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: amiodarone / nifedipine / fentanyl / ambien attending: chief complaint: shortness of breath, nausea major surgical or invasive procedure: right heart catheterization history of present illness: mr. is a 60-year-old man with history of severe dilated cardiomyopathy (ef 10-15%, non-ischemic, likely familial) status post icd implantation with a biventricular upgrade in , amiodarone induced pneumonitis, multiple dvts, chronic atrial fibrillation,htn, hld, dm2, who was recently discharged from for icd firing/v.fib, and after attempting several anti-arrhythmics, was eventually discharged on quinidine. seroquel was discontinued at that time due to its arrythmogenic potential. . he developed constant dyspnea soon after discharge (about 10 days ago) occurring at rest and limiting his mobility to just a few steps. this was accompanied by 2-pillow orthopnea and frequent nightly episodes of pnd limiting sleep. he notes consistent compliance with all his meds, including his diuretics, and denies dietary indiscretions. his appetite was rather limited, in actuality. he is on chronic home 02 at 2l, which he increased to 3l he has had multiple admissions in the past few years for chf exacerbation, and notes that his current symptoms feel similar. . he also endorses consistent nausea over the past 10 days which had been progressive, limiting his appetite, and resulting in daily episodes of dry-heaving. his symptoms seem to have improved within the past 2-3 days, corresponding to a decreased dose of quinidine. . while he denies chest pain, he does endorse a several year history of intermittent chest pressure, occuring once a month. the sensation is substernally localized with a sign, though dissipates within 20 seconds, and is unrelated to exertion. it does not radiate, and is unacompanied by diaphoresis, anxiety, or dyspnea. he is currently chest pain-free. . he has a history of multiple pe and dvt, but denies calf tenderness, pleuritic chest pain, palpitations, or lower extremity edema. . in the ed, his vital signs were 98 82 130/81 100% on 2l. his examination was significant for a lack of jvd, crackles, or lower extremity edema. his cxr demonstrated no congestion, though a bnp was elevated at 6655. ekg demonstrated only afib, ventricular paced with pvcs. bp was running low in the upper 90's after giving anti-hypertensives that were missed that morning. . on arrival to the floor, his vital signs were t=100.3 bp= 97/55 hr= 81 rr= 22 o2 sat= 97%2l. he was comfortable in nad. complaining only of some mild lower back pain. . cardiac review of systems is notable for absence of chest pain, ankle edema, palpitations, syncope or presyncope. . on general review of symptoms, he denies any prior history of stroke, tia, current myalgias, joint pains, cough, sputum, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . past medical history: cardiac risk factors: +diabetes (from steroids for pneumonitis), +dyslipidemia, +hypertension . cardiac history: -history of an acute myocardial infarction due to a small embolic event in -percutaneous coronary intervention, in anatomy as follows: two vessel coronary artery disease. the lmca was a large vessel with no angiographically apparent disease. the lad was a large vessel with apical diffuse narrowing and an abrupt termination. the lcx had a 90% stenosis in the mid to distal lpda with probable filling defect. the rca was small without any angiographically apparent disease. . pacemaker/icd, in for primary prevention, upgrade to biv . other past history: - dyslipidemia - hypertension - dilated cardiomyopathy, severely depressed ef (10-15%), s/p icd for primary prevention - afib - polymorphic vt after dofetilide - amiodarone-induced hypersensitivity pneumonitis - diabetes, diagnosed after being on steroids for pneumonitis - gi bleed on coumadin possibly related to ischemic colitis - osa, not on cpap - multiple previous dvts including dvt and pe in following an ankle trauma, and second episode of pe in . ivc filter placed . also had a right brachial vein dvt in . . past surgical history - lap cholecystectomy - ivc filter placement - bilateral cataract surgery with residual right ptosis social history: social history is significant for the absence of current tobacco use. quit smoking 7 years ago after smoking for 40 years x 2ppd. he drinks no etoh. lives with wife. worked at chemical plant making latex. family history: there is family history of premature coronary artery disease in patient's father, who had first mi at age 37. he had several heart attacks, the second occuring in his 40s. mother also has dilated cardiomyopathy. sister had ? cmy (1 episode of heart failure when very emotional and sad) physical exam: vs: t=100.3 bp= 97/55 hr= 81 rr= 22 o2 sat= 97%2l wt 91.1kg general: patient is a fatigued-appearing gentleman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. mm were dry. neck: supple with jvp to the jaw. no carotid bruits. cardiac: pmi located in 5th intercostal space, midclavicular line. irregular rhythm, rate normal, normal s1, s2. 1/6 systolic ejection murmur heard best at second right ics. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. scattered crackles at the bases but generally quite clear to auscultation. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no lower extremity edema palpated. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge physical examination: weight: 87.6kg heent: jvp 10cm pulm: ctab, no crackles cards: normal exam pertinent results: admission labs: . 11:46am pt-20.7* ptt-25.5 inr(pt)-1.9* 11:46am plt count-204 11:46am neuts-84.6* lymphs-7.5* monos-5.7 eos-0.5 basos-1.7 11:46am wbc-6.6 rbc-5.20 hgb-15.1 hct-46.0 mcv-89 mch-29.0 mchc-32.7 rdw-18.4* 11:46am probnp-6655* 11:46am alt(sgpt)-56* ast(sgot)-40 ld(ldh)-436* alk phos-79 tot bili-1.7* dir bili-0.8* indir bil-0.9 11:46am estgfr-using this 11:46am glucose-118* urea n-27* creat-1.1 sodium-135 potassium-4.1 chloride-96 total co2-25 anion gap-18 11:57am lactate-3.3* 11:57am type- comments-green top 01:50pm lactate-2.3* . discharge labs: 07:10am blood wbc-7.3 rbc-5.54 hgb-15.9 hct-49.0 mcv-89 mch-28.6 mchc-32.4 rdw-18.1* plt ct-188 07:10am blood glucose-99 urean-26* creat-1.0 na-139 k-3.8 cl-99 hco3-32 angap-12 . cardiology: 11:46am ctropnt-<0.01 09:05pm ctropnt-<0.01 . ekg: ventricular paced rhythm at 83 bpm. compared to the previous tracing of no definite change. . right cardiac catheterization : 1. limited resting hemodynamics revealed elevated left and right heart filling pressures. the rvedp was 16mmhg. the mean pcw was 31 in a tracing with come pa pressure artifact. the cardiac output was 4.0l/min and cardiac index 2.0 l/min/m2 using the fick method assuming arterial oxygen saturation from peripheral oximetry and mean arterial pressure from cuff pressures. the oxygen consumption was assumed. the svr was 1320 dynes*sec/cm5 and pvr 180 dynes*sec/cm5. final diagnosis: 1. low output congestive heart failure with elevated filling pressures. . imaging studies: . cxr : again seen is a left-sided pacer defibrillator with leads ending in the expected location of the right and left ventricle, unchanged. lung volumes are normal. the lungs are clear bilaterally with no areas of focal consolidation. there is no pleural effusion or pneumothorax. cardiomegaly remains stable. impression: no acute intrathoracic process. stable cardiomegaly. brief hospital course: mr. is a pleasant 60 year old man with h/o severe non-ischemic cardiomyopathy with ef 10-15% s/p biv icd, amiodarone-induced pneumonitis, coagulopathy with multiple dvt/pe, chronic af s/p ablation, htn, dm2, hld who presents with progressive dyspnea and elevated pwp seen on right heart cath consistent with worsening heart failure: . acute issues: . 1. acute on chronic systolic heart failure: the patient presented with progressive dyspnea since his last hospitalization with an elevated bnp, though he appeared relatively euvolemic on exam, only demonstrating anelevated jvp. his cxr was clear. for further characterization of his cardiac performance, he underwent right sided cardiac catheterization on which demonstrated an elevated pcwp and depressed cardiac index consistent with worsening heart failure. as he is in late-stage hf, a swan catheter was placed in the right ij and he was transferred to the ccu post procedure for more aggressive diuresis. he was begun on a lasix gtt and was diuresed to a wedge pressure of 18 with significant improvement of his symptoms. the gtt was stoppped secondary to hypotension to 70s which resolved, though his pressures remained in the mid-90s to low 100s for the rest of his hospitalization. he was then transferred to the floor on for optimization of his hf regimen. he was transitioned to po torsemide and maintained adequate diuresis. he was started on lisinopril and digoxin, and his beta blocker was transitioned to toprol xl. his spironolactone was increased to 25mg qd. he was seen by dr. of the hf team and will follow up with him as an outpatient. he was without sob on discharge and achieved a dry weight of 87.5 kg. . 2. arrhythmia: he has a fib, with biv/icd in place. he remained v-paced at 70-80s with intermittent pvcs. his quinidine was stopped secondary to nausea, and he experienced a 20 beat run of vt on . he was asymptomatic and his icd did not fire. he was started on mexilitine and experienced one further 10 beat run vt prior to d/c. he will f/u with dr. as an outpatient. . 3. nausea: he presented with 10 days of nausea and dry-heaves, which improved following a dose decrease in his quinidine. the quinidine was eventually stopped in the ccu with resolution of his symptoms. . 4. : his creatinine is elevated from 0.8-1.1 on admission. due to his symptoms of overload, he may have experienced decreased cardiac output from dilation. his cr imrpoved slightly to 1.0 following diuresis. . inactive issues: 5. coagulopathy: he has a history of multiple pe/dvt in the past and is s/p ivc filter in . his fundaparinux was held on the day of admission in anticipation of right-heart cath the following morning but was restarted post-procedure. . 6. dm2- he has steroid-driven dm2 and was continued on glargine and iss with satisfactory fsg. . 7. htn:bp was running somewhat low with sbp 90s-100s, which is apparently at his baseline. . 