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: bradycardia, hypotension major surgical or invasive procedure: intubation thoracentesis history of present illness: pt is an 88 yo male with h/o chf (ef 45%), cad, ckd, tiidm admitted to the micu from rehab with hypotension, junctional bradycardia, and mental status change . the patient was admitted to after a mechanical fall and treated for uti and chf exacerbation. he was discharged to rehab on . for the past few days he complained of worsening weakness and fatigue. he was noted to be bradycardic and metoprolol was held as of . on the day of admission he was found to be hypotensive (sbp 90s), bradycardic (hr 30s), and with mental status changes; he was sent to ed. . in the er the pt was in a junctional rhythm with a rate in the 30s and was treated with atropine. he was treated for hyperkalemia and also given glucagon due to beta-blockade. he reverted to nsr with rate in the 60s. the patient was intubated in the er for mental status changes and airway production in setting of uremia and patient vomiting. he was seen by cardiology who thought the bradycardia was secondary to hyperkalemia, which was secondary to renal failure, and recommended dialysis. renal was consulted and did not believe dialysis was indicated at this time. past medical history: type ii diabetes mellitus ckd with baseline creat 2.0 in , thought secondary to diabetic nephropathy cad s/p cabg 13yrs ago, s/p nstemi with pci x3 ~2 months prior chf (ef 45% echo with inferior hypokinesis, left atrial enlargement) chronic 02 requirement of 2.5 l nc for chf hypothyroidism h/o proteus uti vertigo left eye blindness s/p childhood accident hoh r ear s/p recent mechanical fall social history: lives with wife. three daughters, two that live in the area and visit twice a week. family history: mother died of mi at 67. physical exam: wt 82.2kg t 96.6 hr 59 bp 119/67 rr 14 99% a/c tv 550 rr 14 fio2 40% peep 5 gen: intubated, sedated male in nad heent: right pupil reactive, left opacified, anicteric, mmm neck: supple, jvp nondistended cardio: bradycardic with reg rhythm, nl s1 s2, no m/r/g pulm: occasional bilateral wheeze, o/w cta abd: soft, nt, distended with fluid wave, + bs, no masses, no hsm ext: 2+ peripheral edema (r>l); decreased dp and pt pulses b pertinent results: chest ct: 1. no evidence of that moderate to large right pleural effusion is anything other than a transudate. relaxation atelectasis probably responsible for collapsed right middle and lower lobe. 2. mild mediastinal adenopathy could be due to congestive heart failure. 3. severe atherosclerosis, predominantly in coronaries, also in the aorta, innominate artery, and upper abdomen. 4. probable pulmonary arterial hypertension. mild cardiomegaly. aortic valvular calcification, hemodynamic significance uncertain. 5. ascites. 6. no evidence of sternotomy complications. ecg: normal sinus rhythm with left anterior fascicular block. cannot exclude prior inferior myocardial infarction. compared to the previous tracing of no diagnostic interval change. brief hospital course: a/p: 88yo male with h/o tiidm, cad, chf, ckd p/w hyperkalemia, bradycardia, hypotension, and acute on chronic renal failure. admitting diagnoses improved on discharge. pt discharged to rehab for pt/ot. . 1) bradycardia/hypotension/hyperkalemia: likely multifactorial due to hyperkalemia in the setting of beta-blocker and amiodarone in addition to the recent diagnosis of hypothyroidism. initial rhythm was junctional bradycardia in 40s which improved to sinus rhythm/sinus brady with atropine, treatment of hyperkalemia, and increase of levothyroxine. blood pressure also improved with treatment of bradycardia. the pt had no further episodes of bradycardia after his initial stabilization. amiodarone and metoprolol were restarted in the intensive care unit prior to transfer to the floor. . 2) renal failure: current presentation likely acute on chronic renal failure due to overdiuresis (and subsequent chf precipitated by volume load to treat hypovolemia). etiology of ckd most likely diabetic nephropathy. nephrology believes he will need dialysis within the year. discontinued during hospitalization and was not restarted on discharge. recent creat 2.0-2.6 at osh; 2.2 on discharge. pt was followed in house by nephrology, who by discharge recommended: discontinuing renagel, decreasing calcium to 500mg tid, decreasing lasix to 40mg po qd to decrease risk of hypovolemia, and continuing epogen 10,000u qmwf. pt discharged with caudet catheter and is scheduled for follow-up with urology. pt will follow-up with nephrology locally as he will need close observation. . 