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: no known allergies / adverse drug reactions attending: chief complaint: hypotension, elevated creatinine major surgical or invasive procedure: right heart catheterization with cardiac biopsy pacemaker evaluation with atrial and -ventricular lead placement history of present illness: 62m with hx of dilated cm (ef 35%), a fib on coumadin, aicd for non-sustained vt, pv, hyperferritinitis, copd, irritable bowel syndrome with chronic diarrhea, presents with hypotension and increased creatinine. earlier today he presented to an outpatient clinic for scheduled phlebotomy to treat hyperferritinemia. his bp was found to be 86/56, well below his baseline of 100s/70s. he was asymptomatic. phlebotomy was cancelled and he was sent to the emergency department for evaluation. . for the last several months he has been followed by his primary care, gastroenterology, and cardiology for increased fatigue, hypotension, and irritible bowel syndrome with significant diarrhea. since he has had loose stools daily, non-bloody, some greasy. occasional blood on toilet paper hemorrhoids. workup including egd (), colonoscopy () negative for clear causality. multiple medications, particularly anti-hypertensives, have been discontinued and started in the last few months in an attempt to relieve any medication effect exacerbating his diarrhea. of note, his metoprolol was increased from 25mg daily to 100mg daily one month ago and he has felt weak ever since. he presented with new-onset a fib in and was started on coumadin. . in the last week, he has had several episodes of diaphoresis, a chronic issue now exacerbated. he complains of reduced appetitite and reduced po intake, partially due to fatigue and partially due to feeling full. he denies nausea or vomiting. he complains of mild lower back pain of several months duration, no recent changes. denies cp, sob, palpitations, abd pain, headache, dizziness, lightheadedness. increased urinary urgency in the last few weeks, no change in frequency or quality of urine. . in the ed, he initially presented with bp 84/64 and hr 118. he was given fluids (total 3l) and remained hypotensive to 85/60. lab values revealed a cr of 2.1, significantly elevated from last known value in of 0.8. he denied cp, sob, palpitations, abdominal pain, vomiting, ha, dizziness, or lightheadedness. . in the icu, he initially presented with bp 109/78, hr 109. he was comfortable and complained of no chest or abdominal pain, nor shortness of breath. he denies any symptoms associated with his hypotension and asserts that his cardiologist is comfortable with bp in the 100s/70s. . in the icu, patient's hypotension resolved with holding of his home metoprolol and losartan. he was then called out to the floors, where he remained normotensive but went into persistent afib with rvr in the 130s-140s (at best he was in the 110s-120s). digoxin, metoprolol succinate and diltiazem were all given with no success decreasing rates below 110s-120s. . on , tte was done to evaluate for new cardiac dysfunction, and showed new extreme lv restrictive filling pattern. this is suspected to be related to possible hemochromatosis, as patient has polycythemia, high hematocrit and high ferritin. initially had been planning to follow this outpatient at heart failure clinic, but because patient has been persistently tachycardic there is now concern for connection between poor rate control and restrictive physiology. last night, he was slightly volume overloaded (jvd, crackles) b/c holding diuretics, so he received 40mg lasix. on transfer, he is on room air, bp 116/70, with hr 121. past medical history: 1. dilated cardiomyopathy (ef 35%, last echo in our system ) 2. aicd placed for non-sustained vt (recent interrogation) 3. hyperferritin and polycythemia (ferritin up to 600s, hct in 40s, possibly reactive to hepatic inflammation); therapeutic phlebotomy q 3 months, last . no hemachromatosis, but no liver biopsy. 4. a fib on coumadin (previously on pradaxa) 5. irritable bowel syndrome (diarrhea predominant) 6. barrett's esophagus (last egd ) 7. colon polyps (last colonoscopy ) 8. gerd 9. hiatal hernia 10. hemorrhoids 11. h/o pancreatitis (date unknown) 12. hypertriglyceridemia (832 ) 13. fatty liver disease 14. emphysema tobacco abuse 15. obstructive sleep apnea 16. urinary frequency 17. erectile dysfunction 18. restless leg syndrome 19. osteopenia 20. vit d deficiency 21. inguinal hernia 22. hydradenitis supurativa 23. rosacea 24. depression 25. anxiety 26. night sweats 27. insomnia 28. s/p drainage of perirectal abscess () social history: (per omr) retired (high school spanish teacher), lives with spouse - tobacco: 1ppd - alcohol: 2/day - illicits: denies family history: (per