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: this is a 72-year-old male with a history of type 2 diabetes, end stage renal disease on hemodialysis three days a week, history of alcoholic cardiomyopathy and congestive heart failure with ejection fraction of approximately 30%, who was brought to the emergency room from hemodialysis today after he reported increasing dyspnea on exertion and also noted to be hypotensive. the patient stated he is normally able to walk approximately three flights of stairs and has recently been noticing over the past two weeks that he has only been able to walk up one flight of stairs without getting short of breath. he has not noted any concurrent symptoms such as chest pain, diaphoresis, lightheadedness. the patient denies any fevers, chills, lower extremity edema, orthopnea, weight change or cough. upon arriving in the emergency room, the patient was found to have systolic blood pressures ranging from 60's to the 80's, however, the patient remained lucid with good mental status, awake and oriented times three, and pulses ranging from 70-80. the patient received two liters of fluid boluses, in attempt to increase his blood pressure with only transient effect. a dopamine drip was started with subsequent return in blood pressure. the patient reports that he has been self administering his medications and while he was apparently asked to discontinue taking his ace inhibitor by a note on from ccc, as well as his atenolol, the patient continued to take the medication. these medications were stopped secondary to the patient's tendency for hypotension. the patient's daughter reported that he occasionally misadministers his medication and adds additional doses or takes the wrong dose. dr. , on saw the patient and discontinued his ace inhibitor and had started carvedilol at that time. however, the patient on admission was noted to have taken lisinopril and atenolol. past medical history: type 2 diabetes, atrial fibrillation, chronic, on coumadin, hypertension, gout, cardiomyopathy thought secondary to alcohol, end stage renal disease thought secondary to diabetes and hypertension, congestive heart failure with ejection fraction of approximately 30%, aicd placement. on he had a catheterization with normal coronaries. past surgical history: status post left hip replacement. social history: the patient quit smoking approximately two years ago with an approximately a 40 pack year history, mostly cigar use. he also reports "heavy alcohol use", quit 15 months ago. physical examination: on admission, temperature 97, blood pressure ranging from 59-101 systolic over 38-50 diastolic, heart rate 70-84, 98% on room air, breathing at 12-14. in general he is awake, alert, oriented times three, conversant, pleasant, speaking in full sentences without conversational dyspnea. heent, normocephalic, atraumatic, mildly injected sclera, no lymphadenopathy. oropharynx is clear, moist mucous membranes, positive periorbital edema, pupils are equal, round, and reactive to light, extraocular movements intact. neck, no jvd noted, supple. cardiovascular, 3/6 systolic murmur at the apex with irregularly irregular heart rate. on chest exam he had trace bibasilar rales that decrease with cough, left greater than right. abdomen was soft, nontender, non distended with positive bowel sounds, mildly obese. extremities, no edema. neuro exam, cranial nerves ii through xii intact, no focal findings. skin, mild erythema around dialysis catheter site. laboratory data: white count 8, 68% neutrophils, 27% lymphs, 2% monos, hematocrit 39.4, platelet count 166,000, inr 4.0, sodium 145, potassium 4.1, chloride 98, co2 33. bun 27, creatinine 4.5, glucose 130, cortisol 25.1, lactate 2.0, calcium 8.9, phosphorus 4.4, magnesium 1.6. ekg, v paced at 76. pte in showed bilateral atrial dilation, ef of 30-35%, left ventricle hypokinesis, 2+ mr, moderate as. blood cultures were pending at that point. chest x-ray showed increased cardiomegaly, prominent central vasculature, no change in left pleural effusion. brief summary of hospital course: 72-year-old male with multiple medical problems including end stage renal disease secondary to type 2 diabetes on hemodialysis, likely alcoholic related cardiomyopathy with systolic dysfunction and ejection fraction of approximately 30%, admitted with worsening dyspnea and found to be hypotensive. 