble breathing and some chest pain. you were transferred here and found to have a heart attack. you had a cardiac catheterization which showed your arteries are open but you have a blockage in your subclavian vein. you developed congestive heart failure and acute renal failure which is now resolved. you received antibiotics for pneumonia. you also now have a heart rhythm called aflutter which is not dangerous but does put you at risk for a stroke. we have made the following medication changes: 1. start amiodarone 200mg daily to treat the aflutter and control your heart rate 2. start coumadin to thin your blood and prevent blood clots and strokes. you will need to check your coumadin level (inr) on tuesday at dr. office and they will tell you how much coumadin to take from now on. 3. change the metoprolol 50mg twice daily to "toprol" 50mg once daily, this is the long acting form of metoprolol 4. stop taking percocet 5. stop taking temazepam, take trazadone instead to sleep. 6. stop taking and take lisinopril 5mg daily instead weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: primary care: , a. phone: date/time: tuesday at 1:15pm. . cardiology: phone: ( date/time: please call the office when you get home and make an appt in 5 days of your discharge from the hospital. also, if you would like you can see dr. at the (, he is a cardiologist and you have seen him once in the past. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis atrial cardioversion pulmonary artery wedge monitoring diagnoses: pneumonia, organism unspecified hyperpotassemia subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified personal history of tobacco use depressive disorder, not elsewhere classified atrial flutter percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin old myocardial infarction acute on chronic systolic heart failure stricture of artery diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy 

Answer: The patient is high likely exposed to