omr) his mother died at 81 of heart disease and she had some form of dementia possibly alzheimer's disease. his father died at 55 of vascular complications. he has two brothers, one older and one younger. the older brother has sleep apnea and heart trouble. physical exam: admission physical exam: vitals: t: 96.2 bp: 109/78 p: 109 rr: 11 spo2: 98% ra general: alert, oriented, no acute distress heent: ncat, perrl, eomi, sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops chest: icd in place, site normal abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no edema. . discharge physical exam: tele: atrial and -v paced. has occasional runs of beats nsvt. vitals: t 98.1, bp 105/67, p 61, rr 20, o2 sat 92% ra general: wdwn 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 no jvd. cardiac: rrr. dressing over pacer on l chest wall c/d/i. pmi located in 5th intercostal space, midclavicular line. no m/r/g. no thrills, lifts. no s3 or s4. lungs: crackles 1/3 up bilateral lung bases. resp were unlabored, no accessory muscle use. no wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no clubbing, cyanosis or edema. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission labs: 12:00pm glucose-92 urea n-44* creat-2.1*# sodium-134 potassium-4.4 chloride-97 total co2-25 anion gap-16 12:00pm calcium-9.1 phosphate-4.5 magnesium-2.1 12:00pm wbc-10.4 rbc-5.21 hgb-16.4 hct-45.0 mcv-86# mch-31.4 mchc-36.3* rdw-14.8 12:00pm neuts-65.8 lymphs-24.5 monos-6.9 eos-2.1 basos-0.7 01:15pm alt(sgpt)-15 ast(sgot)-29 alk phos-43 tot bili-0.5 03:15pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 03:15pm urine color-straw appear-clear sp -1.004 05:45pm lactate-1.1 10:22pm pt-33.8* ptt-35.3* inr(pt)-3.4* . cardiac enzymes: 01:15pm blood ctropnt-0.02* 05:41am blood ck-mb-3 ctropnt-<0.01 06:35am blood ck-mb-3 ctropnt-0.01 05:30am blood ck-mb-2 ctropnt-0.03* probnp-* 05:17pm blood ck-mb-2 ctropnt-0.02* . imaging: echo: the left atrium is mildly dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %) with regional variation. the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with depressed free wall contractility. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is further reduced. the left ventricle now displays an extreme restrictive filling pattern. . echo (): focused study to evaluate -v pacer settings baseline atrial paced av delay 150 ms: no atrial systolic contribution to left ventricular filling; lvot vti = 17 cm at atrial paced av delay 200 ms: still no atrial systolic contribution to left ventricular filling; lvot vti = 18 cm. there was no diastolic mitral regurgitation at av delay of 200 ms, and >90% biventricular pacing was preserved. conclusion: post-cardioversion atrial electromechanical dissociation is present; atrial paced av delay set at 200 ms. atrial sensed av delay reprogrammed to 150 ms. m in 3 months, at which time atrial systolic contribution to left ventricular filling, and left ventricular stroke volume, should increase if atrial fibrillation does not recur. . discharge labs: 06:15am blood wbc-8.2 rbc-4.61 hgb-13.8* hct-41.4 mcv-90 mch-30.0 mchc-33.4 rdw-15.5 plt ct-252 06:15am blood pt-25.6* ptt-29.8 inr(pt)-2.4* 06:15am blood glucose-84 urean-24* creat-1.5* na-142 k-4.3 cl-104 hco3-32 angap-10 06:15am blood calcium-8.7 phos-4.8* mg-2.1 brief hospital course: #pump: patient has history of idiopathic familial dilated systolic chf. he is co-managed by dr. who sees him primarily for afib and device follow-up (s/p icd for low ef & previous vt) and dr. at . when he went into afib with rvr, tte showed an ef of 30% and a new extreme rv restrictive filling pattern. due to his history of hyperferritinemia (negative genetic testing for hemochromatosis but patient declined liver biopsy in the past) there was concern that iron deposition could be contributing to his heart failure, causing diastolic dysfunction on top of his preexisting systolic chf. a right heart catheterization was performed on hd7, which showed moderate lv diastolic dysfunction (pcwp 20), mild pulmonary hypertension (pasp 44), mildly elevated right-sided filling pressures (rvedp 14), and a depressed cardiac index (1.7 l/min/m1). endomyocardial biopsy was also done; specimens are pending on discharge. patient remained compensated throughout hospitalization; clinically euvolemic with stable weights on home diuretics. he will follow up with dr. about the results of his biopsy and for future management of his chf. #rhythm: patient was hypotensive on presentation, likely secondary to recent diarrhea and uptitration of metoprolol to 100mg daily, so his antihypertensives were held and he was volume rescuscitated and returned to normotensive status. however, on transfer to the floors he then went into afib with rvr (rates in 