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: vf arrest major surgical or invasive procedure: endotracheal intubation (now extubated) central venous line placement (now removed) femoral line placement (now removed) electrophysiology study with cardiac catheterization history of present illness: 39m w/ pmh significant for ebstein's anomaly s/p tricuspid valve reconstruction, right and left sided systolic congestive heart failure, presenting with palpitations which awoke him from sleep. the patient presented to the ed where he appeared pale and was found to be in vt to the 230's. he began to experience chest pain and was given amiodarone 150mg iv x1, followed by amiodarone gtt. he became diaphoretic and was therefore given etomidate and shocked with 200j. his rhythm then became fine v-fib, he became unresponsive and apneic. cpr was initiated, epinephrine given x1, cpr continued, shocked again at 360j, returned to v-tach @ 240, intubated, returned to sinus rhyhthm, aspirated vomitus. had right bronchus intubation and ett was pulled back in ed. blood pressures dropped to 48/43, started on levophed, pressure increased to 124/77. . on presentation to the ccu, the patient is intubated with mottled skin, on levophed, neosynephrine and vasopressin, with hr 85 and bp 125/77. past medical history: 1. ebstein anomaly, s/p tricuspid valve reconstruction - moderate to severe tricuspid regurgitation - right heart failure, rvef 25% in 2. asd, s/p primary closure 3. left heart failure with evidence of noncompaction of lv, with lvef 28% in 4. hyperlipidemia 5. hypertension 6. obstructive sleep apnea 7. obesity 8. dvt 9. superficial phlebitis 10. endocarditis w/ septic emboli to brain prior to cardiac surgery. social history: remote tobacco use, quit 5-6 years ago. still smokes an occasional cigar. no history of alcohol abuse but has occasional drink. no illicit drugs. patient works as the fax machine repairman. he is married with 1 biologic child, aged 9 months, 2 older children from his wife's prior marriage family history: there is no family history of premature coronary artery disease or sudden death. father's family history is unknown, mother is alive in her 60's physical exam: date and time of exam: general appearance: sedated, intubated, obese vital signs: per r.n. height: 72 inch, 183 cm bp right arm: 95 / 67 mmhg weight: 100 kg t current: 99.6 cm hr: 99 bpm rr: 32 insp/mino2 sat: 93 % on supplemental oxygen: 100% eyes: (conjunctiva and lids: wnl) ears, nose, mouth and throat: (oral mucosa: wnl), (teeth, gums and palette: wnl) neck: (jugular veins: not visible), (thyroid: wnl) back / musculoskeletal: (chest wall structure: wnl) respiratory: (auscultation: diminished on left, rhonchi bilaterally.) cardiac: (rhythm: regular), (palpation / pmi: wnl), (auscultation: s1: wnl, s3: absent, s4: absent) abdominal / gastrointestinal: (bowel sounds: wnl), (bruits: no), (pulsatile mass: no), (hepatosplenomegaly: no) genitourinary: (wnl) femoral artery: (right femoral artery: no bruit), (left femoral artery: no bruit) extremities / musculoskeletal: (digits and nails: wnl), (gait and station: wnl), (muscle strength and tone: wnl), (dorsalis pedis artery: right: 1+, left: 1+), (posterior tibial artery: right: 1+, left: 1+), (edema: right: 0, left: 0) skin: (mottled abdomen, cyanotic extreemities.) pertinent results: admission labs- 05:30am blood wbc-9.4 rbc-4.83 hgb-14.9 hct-44.4 mcv-92 mch-30.8 mchc-33.5 rdw-14.0 plt ct-306 05:30am blood neuts-57.6 lymphs-35.6 monos-4.5 eos-1.9 baso-0.4 05:30am blood pt-16.7* ptt-30.4 inr(pt)-1.5* 02:59pm blood fibrino-546* 02:59pm blood fdp-80-160* 05:30am blood glucose-185* urean-16 creat-1.0 na-133 k-6.3* cl-97 hco3-26 angap-16 05:30am blood ck(cpk)-267* 02:56pm blood ck(cpk)-262* 08:29pm blood ck(cpk)-740* 03:01am blood alt-400* ast-448* ld(ldh)-586* alkphos-68 totbili-1.2 04:12am blood lipase-200* 05:30am blood ck-mb-6 05:30am blood ctropnt-<0.01 02:56pm blood ck-mb-7 ctropnt-0.36* 08:29pm blood ck-mb-9 ctropnt-0.30* 05:30am blood calcium-8.6 phos-4.6* mg-2.1 08:21pm blood vanco-6.6* 06:19am blood type-art po2-71* pco2-51* ph-7.24* caltco2-23 base xs--5 intubat-intubated 05:35am blood glucose-165* na-135 k-9.6* cl-94* calhco3-25 06:19am blood hgb-14.6 calchct-44 o2 sat-90 cohgb-2 methgb-0.2 06:19am blood freeca-1.07* select labs- 04:36am blood wbc-18.9*# rbc-4.13* hgb-12.6* hct-37.2* mcv-90 mch-30.5 mchc-33.8 rdw-14.7 plt ct-307 02:59pm blood pt-24.6* ptt-39.6* inr(pt)-2.5* 03:33am blood glucose-170* urean-48* creat-3.2* na-129* k-4.4 cl-96 hco3-23 angap-14 03:33am blood alt-1211* ast-1132* ck(cpk)-4046* alkphos-53 totbili-1.8* 05:00am blood alt-1286* ast-864* ld(ldh)-677* alkphos-54 totbili-1.7* 04:12am blood lipase-200* reports- head ct with and without contrast impression: 1. no acute intracranial pathology. 