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: percocet attending: chief complaint: sob, increasing edema major surgical or invasive procedure: s/p angioplasty l leg egd colonoscopy history of present illness: 79-year-old m with prior cabg in (lima - lad, svg - om2), hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, peripheral arterial disease and prior episodes of heart failure presents from clinic with incareasing sob and worsening edema. pt. feeling more sob over last month but more so over last week. his diuretic regimen, torsemide was recently increased from 50mg twice a day to 100mg in am; 50mg in pm. pt. taking off hctz due to bump in creat 3.4 but pt. restarted on own at 12.5mg daily. nonpitting thigh edema & in lower legs. weight 208 & dry weight usually <200 lbs. pt describes no chest pain, palpitations. at baseline, pt on home o2 at bedtime for several years now 5l nc. pt has also noted increasing abdominal girth, thigh edema and worsening doe. . ed course: started lasix gtt 1ml/mg/hr off at 1800, received asa 325mg x1, ntg 0.4mg x3, gi cocktail, morphine 2mg iv x1 past medical history: 1. cva: () 3-4 days of slurred speech and right facial droop without residual symptoms. s/p cea (documented however patient without memory of this procedure) 2. iddm (retinopathy, nephropathy, neuropathy) 3. cad s/p 2v-cabg 4. chf d/t diastolic + cri ef 40-45% () baseline weight 200 5. nsvt 6. htn 7. hyperlipidemia 8. pvd s/p r fem- (), r 2nd toe amputation, gangrene l 1st toe s/p amp ((?)) 9. cri (b/l around 2.9-3.1) 10. colon ca s/p hemicolectomy 11. h/o diverticulosis 12. h/o angioectasia in stomach w/ugib and again 13. prostate ca (dx'd ): s/p orchiectomy (), turp () & pelvic xrt () with radiation 'proctopathy'. 14. iron deficiency anemia on bone marrow aspirate () 15. interstitial lung disease w/mediastinal lad & a negative cma. (differential diagnosis included burned out sarcoidosis versus interstitial pulmonary fibrosis (ipf), versus malignancy.) s/p flexible bronchoscopy and cervical mediastinoscopy with biopsies () 16. left cataract surgery . cardiac risk factors: +diabetes, +dyslipidemia, +hypertension . cardiac history: cabg, in anatomy as follows: lima to lad, svg to major om branch . percutaneous coronary intervention, in anatomy as follows: 1. left main and one vessel severe coronary artery disease with diffuse 3 vessel mild-moderate disease. 2. normal right and left heart pressures. . social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. patient is widowed and lives alone, but has assistance that comes into the home to help around the house. he has vna services once a week, and a sister-in-law who assists with shopping. he is independent in his adls. he is a retired foreman for . he does have a remote history of tobacco use, quit in his 20s. no history of etoh abuse or illicit drug use. at baseline, he gets short of breath walking less than one block, and uses a walker. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs - 96.0 bp 108/68 hr 80 rr 18 96%2l nc fs 131, wt 206.6 gen: wdwn middle aged male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: bibasilar crackles, no wheezing or rhonchi. abd: soft, distended, nt, +bs. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. +fluid wave. ext: 2+ thigh edema, toe amputations on l and r foot, non-palpable dp pulses, cool r foot (at baseline) pertinent results: unilateral le veins left left lower extremity venous ultrasound: grayscale, color, and pulse wave doppler demonstrates the common femoral vein, superficial femoral vein, and popliteal veins to demonstrate normal flow with normal phasic respiratory variation. with the exception of the distal superficial femoral vein, which was not visualized well enough to compress, all other veins were compressible. note is made of multiple left inguinal lymph nodes, the largest of which measures 2.3 x 0.7 x 1.2 cm, but which demonstrate likely fatty hila, evidence of benignity. impression: no evidence of dvt in left lower extremity. . art ext impression: significant left tibial arterial disease. inability to identify doppler signal in the left posterior arterial level.