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: iodine attending: chief complaint: dysnpea major surgical or invasive procedure: cardiac catheterization history of present illness: this is a 71 y.o. gentleman with cad (s/p cabg '), multiple pci, icm (ef 30%) with known restrictive lung disease (on 3l home o2), anemia presented from (where he presented with ? pna with progressive dyspnea) for evaluation for acute coronary syndrome with elevated ck but flat tn. when he arrived he was in marked pulmonary edema improved with diureses. (-)n/v/c/d/wt change/f/c. no travel. no known dietary indiscretion or med changes. no pre-syncope. +pnd/orthopnea past medical history: 1. cad s/p cabg' (lima to lad, svg to om2, svg to diag, svg to pda), s/p ptca/stent lmca to d1 , plaque prolapse s/p restent , instent rethrombosis during stent, repeat stent cath : ptca/stent svg to om1, repeat cath stent of lmca, lad, d1 (not cabg candidate). repeat cath ptca of the d1 stent and beyond the stent with balloon. 2. chf: ef 40%, 1+ mr, e/a>1 3. restrictive lung disease, on l home o2 ( diaphragmatic injury during thoracotomy, also component of osa) 4. hyperlipidemia 5. dm 6. s/p cva 7. prostate ca s/p xrt 8. appendectomy social history: lives with girlfriend. quit tobacco , 40 pk yr hx. quit etoh . family history: non contributory physical exam: t:99.5 bp:120/79 hr:90 100% on nrb. wt:104 kg. gen: nad a/o x 2 heent: pearla. op (-) cv: rr, no s3/s4. iii/vi sm at llsb to axilla. no bruits. jvp at 11. pulm: rales b/l 1/2 up abd: s/nt/nd no bruits ext: 1+ dp/radial b/l neuro: motor . gi to lt. cn ii-xii gi. gait wnl. pertinent results: ap portable chest at 8:40 a.m.: no apparent change in the position of the left subclavian central venous catheter whose tip is in the left brachiocephalic vein. there is opacity at the right cardiophrenic angle, which appears increased when compared to prior study, but this may be secondary to lesser inspiration. the patient is in mild failure. ------------------- blood and urine cx: negative to date () echo : left atrium - long axis dimension: *4.7 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.6 cm (nl <= 5.2 cm) right atrium - four chamber length: 5.0 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 1.1 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.1 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 4.2 cm left ventricle - fractional shortening: *0.18 (nl >= 0.29) left ventricle - ejection fraction: 25% (nl >=55%) aorta - valve level: 3.6 cm (nl <= 3.6 cm) aorta - ascending: 3.4 cm (nl <= 3.4 cm) aorta - arch: 2.7 cm (nl <= 3.0 cm) aortic valve - peak velocity: *2.8 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 31 mm hg aortic valve - mean gradient: 18 mm hg aortic valve - valve area: *2.2 cm2 (nl >= 3.0 cm2) mitral valve - e wave: 0.7 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 0.70 10:15pm urine color-straw appear-clear sp -1.005 10:15pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 07:59pm type-art po2-148* pco2-53* ph-7.43 total co2-36* base xs-9 intubated-not intuba 07:59pm lactate-1.4 07:29pm glucose-314* urea n-23* creat-1.0 sodium-135 potassium-4.2 chloride-93* total co2-35* anion gap-11 07:29pm alt(sgpt)-17 ast(sgot)-61* ld(ldh)-775* ck(cpk)-715* tot bili-0.8 07:29pm ck-mb-1 ctropnt-0.02* 07:29pm albumin-3.2* calcium-8.5 phosphate-2.3* magnesium-1.9 07:29pm wbc-5.9 rbc-3.64* hgb-9.1* hct-28.9* mcv-80* mch-25.0* mchc-31.5 rdw-18.3* 07:29pm plt count-184 07:29pm pt-15.5* ptt-28.8 inr(pt)-1.5 brief hospital course: 71yo male w/ known prostate ca, cad s/p cabg, multiple pci, ischemic cmy ef 30%, restrictive lung dz on home o2 (usual 3liters), metastatic prostate ca, anemia, xferred from (where presented for progressive dyspnea/ ? pna) for ? acs w/ elevated cks, but flat troponins. marked cardiogenic pulmonary edema, hypotensive (responded to fluids) on arrival that improved w/ diuresis. he was intially admitted to the cardiology (telemetry floor). events: = patient became hypotensive w/sbp in 60-70s wtih some response to fluid boluses. has had approx 2.5liters via 500cc boluses with his pressures holding in 90's and hr in 80s. patient's creatinine bumped to 2.3, and his urine output dropped. ekg was unchanged, but cardiac enzymes were cycled and ck were mildly elevated. mid day it was reported that a temp of 100.6 had not been recorded on the vitals sheet. a potential septic workup was initiated as a source of the hypotension