2. encephalomalacia of the right occipital pole with associated ex vacuo dilatation of the right lateral ventricular occipital suggestive of prior cerebral injury. ================================ chest cta impression: 1. small left pneumothorax, likely related to acute left rib fractures. other rib deformities are bilateral. 2. bibasilar and peribronchial opacities, could be due to massive aspiration, associated with atelectasis. 3. severe cardiomegaly with marked enlargement of right atrium and right ventricle in this patient with known ebstein malformation and prior sternotomy for tricuspid plasty. 4. mediastinal lipomatosis. 5. venous shunt between the right and the middle hepatic veins, could be due to old budd-chiari disease. tiny filling defect in the abnormal connection could be branching vessels or thrombus, likely old. . ================================ ct chest impression: 1. no residual pneumothorax in the upper two-thirds of the chest. one residual air bubble in the mediastinum. no chest tube was installed. 2. no other change since earlier today. ================================ ct chest - impression: 1. no evidence of intra-abdominal fluid collection. 2. basal pulmonary consolidation with small pleural effusions. 3. mediastinal lipomatosis. 4. right adrenal myelolipoma. 5. evidence of previous right hip avn. . echo with bubble study no spontaneous echo contrast or thrombus is seen in the left atrium/left atrial appendage or the right atrium/right atrial appendage. the left and atrial and right appendage emptying velocities are depressed (<0.2m/s). the intra-atrial septum is thickened consistent with prior asd closure surgery. no residual atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness and cavity size are grossly normal. the apex is heavily trabeculated. systolic function could not be adequately assessed. th e systolic function appears depressed. the right ventricular cavity is dilated with marked free wall hypokinesis. there are simple atheroma in the descending thoracic aorta to 45cm from the incisors. the descending aorta is relatively small, but no coarctation or dissection is seen. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the tricuspid annular ring is identified and appears well seated. mild to moderate tricuspid regurgitation is seen. there is no pericardial effusion. impression: no atrial septal defect by 2d or color doppler. well seated tricuspid annular ring with mild-moderate tricuspid regurgitation. severe right ventricular cavity enlargement with depressed biventricular systolic function. . cardiac mri:impression: 1. normal left ventricular cavity size with globally depressed systolic function. the lvef was severely decreased at 28%. no mr evidence of prior myocardial scarring/infarction although images technically suboptimal. prominent non-compacted left ventricular myocardium that meet cmr criteria for non-compaction. 2. abnormal and apically displaced tricuspid valve consistent with ebstein's anomaly. a tricuspid annulplasty ring was present. moderately depressed systolic function of the functional right ventricle with rvef at 25%. abnormal septal motion consistent with right ventricular pressure / volume overload. markedly dilated inferior vena cava and hepatic veins consistent with elevated right atrial pressure. 3. mild aortic regurgitation. moderate-to-severe tricuspid regurgitation through tricuspid leaflets of functional right ventricle. severe tricuspid regurgitation through tricuspid annulus of structural right ventricle. 4. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was normal. 5. biatrial enlargement. . chest x-ray - impression: 1. stable appearance of the mediastinum and cardiac silhouette. 