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: no known allergies / adverse drug reactions attending: chief complaint: v. fib arrest/ stemi major surgical or invasive procedure: intra-aortic balloon pump removal pulmonary intubation history of present illness: mr. is a 77 year-old creole-speaking male with pmh of transferred from osh s/p stemi c/b vfib arrest with now with bms x 2 to lcx, on pressors with iabp placement. patient initially presented to hospital with intermittent chest pain x 3 days. ekg showed st depressions in v1-v4 with more pronounced r:s ratios and minimal st elevations in ii, iii, and avf concering with an acute posterior stemi. while in the ed, he had unwitnessed vt that degenerated to vf arrest. he received cpr with epi x 1 and shock x 2; he subsequently had return of sinus rhythm and spontaneous respiration with severe agitation requiring intubation. emergent catheterization showed 2 vessel disease with 40% mid-lad disease, sequential 90% proximal 70% distal and 90% ostial rca lesions and 100% occlusion mid left circumflex. overlapping 2.25 x 15mm and 2.5 x 12mm bms were placed in the mid circumflex. wedge pressure was elevated to 17, pa systolic pressure was elevated to 43; and an aortic ballon pump was placed to augment his cardiac output. dopamine was started during cardiac catheterization because of sbps in low 70s. he is now admitted to the ccu for further care. on inital evaluation in the ccu, he is sedated and unresponsive. upon weaning sedation and with minial manipulation within the bed, mr. become more alert and with his family at the bedside was able to move all 4 limbs and follow commands. on review of systems, patient's family endorse that he had complained of decreased exercise tolerance and leg "heaviness". his family denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. they deny recent fevers, chills or rigors. all of the other review of systems were negative. cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: hypertension 2. cardiac history: none 3. other past medical history:none social history: hatian creole speeking man. works at 's, lives alone but has visiting nurse. -tobacco history:never -etoh: heavy drinking, never had sx of withdrawl -illicit drugs: never family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; son with history of cad s/p stent. physical exam: vs: t=95.8 bp=106/71 hr=72 rr=14 o2sat=100% on mechanical ventilator general: intubated and sedated man. heent: ncat. sclera anicteric. conjunctiva were pink. neck: supple, jvp was obscured by instrumentation. cardiac: rr, infaltion of iabp audible throughout precordium. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. abdomen: soft, no hsm. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. no femoral bruits. skin: ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ dp and pt are doplerable left: carotid 2+ femoral 2+ dp and pt are doplerable pertinent results: 07:30pm wbc-13.1* rbc-3.94* hgb-12.5* hct-37.6* mcv-95 mch-31.8 mchc-33.4 rdw-12.8 07:30pm plt count-188 07:30pm pt-17.0* ptt-61.4* inr(pt)-1.5* 07:30pm calcium-7.7* phosphate-3.9 magnesium-2.3 07:30pm alt(sgpt)-135* ast(sgot)-309* ld(ldh)-634* ck(cpk)-2604* alk phos-74 tot bili-0.6 07:30pm glucose-116* urea n-12 creat-1.1 sodium-139 potassium-4.8 chloride-110* total co2-22 anion gap-12 07:42pm lactate-1.8 cardiac enzymes: 07:30pm blood ck-mb-278* mb indx-10.7* ctropnt-3.84* 10:12am blood ck-mb-158* mb indx-3.2 ctropnt-7.48* 06:05pm blood ck-mb-94* mb indx-1.2 ctropnt-5.68* 04:45am blood ck-mb-44* mb indx-0.5 ctropnt-3.90* 04:12am blood ck-mb-14* mb indx-0.2 ck trend: 10:12am blood alt-120* ast-256* ck(cpk)-4866* 06:05pm blood ck(cpk)-7966* 04:45am blood alt-98* ast-222* ld(ldh)-833* ck(cpk)-8716* 04:12am blood alt-82* ast-170* ld(ldh)-698* ck(cpk)-6952* cad risk factors: lipid panel: tcholesterol 235 tag 215 hdl 28 ldl 164 ha1c: 5.6 imaging: cxr: an et tube terminates 1.2 cm above the carina. there is an intraaortic balloon pump which terminates at the level of the carina. a femoral approach catheter terminates more laterally. a transesophageal catheter extends to at least the level of the stomach. the heart size is normal. central vascular congestion with mild interstitial edema is present. a slightly lordotic view limits evaluation at the costophrenic angles, however, there is suggestion of a left pleural effusion. cxr: : the et tube, the ng tube, and the femoral approach catheter are in unchanged position. intra-aortic balloon pump continues to be rather low, 8 cm below the aortic root. the minimal degree of interstitial edema in the left lung has