w/ cxr (? retrocardiac pna vs chf), abg (okay, not acidotic), lactate (up to 2.4 from 1.6), chemistries w/ no anion gap. blood and urine cultures sent and initiation of zosyn and vancomyocin empirically. additionally, patient has been complaining of increasing pain secondary to his prostate cancer. we increased his morphine to 2-4mg from 2mg, however have been informed to give judisciously if signs of respiratory depression/somnolence. patient began exhibiting waxing/ delirium x2 days which he has had several episodes of today. micu was made aware. at 5pm started to improve after 3rd liter of ns. bp 105, mentation okay, o2 sats stable on 3 liters at 94% (note has ef 30%). = patient initially doing much better, maintaining pressures, improved mentation, improving creatinine and urine output, better pain control w/pca. received central line secondary to non-functional peripherals and possible need for future fluid boluses/reliable line. continuing zosyn/vanc, with cultures pending. at end of day, developed substernal chest tightness w/increased depression on lateral leads. relieved w/nitro and rate controled w/10mg of iv lopressor(pushed 5 and 5). heparin drip started, cardiac enzymes cycled. he was admitted to the ccu and taken for cardiac cath: significant data: catheterization: 1. three vessel coronary artery disease. 2. instent restenosis of the first diagonal branch. 3. patent lima->lad, svg->om2. 4. successful ptca of first diagonal. comments: 1. selective coronary arteriogram of this right dominant system revealed angiographic evidence of three vessel coronary artery disease. the lmca had mild diffuse disease. the lad was totally occluded after the first diagonal branch. the first diagonal branch had a focal 95% instent restenosis distally. the lcx had moderate diffuse disease throughout its course with a totally occluded lower pole om1 filling with collaterals. the rca was not engaged. 2. graft angiography revealed a patent lima->lad and a patent svg->om2. 3. successful ptca of the first diagonal branch with a 2.5x15mm balloon. final angiography revealed 30% residual stenosis, no dissection. the chest pain was thought to be demand ischemia in the setting of pneumonia and anemia. on he was transferred back to the cardiology floor. issues of hospital course briefly summarized below. ______________________________________________________________ ## decompensated systolic heart failure: volume overload on exam. stable oxygenation on 4 liters o2. echo () with ef 25% (see data) with mild pulm htn and 1+mr had been on toprol xl 200 daily, changed to metoprolol 50 po bid. daily weights, i/os, and 2 gram na diet were maintained he was approximately 3300cc negative after lasix and zaroxoyn (given during red cell infusion) and nitro gtt. discharge weight of 102 kg, 94% on 2l nc. d/c'd on 40 lasix and lisinopril 2.5. __________________________________________ ## cad. complex mulitvessel disease. mb fractions and troponins do not suggest mi. no episodes of chest pain. (see above and see data for cath result from .) - aspirin - metoprolol 50 (titrate to hr of 80 or less) - plavix 75 daily - he was started on a statin and low-dose ace-i. ___________________________________________________________ ## generalized weakness: likely multifactorial. deconditioning/edema / ?myositis / pain syndrome. -diuresis as above, will consider further eval if unresolving. -pt eval once pulmonary condition improves and additional volume removed. -will monitor ck on statin - no fevers x 48 hours at time of d/c. temp runs in the 98-99 range. - blood cultures negative to date. urine cultures ntd ___________________________________________________________ ## dyspnea: probably mostly related to decomp hf on top of underlying restrictive lung disease (home o2 baseline 3liters) and ? pna. apparently had febrile illness prior to admit to hospital. - continued levoquin (started ) through to complete 7 day, then vanco/zosyn until , then levofloxacin 250 (last dose should be on ) ______________________________________________________ ## diabetes type 2: - unclear what dose of 70/30 is optimal. has been on 50 units last admit, and says he take 100 units when eating optimally. given poor po (which may also reflect the degree of pulm edema +/- carcinoma), will undershoot dose and uptitrate as needed. - continued iss __________________________________________________________ ## anemia: multifactorial. progressive despite recent