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: chest pain, shortness of breath major surgical or invasive procedure: right ij cordis a-line temporary pacemaker placed and removed history of present illness: 71 year old female with h/o morbid obesity, copd/asthma, dm, htn, cad s/p ptca distal lad () with 2 episodes of chest pain resolved by sublingual ntg x 1 and complaining of sob/wheezing. by the time the patient arrived in the ed she had no complaints of chest pain. her ekg showed hr in the 40's and junctional rhythm. she was given aspirin. cxr done and without pneumonia/pulm edema. she was also in acute renal failure with k 6.4, cr 4.0. a right ij cordis was placed in the ed and she was started on dopamine. . patient had a similar presentation in when she presented in a junctional rhythm and acute renal failure. it was felt that she was pre-renal and once fluids were given her renal funtion improved. the junctional rhythm was felt to be due to beta-blocker toxicity and also resolved. . ros: difficult to obtain as patient lethargic, but oriented. past medical history: 1. dm- last hga1c 6.8 in . 2. htn 3. osa- uses bipap at home 21/17 4. restrictive/obstructive lung disease; asthma- on home o2-2 l 5. pt unable to ambulate, uses wheelchair 6. hyperlipidemia 7. s/p cholecystectomy 8. s/p hysterectomy 9. chronic back pain 10. chf with diastolic dysfunction 11. cad- s/p ptca to distal lad 12. cri- baseline ~1.4 social history: lives alone in an appartment in , divorced. currently unemployed, mass health/medicaid. has an aide that comes every day to help her with cleaning, dishes, etc. denies ever smoking, using alcohol, or iv drugs. family history: mother died at age 80yo - had cad, dm father passed away at age 89yo - had cad physical exam: vitals: 96.4f hr 55 112/60 rr 15 97% bipap: 40%/ gen: sleeping, but arousable with bipap on, oriented x 3, morbidly obese, nad heent: pupils large, reactive to light bilaterally, op clear, mm sl dry with dentures. neck: supple, rij cordis cv: distant s1, s2, regular rate pulm: diffuse exp wheezes b/l - anteriorly abd: (+) bs, soft, obese, nontender, no rebound or guarding ext: somewhat cool, well-perfused, 1+ pretibial edema b/l pertinent results: ekg: junctional bradycardia, hr 46, nl axis, rbbb . 08:42pm blood wbc-7.8 rbc-3.78* hgb-9.3* hct-29.0* mcv-77* mch-24.6* mchc-32.1 rdw-15.3 plt ct-203 08:42pm blood neuts-79.3* lymphs-14.7* monos-3.7 eos-2.1 baso-0.2 08:42pm blood pt-12.8 ptt-26.8 inr(pt)-1.1 08:42pm blood glucose-171* urean-66* creat-4.5*# na-131* k-6.3* cl-94* hco3-23 angap-20 08:42pm blood alt-23 ast-22 ck(cpk)-162* alkphos-109 amylase-48 totbili-0.2 08:42pm blood ctropnt-0.07* 08:42pm blood ck-mb-pnd probnp-3563* 01:30am blood type-art po2-352* pco2-51* ph-7.28* caltco2-25 base xs--2 intubat-not intuba 03:07am blood lactate-1.4 03:07am blood freeca-1.19 . cxr: cardiomegaly is stable given differences in projection. perihilar haze is not significantly changed from previous radiographs and may represent patient's baseline. no interstitial lines or pulmonary engorgement is identified. no airspace opacities are present. . echo: conclusions: 1. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). 2. the right ventricular cavity is markedly dilated. there is severe global right ventricular free wall hypokinesis. 3. the ascending aorta is mildly dilated. 4. the mitral valve leaflets are mildly thickened. 5. there is moderate pulmonary artery systolic hypertension. 6. compared with the prior study (images reviewed) of , there is probably no significant change. . renal us: impression: no hydronephrosis. . brief hospital course: ms. is a 71 year old female with h/o morbid obesity, copd/asthma, diabetes mellitus, htn, cad s/p ptca to distal lad () who presents to the ed with chest pain, sob. . cardiac: ms. presented with junctional escape and hypotension. she has a known history of lad disease, s/p ptca in , ef 60%. in the ed, her bp was 86/51 and hr in the 40s so she was given glucagon (pt was on metoprolol and ccb), kayexelate 30 g, dopamine gtt, 2 liters ns, insulin and ca gluconate in ed. beta blockers were held and cardiac enzymes were cycled. her troponins were slightly elevated with peak at 0.07, peak ck at 160. both trended down over the course of the hospitalization. bnp on admission was elevated at 3563. she had an elevated cvp which was felt to be secondary to osa. cxr was clear without evidence of pulmonary edema and no clinical signs of chf. in micu, sbp 150s and hr 60s. she developed pulmonary edema which responded to lasix. a temporary pacer with screw-in lead was put in place by the ep service on and the patient was transferred to the ccu. she was put back on an aspirin and statin. her lasix was held. the patient was temporarily pacer dependent. a permanent pacemaker was considered, however, the patient began pacing on her own and a permanent pacemaker became unnecessary and the temporary screw lead was removed on . the etiology of the patient's sick sinus and stunned atria was felt to be due to her hyperkalemia and acute renal failure. a low dose beta blocker was restarted, however her ace inhibitor was held and renal artery stenosis was ruled out with a normal renal us. an mri was not performed as the patient is unable to