resolved. there is no change in bilateral pleural effusions. there are no focal changes to suggest interval development of infectious process such as pneumonia or aspiration pneumonia. echo: : the left atrium is elongated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with basal inferior and inferolateral (posterior) akinesis. the remaining segments exhibit compensatory hyperkinesis (lvef = 45%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w inferoposterior infarction. no evidence of mechanical mi complications. no echocardiographic evidence of low-output state while on iabp support. micro: sputum culture: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 1+ (<1 per 1000x field): gram negative rod(s). brief hospital course: mr. is a 77 year-old creole-speaking male with pmh of transferred from osh s/p stemi c/b vfib arrest with now with bms x 2 to lcx, on pressors with iabp placement. #. cardiogenic shock: he was transferred from osh with cardiogenic shock (low cardiac index, elevated cvp/ pwp, high svr, hypotension) requiring pressors and intra-aortic balloon pump. etiology secondary to stemi (see below) s/p revascularization with bms x 2 to left circumflex. during ccu stay, hemodynamics were monitored with aortic ballon pump, arterial line, swan ganz catheter and urine output with goal map > 65, uop 50cc/hr and cvp 12 -14 (higher goal likely rv infarct). while on intra-aortic balloon pump, patient maintained on heparin gtt and monitored for complications. of note, he did develop mild thrombocytopenia and symptoms worrying for progressive limb ischemia with decreased peripheral pulses and rising ck. as hemodynamics improved dopamine was discontinued and he was weaned off intra-aortic balloon pump. echocardiogram on while on intra-aortic balloon pump showed ef of 45%, mild regional left ventricular systolic dysfunction, c/w inferoposterior infarction. once hypotension had resolved, he was started on metoprolol and captopril and was discharged on . #. coronaries: he presented to osh with stemi c/b vfib arrest in emergency department. emergent catheterization at osh showed severe 2 vessel disease with 100% occlusion in left circumflex, 40% mid-lad disease, sequential 90% proximal 70% distal and 90% ostial rca lesions. he received bms x2 to left circumflex at osh, and was transferred to for possible intervention on rca. received asa 325mg, plavix load of 600mg; and was subsequentially started on asa 325mg, plavix 75mg, and atorvostatin 80mg. when cardiogenic shock resolved, patient was also started on metoprolol succinate 100mg daily and lisinopril 10mg daily. patient will need further risk factor modification for secondary prevention with better bp and lipid control. # le cramping/ poor peripheral pulses: on review of symptoms, patient complained of lower extremity cramping with exertion, poor dorsal pedial pulses, and symptoms concerning for lower extremity ischemia upon femoral artery vascular access. abi showed severe flow deficit of right lower extremity and significant left tibial disease. this will need to followed as an outpatient and referral to vascular surgery may be appropriate. #. s/p endotracheal intubation: patient was emergently intubated following post-arrest agitation for airway protection; requiring minimal ventilatory support. following resolution of cardiogenic shock, patient was successfully extubated on . immediately following extubation, patient transientally desaturated to mid 80s from mild pulmonary edema and mucus plugging with possible vap. treated successfully with lasix and broad-spectrum antibiotics. respiratory status improved with lasix and by he was no longer requiring supplemental o2. #. elevated ck: upon admission, patient had ck elevated to 2604 which trended up to 8716 during course of hospitalization. etiology was multifactorial from myocardial infarction, muscle injury from cardiac resuscitation and early lower extremity ischemia during intra-aortic balloon pump placement. myocardial ischemia was treated as above. ck trended down once balloon pump was removed. renal function was trended and there was no evidence of myoglobinuria or renal injury associated with elevated ck. #. fever: on , patient developed fever to 101.5. infectious evaluation with blood culture, urinalysis/ culture, sputum culture and cxr was concerning for ventilator associated pna. groin lines (iabp, a-line) also may have been source of infection/ fever. patient was started on broad spectrum antibiotics with vancomycin and cefepime for hap/ possible line infection. sputum culture was growing gnr and gpcs. fever curve and wbc count was trended. #. transaminitis: likely shock liver in the setting of vf arrest with cardiogenic shock. lfts trended down thoughout his hospitalization. patient's underlying alcohol abuse may have also contributed to elevated lfts. medications on admission: unknown antihypertensive discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. famotidine 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. metoprolol succinate 100 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day. disp:*45 tablet extended release 24 hr(s)* refills:*2* 10. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* 11. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain: apply to left buttock area as needed . disp:*30 adhesive patch, medicated(s)* refills:*2* 13. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*11 tablet(s)* refills:*2* 14. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*90 capsule(s)* refills:*2* 15. lisinopril 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 16. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual 5 minutes apart as needed for chest pain: take no more than 2 tablets at a time and call dr. for any chest pain. . disp:*25 tablets* refills:*0* 17. outpatient lab work please check chem-7 on friday with results to dr. at . discharge disposition: home with service facility: home health care discharge diagnosis: acute systolic congestive heart failure st elevation myocardial infarction ventricular fibrillation arrest coronary artery disease hyperlipidemia possible lib ischemia from balloon pump discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a heart attack and your heart developed a very dangerous rhythm that required defibrillation. you needed a machine to breathe and a machine to keep your heart pumping. you were transferred here for an evaluation for your heart arteries but we decided that this was not a good plan for you right now. you had some extra fluid in your lungs and this was removed with medications. you will need to take many new medicines every day to keep your heart beating strong and to prevent the stents in your heart artery from clotting off and causing another heart attack or death. the two most improtant medicines are aspirin and plavix. do not miss of these medications or stop taking them unless dr. specifically tells you not to. you will see dr. in 1 week and dr. in one month. you should not drink alcohol at all until you are seen by dr. and you are tolerating your medicines. we made the following changes to your medicines: 1. stop taking pravastatin, take atorvastatin instead to lower your cholesterol 2. start taking aspirin 325 mg and plavix daily to prevent the stent from clotting off and causing another heart attack 3. start taking metoprolol succinate to slow your heart beat and help your heart pump better 4. start taking lisinopril to lower your blood pressure 5. start taking tylenol and a lidoderm patch to treat the pain in your buttock. you can stop using these once the pain is gone 6. start taking benzonatate three times a day for your cough, you can stop taking this once the cough is gone. 7. start taking ciprofloxacin for your pneumonia for 5 more days 8. start taking vitamin b12, folate, thiamine and a multivitamin to correct any nutritional deficiencies. 9. take famotidine to protect your stomach from the aspirin and plavix 10. start taking furosemide to prevent fluid from building up again in your lungs. 11. use nitroglycerin under your tongue if you have any chest pain again. sit down, take 1 tablet and wait 5 minutes, you can take another tablet if the pain is still there. call 911 if your chest pain is not gone after 2 tablets. call dr. if you have any chest pain. . you will need to monitor yourself for fluid buildup in your legs or lungs. weight yourself every day before breakfast, call dr. if you notice that your weight increases more than 3 pounds in 1 day or 5 pounds in 3 days. your weight at discharge was 158 pounds. you will need to eat a low sodium diet. information regarding this was given to you. you had some vascular flow studies to evaluate circulation in your leg. this test is still pending today and will need to be followed up by dr. followup instructions: name: , l. location: address: , , phone: when: thursday, :15am department: cardiac services when: tuesday at 1 pm with: , md building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute and subacute necrosis of liver paroxysmal ventricular tachycardia cardiogenic shock ventricular fibrillation acute systolic heart failure examination of participant in clinical trial 

Answer: The patient is high likely exposed to