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: patient recorded as having no known allergies to drugs attending: chief complaint: cp, sob -> inutbated @ osh and transferred for emergent cath major surgical or invasive procedure: cardiac catheterization, iabp, tunneled line cardiac catheterization with ecmo support r ij tunnelled dialysis catheter history of present illness: 68 yo male w/ history of dm, htn, nstemi wks ago who developed chest pain and shortness of breath on . on evening of developed "heart burn" before going to bed. awoke on evening acutely short of breath, partially relieved by nitro. was able to sleep sitting up, but then early in the morning on the shortness of breath returned. called ems who found his o2 sats to be low, sbp 160s. he received lasix, morphine 8 mg, ativan 1 mg and nitro paste prior to transfer to . upon arrival to sbp in 60s, hr 30s. he was started on pressors and received atropine x 2. he was also electively intubated and sedated with propofol. iabp could not be placed at osh to poor femoral pulses. trop was 0.59, ck flat. he was transferred to on levophed and dopamine with sbp in the 70-80s. vent settings on transfer: ac tv 600/ rr 18/ fio2 100%/ 0 peep. . in the cath lab found to have severe 3 vessel disease, which was not stented. elevated wedge at 65 - received lasix, nipride, and nitro gtt. iabp placed and pressure improved to 30. tee was done in lab and showed anterior wall hypokineses, mild ai and mod mr, which improved when iabp was restarted. when patient was bolused with versed in the cath lab became hypotensive requiring discontinuation of nitroprusside and nitro gtts; dopamine was restarted. patient was transferred from cath lab to ccu intubated w/ balloon pump in place. past medical history: - nstemi wks ago - adenosine mibi at that time showed lateral wall was down with distal anterior and septal ischemia, ef 40%, treated w/ medical management - htn - dm - x 15+ yrs, on inuslin x 10 yrs - cri w/ baseline cr 4.0, not yet on hd - blindness - gerd - hypercholesterolemia social history: sh: retired firefighter. married. used to smoke cigars and occasionally cigarettes but quit in the . no etoh. family history: fh: mother - died in 50s suddenly, unknown causes; brother - "heart problems" physical exam: vitals on arrival to icu: t 91.8 hr 88 bp 127/63 rr 20 sat 98% ac 550/ rr 20/ fi02 100%/ peep 5 gen: intubated, sedated, responds to painful stimuli heent: r eye - opaque cataract, l eye - pupil reactive heart: distant hs, murmurs not appreciated resp: good air movement bilat, occ l exp wheeze abd: + bs, soft ext: warm, pulses dopplerable, + pitting edema to mid-calves bilat neuro: moving all four extremities pertinent results: 02:42pm hgb-11.9* calchct-36 o2 sat-99 02:42pm glucose-307* lactate-3.4* k+-6.1* 02:42pm type-art rates-/18 tidal vol-600 po2-195* pco2-45 ph-7.13* total co2-16* base xs--14 -assist/con intubated-intubated 03:00pm pt-14.8* ptt-94.5* inr(pt)-1.3* 03:00pm plt count-168 03:00pm neuts-87.0* bands-0 lymphs-8.5* monos-4.0 eos-0.3 basos-0.1 03:00pm wbc-15.7* rbc-3.64* hgb-11.3* hct-33.2* mcv-91 mch-30.9 mchc-33.9 rdw-14.4 03:00pm %hba1c-6.4* -done -done 03:00pm ctropnt-0.25* 03:00pm glucose-319* urea n-70* creat-4.2* sodium-130* potassium-5.8* chloride-102 total co2-16* anion gap-18 06:20pm calcium-7.5* phosphate-4.0 magnesium-1.6 10:46pm caltibc-191 vit b12-795 folate-greater th ferritin-215 trf-147* 10:46pm albumin-3.1* iron-32* 10:46pm ck-mb-90* mb indx-9.9* ctropnt-1.99* 10:46pm ck(cpk)-911* . c.cath : 1. severe left main and a three vessel coronary artery disease. 2. cardiogenic shock requiring iabp for hemodynamic support. 3. severe systolic and diastolic left ventricular dysfunction. 4. severe mr improved with iabp and diuresis. . echo : there is severe regional left ventricular systolic dysfunction with severe hypokinesis of the anterior wall, apex, lateral wall and basal to mid inferior walls. the distal inferior and basal anteroseptal walls contract best. overall left ventricular systolic function is severely depressed (ef 20-25%) the aortic valve leaflets are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric jet of moderate to severe (3+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. . carotid u/s : minimal bilateral ica calcific plaque, no appreciable associated stenosis, however (graded as less than 40% bilaterally). . ruq u/s : 1. limited study due to patient immobility and intubated status. however, no son evidence of cholecystitis . c.cath : 1. severe three vessel coronary artery disease. 2. successful pci of the major d1. 