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: ciprofloxacin / zometa / keflex / tetracycline / erythromycin / iodine containing agents classifier / nuts / fish derived / lisinopril attending: chief complaint: shortness of breath major surgical or invasive procedure: -left thoracotomy with placement of epicardial biv lead history of present illness: 68 yo f w/ class iii systolic hf with ef of % s/p biv-icd placement, severe asthma and back pain who presents from the holding area of the cath lab with dyspnea/tachypnea prior to exchange of lv lead. pt had recent admission for polymorphine vt with her icd discharging 5 times and she was found to have malpositioned anterior lv lead. after she was stabilized and breathing had improved she was discharged on with plan to come back in for scheduled outpatient lv lead exchange which was today. her weight at the time of discharge was 160lbs. pt reports she felt fine when leaving on but quickly started to all of a sudden feel "worse". pt reports feeling sick from then until now. she describes it as feeling fatigued, with worsened breathing, and nausea. her weight was decreasing while at home and she was 156 at home on the day of admission. she reported worsening breathing, with a coughing fit the day prior. she denies any fevers or chills or sick contacts. she was recently treated for a pneumonia on her previous admission. she denies any dietary indiscretions or problems with the milrinone pump. her vna reported that she heard crackles the day prior to admission. of note at the time of discharge the following changes were made to her regimen (stopped digoxin, stopped valsartan, stopped gabapentin, decreased metoprolol from 75mg to 50mg, increased torsemide prn from 40 to 50mg,decreased sertraline from 200-->100), and the patient reports not problems with physically making these changes. in the holding area to the cath lab the patient was noted to be acute tachypnic to the 40s with crackles in the lungs posteriorly with jvp elevated to the mandible. she received 80iv lasix x1 and placed a foley. dr. evaluated the patient in the hodling area and felt she required further evaluation and management with lasix drip and milrinone drip on arrival to ccu she reports feeling 100% better. she continues to feel a little nauseus and denies any chest pain or palpitations. she is feeling overwhelmed with her illness and her multiple hospitalizations recently. and complaining of back pain. on review of systems, she reports improved swelling in her legs bilaterally, no abdominal pain, last moved her bowels the day prior to admission, no hematuria or dysuria. she reports her mood is stable compared to prior to the change in her medications. she reports she cannot sleep flat because of back pain and problems getting comfortable. past medical history: 1. severe nonischemic cardiomyopathy with lvef of 10% s/p bivicd placment -bivicd is model: xt crt-d,implanted at medical center on last interrogated and set to 1:1av conduction 2. severe mitral regurgitation, severe tricuspid regurgitation and moderate pulmonary hypertension. 3. paf status post ablation. 4. severe asthma. 5. old compression fractions of t8 and t10. 6. venous stasis disease. 7. anxiety, depression. 8. restless legs syndrome. 9. recent septic bursitis of the right knee. social history: the patient used to work as a jeweler and makes jewelry. she lives with her husband. remote smoking history, quit over 40 years ago, occasional etoh and no illicit drug use family history: father may have had a heart attack, but died from a blood clot to the brain. mother had diabetes and cirrhosis. son with -1 antitrypsin deficiency. physical exam: admission physical exam: vs: 97.8, 107, 79/53, 13, 985 3l nc wt 155lbs general: sitting up in bed, changing positions often, appears uncomfortable but not in distress heent: peerla, sclera anicteric, mmm, no oral lesions neck: supple with jvp of 10 cm. cardiac: irregular and tachycardic, systolic murmur at the left upper sternal border and at the apex, with diffuse pmi at the 6th intercostal 2cm lateral to midclavicular lungs: no chest wall deformities,pt is kyphotic. crackles at the left base but not the right. moving good air bilaterally, no wheezes but hollow breath sounds throughout. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: darkned skin bilaterally on the extremities. no peripheral edema, 2+dp pulses bilaterally. picc in the lue without erythema at hte site. neuro: aaox3, cnii-xii grossly intact, 5/5 strength biceps, triceps, wrist, knee/hip flexors/extensors, 2+ reflexes biceps, brachioradialis, patellar, ankle. discharge physical exam tm 98.6 tc 97.6 hr 77-81 rr 18-20 bp 87-96/50-66 i/o1490/1525 weight 70.7 o2 96%ra gen: aaox3, fatigued appearing, but affect much improved heent: jvd 1/2 up to mandible. right scar c/w prior ij. heart: rrr. dressing left side chest c/d/i lungs: crackles at left base abdomen: soft, nt, nabs ext: 1+ edema l>r neuro: nonfocal skin: right picc without erythema or exudate pertinent results: admission labs: 02:30pm blood wbc-13.7*# rbc-3.66* hgb-11.7* hct-34.2* mcv-93 mch-31.8 mchc-34.1 rdw-14.5 plt ct-375 02:30pm blood neuts-80.6* lymphs-11.1* monos-5.3 eos-2.6 baso-0.4 05:23am blood pt-15.4* ptt-32.8 inr(pt)-1.4* 02:30pm blood glucose-116* urean-15 creat-1.3* na-139 k-3.4 cl-96 hco3-29 angap-17 02:30pm blood alt-12 ast-20 ck(cpk)-39 alkphos-80 totbili-1.1 02:30pm blood ck-mb-2 ctropnt-<0.01 02:30pm blood calcium-8.8 phos-3.6 mg-2.0 urine: 02:25pm urine color-yellow appear-clear sp -1.008 02:25pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 02:25pm urine rbc-4* wbc-3 bacteri-few yeast-none epi-0 transe-<1 imaging: ct venography of coronary veins : the only mapped coronary vein visualized was seen along the inferior septum/inferior wall aspect of left ventricle, along the posterior descending coronary artery, most probably a middle cardiac vein. the left ventricular pacing lead is seen coursing into the coronary sinus and then into the great cardiac vein. focal stenosis at the origin of the celiac artery is causing approximately 40% narrowing. in addition, there is stenosis in the superior mesenteric artery just beyond its origin, which is incompletely imaged.for other findings on the heart and thorax, please refer to ct dated . cxr : 1. right upper extremity picc unchanged in location in the lower svc. 2. interval increase in pulmonary vascular engorgement and mild interstitial edema. moderate cardiomegaly is unchanged. echo : pre lead placement: perioperative exam performed to monitor hemodynamics and assess ventricular resynchronization therapy. severely depressed lv systolic function with lvef < 15% with global hk and severely dilated lv. the left atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the right ventricular cavity is dilated with severe global free wall hypokinesis. the ascending, transverse and descending thoracic aorta are normal in diameter with mild atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal, but restricted leaflet motion is seen. the mitral regurgitation vena contracta is >=0.7cm. severe (4+) mitral regurgitation is seen. there is no pericardial effusion. intact ias. no clot in laa. normal coronary sinus. severe diastolic dysfunction with e' = 5 cm/sec. post lead: mild improvement in lv systolic function, otherwise unchanged. : the left atrium is moderately dilated. the left atrium is elongated. the estimated right atrial pressure is at least 15 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 15 %). the estimated cardiac index is depressed (<2.0l/min/m2). the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. the mitral valve leaflets do not fully coapt. an eccentric jet of moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets fail to fully coapt. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study dated (images reviewed), the degree of tricuspid regurgitation is worse. other findings are similar. tte: impression: marked biventricular cavity enlargement with severe global biventricular systolic function c/w diffuse process (toxin, metabolic, cannot exclude multivessel cad). moderate to severe mitral regurgitation. pulmonary artery hypertension. compared with the prior study (images reviewed) of , the left ventricular cavity is more dilated. right ventricular function is slightly worse. the estimated pa systolic pressure is now higher. brief hospital course: ms. is a 68 year old female with history of nyha class iii systolic heart failure s/p biventricular pacemaker/icd (biv icd) placement in , who presented for elective lead revision of her biv pacer leads. she had placement of an epicardial lead on the lateral aspect of left ventricle but