2. status post extubation. no evidence of atelectasis. . ekg - sinus rhythm. the p-r interval is prolonged. left axis deviation. right bundle-branch block with left anterior fascicular block. there are q waves in the inferior leads consistent with prior infarction. there is an abnormal precordial transition consistent with possible prior anterior myocardial infarction. low voltage in the precordial leads. compared to the previous tracing the p-r interval is longer. brief hospital course: 39m w/ pmh of ebstein's anomaly, s/p tricuspid valve reconstruction, right and left sided systolic congestive heart failure, presenting with unstable ventricular tachycardia, s/p resuscitation with return to sinus tachycardia, s/p intubation and extubation. . # ventricular tachycardia: likely result of natural history of ebstein anomaly. patient underwent cpr and intubation with return to normal sinus rhythm. suppressed ectopy with amiodarone. also started metoprolol for rate-control. amiodarone increased to 200mg tid. had cardiac mri with final read as above. patient then underwent ep study where they were unable to induce ventricular fibrillation so unable to ablate. ep was unable to place an icd during this admission given recent procedure and significant abnormal heart anatomy. patient to follow up with dr. in weeks to discuss possible icd placement in the future. in addition, patient to have monitor set up at home as per dr. . . #respiratory failure - now resolved. initially primarily hypoxemic, with unclear etiology. differential includes ards, pna/sepsis, shunt, and volume overload. improvement with nitric oxide suggested some shunt physiology, although intracardiac shunt was not evident on tee. respiratory failure improved with diuresis. decreased fi02 and peep and nitric oxide weaned off with improved compliance. methemaglobin negative. multifactorial secondary to chf, osa, and restrictive ventilation due to habitus. required mechanical ventilation from admission (intubated during v fib arrrest in ed), and extubated on , without difficulty. since, patient has been satting well on room air using cpap at night. . #hypotension (resolved): initially secondary to vt, in addition probably contribution from sedatives, positive pressure ventilation especially in the setting of marked rv dysfunction. also be intravscularly volume depleted, but total body overloaded. sepsis less likely at this point, given broad spectrum antibiotic coverage, negative culture data, although stil febrile. patient initially on 3-pressors which were weaned off. in terms of sepsis work-up all culture data negative, although patient was treated empirically for vap. initially held all blood pressure medications including beta blocker and ace inhibitor which were restarted slowly after hypotension had resolved. . # fevers: leukocytosis/fever/right lobe infiltrate- patient felt to have likely aspiration pna with witnessed emesis during intubation. cultures were all negative. femoral line was removed and sent for culture. given negative culture data, patient was treated for vap and then there was concern that possible drug fever given persistant fever and no positive culture data. fevers improved after patient was extubated and did not recur. . # chronic systolic congestive heart failure: has right sided heart failure only, s/p tricuspid reconstruction and asd repair. patint on low dose metoprolol and lisinopril as above, cont aspirin 325. initially held statin in the setting of worsening liver abnormalities but restarted as lfts improved. continued patient's outpatient lasix dose of 40 mg po daily once blood pressures had improved. . # pain: has left sided chest wall pain fractured ribs from resuscitation. patient was treated with lidocaine patch daily as well as standing tylenol. patient was discharged on tylenol prn. . #gout: patient as outpatient on colchicine and allopurinol although patient not taking allopurinol at home. initially concern that fever may be secondary to gout. patient was tapped and tap revealed wbc, joint fluid 300* #/ul 0 - 150 rbc, joint fluid * #/ul 0 - 0 polys 80* % 0 - 25 lymphocytes 4 % 0 - 75 monocytes 0 % 0 - 70 macrophage 16 % 0 - 70 few siderotic granules present joint crystals, number no. patient states that he is having pain in his right knee which he thinks is from his gout. given improvement in renal function and patient's request restarted colchicine at outpatient dose. . # anemia - patient with cr 31 currently previous baseline 41. patient has not had anemia labs checked. added on anemia labs to discharge labs. patient