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: acute mental status change major surgical or invasive procedure: embolectomy history of present illness: pt's a 82 yo f with h/o htn, h/o of prox a-fib, (not on coumadin), mood disorder on depakote (has had since cva 4 yrs prior), with prior l inferior division mca infarct now presenting with altered mental status. pt basically at baseline aa0x2, has been reclusive living alone with mood disorder since her stroke - but has family heavily involved in her care - including ex-husband who visits daily. pt basically has been at her baseline (which is described as more aggressive - usually asking her family to leave within 10-15minutes of being around her), but then 3-4 days ago noted being more lethargic - less aggressive but without any other notable complaints per ex-husband who saw pt then (no report of cp, f/c, ha, sob as best assessed). family getting concerned - were thinking would be needing more higher level care placement as pt generally weaker (no focal weaknesses) - but sunday started appearing at baseline again. pt was seen monday early and was doing well (has called ex-husband roughly around 2pm and noted again at her baseline) - however when home aide came by apartment today in the morning - pt did not respond to door - found lethargic with emesis/stool/urine around her. no further information able to be obtained related to any events preceding to the evident n/v, bowel/stool incontinance. <br> pt denies any cp, ha symptoms - can not elaborate further - was sent to ed - noted aggitated, +echolalia described in ed and from home aide initially - all consistant per family with her prior cva 4 yrs prior. ct head without sig changes - however noted poor quality due to aggitation - neurology consulted. noted trop elevated 1.12 - cardiology called - stated will not cath at present but for full medical treatment. pt had been put in restraints in ed with foley placed - pt was subsequently severely aggitated. on arrival to floor - pt much calmer - not in restraints - family at bedside. <br> in pt treated with hep gtt, asa/plavix (though pt refused to take), iv metoprolol (due to declining po meds), and vanc 1g/ceftriaxone 1g - for emperic treatment with leukocytosis (d/w ed resident - they stated just emperic tx with leukocytosis - were not aiming towards meningitis at time or any focal infection). <br> ros: pt unable to appropriately respond to full questions. past medical history: -htn -prox atrial fibrillation -mood disorder - on depakote -cva 4yrs prior as above frequent utis reported in past anxiety h/o hsv i around mouth, s/p valtrex right cataract surgery social history: lives alone, divorced, though ex-husband visits daily, 2 children, no tob/etoh/drugs. russian speaking. since stroke, pt more reclusive with h/o of mood disorder, but family very involved with care - pt lives by herself - but gets assistance from family for all idls, and for help with food preparation, bathing - pt able to go to restroom and does take medications by herself (as arranged in pill box by family). <br> pt does not have officially assigned hcp - however 2 daughters collectively have been making decisions on her care since her stroke 4 yrs prior. nok: cell) , (cell), (work). ex-husband (but also highly involved in daily care of patient - . family history: htn, no seizures or strokes physical exam: discharge vitals: 97.1 150/88 (generally sbp 100-120) 81 18 97ra gen: elderly female, nad. heent: perrl, eomi. no scleral icterus. no conjunctival injection. mucous membranes moist. no oral ulcers. neck: supple, no jvp lungs: cta bilaterally anteriorly, no wheezes, rales, rhonchi. normal respiratory effort. cv: irreg irreg, no murmurs, rubs, gallops. abdomen: soft, nt, nd, nabs extremities: l arm with significant post-surgical eccymosis, without hematoma or bleeding. ecchymosis stable, with gradual dilutional spread. neurological: cn2-12 grossly intact. no focal defecits. pertinent results: 04:46pm lactate-2.8* 01:18pm glucose-170* lactate-4.8* 01:15pm urine color-yellow appear-clear sp -1.017 01:15pm urine blood-lg nitrite-neg protein-30 glucose-1000 ketone-50 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:15pm urine rbc-0-2 wbc-0-2 bacteria-rare yeast-none epi-0-2 01:15pm urine granular-<1 hyaline-<1 01:15pm urine mucous-few 01:10pm glucose-175* urea n-20 creat-0.8 sodium-139 potassium-4.3 chloride-97 total co2-25 anion gap-21* 01:10pm alt(sgpt)-34 ast(sgot)-132* ck(cpk)-6902* alk phos-61 tot bili-1.2 01:10pm lipase-12 01:10pm ctropnt-1.12* 01:10pm ck-mb-237* mb indx-3.4 01:10pm albumin-4.5 calcium-9.8 phosphate-3.3 magnesium-2.0 01:10pm wbc-15.4* rbc-5.10 hgb-15.7 hct-45.9 mcv-90# mch-30.8# mchc-34.2 rdw-13.0 01:10pm neuts-87.8* lymphs-7.0* monos-4.5 