3. partially successful pci of lad with focal in-stent underexpansion with high risk of restenosis. . trans-esophageal echo : 1. no atrial septal defect is seen by 2d or color doppler. 2. there is moderate to severe regional left ventricular systolic dysfunction with hypokinesia of the apex, mid and apical portions of the inferolateral, lateral and inferior walls. overall left ventricular systolic function is moderately depressed. 3. right ventricular function is mildly depressed. 4. there are simple atheroma in the ascending aorta. 5. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. mild to moderate (+)mitral regurgitation is seen. 7. tip of the intraortic balloon pump in good position. 8. post percutaneous intervention ejection fraction is slightly improved. . r ij tunnelled catheter placement : uncomplicated ultrasound and fluoroscopically guided tunneled hemodialysis catheter placement via the right internal jugular venous approach with the tip positioned in the right atrium brief hospital course: 68 yo male w/ htn, dm, s/p recent nstemi who presented to osh after developing chest pain and sob, intubated at osh for increasing hypoxia and concern for pulmonary edema. cardiac cath revealed severe 3vd with decreased ef, elevated pulmonary pressures, and thrombocytopenia. he was not a ct surgical candidate, so he underwent repeat cardiac catheterization with atherectomy and placement of bms to the lad. . # cardiogenic shock/chf - the patient presented in shock, most likely due to lv dysfunction secondary to underlying ischemia. this resulted in systemic hypoperfusion, hypoxemia and lactic acidosis. he had elevated cardiac enzymes and severe 3 vessel cad at cath, felt not ammenable for stenting initially. he was evaluated but deemed not a ct surgical candidate, so was taken for cath to undergo high risk intervention. he received rotational atherectomy with stent placement x2 (bms). initially he had increased r and l sided pressures, w/ extremely elevated pcwp of 65; this improved after diuresis and placement of iabp. he was started on cvvh for volume removal. initail echo showed ef 25%, but repeat tee showed improvemed ef of 35-40%, with evidence of ant/lat wall hypokinesis, and mr. his iabp and pressers were weaned slowly and the patient extubated. he was continued on statin, aspirin, and plavix. his blood pressure remained stable and he was started on low dose b-blocker and acei. he was transfered to the floor and monitored. he will be discharged to rehab and scheduled for follow up with his cardiologist at , dr. , in 1 month. . # ischemia - the patient had a documented nstemi and severe 3vd by c.cath, but was not a surgical candidate due to his poor overall functioning. he underwent repeat cardiac cath for high risk intervention, and had rotational atherectomy and placement of 2 bare metal stents, to the lad and diagonal branch. he was continued on aspirin, plavix, and statin. b-blocker and acei were begun once the patient was stabilized. he will f/u with dr. , his cardiologist at . . # rhythm - the patient had bigeminy initially causing technical difficulty with balloon pump. he was then in sinus rhythm for the remainder of his hospitalization. . # respiratory failure - the patient was intubated on arrival at for increasing shortness of breath and dropping o2 sats. this was likely due to acute cardiogenic pulmonary edema in setting of impaired cardiac function/shock. he developed ventilator-associated pneumonia, initially with enterobacter in the sputum, then with mssa. he received > two weeks of iv antibiotics (cefepime/cipro, then switched to vancomycin, then to nafcillin). . # hyperbilirubinemia: the patient was noted to have elevated bilirubin, (direct primarily) along with mild elevation in lfts. his exam was benign and ruq was negative. dic labs were checked and were normal. . # thrmobocytopenia: platelets dropped significantly during the hospitalization. hit and dic labs were negative. the likely etiology was acute inflammation. the patient's platelets normalized and remained stable. . # renal failure - the patient had a baseline cr 3.0- 4.0, but had not yet started dialysis. he was placed on cvvh for volume removal, and followed by the renal service. after extubation, a tunnelled catheter (r ij) was placed and he began hemodialysis m,w,f, which will be continued after discharge. his hepatitis b serologies are as follows: surface antigen negative, surface antibody positive, core antibody negative. . # anemia - normocytic, likely anemia related to chronic kidney disease. iron studies revealed mixed aocd with iron deficiency (iron 32, tibc 191, ferritin 