will require active type and screen prior to additional procedures . fen: regular cardiac diet, replete lytes prn . access: piv . prophylaxis: hep sc, colace, senna, ppi daily code: full colde medications on admission: albuterol - 90 mcg aerosol - ii puffs ih qid prn allopurinol - 300 mg tablet - 2 tablet(s) by mouth daily atorvastatin - 20 mg tablet - 1 tablet(s) by mouth once a day colchicine - 0.6 mg tablet - one tablet(s) by mouth once a day digoxin - 125 mcg tablet - 1 tablet(s) by mouth daily fluticasone - 220 mcg aerosol - 2 puffs nasally twice a day x two weeks furosemide - 40 mg tablet - 1 tablet(s) by mouth once a day lisinopril - 10 mg tablet - 1 tablet(s) by mouth once a day metoprolol succinate - 25 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day discharge medications: 1. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 3. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 4. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 7. amiodarone 200 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 8. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation four times a day as needed for shortness of breath or wheezing. discharge disposition: home discharge diagnosis: primary: ventricular fibrillation arrest . secondary: ebstein's anomaly chronic left heart failure hyperlipidemia hypertension obstructive sleep apnea gout discharge condition: good, hemodynamically stable, afebrile discharge instructions: you were admitted after cardiac arrest. the arrest was most likely caused by underlying rhythm abnormalities related to your ebstein's anomaly. you were intubated for airway protection, and finally extubated after your respiratory status improved. you had fevers that resolved after extubation. as you improved significantly, you were transferred to the floor from the icu. you were evaluated by an electrophysiology study, but no ablatable source could be identified in your heart. you need to follow-up in 2 weeks with dr. for further evaluation and possible icd placement. please also follow-up as strongly advised below. dr. is arranging for you to have an outpatient cardionet or loop recorder at home after discharge. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction:1500ml . the following changes were made to your medications: - we are stopping your digoxin as your have not been on it in the hospital -stop allopurinol for now, re-discuss with dr. lisinopril to 2.5mg po daily -change metoprolol to 25 mg po bid -start amiodarone 200mg po 3 times daily -start aspirin 325mg po daily . if you experience any chest pain, shortness of breath, palpitations, weakness, nausea, vomiting, dizziness, lightheadedness, or have any other concerns please your md or return to the ed. followup instructions: please call to set up a follow-up appointment within 2 weeks with dr. ( for further evaluation for icd and monitoring of your cardiac status. . please follow-up with the adult congenital heart clinic within 1 month for further monitoring of your ebstein's anomaly. . please call the rheumatology department ( for a follow up appointment with dr. to discuss when and if to restart allopurinol treatment for gout. . please follow-up with sleep medicine ( to schedule a repeat outpatient sleep study. . please call the clinic ( as outpatient to discuss weight loss in the case of further possible heart surgery. we would reccomend you follow up within 1-2 weeks. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach arterial catheterization arterial catheterization arterial catheterization laryngoscopy and other tracheoscopy arthrocentesis cardiac mapping cardiopulmonary resuscitation, not otherwise specified diagnoses: other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) anemia, unspecified mitral valve disorders acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver hyposmolality and/or hyponatremia gout, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax cardiac arrest alkalosis cardiogenic shock chronic systolic heart failure personal history of venous thrombosis and embolism other postprocedural status obesity, unspecified ventilator associated pneumonia closed fracture of two ribs venous (peripheral) insufficiency, unspecified other specified misadventures during medical care ebstein's anomaly personal history of thrombophlebitis 

Answer: The patient is high likely exposed to