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: no known allergies / adverse drug reactions attending: chief complaint: chf exacerbation major surgical or invasive procedure: right and left heart cathterization. history of present illness: this is an 83 year old gentleman with cad s/p stent x 2 (lad, rca), s/p pacemaker for lbbb/syncope, htn, h.o. mi () presented to the ed from his cardiologist's office with worsening shortness of breath. . he was feeling in his usual state of health until two weeks ago when he noted progressive dyspnea on exertion that was apparent at rest. he has had no medications changes, changes in diet. he has had no symptoms of chest pain recently and has not required use of his sl ntg. his symptoms have been associated with exacerbation of an underlying cough that is worse at night and associated w/ clear phlegm and chronic blood streaking. he reports worsening intermitant abdominal cramping and diarrhea. he denies fevers but notes night-time chills. he has had no episodes of chest pain during this period. he denied symptoms of heart failure including symptoms of pnd, orthopnea or peripheral edema. he is able to lie flat with one pillow. last friday, his son was concerned regarding his father's increasing shortness of breath and called his cardiologist dr. who recommended coming in for his regularly scheduled appointment today. . his recent cardiac history is significant for a recent hospitalization in of this year. he had a full workup done including a coronary angiogram that showed significant stenosis to the rca and lad, with two drug-eluting stents placed.he was noted to have a new mr murmur at this time. an outside echo at that time was reported to have an ef of 20%. unfortunately, an echocardiogram was not done here. it was felt that it was most likely ischemic and his medical regimen was adjusted. this he had a repeat echocardiogram done that shows an ef of 43%, 4+ mitral regurgitation as well as a significant elevated pa pressures . at his cardiology appointment today, his shortness of breath acutely decompensated. he was placed on an oxygen face mask with desaturations to the 70s. he was referred to the emergency department where vital signs were significant for hr 97 190/130 41 70% on facemask. chest x-ray showed hypervolemia, pulmonary vascular congestion. a abg was obtained which showed respiratory acidosis with a ph 7.20, pco2 69, po2 31, hco3 28, lactate 2.1.(felt to be venous) cbc showed no abnormalities, chemistry panel showed cr 1.7 and hyperglycemia. a nitro gtt was started, he was given 40mg iv lasix and 4mg of morphine. he put out 250 cc urine prior to tranfer to the ccu. an ekg was significant for old lbbb and hr 65. he was started on bipap with saturation of 99%. . . review of systems on review of systems, he denies any prior history of stroke, tia, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, black stools or red stools. he denies recent fevers. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: h.o. systolic dysfunction (ef 40%) severe mr/tr - cabg: - percutaneous coronary interventions: cad s/p stent to ptca, lad stent x 1 (30-40% inflow stenosis), rca stent x 1 () (started on plavix, carvedilol, asa 325 and atorvastatin) - pacing/icd: sigma single chamber pacemaker w/ unipolar lead for lbbb and syncope 3. other past medical history: status post knee surgery, status post hernia repair chf bph status post recent right eye cataract removal h.o. knee surgery h.o. hernia repair bph h.o. od cataract removal chronic mild renal failure social history: - tobacco history: he quit tobacco in - etoh: significant alcohol excess - illicit drugs: denies illicit drug use. he lives alone. he is widower. he does not use a walker or a cane. he has two sons with whom he is close. family history: significant for father with an mi at the age of 69. he also has a son who has had an mi and ptca. physical exam: admission vs: 96.0 64 159/134 100% on bipap general: oriented, breathing labored however appropriate and able to converse. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: elevated jvp, difficult to ascertain height given bipap machine cardiac: distant heart sounds, over breath sounds. rr. normal s1, s2. sm loudest at apex. lungs: no chest wall deformities, scoliosis or kyphosis. resp were labored with accessory muscle use. diffuse crackles throughout lung fields. no wheeze or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: cxr findings: ap upright portable chest radiograph is obtained. a single-lead pacer device appears unchanged and the distal portion of the lead is poorly assessed given underpenetration. there is pulmonary vascular congestion and pulmonary edema with bilateral small pleural effusions, right greater than left. no definite pneumothorax. bony structures appear grossly intact. . impression: findings compatible with congestive heart failure. .. cxr findings: in comparison with the study of , there is mild improvement of the still substantial congestive heart failure. single-lead pacer device is again seen. . . echo the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with distal septal and anterior hypokinesis. the remaining segments contract normally (lvef = 40-45%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: mild regional left ventricular systolic dysfunction, c/w cad. moderate to severe mitral regurgitation. mild pulmonary hypertension. . compared with the prior study (images reviewed) of , severity of mitral and tricuspid regurgitation has decreased. pulmonary pressures are lower. . ct torso w/o contrast 1. moderate calcification within the aortic arch, in this patient who is preop for mitral valve replacement. 2. small nonhemorrhagic right pleural effusion with adjacent atelectasis. 3. subpleural ground glass opacities, which can be seen with nonspecific interstitial pneumonitis (nsip). . dental panoramex: results not available for viewing . mrsa screen (final ): no mrsa isolated. . staph aureus screen (final ): no staphylococcus aureus isolated. . 08:25am blood wbc-5.1 rbc-4.02* hgb-12.9* hct-37.5* mcv-93 mch-32.0 mchc-34.3 rdw-14.9 plt ct-152 08:25am blood plt ct-152 02:50pm blood pt-12.3 ptt-24.4 inr(pt)-1.0 08:25am blood glucose-93 urean-32* creat-1.6* na-141 k-4.5 cl-102 hco3-27 angap-17 05:08pm blood creat-2.1* na-137 k-4.2 cl-99 02:50pm blood glucose-197* urean-29* creat-1.7* na-139 k-4.6 cl-101 hco3-24 angap-19 05:45am blood alt-15 ast-21 ld(ldh)-191 alkphos-93 totbili-0.6 06:21am blood ck(cpk)-37* 09:30pm blood ck(cpk)-43* 06:21am blood ck-mb-3 ctropnt-<0.01 09:30pm blood ck-mb-3 ctropnt-<0.01 02:50pm blood probnp-* 08:25am blood calcium-9.1 phos-3.3 mg-2.1 02:50pm blood calcium-9.7 phos-4.8* mg-2.0 01:49pm blood %hba1c-5.8 eag-120 06:21am blood triglyc-75 hdl-95 chol/hd-1.6 ldlcalc-45 03:03pm blood lactate-2.1* brief hospital course: hospital course: this is an 83 year old gentleman with cad (des to lad, rca in ), with a pacemaker pacemaker for lbbb/syncope, htn, h.o. mi () who presented for management of acute decompensation fo systolic and diastolic heart failure to the cardiac intensive care unit. he was initially diuresed with a lasix gtt. an echo following admission demonstrated moderate to severe mitral regurgitation, mild regional left ventricular systolic dysfunction and mild pulmonary hypertension. a left heart cath which revealed unchanged coronary anatomy when compared to prior. the patient was evaluated by cardiac surgery for possible future mitral valve replacement. . active issues # acute decompensation of systolic and diastolic dysfunction: the patient presented from his cardiologist's office with acute on chronic progresive dyspnea, crackles on lung exam and elevated bnp, a cxr consistent with pulmonary edema and requiring bipap concerning for left sided heart failure. the etiology of acute on chronic failure felt to be secondary to worsening mr in the context of marked systolic hypertension versus restenosis of lad infection. he acutely flashed while tachycardic and hypertensive while visiting his cardiologist representing acute presentation. cardiac enzymes were cycled and negative. he was initially aggressively diuresed with a lasix gtt on admission with net -2.5 liters overnight. he was weaned off bipap to 2 liter nasal cannula within several hours and was saturating well on nasal cannula by hd 3. an echo on hd 2 demonstrated ef 40-45%, with moderate to severe mitral regurgitation,(systemic bp 137) mild regional left ventricular systolic dysfunction and mild pulmonary hypertension.