215, transferrin 147). folate was >20, and vitamin b12 was 795. he had no obvious source of blood loss. epogen was started three times a week with hemodialysis. . # htn - he was initially on pressers and had a balloon pump. after these were weaned, low dose b-blocker (metoprolol 12.5 ) and ace-inhibitor (captopril 6.25 tid) were begun. . # dm - his diabetes is longstanding with nephropathy and blindness. hga1c was 6.4 upon admission. he was on nph and regular insulin at home; while on cvvh and tph, he was given an insulin drip. this was changed to a sliding scale. nph was not re-started during the hospitalization as pt's intake was moderate and sugars were controlled with the sliding scale. . # hyperlipidemia - the patient was continued on lipitor. . # fen - he was placed on tpn while intubated, but restarted on a renal/cardiac diet after extubation. he tolerated his diet w/o difficulty. . # prophylaxis - the patient was on a heparin drip while on the iabp. after removal of the balloon pump, he was placed on sc heparin. he was kept on a ppi. . full code medications on admission: meds at home: baby aspirin isosorbide 60 mg qd cozaar 100 mg qd lisinopril 40 mg qd atenolol 100 mg qd plavix 75 mg qd lipitor 40 mg qd bumex 0.5 mg qd folic acid 1 mg vitamin d omeprazole 20 mg felodipine xr 5 mg qd nph 20 units qam/19 units qpm regular insulin cosopt eye drops - 1 gtt in l eye discharge medications: 1. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 5. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day): hold for systolic bp < 100. . 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. epoetin alfa 2,000 unit/ml solution sig: () units injection qmowefr (monday -wednesday-friday): with hemodialysis. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) inj injection tid (3 times a day): d/c once patient ambulating. 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for sbp < 100. 10. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 11. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 12. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day): to left eye. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 14. insulin regular human 100 unit/ml solution sig: sliding scale units injection asdir (as directed). 15. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 16. colace 100 mg capsule sig: one (1) capsule po twice a day. 17. sevelamer 800 mg tablet sig: two (2) tablet po tid (3 times a day). 18. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 19. alprazolam 0.25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety. discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. nstemi 2. cardiogenic shock s/p iabp 3. acute on chronic renal failure, with initiation of hemodialysis discharge condition: stable, maintaining oxygen saturation on room air, maintaining blood pressure discharge instructions: you were found to have blockages in the arteries that feed your heart, and had a stent placed in one of these arteries. in addition, your heart does not pump as it should. . please take all your medications as prescribed. . call your doctor or return to the hospital if you have chest pain, shortness of breath, palpitations, or any other concerning symptom. followup instructions: you have an appointment with dr. (a cardiologist) at on at 10:20 am. dr. office is on the of the hospital. . you will be followed by kidney physicians at for hemodialysis. they will set you up with outpatient hemodialysis once you leave rehab. . please call your primary doctor for an appointment within 2 weeks. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis implant of pulsation balloon transfusion of packed cells insertion of drug-eluting coronary artery stent(s) extracorporeal membrane oxygenation [ecmo] infusion of vasopressor agent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] insertion of three vascular stents procedure on two vessels diagnoses: acidosis thrombocytopenia, unspecified anemia in chronic kidney disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria mitral valve disorders acute kidney failure with lesion of tubular necrosis chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure other specified cardiac dysrhythmias cardiogenic shock long-term (current) use of insulin methicillin susceptible pneumonia due to staphylococcus aureus acute combined systolic and diastolic heart failure subendocardial infarction, subsequent episode of care diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled profound impairment, both eyes, impairment level not further specified 

Answer: The patient is high likely exposed to