eos-0.6 basos-0.2 01:10pm plt count-196 01:10pm pt-12.5 ptt-21.9* inr(pt)-1.1 <br> discharge labs: 09:25am blood wbc-7.9 rbc-4.07* hgb-12.5 hct-36.7 mcv-90 mch-30.8 mchc-34.1 rdw-13.5 plt ct-272 09:25am blood glucose-270* urean-11 creat-0.7 na-142 k-4.3 cl-106 hco3-32 angap-8 09:25am blood calcium-9.8 phos-3.1 mg-2.1 01:19am blood vitb12-181* 01:19am blood tsh-2.1 06:55am blood valproa-19* 07:10pm blood pt-18.9* ptt-150* inr(pt)-1.7* 02:00am blood pt-16.4* ptt-26.0 inr(pt)-1.5* 09:25am blood pt-19.6* ptt->150 inr(pt)-1.8* 10:35am blood pt-21.3* ptt->150* inr(pt)-2.0* 01:10pm blood alt-34 ast-132* ck(cpk)-6902* alkphos-61 totbili-1.2 06:30am blood ck(cpk)-4823* 08:10pm blood ck(cpk)-1455* 01:10pm blood ctropnt-1.12* 03:25am blood ck-mb-12* ctropnt-0.45* 11:58am urine color-yellow appear-clear sp -1.009 11:58am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-tr . blood cultures: neg x 2 urine culture: negative x1, pending x 1 rpr negative <br> cxr: impression: 1. enlargement of the cardiac silhouette, without evidence of pulmonary edema and without change compared to , suggesting possible cardiomyopathy. 2. slight increased, now moderate-sized hiatal hernia. <br> ekg compared to 05' ekg - nsr, new twi in avl, +min st dep v4-6 - otherwise no other acute st/tw changes. <br> non-contrast head ct: impression: no acute hemorrhage or obvious major acute area of infarction. if acute infarction is of clinical concern, mr has improved sensitivity in comparison to non-contrast head ct. chronic infarct in left mca distribution. <br> cardiac echo: conclusions the left atrium is dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with akinesis of the mid to distal anterior septum, anterior wall and apex. a left ventricular mass/thrombus cannot be excluded. right ventricular chamber size and free wall motion are normal. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: focal lv systolic dysfunction consistent with lad infarction. mild aortic regurgitation. <br> cxr: the patient's radiograph currently demonstrates new bilateral perihilar opacities consistent with interval development of pulmonary edema. there are bilateral pleural effusions also developed in the meantime interval, most likely small to moderate. there is no pneumothorax and there is no change in the cardiomediastinal silhouette. . lle leni: preliminary report !! wet read !! no dvt lle. brief hospital course: 82 yo f with h/o htn, h/o of prox a-fib, (not on coumadin), mood disorder on depakote (has had since cva 4 yrs prior), with prior l inferior division mca infarct now presenting with altered mental status with troponin elevation. <br> # ams/nstemi: patient began to have mental status changes days prior to admission, then was found on the floor with emesis/stool/urine around her. in ed, had altered ms with new inferolateral st depressions and t-wave inversions in avl on ecg, elevated troponin and no acute changes on ct head. neurology was consulted for possible metabolic encephalopathy, either due to effect of medications (on depakote at home) or infection (t to 100.4 and leucocytosis). her family declined a lumbar puncture. acs protocol was initiated with iv heparin and betablockers, while patient refused po medications. the family chose not to undergo catheterization, opting for more conservative medical management. the morning of the patient was noted to be in atrial fibrillation with rapid ventricular response with decreased urine output and new pulmonary edema on cxr. echocardiogram that day showed akinesis of the mid to distal anterior septum, anterior wall and apex. diuresis was undertaken. then at 1700, the patient's left hand was noted to become cold, blue and painful. vascular surgery was consulted, the patient was transferred to the ccu. she was also started on a high dose statin and a small dose of an ace inhibitor. neurology recommended that she have a non-emergent mri head to r/o embolic stroke not visualized on head ct, however family declined as it would not likely change management. <br> # anticoagulation: patient has multiple indications for being maintained on anticoagulation, and at the time of discharge, pt is currently on a heparin drip while bridging to therapeutic inr. considering thromboembolism to her arm requiring embolectomy, her atrial fibrillation, and her history of strokes in the past, i recommend overlapping her heparin drip with a therapeutic inr x 48 hours. please note that at the time of discharge, her inr measured 2, however this is likely overestimated, as her ptt at the time was >150, and at that level of anticoagulation can falsely elevate the inr. i recommend obtaining a repeat inr upon admission. please titrate coumadin dosing prn for goal inr . <br> # left hand ischemia: patient was noted to have a palpable brachial pulse and absent radial pulse on the left side. most probably cause was felt to be an arterial clot in the setting of atrial fibrillation. the patient had already been started on a heparin drip for acs and this was continued. the vascular surgery team was consulted regarding the limb ischemia and embolectomy was felt to be indicated as she continued to have cyanosis of her left hand despite being on the heparin drip. she had a successful embolectomy on of the left brachial artery under local anesthesia. her post-op course was complicated by a large 8cm hematoma at the entry site in the left arm, which was followed closely by vascular surgery, as no urgent need for hematoma evacuation was indicated overnight. given a stable hematocrit, the patient was continued on iv heparin for anticoagulation for her recent nstemi as well as her history of afib. <br> # atrial fib - patient has a history of paroxysmal a-fib, but was not on coumadin due to a high risk of falls. she was found to be in atrial fibrillation with rvr the morning of , but since has been adequately rate controlled with metoprolol. given her recent embolic event to her left arm, she was started on coumadin with a heparin bridge. to avoid an excessive bleeding risk, her plavix was discontinued(patient was started on aspirin and plavix after an mca cva apprx 3 years ago) and her aspirin dose was reduced to 81mg daily. <br> # mood disorder: patient has had behavioral problems since a cva three years ago. after admission her mental status apparently returned to baseline. she was continued on home doses of depakote, paxil and zyprexa. restraints and foley catheter were avoided. <br> # pulmonary edema - patient was diuresed with iv lasix. she is incontinent and did not have a foley catheter, making it difficult to measure her fluid balance, but she appeared to be euvolemic and breathing comfortably at the time of discharge. <br> # htn - patient was adequately controlled with metoprolol and lisinopril. <br> prophylaxis - patient maintained on famotidine and sq heparin. <br> nok: (cell) , (cell), (work). ex-husband (but also highly involved in daily care of patient - . code: full dispo: pt discharged to rehab ltac medications on admission: confirmed with family : aspirin 81 mg po q day lisinopril 10 mg po q day depakote 250 mg po bid metoprolol 25 mg po bid zyprexa 5 mg po q day paxil 10 mg po q am vitamin c 500 mg po bid discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. olanzapine 5 mg tablet sig: one (1) tablet po daily (daily). 4. paroxetine hcl 10 mg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 6. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 9. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: per protocol units intravenous contin: please continue heparin gtt until inr for 48 hours. 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 11. cyanocobalamin 1,000 mcg/ml solution sig: one (1) ml injection daily (daily) for 4 days. 12. valproic acid (as sodium salt) 250 mg/5 ml syrup sig: two y (250) mg po q12h (every 12 hours). 13. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day): hold for loose stools. 14. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain or fever. 15. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: -altered mental status -non st-elevation myocardial infarction -left arm ischemia -b12 deficiency. discharge condition: good discharge instructions: you were admitted with altered metntal status. you ruled in for a heart attack but the decision was made to pursue conservative management. your heart went into a rapid rate and a blood clot traveled to your left arm causeing a blockage. you were taken to the or for removal of the clot. you were put on a heparin drip and will need to be on long term anticoagulation with coumadin to prevent further blood clots. you were also noted to have low b12 level which can contribute to altered mental status and you being given b12 supplementation weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: provider: , md phone: date/time: 3:15 medical office building; . procedure: incision of vessel, upper limb vessels diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation hematoma complicating a procedure peripheral vascular disease, unspecified atrial flutter hypopotassemia other b-complex deficiencies diaphragmatic hernia without mention of obstruction or gangrene anxiety state, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits acute systolic heart failure metabolic encephalopathy urinary incontinence, unspecified volume depletion, unspecified arterial embolism and thrombosis of upper extremity unspecified episodic mood disorder 

Answer: The patient is high likely exposed to