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: history of present illness: the patient is a 68 year old female with a history of morbid obesity, history of sleep apnea, obesity hypoventilation syndrome, congestive heart failure with diastolic dysfunction, restrictive lung disease, the emergency department with a chief complaint of increasing shortness of breath for four to five days. the patient had mild productive cough but no fevers or chills. prior to her admission on , her o2 saturation dropped from the low-90s which is her baseline, down to 78 to 80% at home with a heart rate in the 130s to 140s. of 99.8 f.; blood pressure 123/70; heart rate 130 to 140; respirations 30; 02 saturation 80% on room air, up to 95% on four to five liters. she was found to be atrial fibrillation with rapid ventricular response to the 140s and started on heparin and diltiazem for rate control. after admission to the medical floor on , she required more oxygen to the point of 100% face mask. arterial blood gas was initially 7.23, 98, 117, 100% non-rebreather mask; 7.25, 95, 58, on 5 liters nasal cannula, to 7.25, 99, 75, on bi-pap, then to 7.26, 96, 72, on c-pap. she was transferred to the cardiac care unit on , for cardiac and respiratory failure. her issues in the cardiac care unit included: 1. pulmonary: respiratory failure secondary to hypoventilation secondary to morbid obesity in the setting of restrictive lung disease and congestive heart failure. the patient did not require intubation and continued on bi-pap and c-pap. she was started on potassium chloride and progesterone to increase her respiratory drive. on , the patient was started on nasal cannula o2 during the day with continued bi-pap at night. her o2 saturation on nasal cannula of four to five liters was as low as 90%. 2. cardiovascular: congestive heart failure; the patient was aggressively diuresed with intravenous lasix, for a total of nine liters negative while in the cardiac care unit. paroxysmal atrial fibrillation: started on anti-coagulation on diltiazem and digoxin. 3. gastrointestinal: constipation; aggressive bowel regimen including lactulose and golytely. 4. decreased mental status: believed to be secondary to hypoxia and hypercarbia, resolved with improved oxygenation. past medical history: 1. restrictive lung disease with pfts, fev of 1.38, 77%, fvc of 1.78, 71%, mild decrease in dlco, on home o2 two to three liters at night. 2. morbid obesity. 3. presumed obstructive sleep apnea. 4. obesity hypoventilation syndrome. 5. congestive heart failure with diastolic dysfunction, echocardiogram in very limited, ejection fraction was 67% on stress test in . history of positive stress in 09 of ; with reversible defects laterally and inferior laterally which was never worked up. 6. hypertension. 7. type 2 diabetes mellitus. 8. stasis dermatitis. allergies: no known drug allergies. medications at time of transfer to floor 1. simvastatin 10 mg p.o. q. h.s. 2. glucophage 1000 mg p.o. twice a day. 3. avandia 4 mg p.o. twice a day. 4. provera 5 mg p.o. q. day. 5. diltiazem 90 mg p.o. four times a day. 6. digoxin 0.125 mg p.o. q. day. 7. lasix 60 mg intravenously three times a day. 8. colace 100 mg p.o. three times a day. 9. coumadin 2.5 mg p.o. q. h.s. 10. fleets enema p.r.n. 11. atrovent nebulizers p.r.n. 12. dulcolax p.r.n. 13. milk of magnesia p.r.n. 14. tylenol p.r.n. 15. ioconasol powder. physical examination: temperature 98.9 f.; pulse 85 to 112; blood pressure 93/60; respirations 23; o2 saturation 90% on five liters nasal cannula, 95% on non-rebreather face mask. in general, the patient alert, in no acute distress sitting in a chair. heent: oropharynx is clear. moist mucous membranes. neck supple. unable to assess jugular venous pressure secondary to morbid obesity. cardiovascular: irregularly irregular rhythm, normal s1 and s2. grade ii/vi systolic ejection murmur at right upper sternal border. lungs: rare crackles bilateral bases. abdomen obese, soft, nontender, nondistended. positive bowel sounds. extremities: three plus non-pitting edema bilaterally to the thighs. right upper extremity edema near picc line. decreased range of motion of right shoulder secondary to pain. erythema of bilateral calves but not warm to touch. laboratory: cbc within normal limits. inr 2.8. sodium 143, chloride 93, potassium 4.4, bicarbonate 41, bun 12, creatinine 0.4. chest x-ray unchanged from previous studies, shows congestive heart failure and bilateral pleural effusions. hospital course: 1. pulmonary: hypercarbic respiratory failure secondary to morbid obesity/hypoventilatioin and chf. she was continued on nasal cannula during the day. her o2 saturations improved to 93 to 97% on 2 liters via nasal cannula. an attempt to continue bi-pap at night was tried, however, the patient's o2 saturations dropped to the high 80s on bi-pap. instead, she was kept on her nasal cannula at night. the patient was tried on cpap but did not tolerate this either. 