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: penicillins attending: chief complaint: massive pulmonary embolism major surgical or invasive procedure: n/a history of present illness: mr. is a year old spanish-speaking man with a history of past mis in and , reported chf, afib on coumadin until 2 months ago, defibrillator/?pacer for 10 years, who presents from an outside hospital with a massive pulmonary embolism. he apparently was approximately in his usual state of health and eating dinner with his family after which he went to the bathroom. a relative noted that he had not come out and went to check on him, and found him blue and unresponsive. 911 was called. they took about 10-15 minutes to arrive per his family, and per an ems runsheet, arrived at 1750 on , and per the run sheet, departed for the hospital at 1802, arriving 1824. the run sheet notes that he was unresponsive and placed on a nrb at 15l. by report, although timing it is not clear from the paperwork, he was intubated during transport; by verbal report of family but not of osh or ems paperwork, compressions were performed. of note, the patient has a defibrillator per his medicalert bracelet. . when he arrived to the , he was taken for an emergency ct scan with contrast, which revealed a clot occluding the right main pulmonary artery and branches. they also noted upgoing toes and rigid tone; he received 2 mg of lorazepam for muscle rigidity. based on this, he was transferred to the for further management. it does not seem that heparin was started at that time. . on arrival in the ed, heparin was started at the , where a radiology read of the lgh ct scan revealed an rv/lv ratio >2 and iv contrast in the ivc, each suggesting rv strain. he received another 2 mg of lorazepam. heparin was started, with a bolus of 5400 units, and a drip of 1200 units/hr. iv access was established with two 20g and an 18 g; a groin stick was done for labs in the ed. . at time of arrival in the ed at 2115, he had vitals of 98.8, hr 99, bp 134/83, rr 13, o2 100% with vent settings not recorded in the ed run sheet. 200 cc of urine output was recorded in his foley over the two hours he was in the ed. he apparently received one liter of fluid plus additional fluid. . the micu resident briefly evaluated the patient in the ed where a brief exam was notable for unresponsiveness, warm feet, and mild response to withdrawal. further evaluation once he arrived in the micu is detailed below. a family meeting in spanish and english was held with many members of his family; members of his family translated and one of the micu team obtained history in both spanish and english. an icu consent was obtained. the neob was notified per protocol and refused based on age. past medical history: per family and medicalert summary: - implanted defibrillator (seen on cxr) - past mis , - had been on coumadin for unclear indication, family said he had been on it for a long time but stopped a couple months ago (?for supratx inr per one ed note) - chf social history: was a farmer in the republic. tobacco 40 years, now quit. no etoh, no drugs. family history: likely only lightly contributory in this year old man, but significant for mi in his brother, cva in a sister, and prostate cancer in a brother. physical exam: general appearance: appears younger than stated age; unresponsive; mottled cold skin eyes / conjunctiva: no(t) perrl, no(t) sclera edema, right pupil irregular in appearance; left round and reactive head, ears, nose, throat: normocephalic, endotracheal tube, og tube, no sign of head trauma cardiovascular: (s1: normal), (s2: normal), quiet heart sounds peripheral vascular: (right radial pulse: diminished), (left radial pulse: diminished), (right dp pulse: diminished), (left dp pulse: diminished) respiratory / chest: (expansion: symmetric), (breath sounds: bronchial: , rhonchorous: ) abdominal: bowel sounds faint extremities: right: 1+, left: 1+, cyanosis skin: cool, mottled neurologic: responds to: noxious stimuli, movement: no spontaneous movement, tone: increased pertinent results: 10:50pm blood wbc-10.9 rbc-3.32* hgb-11.0* hct-31.1* mcv-94 mch-33.2* mchc-35.4* rdw-13.1 plt ct-129* 10:50pm blood neuts-79.4* lymphs-11.7* monos-7.4 eos-1.0 baso-0.5 10:50pm blood pt-14.7* ptt-150* inr(pt)-1.3* 04:14am blood fibrino-235 10:50pm blood glucose-120* urean-27* creat-1.6* na-139 k-5.7* cl-110* hco3-20* angap-15 10:50pm blood ck(cpk)-122 10:50pm blood ck-mb-7 ctropnt-0.11* probnp-1140* 