1. dyspnea: possible etiologies included worsening of his aortic stenosis, underlying pulmonary disease or an infectious process. the chest x-ray did not demonstrate an infiltrate and his clinical symptoms did not point towards signs of infection with no fever and no white count. the patient was given a dose of ceftriaxone, azithromycin in the emergency room but was not continued on any other antibiotics at this point. the patient had a repeat echocardiogram done which showed markedly dilated atria, left ventricular wall thickness, normal severe global hypokinesis of the left ventricle with an ejection fraction of 20-25%, moderate as, mild ai, moderate to severe mr, 3+ tr, and the changes noted from a prior tte include a low ejection fraction and more severe mitral regurgitation. the patient was seen by the heart failure service while in the hospital who recommended that the patient start low dose beta blocker if his blood pressure could tolerate and as an outpatient will try to include an ace inhibitor in his medical regimen when his blood pressure can tolerate it. at this point he will be continued on his digoxin at his current dose and levels will be checked at hemodialysis this weekend. his current dose of digoxin is .125 mg q day. repeat chest x-ray on day #2 of hospital stay showed continued cardiomegaly, no chf, no significant effusions, no infiltrate and no change from prior. the patient was most likely slightly fluid overloaded, resulting in his symptoms of dyspnea. 2. hypotension: unclear etiology of the patient's hypotension but may be related to medicine non compliance. the patient was reportedly started on carvedilol by dr. on but cannot afford the medication and decided to take atenolol. in addition he continued to take his ace inhibitor, lisinopril. sepsis was thought to be a less likely cause of the patient's hypotension given no signs of infection and his blood cultures remained negative throughout the hospital stay. blood pressure, although did not respond to fluids, however, remained stable once off the dopamine drip. the patient was briefly on the dopamine drip in the intensive care unit but maintained his pressures while on the regular hospital floor. he never had mental status changes throughout his hospital stay. the patient's blood pressures, baseline systolic in the 80's to 90's and was well tolerated by the patient as far as mental status and perfusion. further fluid boluses were held secondary to the patient's labile fluid status. he was started on low dose toprol xl 12.5 mg q day on the day of discharge which he tolerated well without incident. 3. cardiac: the patient's echocardiogram on showed worsening of his mitral regurgitation as well as worsening of his ejection fraction. given these findings, the patient would benefit greatly from addition of beta blocker and ace inhibitor to his medical regimen. the patient was continued on his digoxin dose of .125 mg q day and levels were checked which were within therapeutic range. the patient's beta blocker and ace inhibitor were held given the patient's level of hypotension and a low dose beta blocker was introduced on the day of discharge. the patient will follow-up with the cardiologist, dr. on for the possible re-introduction of the ace inhibitor at that point. the patient's mitral regurg would greatly benefit from the ace inhibitor. 4. renal: the patient received hemodialysis on both and and was followed closely by the renal service and dr. . the patient will have a follow-up hemodialysis on saturday which they will recheck his blood pressure as well as make sure the patient is taking appropriate medications. for the patient's atrial fibrillation his rate was controlled throughout his hospital stay and he was continued on his coumadin at a dose of 2.5 mg q h.s. and his inr was stable between 2 and 3. condition on discharge: good. discharge status: to home with services. discharge diagnosis: 1. hypotension. 2. end stage renal disease on hemodialysis. 3. type 2 diabetes. 4. congestive heart failure. 5. systolic from likely alcoholic cardiomyopathy. 6. severe mitral regurgitation. 7. moderate tricuspid regurgitation. 8. moderate atrial stenosis. follow-up: he is to follow-up with dr. , his primary care physician, weeks. he is to follow-up with dr. , his cardiologist, on at 12:30. he is to keep his appointment for hemodialysis on . discharge medications: include nephrocaps one po q day, allopurinol 300 mg po q day, coumadin 2.5 mg q h.s., digoxin .125 mg q day, toprol xl 12.5 mg q day, not on dialysis days, phos-lo three tabs tid with meals. , m.d. dictated by: medquist36 procedure: hemodialysis diagnoses: atrial fibrillation rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease mitral valve insufficiency and aortic valve stenosis diseases of tricuspid valve alcoholic cardiomyopathy poisoning by other and unspecified agents primarily affecting the cardiovascular system accidental poisoning by agents primarily affecting cardiovascular system poisoning by sympatholytics [antiadrenergics] 

Answer: The patient is high likely exposed to