( rvsp in the 60's) overall echo demonstrated improvement in the severity of mitral and tricuspid regurgitation and lower pulmonary pressures when compared to most recent echo in but at a lower systolic blood pressure. the lasix gtt was stopped on hd 3 after diuresis of 3.5 liters and a mild acute on chronic renal dysfunction. on hd4 a left heart cath showed right dominant system with no flow limiting disease (patent stent sites) and lvedp of 10 mmhg, rvedp of 9 mmhg, ci of 2 l/min/m2 and a mildly elevated svr and pvr at 1621 dynes-sec/cm5 and 211 dynes-sec/cm5 respectively. cardiac surgery was consulted to evaluate the patient for future mitral valve replacement. initial studies including a ct torso without contrast and dental panoramex were performed while the patient was inhouse. future discussion regarding possible mitral valve replacement will continue in the outpatient setting. his lasix was increased to daily dosing and carvedilol was doubled. lisinopril will be restarted in outpatient setting following renal function. . # coronary artery disease: history of cad status post des to lad and rca in of last year after presenting with symptoms of syncope post-micturition. he was started on plavix, carvedilol, asa 325, lisinopril and atorvastaton at that time. on admission, no symptoms of chest pain. cardiac enzymes were cycled and negative. lisinopril held in setting of acute rise in bun and creatinine after diuresis and to be restarted in the outpatient setting by his cardiologist. carvedilol was doubled. . # rhythm: in sinus rhythm on admission with old left bundle branch block. he has a single chamber pacemaker long ago placed for managment of lbbb with syncope. his heart rate and rhythm were monitored throughout the admission and he was continued on is home regimen of carvedilol which was doubled to 25 mg . . # htn: history of hypertension. hypertensive on admission to cardiologist office today. he was continued on home regimen as outlined above. . # acute on chronic renal insufficiency: history of elevated creatinine during past admissions felt to be pre-renal. elevated creatinine above 1.5 baseline per cardiologist report likely in the setting of acute decompensation of heart failure and poor forward flow. in the setting of diuresis mild acute on chronic renal insufficiency tolerated with creatinine increase from 1.7 to 2.1 and a mild metabolic contraction alkalosis. diuresis and lisinopril held prior to discharge and renal function improved to 1.6 at the time of discharge. . # hemoptysis/ cough: history of chronic hemoptysis with evaluation by ent in . recommendation at that time was to have formal evaluation by pulmonology. remote smoking history. no documentation of prior rheumatologic work-up. the patient reports intermittant hemoptysis with worsening symptoms of cough recently concerning for worsening pulmonary artery hypertension. no focal consolidation apparent on admission cxr or sx of fever. he has had a flu shot this year. . transitional issues: # medical management: lisinopril to be restarted following f/u of renal function. carvedilol doubled to 25mg and lasix increased to daily dosing. # code: full medications on admission: 1. atorvastatin 40 mg daily 2. carvedilol 12.5 mg 3. plavix 75 mg daily 4. furosemide 20 mg qmon,wed,, 5. lisinopril 40 mg daily 6. aspirin 325 mg daily discharge medications: 1. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. lasix 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home with service facility: vna discharge diagnosis: 1. acute on chronic heart failure 2. mitral valvue regurgitation 3. acute on chronic renal failure. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: 1. you were admitted for shortness of breath, which was due to worsening of your heart failure. you were determined to have worsening mitral valvue regurgitation. you received lasix during your admission, and the pulmonary edema or fluid in your lungs improved. you will need to continue your heart failure medications as an outpatient. the directions for these medications are: lasix 20 mg daily carvedilol 25 mg twice daily lisinopril 20 mg daily 2. you were also evaluated by dr. of cardiothoracic surgery. you will need to follow-up with dr. as an outpatient. his office will give you a call this week to let you know of your appointment. 3. it is very important that you take your medications as prescribed. 4. it is very important that you keep all of your doctors . 5. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: name: , address: , , phone: appt: please call dr office to set up a follow up appt from your hospital stay within 1 week. dr. office will call you this week for a follow-up appointment. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: thrombocytopenia, unspecified mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified cardiac pacemaker in situ acute on chronic systolic heart failure diverticulosis of colon (without mention of hemorrhage) hemoptysis, unspecified 

Answer: The patient is high likely exposed to