3) chf: diastolic dysfunction with ef 60% and home o2 requirement of 2.5l. pt diuresed with lasix iv and po. outpatient regimen of asa, metoprolol, statin continued; discontinued because of arf. at dry weight and baseline o2 requirement on discharge. lasix 40mg po qd on discharge with care not to overdiurese. pt will follow-up with his cardiology at . . 4) right pleural effusion: the pt received a therapeutic/diagnostic thoracentesis for non-resolving right pleural effusion the day prior to discharge. 2l fluid removed, with subjective improvement in dyspnea. the effusion was found to be transudative and is most likely secondary to heart failure. the effusion is less likely secondary to infection in this pt who remained afebrile and appear nontoxic. gram stain negative, although cultures pending. also of concern is malignant effusion in setting of ascites. pleural fluid culture and cytology will need follow-up. . 5) ascites/liver function: likely secondary to right heart failure; ruq showed no liver pathology. repeat us showed mild ascites. improved with diuresis. repeat lfts showed resolved transaminases with alk phos 192, ggt 147, total bili 0.3. pt without symptoms of biliary disease. recommend follow-up lfts for resolution within one month of discharge. . 6) cad: pt denied cp during admission. outpatient regimen of asa, lipitor, and metoprolol continued; as above, held for arf. . 7) tiidm: qid fs's, riss. glyburide held in house with adequate blood sugar control; consider restarting as outpatient as needed. . 8) communication: wife . 9) code status: full medications on admission: riss tylenol 650 po q 3 hrs milk of magnesia prn dulcolax prn lasix 80 mg qd prilosec 20 mg po bid glyburide 2.5 mg colace 100 mg po bid folic acid 1 mg qd vitamin b12 500 mg qd vitamin b6 50 mg po qd ambien 5 mg qhs prn lopressor 50 mg po bid ( d/c'd ) asa 325 mg po qd plavix 75 mg qd amiodarone 200 mg po qd lipitor 40 mg qd metolazone 2.5 po qd losartan 50 mg po levothyroxine 25 mcg qd flomax 0.4 po bid remeron 15 mg po qhs discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin, buffered 325 mg tablet sig: one (1) tablet po daily (daily). 7. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 9. albuterol 90 mcg/actuation aerosol sig: 6-8 puffs inhalation q6h (every 6 hours) as needed. 10. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. epoetin alfa 10,000 unit/ml solution sig: one (1) 10,000 injection qmowefr (monday -wednesday-friday). 13. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 15. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). 16. haloperidol lactate 5 mg/ml solution sig: 2.5 mg injection q4h (every 4 hours) as needed for agitation. 17. insulin regular human 100 unit/ml solution sig: as directed units injection asdir (as directed): sliding scale is attached. 18. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 19. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 20. vitamin b-6 50 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: bradycardia congestive heart failure acute on chronic renal failure right pleural effusion discharge condition: on 2.5l o2 as per outpatient, afebrile, vital signs stable discharge instructions: please contact a physician if you have shortness of breath that does not improve. . please contact a physician if you have chest pain that does not resolve. . please take your medications as prescribed. followup instructions: please follow-up with your pcp . please follow-up with you cardiologist dr. please follow-up with a renal physician in your area or you may call the renal clinic at ( for an appointment- you should see them within 1 month of discharge please f/u with urology on at 10:15 am on 3 () md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube thoracentesis transfusion of packed cells diagnoses: hyperpotassemia anemia in chronic kidney disease coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other specified cardiac dysrhythmias old myocardial infarction hypovolemia diastolic heart failure, unspecified delirium due to conditions classified elsewhere diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled other specified hypotension 

Answer: The patient is high likely exposed to