procrit escalation. guaiac (-). ? anemia of chronic disease (due to prostate ca) hct on d/c 30.8. - xfuse prbc today - dose with procrit ____________________________________________________________ ## pelvic discomfort: robable bladder spasm foley catheter -ua neg, ucx pending -increased oxybutinin to 10mg today, monitored for anticholinergic side effects -on duragesic patch with prn morphine ______________________________________________________________ ## pain syndrome: related to bony pain from prostate ca. lucid now on exam. will offer prn morphine and calculate narcotic requirement and then dose duragesic appropriately. - morphine prn ## mental status: per wife he is at his baseline. thinks president is but is a/o x 3 otherwise. knows horseracing details and current events, but does not follow politics. good attention. non-focal neuro exam. ## occasional hypotension: initially thought to be sepsis vs. chf. patient is still somewhat orthostatic. repeating bp usually with normal values. his baseline sbp is in the 90s-100s. it is in the low 90s in the am. on d/c bp was 100/60 with hr in the 80s-90s. afebrile with negative blood cultures. echo w/o effusion, with ef 25%. ## cri: blc 1.5. due to diabetes. cr during admission ranged from 1-2.3. was 1.7 on d/c prior to decreasing ace-i dose to 2.5. _________________________________________________________ ## prophylaxis: sc heparin, protonix ____________________________________ ## access: had left subclavian central line which was discontinued on per instructions that patient is not able to be transferred to rehab with access. will likely need to place a peripheral iv on admission. ## code: full ## dispo: to rehab in , ri. per pt: would benefit from rehab. medications on admission: metoprolol 100 , asa, plavix, isosorbide 20 tid, lasix 80 tid, lovenox 60 , prevacid, neurontin 300 tid, actos 15 daily, duragesic 25, levoquin 500 daily, ntg paste. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 5. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 6. oxybutynin chloride 5 mg tablet sig: two (2) tablet po tid (3 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 9. insulin regular human 100 unit/ml cartridge sig: one (1) asdir injection once a day: sliding scale. 10. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 11. fentanyl 25 mcg/hr patch 72hr sig: one (1) patch 72hr transdermal q72h (every 72 hours). 12. atorvastatin calcium 40 mg tablet sig: two (2) tablet po daily (daily). 13. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po qhs (once a day (at bedtime)). 14. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 15. furosemide 40 mg tablet sig: one (1) tablet po twice a day. 16. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 17. levofloxacin 250 mg tablet sig: one (1) tablet po once a day for 4 days: last dose on . 18. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 19. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): hold for cr>1.5. discharge disposition: extended care facility: health center discharge diagnosis: pneumonia congetive heart failure with ef 30% coronary artery diseae prostate ca anemia restrictive lung diseae discharge condition: stable at 104/67, 77, 97% 2l, wt of 101 kg discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1000 cc please notify doctors chest discomfort, palpitations, shortness of breath, lightheadedness, cough, fevers or other symptoms of concern. followup instructions: please follow-up with dr. after leaving rehabilitation. procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization transfusion of packed cells transfusion of other serum insertion of drug-eluting coronary artery stent(s) diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified septicemia severe sepsis personal history of malignant neoplasm of prostate aortocoronary bypass status percutaneous transluminal coronary angioplasty status systolic heart failure, unspecified paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease hypotension, unspecified personal history of other diseases of circulatory system long-term (current) use of insulin unspecified disorder of kidney and ureter other complications due to other cardiac device, implant, and graft other diseases of lung, not elsewhere classified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled secondary malignant neoplasm of bone and bone marrow epistaxis anemia in neoplastic disease 

Answer: The patient is high likely exposed to