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: penicillins attending: chief complaint: dyspnea, tachycardia major surgical or invasive procedure: attempted tee, failed tee with cardioversion history of present illness: 65ym h/o dvt, dm c/b neuropathy presenting with doe found to have multiple pulmonary emboli. . per patient had been in usoh when developed worsening of breath over the last 3-4days. developed in the setting of rhinorrhea so patient thought symptoms reflective of uri so treated symptomatically. in last 2 days developed worsening dyspnea on exerion with labored breathing after walking only a block. he reported associated chest tightness, pleuritic cp with deep breath as well as diaphoresis. symptoms prompted presentation to pcp . in pcp's office ekg demonstrated aflutter. patient received lovenox 100mg in setting of arrhythmia and instructed to present to the ed. . in the ed, initial vs: 98.6 83 103/40 18 98% 2l nasal cannula. ekg: aflutter@ 107, na, ni. patient received asa 325. labs with bnp 347, trop <0.01. cta with pe involving rul, rml, rll, lingula, and lll - no evidence of pulmonary infarct or r heart strain. started on heparin ggt without bolus (has already received lovenox). hr noted to elevate to 110sin flutter with exertion. due to c/o sob and labile hrs decision made to admit to the micu overnight for monitoring. hemodynamics prior to transfer: 145/90 hr: 100 in aflutter. . on arrival to the micu, patient with continued complaint of chest tightness and intermittent sob. denies palp, n/v. . regarding history of dvt, per patient reports two instances during which he was treated for coumadin in setting of dvt. both thromboembolic events occurred in the context of lower extremity surgeries. per patient last clot ~3-4years ago. has been off anticoagulation for several years. he is uptodate with cancer screening; last c-scope during 2which benign polyps were removed. no b sx with excpetion of sweats in acute setting. no family history of clot. no recent immobilizations, recent car trips. past medical history: dm c/b neuropathy htn osa hl history of dvt status post left knee total replacement right fasciotomy of four compartments right knee replacement three times social history: retired construction worker lives in with wife - : 1yr hx 50yr ago - alcohol: case of beer/week - illicits: denies family history: no h/o of clot disorders or malignancies physical exam: admission exam heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, irregularly irregular, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . discharge exam pertinent results: initial labs: 02:35pm wbc-8.2 rbc-4.36* hgb-14.5 hct-39.2* mcv-90 mch-33.3* mchc-37.0* rdw-12.9 02:35pm neuts-74.1* lymphs-20.2 monos-4.6 eos-0.7 basos-0.3 02:35pm plt count-301 02:35pm pt-10.2 ptt-30.0 inr(pt)-0.9 02:35pm glucose-167* urea n-30* creat-1.1 sodium-136 potassium-4.5 chloride-102 total co2-26 anion gap-13 02:35pm ctropnt-<0.01 02:35pm probnp-347* 02:35pm albumin-3.9 calcium-10.7* phosphate-3.0 magnesium-2.2 02:35pm tsh-0.58 . on discharge: 06:30am blood wbc-6.5 rbc-4.38* hgb-13.9* hct-38.6* mcv-88 mch-31.8 mchc-36.1* rdw-13.4 plt ct-211 06:30am blood pt-24.6* ptt-31.2 inr(pt)-2.4* 06:30am blood glucose-151* urean-30* creat-1.1 na-135 k-4.5 cl-100 hco3-26 angap-14 06:30am blood calcium-10.2 phos-3.3 mg-2.0 . imaging: admission ecg: atrial flutter with variable a-v block. possible inferior wall myocardial infarction of indeterminate age. poor r wave progression, probably normal variant. no previous tracing available for comparison. . cta chest: 1. extensive pulmonary emboli as described above without evidence of right heart strain or pulmonary infarct although perfusion abnormalities are suspected in each lung. (filling defects are present in the segmental and subsegmental branches of the left lower lobe pulmonary artery, lingular branch of the left upper lobe pulmonary artery, branches of the right lower lobe pulmonary artery, right middle lobe pulmonary artery and right upper lobe pulmonary artery.) 2. right upper lobe ground-glass nodule of 13 mm and additional smaller nodules. follow-up chest ct is recommended in six months for surveillance. 3. suspected bony demineralization and mild loss in height among several lower thoracic vertebral bodies. . lenis: impression: near occlusive left popliteal venous thrombosis. . tte: the left atrium is moderately dilated. the left atrium is elongated. the right atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. overall left ventricular systolic function is low normal (lvef 50-55%) secondary to very mild global hypokinesis. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: biatrial enlargment. low normal left ventricular systolic function. no significant valvular disease. borderline pulmonary artery systolic hypertension. mild ascending aorta dilatation. . tee findings the tee probe was passed to 50 cm. the heart was unable to be adequately visualized due to poor contact between the probe and the esophagus despite multiple attempts and probe maneuvers. the procedure was aborted. general comments: informed consent was obtained. a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. the patient was monitored by a nurse throughout the procedure. the patient was sedated for the tee. medications and dosages are listed above (see test information section). the posterior pharynx was anesthetized with 2% viscous lidocaine. 0.2 mg of iv glycopyrrolate was given as an antisialogogue prior to tee probe insertion. no tee related complications. suboptimal image quality - poor echo windows. suboptimal image quality - body habitus. image quality was suboptimald - poor esophageal the patient. conclusions impression: unsuccessful tee. . tee the left atrium is mildly dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. right atrial appendage ejection velocity is good (>20 cm/s). no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is low normal (lvef 50-55%). there are simple non mobile atheroma in the aortic arch and descending thoracic aorta to 40 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is no pericardial effusion. brief hospital course: 65ym h/o dvt, dm c/b neuropathy presenting with doe found to have multiple pulmonary emboli, course complicated by atrial flutter requiring cardioversion. active issues by problem: # multiple pulmonary emboli: patient with h/o of dvt, however had been labeled as provoked in setting of le surgeries. largest risk factor is history of previous dvt. in addition patient obese with relative immobility in setting of chronic lower extremity pain; however lacks recent surgical interventions, recent long travel, or hx of malignancy to additionally predispose. with recurrent thromboembolism, he will likely need lifelong anticoagulation. could consider an outpatient hematology work-up for evaluation of hypercoagulable state if this would alter future management. his ct angiogram did not show signs of right heart strain and after a brief episode of hypotension on arrival to the ed he was hemodynamically stable. his troponin was normal, but his bnp was mildly elevated, suggesting that there may be some slight strain. he was started on a heparin drip. he was started on warfarin at an initial dose of 7.5mg daily which was briefly uptitrated to 10mg. when therapeutic heparin gtt was discontinued and he was continued on warfarin 7.5 mg daily. his coumadin will be managed as an outpatient by his pcp, goal inr of . # atrial flutter: likely triggered by pulmonary emboli resulting in acute stretch of right atrium. given his stable blood pressures his metoprolol dose was titrated up through the day to improve rate control. diltizem was also started and uptitrated. eventually he was transitioned to the long acting metoprolol succinate 200 mg daily and diltizem 360 mg daily. he underwent an attempted tee guided cardioversion which was unsuccessful on (could not get good visualization of heart to r/o thrombus). he subsequently underwent a second attempt on which successfully ruled out thrombus and he was cardioverted to sinus without any complications. per cardiology recommendations, his metoprolol was dc'd and his diltiazem decreased to 180mg. he was discharged on this regimen and will follow up in clinic in 2 weeks. # htn: lasix (which he does not take anyway) and lisinopril initially held in setting of acute clot. he was continued on asa 81mg. he was restarted on half his home dose of lisinopril at 10 mg daily. patient was normotensive at time of discharge. he was not restarted on his lasix, as he said he has not taken this for quite some time at home. will defer to his pcp to decide about restarting. chronic inactive issues: # hyperlipidemia: on simvastatin 80 mg on admission, however this was decreased to 10 mg in the setting of starting diltiazem, given increased risk for rhabdomyolysis. # dm: followed with qid finger sticks. his metformin was held in the setting of dye load. he was continued on his home dose of nph insulin and managed with a humalog sliding scale. his metformin was restarted on discharge. # gerd: continued omeprazole # chronic le pain: continued