2. cardiovascular: congestive heart failure; the patient continued to be diuresed with intravenous lasix. total diuresis to date negative 12 to 15 liters. paroxysmal atrial fibrillation/atrial flutter: cardiology was consulted for a possible transesophageal echocardiogram and cardioversion. they did not recommend cardioversion now as she cannot tolerate tee due to need to lie flat.plan to f/u with cardiology as outpatient after several weeks anticoagualtion and consider cardioversion at that time. the patient was continued on diltiazem and digoxin. her rate was still poorly controlled. a beta blocker was added. there is a questionable history of beta blocker intolerance with wheezing reported on prior admit however pt's omr med list indicates that she was on atenolol at the time of admisison. she had no wheezing while on beta blockers here ofr last 2 days of admit. coronary artery disease: the patient has a history of positive stress tests with reversible defects. cardiology was consulted for possible cardiac catheterization. the patient refused cardiac catheterization since she is unable to lie flat. the patient was continued on statin and aspirin.repeat tte was done that showed decraesd ef of 35-40% and multiple regional wall motion abnormalities. beta blocker and ace-i have been added to help with cad and chf managament. aortic stenosis murmur on examination with mild as confirmed on echo this admit. 3. hematology: the patient on anti-coagulation for paroxysmal atrial fibrillation. 4. right shoulder pain: right shoulder films were normal. the patient's pain improved spontaneously without intervention.she appears to have right rotator cuff tendonitis vs bursitis. need pt to help increase use and could use tylenol or low dose nsaids for increased pain. 5. gi: severe constipation; the patient needs to be maintained standing regimen of lactulose and titrate as needed to maintain 1 bm per day 6. diabetes mellitus: the patient was continued on home medications, glucophage and avandia as well as a regular insulin sliding scale.her glucotrol and amaryl were added back the day prior to discharge. code status: the patient is "do not resuscitate", "do not intubate", however, patient is agreeable to medical intensive care unit transfer for pressors as necessary. discharge status: discharge patient to rehabilitation. discharge condition: stable.of note, pt says her breathing is better than it has been in 2 years. she uses home o2. discharge medications: 1. diltiazem 120 mg p.o. four times a day. 2. digoxin 0.125 mg p.o. q. day. 3. lasix 120 po 4. colace 100 mg p.o. three times a day. 5. lactulose 3o cc po qid 6.amaryl 2 mg po bid 7.glucotrol xl 10 mg po qd 8. dulcolax 10 mg p.o. prn 9. aspirin 325 mg p.o. q. day. 10. simvastatin 10 mg p.o. q. h.s. 11. provera 5 mg p.o. q. day. 12. protonix 40 mg p.o. q. day. 13. avandia 4 mg p.o. twice a day. 14. glucophage 1000 mg p.o. twice a day. 15. tylenol 325 mg p.o. q. four to six hours p.r.n. 16. aldactone 25 mg p.o. 17. albuterol mdi two puffs q. two to four hours p.r.n. 18. coumadin: 1.5 mg po qd- needs to be monitored an dad for inr 19. lopressor 25 po bid po 20. o2 2l np 21. regular insulin sliding scale. 22. lisinopril 5 mg po qd follow-up instructions: the patient has a cardiology appointment on , at 4 p.m. at center, , with dr. . she also needs f/u with dr. in at in weeks (dr. is covering for her pcp- . who is on maternity leave). pt will also need pulmonary f/u with dr. (i think he is her outpatient pulmonary doctor) discharge diagnoses: 1. hypercapnic respiratory failure-resolved with crhonic co2 retention. 2. obstructive sleep apnea/obesity hypoventialtion syndrome 3. congestive heart failure 4. hypertension. 5. diabetes mellitus, type 2. 6. restrictive lung disease. 7. atrial fibrillation/atrial flutter. 8. cad with echo evidence of prior mi and reduced ef 9. mild as 10. constipation , m.d. dictated by: medquist36 procedure: non-invasive mechanical ventilation diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation aortic valve disorders acute respiratory failure unspecified sleep apnea morbid obesity other diseases of lung, not elsewhere classified 

Answer: The patient is high likely exposed to