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: ischemic/infected left foot s/p surgery. major surgical or invasive procedure: n/a history of present illness: 80 year old male with extensive past medical history notable for cad, a fib with pacemaker, carotid stenosis bilaterally, severe peripheral disease s/p r femoral graft, and admission in for tia manifest as r sided weakness, admitted to surgery on with ischemic r foot past medical history: -htn -cad, with 2 cabg's in 85 and 97, 3 mi's -afib on coumadin with pacemaker -iddm with cri -chf with documented ef=25% -pvd s/p bypass grafts -aaa -?copd -carotid stenosis with stent placed in r carotid in , and "bad blockage " of left carotid, with no prior operation. social history: retired wholesale distributor, lives at home with wife, 35 pack year hx smoking, quit 35 yrs ago. no etoh, drug use family history: non-contributory physical exam: n/a - pt deceased neg hr neg resp neg pupillary response pertinent results: date: title: bedside swallow eval bedside swallowing evaluation: cognition, language, speech, voice: pt appears to have significant neurological deficits that have not been previously documented in the chart which indicate a new neurological event. pt is severely dysarthric and virtually unintelligible (previously documented in chart). pt exhibits expressive aphasia (unable to name simple objects i.e., spoon, or pen), but seems to respond with an unintelligible stereotypy. he followed most of my simple commands and was reliable for yes/no questions ("are you a woman/man? is it nightime/daytime? are you in the hospital?") his voice was dry and strong. he had no intelligible expressive language, rather seemed to produce primary uninteligible stereotypies. teeth: beautiful set of healthy teeth. secretions: mild caked secretions clinging to soft palate. oral motor exam: pt with r ptosis, r facial droop, and some signs of oral apraxia (closing mouth when asked to open), tongue is symmetric upon protrusion- but protrusion was weak. palatal elevation appeared symmetric but difficult to fully assess due to limited mouth opening. gag is intact. labial seal is weak bilaterally with anterior spillage out of both corners of his mouth for purees and liquids. swallowing assessment: pt administered thin liquids by tsp and by cup with delayed initiation of swallow and immediate coughing jag. pt admin puree with delayed swallow, abnormal "chewing" of puree, and mild diffuse oral cavity residue. pt admin small piece of cracker with prolonged mastication and moderate oral residue requiring liquid swallow to partially clear. pt admin nectar thick liquid by tsp and cup with no overt s/s aspiration but odd oral prep for cup and spoon (? oral apraxia) and impression of discoordinated swallow. straw not attempted. pt admin pill whole in puree and instructed not to chew it. he chewed it anyway and required multple sips of nectar thick liquid to clear it. summary / impression: pt presents with what appears to be acute neurological changes including r facial droop, r ptosis, r hemiparesis, in the setting of dysphagia, expressive aphasia, severe dysarthria, and possible oral apraxia. as many of these neurological findings were not previously documented, it is reasonable to assume that they indicate acute neurological changes and a neurological evaluation is warranted. recommendations: 1. neurological consult. 2. diet: nectar thick liquids and pureed solids. 3. meds crushed in puree. 4. check oral cavity for pocketing and please provide frequent oral care (as much as pt will tolerate). these recommendations were shared with the patient, nurse and medical team. cardiology report echo measurements: left atrium - long axis dimension: *5.9 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.9 cm (nl <= 5.2 cm) right atrium - four chamber length: *6.2 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 0.7 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 0.7 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: *6.3 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 5.1 cm left ventricle - fractional shortening: *0.19 (nl >= 0.29) left ventricle - ejection fraction: 20% (nl >=55%) aorta - valve level: 3.0 cm (nl <= 3.6 cm) aorta - ascending: 2.8 cm (nl <= 3.4 cm) aortic valve - peak velocity: *2.4 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 23 mm hg aortic valve - mean gradient: 12 mm hg aortic valve - valve area: *1.1 cm2 (nl >= 3.0 cm2) mitral valve - e wave: 1.2 m/sec mitral valve - a wave: 0.6 m/sec mitral valve - e/a ratio: 2.00 mitral valve - e wave deceleration time: 230 msec tr gradient (+ ra = pasp): *38 mm hg (nl <= 25 mm hg) interpretation: findings: left atrium: moderate la enlargement. right atrium/interatrial septum: moderately dilated ra. a catheter or pacing wire is seen in the ra and/or rv. left ventricle: normal lv wall thickness. moderately dilated lv cavity. severely depressed lvef. no resting lvot gradient. no lv mass/thrombus. no vsd. right ventricle: normal rv wall thickness. dilated rv cavity. rv function depressed. aorta: normal aortic root diameter. focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. aortic valve: ?# aortic valve leaflets. moderately thickened aortic valve leaflets. moderate as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. moderate mitral annular calcification. mild thickening of mitral valve chordae. calcified tips of papillary muscles. no ms. moderate to severe (3+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. normal tricuspid valve supporting structures. no ts. moderate tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. normal main pa. no doppler evidence for pda pericardium: no pericardial effusion. conclusions: the left atrium is moderately dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (ejection fraction 20 percent) secondary to akinesis of the interventricular septum, inferior free wall, and the basal and midventricular segments of the posterior wall; the remaining segments of the left ventricle are hypokinetic. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (tape reviewed) of , multiple abnormalities, as previously noted, persist. liver or gallbladder us (singl reason: ruq ultrasound for 80 y.o. male with v fib arrest, elevated lft indication: vfib arrest with elevated lfts, on pressors. findings: the gallbladder is distended with sludge and single gallstone is noted, not within the neck of the gallbladder. there is gallbladder wall edema. there is a small amount of perihepatic ascites. common bile duct is normal and measures 2 mm. the liver is unremarkable without masses or biliary ductal dilatation. the inferior vena cava at the level of the liver is enlarged, and the hepatic veins are noted to be engorged. the kidneys demonstrate cortical atrophy and increased echogenicity bilaterally. the right kidney measures 10.6 cm and the left kidney measures 10.6 cm. no renal hydronephrosis or masses seen. notice made of an infrarenal distal abdominal aortic aneurysm with maximal diameter of 5 cm. the common iliac arteries are normal in caliber but demonstrate atherosclerotic calcification. the spleen is normal in size. impression: 1) gallbladder filled with sludge and a nonobstructing gallstone. the presence of gallbladder wall edema in a patient with congestive failure and low albumin is non-contributory for evidence for cholecystitis. clinical correlation is needed. 2) distal infrarenal abdominal aortic aneurysm with maximal diameter of 5 cm. 3) engorged hepatic veins and enlarged inferior vena cava, suggestive of congestive heart failure. 4) cortical atrophy and increased cortical echogenicity of the kidneys bilaterally, suggesting chronic parenchymal disease. chest (portable ap) reason: intubated, s/p v-fib arrest medical condition: 80 year old man s/p right common femoral and profundus femoral endarterectomy with removal of infected right femoral patch, debridement of right common femoral arteries and patch angioplasty of right femoral artery using bovine patch pericardium.2. right leg four-compartment fasciotomy. with acute satting down to 70% on ra indication: intubated, status post ventricular fibrillation arrest. right common femoral and profundal femoral endarterectomy on including removal of infected femoral patch. findings: the ap single view is analyzed in direct comparison with a previous chest examination obtained 12 hours earlier the same day. the patient is now intubated, the et tube terminating in the trachea approximately 6 cm above the level of the carina. there is no evidence of pneumothorax. the patient is status post sternotomy and the presence of a procine aortic valve prosthesis is recognized. left-sided permanent pacer with dual-electrode system, debrillator coils in unchanged position. the same holds for a right-sided subclavian approach wide-caliber central venous line terminating in the lower svc. the pulmonary vasculature has not undergone any change nor are there new parenchymal infiltrates. the local pleural density on the right base also appears unchanged. impression: uncomplicated intubation. carotid series complete findings: duplex evaluation was performed of bilateral carotid arteries. there was no flow is noted within the left internal carotid artery. power doppler, color doppler, and pulse doppler is consistent with a left ica occlusion, and this is unchanged from the prior report dated . on the right, peak systolic velocities are 199, 93, and 215 cm per second in the ica, cca, and eca respectively. the ica end-diastolic velocity is 32 cm per second. the ica:cca ratio is 2.1. this is consistent with 60-69% stenosis and is unchanged from the prior study dated . there is antegrade vertebral artery flow bilaterally. impression: left ica occlusion, right ica stenosis of 60-69%, unchanged from prior studies. 7:34 am c1752 cath,hem/perti dialysis short term procedure: this procedure was performed by dr. and dr. . dr. , the attending radiologist, was present during the entire procedure and supervising. the risks and benefits were discussed with the family of the patient and informed consent was obtained. the patient was brought to the angiography suite and placed on supine position. the skin on the right neck was prepped and draped in the standard sterile fashion. ultrasound of the right neck was performed and demonstrates a patent right internal jugular vein. under ultrasonographic guidance the right internal jugular vein was accessed with a micropuncture 21 gauge needle. a 0.018 guidewire was then advanced through the needle. the needle was exchanged to a 4 french catheter sheath. the wire was replaced by a 0.035 wire. the vein, skin, and subcutaneous tissues and vein were dilated up to 14 french with two dilators. under fluoroscopic guidance, a 14.5 gauge 20 cm dialysis catheter was inserted over the wire. the tip of the catheter was located in the right atrium. the catheter was fixed to the skin with 2 o silk. a final chest x- ray was obtained and demonstrates the tip of the catheter to be in the right atrium. it also demonstrates a left chest wall pacemaker with two leads in the right atrium and right ventricle. there is also a mechanic aortic valve and external wires. the patient tolerated the procedure well and there were no complications. the catheter was flushed and heplocked. impression: successful placement of a temporary dialysis catheter with the tip in the right atrium. radiology final report (revised) 2:33 pm ct head w/o contrast indication: 80 year old man