cymbalta and prn tylenol transition of care issues: # anticoagulation: will need to have inr followed at his pcp's office for titration of his coumadin dosing. next inr draw should be . # pe/dvt: will likely need lifelong anticoagulation now, given recurrence of dvt. consider hypercoagulable work up as an outpatient # lung opacity: cta chest showed right upper lobe ground-glass nodule of 13 mm. recommend follow up ct in 6 months # patient remained full code on this admission medications on admission: atenolol - (prescribed by other provider) - 50 mg tablet - 1 tablet(s) by mouth daily duloxetine - 60 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once daily furosemide - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth daily lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - apply to affected area maximum 12 hours in a 24 hour period lisinopril - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth daily metformin - (prescribed by other provider) - 500 mg tablet - 2 tablet(s) by mouth q am omeprazole - (prescribed by other provider) - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day simvastatin - (prescribed by other provider) - 80 mg tablet - 1 tablet(s) by mouth daily aspirin - (prescribed by other provider) - 81 mg tablet, chewable - 1 tablet(s) by mouth daily calcium ] - (otc) - 500 mg tablet - 1 tablet(s) by mouth twice a day docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day multivitamin-minerals-lutein - (otc) - tablet - 1 tablet(s) by mouth daily nph insulin human recomb - (prescribed by other provider) - 100 unit/ml suspension - 50 units once a day discharge medications: 1. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. warfarin 2.5 mg tablet sig: three (3) tablet po once daily at 4 pm. disp:*90 tablet(s)* refills:*2* 4. lisinopril 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day: apply to affected area maximum 12 hours in a 24 hour period . 6. metformin 500 mg tablet sig: two (2) tablet po once a day. 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 8. calcium 500 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po twice a day. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. multivitamin-minerals-lutein tablet sig: one (1) tablet po once a day. 11. nph insulin human recomb 100 unit/ml suspension sig: fifty (50) units subcutaneous daily with dinner. 12. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). disp:*30 capsule, extended release(s)* refills:*2* 13. outpatient lab work please have inr checked at your pcp's office on 14. simvastatin 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: pulmonary embolism, atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . it was a pleasure caring for you while you were admitted to . you were admitted because you were short of breath. you were found to have blood clots in your lungs. you were started on blood thinning medications to treat your clots. during your admission your heart rate was in a fast irregular rhythm. this was treated with cardioversion (shocking your heart into a normal rhythm) and a medication to help slow your rate. . the following changes have been made to your medication regimen: please start taking - warfarin 7.5 mg daily - diltiazem 180 mg daily - lisinopril 10 mg daily (rather than 20 mg) - simvastatin 10 mg daily (rather than 80 mg, as this can interact with diltiazem) please stop taking: - atenolol . please take the rest of your medications as prescribed and follow up with your doctors . . you will need to have your inr checked on wednesday or thursday at your primary doctor's office followup instructions: name: , p. location: medical associates address: , , phone: ***the office is working on an appt for you this week and will call you at home with the appt. if you dont hear from them by tomorrow afternoon, please call them directly to book. department: cardiac services when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: diagnostic ultrasound of heart atrial cardioversion diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux pure hypercholesterolemia atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use depressive disorder, not elsewhere classified atrial flutter other and unspecified angina pectoris long-term (current) use of insulin personal history of venous thrombosis and embolism acute venous embolism and thrombosis of deep vessels of proximal lower extremity knee joint replacement tachycardia, unspecified other pulmonary embolism and infarction benign essential hypertension pain in limb 

Answer: The patient is high likely exposed to