10:50pm blood calcium-7.1* phos-3.3 mg-1.2* 09:49pm blood lactate-1.5 cta findings: the heart is mildly enlarged. there is atherosclerotic disease of the aorta, which is tortuous. there is extensive thrombus within all lobar and most segmental branches of the right pulmonary artery. also noted is a small filling defect compatible with thrombus within the left main pulmonary artery at the origin of the left upper lobe pulmonary artery. there is reflux of contrast into the ivc. there is no enlargement of the main pulmonary artery. no pericardial effusions are identified. there is no mediastinal or hilar lymphadenopathy. a single-lead pacemaker is noted with the lead terminating in the right ventricle. an endotracheal tube terminates at the carina. emphysematous changes are noted throughout both lungs with scarring at the lung apices. motion limits evaluation for small nodules. there are no pleural effusions or pneumothorax. images of the upper abdomen demonstrate multiple low-density lesions within the kidneys bilaterally, which are too small to characterize but likely consistent with cysts. there is a coarse calcification within the liver likely representing a granuloma. there is tortuosity of the aorta. no acute osseous abnormalities are detected. multilevel degenerative changes are noted throughout the spine. impression: 1. extensive right sided pulmonary embolus involving all lobar and most segmental branches. small filling defect in the left main pulmonary artery at the origin of the left upper lobe pulmonary artery. strain. 2. emphysema with scarring at the apices. 3. multiple low-density lesions in the kidneys which are too small to characterize but likely represent cysts. 4. endotracheal tube terminating at the carina. subsequent chest x-ray demonstrates appropriate positioning of the endotracheal tube. echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the diameters of aorta at the sinus and ascending are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. moderate to severe tricuspid regurgitation. pulmonary artery hypertension. brief hospital course: m pmhx of chf present intubated and unresponsive after becoming unresponsive suddenly at home, and diagnosed at an outside hospital with a massive pulmonary embolism. . # goals of care: a discussion was held with the family about the uncertainty of current situation and potentially grave consequences of hypoperfusion. the family decided to make the patient comfort measures only. a morphine drip, fentanyl drip and versed drip were started and the patient was extubated. he expired shortly after. . # pulmonary embolism: the patient presented with cardiopulmonary collapse, suggestive of a massive pulmonary embolism. this diagnosis was shown on imaging as discussed earlier. the patient was relatively stable and thus tpa or embolectomy were not performed however heparin gtt was continued. fluid was given to support r heart function. the patient arrived intubated. the patient was made cmo per the families wishes and was subsequently extubated. . # cardiac arrest: the history was somewhat unclear, however, per reports had bls resuscitation upon ems arrival. per handoff from ed and report from family chest compressions were performed. the patient was started on a cooling protocol with a plan for 24hrs of controlled hypothermia. an echo was performed with the results being listed above. the patient required dopamine infusion for cardiac support. . # congestive heart failure: the patient had a history of prior mis and had defibrillator in place. an echo was done. fluids were given for r heart function. dopamine infusion for cardiac support. . # low urine output: likely due to pre-renal causes or continued hypoperfusions secondary to compromised circulation. patient given fluid and started on ionotropes. medications on admission: asa 81 mg galantamine 8 mg po daily metoprolol xr 25 mg po daily diovan tablet of 160/12.5 mg tab discharge disposition: expired discharge diagnosis: expired discharge condition: n/a discharge instructions: n/a followup instructions: n/a md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnoses: acidosis coronary atherosclerosis of native coronary artery congestive heart failure, unspecified atrial fibrillation acute respiratory failure old myocardial infarction automatic implantable cardiac defibrillator in situ other pulmonary embolism and infarction acute cor pulmonale 

Answer: The patient is high likely exposed to