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: sulfa (sulfonamides) / penicillins / clarithromycin / vioxx / ultram attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: micu admit note . cc:. hpi: 84 yo f with h/o afib on coumadin, mvr, copd, htn who was admitted to today with sob thought to be secondary to chf and pna. she was transfered to the micu after becoming hypoxic, diaphoretic, and hypotensive requiring intubation and a levophed gtt. . during the code, patient was found to have be in respiratoy distress using accessory muscles to breath after eating dinner. bp was unable to be obtained with dopplers. she had strong b/l femoral pulses. a right ij was unsuccessful; a right fem line was placed. she was started on a levophed gtt, intubated, and transfered to the micu. . as per the chart, she presented to the ed with progressive sob, intermittent right sided chest pain, and an occasional productive cough. she denied fevers/chills. pt reported orthopnea, doe, and le swelling worse than baseline. at baseline she ambulates with a walker. . in the ed patient received ctx/azithro, solumedrol 125 iv, dilt 10 iv, asa 325. she was noted to be in aflutter at a rate of 140s, that improved with dilt 10 iv x1. she received an additional 2 doses of lasix 20 mg iv. . pmh: 1. gerd 2. paf 3. mechanical mvr (at for mr) - on coumadin 4. copd 5. aaa repair 6. h/o dvt 8. htn 9. h/o pna 10. h/o gastritis 11. djd 12. oa 13. diverticulosis 14. chronic pain 15. spinal stenosis 16. s/p fall and rib fracture in 17. piaget's disease . meds at home: hctz 25 qd quinine 325 qd calcium carbonate 500 tid desipramine 10 hs lactulose 30 q8 prn salmeterol 50 mcg trazodone 50 hs prn fluticasone 100 mg ipratroprium qid coumadin 2 mg hs pantoprazole 40 qd albuterol mdi klonopin 1 hs prn vicodin (not taking) dilaudid (not taking) senna colace . all: sulfa - rash, pcn - hives, vioxx - n/v, clarithro - unknown, ultram - lightheadedness, fosamax -- unknwon . shx: per primary evaluation in ed, patient lives by herself independently. >50 pack-year smoking hx with current use of pack per day. denies etoh or drugs. daughter helps her at home. there was a recent question of diversion of patient's home pain meds in omr -- missing several doses when vna saw her. . fhx: nc . pe: tc 96.5 hr 68 bp 119/69 rr 25 o2sat 100% vent: ac 400/16(actual 22)/peep 5/fio2 50% gen: frail elderly female, intubated/sedated heent: pupils ~2 mm and equal, dry mmm neck: unable to assess cv: rrr, nl s1s2, valve click lung: coarse rhoncherous breath sounds throughout anteriorly, no wheezes abd: soft, nt, bs+ ext: cool, minimal peripheral edema, strong dp/pt pulses bilaterally . labs: . . . . . . . . . . past medical history: gerd chronic paroxysmal a-fib mvr aaa repair copd hx dvt htn tah paget's disease of lle hx gastritis hx rml pna djd oa diverticulsosi chronic pain spinal stenosis . family history: not compliant with taking fh pertinent results: abg during code: ph 7.44 pco2 28 po2 426 hco3 20 on ambu bag na:138 k:5.0 cl:105 hgb:10.0 hct:30 glu:406 freeca:1.53 lactate: 10.6 10.2-> inr 7.0 ck 68, trop 0.02 ldh 550, hapto <20, . studies: rle u/s : no dvt . cxr : mild chf, b/l pleural effusions r>l, rll consolidation, flattened diaphragms . ekg: aflutter 150, no st/t changes . echo : overall left ventricular systolic function is normal (lvef>55%). a bileaflet mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. mitral regurgitation is present but cannot be quantified (likely normal for this prosthetic valve). there is mild pulmonary artery systolic hypertension. . . brief hospital course: a/p: 84 yo f with af, mvr on coumadin, copd with acute respiratory distress and hypotension requiring intubation and levophed. . # hypoxic respiratory distress. after evaluation and triage in the ed, she arrived on the inpatient floor without respiratory distress satting well on 2lnc. approximately three hours later she developed acute respiratory distress, the differential included aspiration event, but later was demonstrated to have low risk for aspiration by speech and swallow, a flash pulmonary edema from ischemia or tachycardia (ecg with new symmetric lateral twi's), cap (rll consolidation with effusion), pe (however this seems unlikely given inr of 10; and negative le dopplers) stroke. in the unit she was started on vancomycin. she was kept on ventilator and on levophed in the unit for one day only. she has responded well to antibiotics, lasix prn, and has remained afebrile with good o2 sats on 2lnc. repeat cxr showed bilateral infiltrates. a cardiac echocardiagram indicated that she did have a decreased lvef of 30-35%, which may have contributed to her shortness of breath. she was stabilized and transferred back to the floors, she was treated with levaquin, for a community acquired pneumonia, a viral nasal aspirate was negative for influenzae, urine legionella was also negative. her oxygen requirements were slowly tapered and she required 2l of oxygen at time of discharge to rehabiliation. she was to finish a 10 day course of antibiotics for presumed