did not get improvement in her ef, so she continues on home milrinone. #systolic heart failure- the patient has severe idiopathic nonischemic dilated cardiomyopathy, followed by dr. in the clinic. she has a biv icd and is on betablocker, torsemide, spironolactone. pt was previously on digoxin which was d/cd on her last admission as well as her hypotension. she has been diuresed with torsemide and on admission her weight was 155 lbs, below her documented dry weight of 160. while in the holding area for lead revision, she became acutely short of breath, and likely had a flash pulmonary edema in the setting of tachycardia with decreased diastolic time. she had increased pulmonary edema on cxr despite being below her discharge weight. during this admission she was originally diuresed with a lasix drip and then on hd#2 was switched back to home po torsemide. her ef was not improved with revision of the biv pacer (see below) lead and so she continued on her home heart failure regimen including milrinone 0.25 mcg/kg/min, metoprolol succinate 50 mg daily, tosemide 60 mg daily, spironolactone 12.5 mg daily. #ventricular dysynchrony: on ms. placement of epicardial left ventricle pacemaker lead placement via a left thoracotomy. this procedure was performed by dr. . please see the operative note for details. she tolerated the procedure well and was transferred in critical but stable condition to the surgical intensive care unit. she was extubated and weaned from neosynepherine. on post-operative day one her chest tube was removed without incident. her permanent pacemaker was interrogated by the electrophysiology service and found to be in good working condition. after the new lead was placed, however, a repeat echocardiogram did not show that her dyssynchrony was resolved. she was taken off her milrinone to see if the new lead would allow better ef, however her creatinine went up, her blood pressure dropped and her mental status decreased--all suggesting decreased perfusion when off the milrinone. thus, she was restarted on milrinone and this was set up to continue at home. she was seen by the palliative care team about her overall prognosis because she is now milrinone-dependent. they discussed turning off her icd when she is ready, and she will think about this and talk with her family when she goes home. #hypotension: thought to be due to end-stage heart failure. patient presented with bp of 79/59. although she was asymptomatic, this was below her previous baseline of sbp 90's to 100's. following her epicardial lead placement, she continued to have sbp's of 70's to 80's and complained of fatigue. she was briefly on phenylephrine infusion in the cvicu following her procedure, but was weaned off prior to transfer to cardiology floor on . her milrinone was adjusted as above and her blood pressures remained in the 80-90s, asymptomatic. # paroxsymal atrial fibrillation: was rate controlled with metoprolol during admission and continued her aspirin 81 mg daily. she did not like taking warfarin and having inr checks and her chads score is only 2 giving her an overall low risk of stroke during the rest of her life expectancy from heart failure, thus her warfarin was discontinued. # depression: she did have significant depression during admission, which worsened when she was taken off the milrinone and then restarted on it. this was felt to be an appropriate response due to her worsening overall prognosis and difficulty adjusting to the fact that she had no other options besides home milrinone now. she was continued on her sertraline. transitional issues: - monitor for heart failure exacerbation symptoms and adjust her diuretics as needed - return to clinic with dr. and repeat echo medications on admission: 1. fluticasone-salmeterol 500-50 mcg/dose disk 2. multivitamin qday 3. aspirin 81 mg qdya 4. pantoprazole 40 mg er qday 5. magnesium oxide 400 mg (hold while inpatient) 6. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation every six (6) hours as needed for sob. 7. montelukast 10 mg po hs 8. cholecalciferol (vitamin d3) 800 u qday 9. ropinirole 0.25 mg po qhs (hold while inpatient) 10. milrinone continuous infusion for weight of 160lbs, at 0.38mcg/kg/min 11. ferrous sulfate 325 mg (65 mg iron) qday 12. sertraline 100 mg po qday. 13. prednisone 10 mg prn for asthma attack (hold while inpatient) 14. tums 200 mg calcium 1000mg po qday 15. metoprolol succinate 50 mg er (switch to 25mg po tartrate while inpatient) 16. torsemide 50 mg prn if you gain 3 lbs in 1 day: (hold while inpatient) 17. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. (prn while inpatient) 18. coumadin 2.5mg po qday 19. albuterol sulfate neb 20. loratadine 10 mg qday. (hold while inpatient) 21. spironolactone 12.5mg po qday 22. oxycodone 5 mg tablet q6h prn pain 23. potassium chloride 20 meq (hold while inpatient) discharge medications: 1. milrinone 0.25 mcg/kg/min iv drip infusion start: after completion of bolus dose rx *milrinone 1 mg/ml continuous disp #*30 bag refills:*2 2. acetaminophen 1000 mg po tid 3. aspirin 325 mg po daily 4. metoprolol succinate xl 50 mg po daily start: in am please hold sbp < 90, hr < 50 5. fentanyl patch 12 mcg/hr tp q72h rx *fentanyl 12 mcg/hour change every three days disp #*10 transdermal patch refills:*0 6. fluticasone-salmeterol diskus (500/50) 1 inh ih 7. magnesium oxide 400 mg po bid 8. torsemide 60 mg po daily rx *torsemide 20 mg daily disp #*90 tablet refills:*2 9. spironolactone 12.5 mg po daily 10. senna 1 tab po daily rx *sennosides 8.6 mg daily disp #*30 tablet refills:*2 11. albuterol 0.083% neb soln 1 neb ih q6h:prn sob/wheezing 12. montelukast sodium 10 mg po daily 13. sertraline 100 mg po daily 14. ropinirole 0.25 mg po qpm 15. trazodone 25 mg po hs:prn insomnia/anxiety take 12.5 mg as needed for anxiety 16. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 17. polyethylene glycol 17 g po daily rx *polyethylene glycol 3350 17 gram/dose daily disp #*30 unit refills:*2 18. oxycodone (immediate release) 5 mg po q4h:prn pain hold for sedation or rr<10 rx *oxycodone 5 mg every 4 hours disp #*90 tablet refills:*0 19. pantoprazole 40 mg po q24h 20. loratadine *nf* 10 mg oral daily 21. potassium chloride 20 meq po daily duration: 24 hours 22. outpatient lab work please check chem-7 with results to dr. at phone: fax: icd 9: 428 discharge disposition: home with service facility: discharge diagnosis: decompensated systolic congestive heart failure--ef 15% . hypertension atrila fibrillation asthma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you while you were here at . you were admitted to the hospital because you were suddenly short of breath and were briefly in the cardiac intensive care unit while we got some extra fluid out of your lungs. you some testing to determine how to fix your pacemaker lead so that it made your heart squeeze the best. it was decided that you would require surgery to have this done and tolerated the procedure well. unfortunately, this procedure did not help the pumping function of your heart so you will need to continue the milrinone at home. follow-up needed for: 1. heart failure- it will be very important to weigh yourself daily, if you increase in >3 lbs in 1 days or 5 pounds in 3 days you should take your torsemide and call dr. office 2. surgical wound: you will see the surgeons at the end of next week to take off the dressings. it was a pleasure taking care of you in the hospital! followup instructions: department: cardiac surgery when: thursday at 1 pm with: , md building: lm bldg () campus: west best parking: garage with: dr. address: 131 ornac jcb , department: cardiology when: thursday at 1:40 pm phone: department: cardiac services when: tuesday at 10:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 11:00 am with: dr. building: sc clinical ctr campus: east best parking: garage procedure: insertion or replacement of epicardial lead [electrode] into epicardium diagnoses: other primary cardiomyopathies anemia, unspecified mitral valve disorders congestive heart failure, unspecified acute on chronic diastolic heart failure asthma, unspecified type, unspecified other chronic pulmonary heart diseases personal history of tobacco use depressive disorder, not elsewhere classified pulmonary collapse anxiety state, unspecified hypotension, unspecified long-term (current) use of other medications mechanical complication of automatic implantable cardiac defibrillator other left bundle branch block long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diseases of tricuspid valve leukocytosis, unspecified venous (peripheral) insufficiency, unspecified restless legs syndrome (rls) 

Answer: The patient is high likely exposed to