fit in mr machine. she was started on coumadin for atrial fibrillation and inr will be checked as an outpatient. plavix was discontinued. she was followed in the ccu by her primary cardiologist dr. . ace inhibitor should be restarted at her first pcp . . arf: ms. presented with acute renal failure with a creatinine of 4.5 (baseline 1.3). a fena was calculated and found to be <1% and feurea 12.5%, both indicative of pre-renal renal failure, however possibly in setting of low cardiac output from bradycardia. the renal service was consulted in the ed and felt there was no urgent indication for hd. k was 6.2 on presentation and 5.5 on recheck. electrolytes were checked frequently while the patient was in renal failure and fluids were given. potassium normalized and was 3.5 on d/c. a renal ultrasound was performed which showed no hydronephrosis. the patient's creatinine normalized prior to discharge. her ace inhibitor was held, but will be restarted at first outpatient f/u visit as above. . pulm: ms. presented with shortness of breath and wheezing which could was felt to be secondary to a copd flare. she was treated with fluticasone/salmeterol inh, fluticasone nasal spray and ipratroprium inh. a cxr was clear. she was put on bipap per her home regimen. . hypertension: ms. blood pressure stabilized after admission and became difficult to control. she was treated with isosorbide dinitrate 10 mg po tid, hydralazine hcl 20 mg iv q6h, clonidine hcl 0.2 mg po bid, and amlodipine 10 mg po daily. . diabetes: the patient was on insulin sliding scale with finger sticks. glyburide was held. . full code medications on admission: albuterol sulfate 0.083 % one neb q4h aspirin 325 mg tablet po qday atorvastatin 80 mg po qday clopidogrel 75 mg po qday metoprolol tartrate 12.5mg po bid lisinopril 20 mg po qday glyburide 5 mg po bid amitriptyline 50 mg po qhs ferrous sulfate 325mg po qday gabapentin 600 mg po tid ipratropium bromide 17 mcg inh qid fluticasone-salmeterol 250-50 fluticasone 50 mcg one spray each nostril qday furosemide 40 mg po qday verapamil sr 240mg po qday discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. gabapentin 300 mg capsule sig: one (1) capsule po q48h (every 48 hours). 3. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours). 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 7. fluticasone 50 mcg/actuation aerosol, spray sig: one (1) spray nasal (2 times a day): one spray in each nostril. 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 9. imdur 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. disp:*30 tablet sustained release 24hr(s)* refills:*2* 10. clonidine 0.2 mg tablet sig: one (1) tablet po bid (2 times a day). 11. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 12. warfarin 2.5 mg tablet sig: two (2) tablet po at bedtime. disp:*60 tablet(s)* refills:*2* 13. outpatient lab work inr monitoring twice a week by vna, goal inr 2.0-3.0, results to be faxed to dr. office (fax # , phone # ). discharge disposition: home with service facility: family services association of greater discharge diagnosis: primary: bradycardia acute renal failure right heart failure with pulmonary htn dm htn osa- uses bipap at home asthma- uses o2 at home cad s/p lad ptca on secondary: restrictive lung disease on pt unable to ambulate, uses wheelchair hyperlipidemia discharge condition: stable. the patient is chest pain free and taking po. a rehab facility was recommended by physical therapy, however the patient refused. she will be discharged home with vna. discharge instructions: you were admitted with a slow heart rate and renal failure. you have been started on a new medication called coumadin for a heart rhythm called atrial fibrillation. this medication needs to be taken daily and must be followed in clinic. the vna will be drawing your blood and faxing the results to dr. office until the coumadin clinic takes over monitoring of your inr. you had been taking lisinopril at home. this medication was held while you were in the hospital because your kidneys weren't functioning appropriately. you should restart this medication after seeing your pcp, . . you are no longer taking plavix. please keep all outpatient appointments. if you begin to experience any chest pain, shortness of breath, immediately. followup instructions: you have the following appointments: 1. ,non-fluoro(b) pain management center date/time: 1:40 2. , m.d. phone: date/time: 1:45 3. , m.d. date/time: 4:30 4. dr. on , at 12:30 in . you also need to follow up with the coumadin clinic to have the level of coumadin in your blood tested. the vna will draw your blood twice a week and fax the results to dr. office (fax # ) in the meantime. procedure: insertion of temporary transvenous pacemaker system transfusion of packed cells diagnoses: acidosis hyperpotassemia nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other specified cardiac dysrhythmias hypotension, unspecified morbid obesity chronic obstructive asthma, unspecified hypovolemia fall from other slipping, tripping, or stumbling diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled background diabetic retinopathy diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled unspecified deficiency anemia 

Answer: The patient is high likely exposed to