pneumonia. . # hypotension. on transfer to the floor she developed acute hypotension, the differential included sepsis, cardiogenic shock from ischemia, and adrenal insufficiency a code was called and she was transferred to the micu. she was pancultured without growth, an echocardiagram indicated wall motion abnormalities, and a decreased lvef, her cardiac enzymes were cycled with a slight elevation of troponins at 0.03. she was not anticoagulated as her inr was 10 and there was concern for dic. she was initially maintained on levophed, but weaned off without difficulty, her blood pressures remained stable for the rest of her hospital course. she was initially treated with diltiazem while in the icu but she was changed to metoprolol for blood pressure control and rate control as she was shown to have a decreased ef. her heart rate increased to the 120s on metoprolol and her blood pressures could not tolerate increase of metoprolol with sbp in the 110s, thus diltiazem was reapplied and titrated upwards while tapering off the metoprolol. there may be indication at rehab to attempt to add an ace inhibitor and continue the diltiazem for rate control, as this was suspect in her acute hypotensive decompensation. . # coagulopathy. her inr was elevated on admission with an inr of 10. this was thought to be associated with compliance as she has had multiple admission with elevated inrs. she was given ffp and vitamin k to reverse the coagulopathy. after stabilization of her hypotension and return to the floor, she was restarted on heparin for mvr prophylaxis, and her outpatient coumadin was restarted for a goal of inr . her inr was 1.1 at time of discharge with instructions to titrate coumadin for a goal of inr . she was to be maintained on a heparin sliding scale until her coumadin was therapeutic . # ckk- her creatine remained at her baseline during this dmission. . # afib- she has a history of atrial fibrillation, which during the course of hypotensive code and transfer to the unit evolved to atrial flutter. she was rhythm controlled with diltiazem and she remained atrial fibrillation, her cardiac medications were converted from diltiazem to metoprolol to better address her chf but her heart rate increased and thus she was titrated back to diltiazem. . # mechanical mv. initially her inr of 10, she was given ffp and vitamin k, and her inr normalized. she was restarted on heparin, and her coumadin was restarted, please see coagulopathy for further detail . # copd. this likely contributed to respiratory distress, she was symptomatically controlled with atrovent. . # anemia. her hematocrit remained at baseline levels, she did not require transfusions. . # fen. a speech and swallow evaluation demonstrated she had only low risk for aspiration, she was maintained on thin liquids, and a soft dysphagia diet. medications on admission: hctz 25 qd quinine 325 qd calcium carbonate 500 tid desipramine 10 hs lactulose 30 q8 prn salmeterol 50 mcg trazodone 50 hs prn fluticasone 100 mg ipratroprium qid coumadin 2 mg hs pantoprazole 40 qd albuterol mdi klonopin 1 hs prn discharge medications: 1. aspirin, buffered 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 6. clonazepam 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). disp:*30 tablet(s)* refills:*2* 7. quinine sulfate 325 mg capsule sig: one (1) capsule po hs (at bedtime). disp:*30 capsule(s)* refills:*2* 8. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 10. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*5 units* refills:*0* 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. disp:*30 tablet(s)* refills:*0* 13. warfarin 2 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 14. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 4 days. disp:*2 tablet(s)* refills:*0* 15. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) inhalation four times a day. disp:*5 units* refills:*2* 16. fluticasone 110 mcg/actuation aerosol sig: one (1) inhalation four times a day as needed for shortness of breath or wheezing. disp:*1 unit* refills:*0* 17. diltiazem hcl 90 mg tablet sig: one (1) tablet po four times a day. disp:*120 tablet(s)* refills:*2* 18. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: one (1) intravenous asdir (as directed): please titrate on heparin sliding scale. disp:*1 qs* refills:*2* discharge disposition: extended care facility: & rehab center - discharge diagnosis: pneumonia chf discharge condition: stable discharge instructions: please take your medications as instructed if you experience increased shortness of breath, chest pain, or other concerning symptoms please call your doctor please follow up with the doctors listed below. followup instructions: provider: , date/time: 6:00 provider: , m.d. phone: date/time: 3:45 provider: , m.d. phone: date/time: 4:30 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation atrial flutter heart valve replaced by other means acute respiratory failure long-term (current) use of anticoagulants dehydration osteitis deformans without mention of bone tumor 

Answer: The patient is high likely exposed to