with new right-sided weakness and aphasia. evaluate for hemorrhage or infarction. technique: noncontrast head ct. the prior ct head without contrast of is not available at the time of interpretation for comparison. findings: there is no evidence of acute intracranial hemorrhage or mass effect. there are areas of hypoattenuation within the white matter of the left frontal lobe and right parietal lobe which likely represent old infarctions. however, the prior study is not yet available on pacs for direct comparison. there is also more diffuse subcortical and periventricular white matter hypoattenuation within the cerebrum which likely represents chronic microvascular ischemia. there is no hydrocephalus, shift of normally midline structures. the osseous and soft tissue structions are unremarkable. impression: no evidence of intracranial hemorrhage. there are hypodense areas within the cerebrum as described that most likely represent areas of old infarction, though prior studies are not yet available on pacs for comparison. mri is more sensitive in the detection of acute infarction. 10:59:44 am cardiology report ecg study date of atrial paced rhythm conduction defect of lbbb type since pervious tracing, no significant change intervals axes rate pr qrs qt/qtc p qrs t 65 0 180 494/505 0 -29 175 07:40pm glucose-156* urea n-126* creat-4.0*# sodium-142 potassium-3.5 chloride-98 total co2-23 anion gap-25* alt(sgpt)-17 ast(sgot)-30 ck(cpk)-485* alk phos-105 amylase-38 tot bili-3.0* albumin-3.4 calcium-8.4 phosphate-7.6*# magnesium-2.4 wbc-10.6# rbc-3.78* hgb-9.8* hct-30.6* mcv-81* mch-25.9* mchc-32.0 rdw-18.0* pt-18.5* ptt-38.4* inr(pt)-2.2 plt count-117* brief hospital course: pt deceased during this hospital course. pt admitted on for ischemic left foot. pt started on heparin iv / nephrology consult / hd scheduled. on admission pt confused. cardiology consulted for pre-op clearence pt pre-op'd in the usual fashion. pt undergoes a: procedure: 1. right common femoral and profundus femoral endarterectomy with removal of infected right femoral patch, debridement of right common femoral arteries and patch angioplasty of right femoral artery using bovine patch pericardium. 2. right leg four-compartment fasciotomy. vac placed on right groin intra-op. no complicaztions / pt extubated in the or / transfered to the pacu in stable condition. pt remained on heparin / recieves 1 unit prbc's after recovery from anesthesia, pt transfered to the vicu in stable condition pt with doppler at signal / forefoot still cyanotic / vac in place / pt moving toes pt on vanco perioperative pt diet advanced / glucose monitered renal sees pt / no hd cardiology signs off post op after neg ekg changes / troponin and ck/mb follwed ir unable to place tunneled cath / pt cr stable at 3.8 / pt with less asterixis foot ischemic / heparin cont., but monophasic at pt remains confused / has difficulty swallowing / poor po intake / swallow eval and nutrition consult ordered. narcotics dc'd because of the confusion. troponin is elevated, but trending down / cardiology reconsulted / recomendations are c/w heparin / asa / continue to follow cardiac enzymes / pt started on low dose lopressor 12.5 . cardiology sees pt. renal following pt / recieves tunnel catheter from ir / hd arranged for pt. cardiology recommendations adhered to. pt continues to have perioperative troponin/ck leak with negative mb - increase troponin likely secondary to renal failure / increase ck likely secondary to leg surgery pt af is rate controlled with amio / and remains anticoagulated. pt has right sided facial droop and right arm weakness / nuerology consulted for possible cva. pt remains asterixis / pt recieves hd. foley dc'd carotid us done - no significant embolic source pt codes / is found pulsless with v-fib 180's and apneic / acls protocol initiated / intubated / transfered to sicu. pt worked up for mi / pe / elctrolyte imbalance. cardiology sees pt in the sicu / pacer interogated / ep consult - device is working well. pt remains in sicu / intubated. ck's cycled gi consulted for questionable gi bleed pt in acidosis ( concernig ) / renal aware pt not stable for hd. / meds adjusted electrolytse repleted pt remains on pressors pt experiences increase temp. to 101.3 / cx followed / ab adjusted. - pt ef 20% renal evalulates for hd - lytes stable . hd deferred neurolgy recommndations noted - ct scan / ? eeg hd still deferred / pt unstable remains on pressors / intubated family makes pt dnr/dni/cmo pt continues to deteriorate pt recieves morphine for comfort / pressors dc'd pt expires / family present medications on admission: coumadin 2', lantus 5', amio 400', asa 325', lasix 120' procrit weekly, zaroxyln 2.5', coreg 3.125', zyprexa 5', zocor 40', colace 200", plavix discharge medications: n/a - pt deceased discharge disposition: expired discharge diagnosis: n/a - pt deceased discharge condition: n/a - pt deceased discharge instructions: n/a - pt deceased followup instructions: n/a - pt deceased procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other revision of vascular procedure insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis fasciotomy transfusion of packed cells endarterectomy, lower limb arteries diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery acute kidney failure, unspecified cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease old myocardial infarction ventricular fibrillation infection and inflammatory reaction due to other vascular device, implant, and graft acute myocardial infarction of unspecified site, initial episode of care diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled atherosclerosis of native arteries of the extremities, unspecified iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to