\ comparison: when compared to the exam performed on , there are no significant changes except for the fact that no doppler signal was identified in the left posterior tibial arterial level. . left foot xray: impression: no radiographic evidence for osteomyelitis. status post first digit amputation. . pertinent labs: wbc rbc hgb hct mcv mch mchc rdw plt ct 06:35am 6.1 4.30* 10.4* 34.6* 81* 24.1* 29.9* 18.2* 159 glucose urean creat na k cl hco3 angap 06:35am 154* 72* 2.6* 149* 3.6 108 30 15 . coags: pt ptt plt ct inr(pt) 06:35am 19.0* 31.1 1.8 . digoxin 01:00am 0.7 brief hospital course: 79 year old male with past medical history of cad s/p cabg, congestive heart failure, diabetes, and chronic renal insufficiency here with chf exacerbation and left foot ulcer . acute on chronic systolic and diastolic heart failure: patient with low ef, and diastolic failure. he presented with sob and weight of 206 pounds from a dry weight <200 per recent clinic notes. he has edema to knees with clear lungs. acs as cause for the exacerbation was ruled out with cardiac markers x3. the patient was diuresed with iv lasix 80mg for several days with goal net negative 2l. daily weights were taken and strict i/o were monitored. once he le edema improved and weight approached 200, his was switched back to his home dose of torsemide 100mg qam and 50mg qpm. he was continued on toprol xl 100mg and digoxin 0.0625. also of note patients oxygen requirement improved with diuresis. per patient, he is on 5l at home; he required 1-2l after diuresis. subsequent to the vascular procedure c/b gib, his diuretics were held. his home torsemide was resumed prior to discharge. . left toe ulcer/claudication/pvd: patient complaining of claudication when walking and at rest. s/p 2 toe amputations. vascular was consulted. pt's coumadin was held prior to going to the or, he was placed on a hep gtt with ptt goal 60-80 prior to going to the or. vascular took pt to or for angio on tuesday per results of nias: significant left tibial arterial disease. he underwent left leg arteriogram and angioplasty with below-knee popliteal anterior tibial arteries. his course was complicated by a gib in setting of his known gi avms. . gib: pt with known avms and known prior gibs. following heparinization for the vascular procedure pt's ptt was supratherapeutic, hep was reversed with potamine. pt subsequently started to have brbpr in addition to melena. pt's hct also dropped. he was sent to the micu for closer monitor. he received 2 uprbc while in the micu, his hct was stable at 34, he had no further melena or hematochezia. pt was instructed not to resume coumadin per dr. , indefinately given high risk of rebleeding. his asa 81mg was resumed, tolerated well. . cad: patient ruled out for acs with cardiac enzymes negative x3. s/p cabg. troponins at at baseline 0.18 and cks are flat. asa 325 mg, toprol 100bid, simvastatin 10mg daily, however with gib as above his aspirin was initially held, his bb was held initially but resumed and titrated up slowly. at time of discharge his aspirin was resumed at 81mg daily. simvastatin was continued. . adjustment disorder: patient with difficulty adjusting to medical problems. psychiatry consult appreciated and they recommened psych vna. patient also with trouble sleeping. they recommended to avoid ambien, since patient confused with this and also avoid trazadone. they recommend to use low dose remeron for sleep when needed. social work consult also appreciated whom recommended using social network, given involved family to help with coping. . atrial fibrillation: diagnosed recently, rate controlled and on coumadin. continued toprol 100mg , digoxin and coumadin 1mg daily. as noted above, his coumadin was held prior to the or, given gib no anticoagulation was resumed. his bb as noted above also held but resumed and titrated to 75mg . his dig was continued. . diabetes mellitus type ii: cont home regimen of lantus and hemalog sliding scale. - lantus 32 units q am, humalog per sliding scale, less aggressive in pm. no ace-i given renal insufficiency. diabetic diet. his lantus was decreased to 16u qam due to some episodes of hypoglycemia. this is to be retitrated up per pcp as an outpatient. his fs were stable at time of discharge without further episodes of hypoglycemia. . acute on chronic renal insufficiency: patient has long standing renal insufficiency, with recent baseline around 3.0. be secondary to poor forward flow with chf exacerbation, improved with diuresis. pt also