8. hld: continued zocor transitional issues: none medications on admission: 1. aspirin 81 mg tablet, po daily (daily). 2. captopril 25 mg tablet 3. cholecalciferol (vitamin d3) 1000mg qd 4. quinidine gluconate 324 mg tablet sustained release po q8h 5. escitalopram 10 mg tablet po daily 6. fondaparinux 7.5 mg/0.6 ml daily 7. furosemide 100mg po bid 8. multivitamin qd 9. methylprednisolone 5mg po daily 10. metoprolol tartrate 200mg 11. mirtazapine 15mg qhs 12. omeprazole 20 mg capsule, 40mg 13. simvastatin 40 mg tablet daily 14. spironolactone 12.5 mg qd 15. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for back pain. 16. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) ml inhalation every 4 hours () as needed for sob, wheezing. 17. insulin glargine 100 unit/ml cartridge sig: eight (8) units subcutaneous once a day. 18. senna 8.6 mg tablet prn constipation 19. docusate sodium 100 mg capsule discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*5* 3. cholecalciferol (vitamin d3) 400 unit tablet sig: 2.5 tablets po daily (daily). 4. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 5. fondaparinux 7.5 mg/0.6 ml syringe sig: one (1) injection subcutaneous daily (daily). 6. torsemide 100 mg tablet sig: 0.5 tablet po twice a day. disp:*30 tablet(s)* refills:*5* 7. multivitamin tablet sig: one (1) tablet po once a day. 8. methylprednisolone 2 mg tablet sig: 2.5 tablets po daily (daily). 9. toprol xl 200 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*60 tablet sustained release 24 hr(s)* refills:*5* 10. mirtazapine 15 mg tablet sig: one (1) tablet po at bedtime. 11. omeprazole 20 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po twice a day. 12. zocor 40 mg tablet sig: one (1) tablet po at bedtime. 13. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 14. vicodin 5-500 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. 15. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) ml inhalation q4hours prn () as needed for sob. 16. insulin glargine 100 unit/ml cartridge sig: eight (8) units subcutaneous at bedtime. 17. quetiapine 50 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 18. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 20. mexiletine 150 mg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*60 capsule(s)* refills:*2* 21. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*5* discharge disposition: home with service facility: nursing services discharge diagnosis: 1. acute on chronic systolic heart failure exacerbation 2. nausea/vomiting secondary to quinidine 3. atrial fibrillation s/p biv icd with intermittent self-terminating v-tach discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital with shortness of breath that was likely caused by an exacerbation of your congestive heart failure. you underwent a catheterization procedure to establish this diagnosis, and you spent a few days in the cardiac icu to remove some excess fluid from your body with lasix. you were then transferred back to the regular cardiology floor, where we optimized your medications and finished diuresing you. your breathing improved greatly by the time of discharge. you also experienced nausea and vomiting prior to your admission and in the hospital. we suspect this was triggered by the quinidine, so this was stopped. you were started on a new drug to control your heart rhythm, called mexilitine. the following changes were made to your medications: 1. stop lasix 2. start torsemide, a new diuretic which is absorbed more evenly 3. start mexilitine to help control your heart rhythm 4. stop quinidine, as it probably caused nausea and vomiting 5. start lisinopril instead of captopril to protect your heart 6. stop captopril 7. increase spironolactone to 25mg daily 8. start toprol xl 100mg daily to protect your heart 9. stop metoprolol tartrate 10. start digoxin 0.125mcg daily to help your heart contract harder please continue all other medications as prescribed by your other doctors. as always, please remember to weigh yourself daily, and call your doctor if your weight increases more than 3 pounds. followup instructions: your pcp has been notified of your admission and will call you at home with an appointment to be seen soon. you have an appointment to see dr. in to treat your heart rhythm. department: cvi , when: monday at 11:20 am with: building: (, ma) campus: off campus best parking: free parking on site you have the following appointment to meet with dr. of our heart failure team to manage your chf. department: cardiac services when: monday at 10:00 am with: dr. building: sc clinical ctr campus: east best parking: garage md procedure: right heart cardiac catheterization diagnoses: other primary cardiomyopathies other iatrogenic hypotension obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified atrial fibrillation personal history of tobacco use other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction postinflammatory pulmonary fibrosis automatic implantable cardiac defibrillator in situ personal history of venous thrombosis and embolism nausea alone acute on chronic systolic heart failure secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to