130s-140s). digoxin, metoprolol, and diltiazem failed to rate control him (best rates in 110s-120s) so dofetilide was added by ep for rhythm control. unfortunately, dofetilide caused the patient to have a brief episode of torsades de pointes so had to be discontinued. next verapamil, dig and metoprolol were tried; however, the patient then had an episode of vtach progressing to ventricular fibrillation, terminated by his icd. he was finally loaded with amiodarone (not used initially due to concern that it may have caused hypotension/pulmonary fibrosis in the past) and the verapamil and digoxin were stopped. his pacemaker was then upgraded with the addition of atrial and lv leads (ddd mode), and he is now av paced . echo following pacer upgrade showed that he still had suboptimal lv filling with, so av conduction delay was increased to 200ms. he will need an echo in 3 months to confirm improved ventricular filling. meds on discharge are amiodarone, metoprolol and his home dose coumadin. # hypotension : presented with hypotension to the 80s/50s, not resolved following 3l ns in the ed, but improved shortly thereafter on transfer and with holding of metoprolol and his . at baseline the patient has blood pressure in the 100s/70s, partially due to liver disease and advanced systolic hf. he has had episodes of asymptomatic hypotension into the 80s/50s previously in which were found to be due to dehydration and over-medication with anti-hypertensives. his pressure were in the low 100's throughout hospitalization and he was asymptomatic throughout. his home metoprolol and losartan were restarted at half dose before discharge, which he tolerated well. . # acute renal failure: cr on presentation 2.1, last measurement in omr from is 0.8. this improved to 1.4 on discharge, was likely result of initial hypovolemia. . # diarrhea, irritable bowel syndrome: currently under evaluation by gi with no clear cause despite egd, colonoscopy, lab testing. patient was tested for hiv many years ago and did not agree to be tested again. he did not have any issues with diarrhea during hospitalization. however, as he had been having episodic diarrhea and diaphoresis prior to admission, the question of whether he had a carcinoid tumor was suggested by his gastroenterologist dr. . as patient was discharged before the requisite 3 days of holding dietary indoles (caffeine, certain fruits etc) had ended, he could not undergo 24 hour urine collection for metanephrine testing during hospitalization. if his symptoms return and are suspicious for carcinoid, this will be done by his gastroenterologist. # hyperferritin, polycythemia: did not receive scheduled q3monthly phlebotomy. hct currently at baseline in mid-40s. per their last note, the liver team does not feel q3monthly phlebotomy is necessary for disease management, at this time it is continued for "patient comfort." this disease history is somewhat unclear; as above, he will establish care with hematology for further evaluation. . # emphysema: all inhalers stopped in late of this year, no steroids currently in use. patient is not dyspnic or hypoxic. patient on nebulizers as needed. would recommend pfts as outpatient and pulmonary follow-up in fellows clinic with dr. . . # obstructive sleep apnea: irregularly compliant with cpap at home, no paroxysmal nocturnal dyspnea events. . # urinary frequency: uop brisk on admission (100 cc/hr). tamsulosin may have impact on blood pressure and thus was initially held. urine cultures were negative. tamsulosin was restarted on discharge. . # restless leg syndrome: continued gabapentin, renal dose adjustment made . # depression and anxiety: continued celexa . # insomnia: continue qhs clonazepam . # rib pain: secondary to mechanical fall 3 months ago. continued oxycontin home dose transitional issues - heart biopsy f/u - needs echo in 3 months to assess for improved lv filling s/p increase in pacer av delay, presuming afib has not returned - may need 24 hour urine collection for metanephrines if concern for carcinoid tumor medications on admission: metoprolol 75mg daily (am) furosemide 40mg daily (am) losartan 50mg daily (pm) digoxin 0.250mg daily (pm) simvastatin 20mg daily (pm) fenofibrate 200mg daily (pm) tamsulosin 0.4mg qhs omeprazole 40mg clonazepam 1mg qhs gabapentin 600mg qhs oxycontin 20mg qhs citalopram 60mg daily folic acid 1mg daily (am) mvi daily (am) vitamin e 400units thiamine 100mg daily (am) . note: over the last 4-6 weeks, has stopped the following: combivent flovent prednisone (taper from pna) modafenil benicar amiodarone lorazepam atorvastatin mesalamine asa discharge medications: 1. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. clonazepam 0.5 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 5. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 6. fenofibrate 50 mg capsule sig: four (4) capsule po once a day. 7. oxycodone 20 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po hs (at bedtime). 8. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm: take 5mg one day per week per your regular schedule and have your inr checked when you see dr. next week. disp:*32 tablet(s)* refills:*0* 9. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 10. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 11. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*0* 12. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 13. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*0* 14. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po at bedtime. 15. vitamin e 400 unit capsule sig: one (1) capsule po bid (2 times a day). 16. amiodarone 200 mg tablet sig: as directed tablet po as directed: take 1 pill twice a day for 7 days (first day = , last day = ) and then 1 pill once a day every day after that. disp:*37 tablet(s)* refills:*0* 17. clindamycin hcl 300 mg capsule sig: one (1) capsule po every eight (8) hours for 7 days: start date = stop date = . disp:*21 capsule(s)* refills:*0* 18. outpatient lab work please have inr drawn thursday and faxed to dr. ( 19. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. discharge disposition: home discharge diagnosis: primary diagnosis: atrial fibrillation with rapid ventricular response ventricular tachycardia compensated dilated cardiomyopathy secondary diagnoses: iatrogenic hypotension, not shock acute renal failure compensated chronic systolic congestive heart failure atrial fibrillation polycythemia hyper-ferritinemia (not hemochromatosis) irritable bowel syndroms, diarrhea predominant discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were referred to the hospital for low blood pressure, most likely caused by your recent diarrhea and recently increasing your blood pressure medications. your blood pressure improved with iv fluids, but you then developed a rapid heart rate and irregular rhythm (atrial fibrillation and ventricular tachycardia). your heart rhythm was ultimately stabilized when we upgraded your pacemaker and made some changes to your heart medications (see below). because you have heart failure and high iron levels, a cardiac biopsy was also done to determine whether iron deposition in your heart muscle is contributing to your heart failure (a potentially treatable condition). results of the biopsy are still pending and will be followed up on with you by dr. . we made the following changes to your medications: 1) added amiodarone 200 mg twice a day for 1 week (start=, stop=) then taper down to amiodarone 200 mg once a day after that 2) added clindamycin 300mg every 8 hours for 7 days (start=, stop=) 3) decreased metoprolol succinate to 50mg daily 4) stopped digoxin 0.25mg daily 5) decreased losartan to 25mg daily 6) decreased gabapentin to 300mg at bedtime you should take the rest of your medications as prescribed before hospitalization. please attend the doctor's appointments scheduled for you listed below. followup instructions: new appointments scheduled for you: department: cardiology (electrophysiology) with: dr. when: please call ( to schedule an appointment in the next month department: device clinic when: tuesday, at 1:30 pm where: clinical ctr, department: cardiac services when: monday at 2:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: friday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage ============================================= previously scheduled appointments (you should keep): 02:00p dr. clinical ctr, cardiology 01:30p device clinic clinical ctr, device clinic 11:30a , (liver center) lm , liver center procedure: right heart cardiac catheterization biopsy of heart implantation of cardiac resynchronization defibrillator, total system [crt-d] diagnoses: other primary cardiomyopathies other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) esophageal reflux tobacco use disorder congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation depressive disorder, not elsewhere classified pure hyperglyceridemia paroxysmal ventricular tachycardia anxiety state, unspecified urinary frequency other emphysema long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ acute on chronic systolic heart failure chest pain, unspecified barrett's esophagus disorder of bone and cartilage, unspecified insomnia, unspecified irritable bowel syndrome restless legs syndrome (rls) personal history of colonic polyps history of fall polycythemia vera cardiac rhythm regulators causing adverse effects in therapeutic use other specified diseases of blood and blood-forming organs 

Answer: The patient is high likely exposed to