received mucomyst 1200mg x2 days prior to and subsequent to his angiography. he also received bicarb prior to the procedure. at time of discharge his cr was at his baseline 2.6. epo as outpatient calcitriol at home dosing. . history of stroke: given gib his anticoagulation was held. asa was resumed. . hyperlipidemia: continued home dose of simvastatin. . hypertension: continuing home medications . iron deficiency: continuing iron . anemia: hct improved with 2uprbc as noted above, receives epo on outpatient basis. . insomnia: behavioral, low dose remeron if needed, avoid ambien and trazadone per psychatry . code: spoke with pt at length who was very lucid at time of conversation. he expressed his wish to be dnr/dni. his son is his hcp. pt, family is aware of his wishes and respect his dnr/dni status. medications on admission: -asa 325mg qd -calcitriol 0.25mcg qd -coumadin 1mg qd -digoxin 0.0625mg qd -colace -epo 2,000 u/ml per renal clinic, -iron qd -insulin lantus 32 units q am, humalog per sliding scale, -mag 250mg qd, -omeprazole 20mg -kcl 10meq qd -simvastatin 10mg qd -toprol xl 200mg -torsemide 100mg in am;50mg in pm -hctz 25mg as needed -ambien 5mg prn discharge medications: 1. torsemide 100 mg tablet sig: one (1) tablet po each morning. 2. torsemide 100 mg tablet sig: tablet po each evening. 3. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 5. digoxin 125 mcg tablet sig: one half tablet po daily (daily). 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 7. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day): 75mg . disp:*180 tablet(s)* refills:*2* 10. insulin glargine 100 unit/ml solution sig: sixteen (16) units subcutaneous qam. discharge disposition: home with service facility: vna discharge diagnosis: primary: -acute on chronic systolic and diastolic chf -ischemic l leg s/p angioplasty -gib from known avms secondary: 1. cva: () 3-4 days of slurred speech and right facial droop without residual symptoms. s/p cea (documented however patient without memory of this procedure) 2. iddm (retinopathy, nephropathy, neuropathy) 3. cad s/p 2v-cabg 4. chf d/t diastolic + cri ef 50% () baseline weight 200 5. nsvt 6. htn 7. hyperlipidemia 8. pvd s/p r fem- (), r 2nd toe amputation, gangrene l 1st toe s/p amp ((?)) 9. cri (b/l 2.3-2.5) 10. colon ca s/p hemicolectomy 11. h/o diverticulosis 12. h/o angioectasia in stomach w/ugib and again 13. prostate ca (dx'd ): s/p orchiectomy (), turp () & pelvic xrt () with radiation 'proctopathy'. 14. iron deficiency anemia on bone marrow aspirate () 15. interstitial lung disease w/mediastinal lad & a negative cma. (differential diagnosis included burned out sarcoidosis versus interstitial pulmonary fibrosis (ipf), versus malignancy.) s/p flexible bronchoscopy and cervical mediastinoscopy with biopsies () 16. left cataract surgery . depression w/adjustment disorder discharge condition: stable, no further bleeding, hct stable discharge instructions: you were admitted with a chf exacerbation. you were diuresed with good effect. your home diuretic was resumed at time of discharge. you must weigh yourself daily, call dr. if your weight increases by more than 3pounds. you must restrict your salt intake and fluid intake to no more than 1.5 liters. . if you have chest pain, shortness of breath, palpitations, lightheadedness, dizziness or bleeding from your rectum, black stools call your physicians or go to the emergency room. . your anticoagulation was held in the setting of bleeding. followup instructions: provider: , : date/time: 2:00 . please call dr. office tomorrow at to schedule a follow up appointment in the next week. procedure: angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries aortography endoscopic control of gastric or duodenal bleeding closed [endoscopic] biopsy of rectum procedure on two vessels diagnoses: anemia in chronic kidney disease congestive heart failure, unspecified acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes chronic kidney disease, unspecified other and unspecified hyperlipidemia unspecified disorder of kidney and ureter long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy atherosclerosis of native arteries of the extremities with ulceration ulcer of heel and midfoot angiodysplasia of stomach and duodenum with hemorrhage acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to