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: nsaids / dyazide / aspirin attending: chief complaint: chronic systolic congestive heart failure, ventricular tachycardia major surgical or invasive procedure: dialysis line placement history of present illness: mr. is a 76 year-old man with coronary artery disease s/p 4 vessel cabg (lima to the lad, svg to pda, svg to d1, svg to om1 with jump to om2 & om3) c/b aortic dissection and bioprosthetic , 35% () s/p biv pacemaker, af on amiodarone, failed endovascular repair of aaa, r->l fem-fem bypass graft () following resulting in r iliac dissection, aaa repair , with recent admissions for diuresis that now presents to the ccu with ams. . the pt was at (discharged ) following admission for worsening dyspnea and bilateral lower extremity edema. at that time the pts symptoms had been progressive over the prior 2 months. the pt had experienced worsening of his edema, preventing him from ambulating even with his walker, mild doe, and nausea and vomitting for days prior to her admission to . . the pt was then admitted to () during which he was on lasix drip with aggressive diuresis. sbp somewhat low that admission and was ~85-95 when discharged. . the patient then re-presented on with generalized malaise, ankle pain, and intermittent lethargy. over the past 8 days the pt has been lethargic and intermittently delirius. he was found to have a coag negative staph uti which is being treated with vancomycine (day 1=). because of his altered mental status and transient abdominal pain he had a ct head and abdomen, both of which were negative for any acute process. he has appeared total body overloaded, but mostly with normal o2 sat on ra. lasix has been held in the setting of borderline bp. he has triggered 5 times for his altered mental status and hypotension, which has been attributed to a combination of delirium from uti and oxycodone, which he has been getting because of ankle pain of unclear etiology. creatinine has also been rising from baseline 2.0 up to 3.5 today. . because he remained with tenuous blood pressures and apparent volume overload, mr. was planning on being electively transferred to the ccu for ionotropic support and further diuresis. . immediately prior to transfer, he noted on telemetry to have slow vt at a rate of ~110. patient was found lethargic but arousable, then briefly rolled his eyes back and became briefly unresponsive for seconds. monitor showed vt that returned to nsr, and patient returned to responsiveness before any drugs or shocks could be delivered. abg showed 7.42/46/39. . on arrival to the ccu, patient difficult to arouse but following commands and a&o x 1. shortly after arrival to the ccu, mr. had several further episodes of self-terminating vt with ? decreased responsiveness and bp falling to 60s. episodes resolved within 30 seconds without intervention, with bp returning to the 80s systolic. . on arrival to the ccu, review of systems was positive for shortness of breath. the patient denies chest pain. other review of systems was negative. past medical history: --hypertension --hyperlipidemia --gout --atrial fibrillation on amiodarone. --coronary artery disease status post 4vcabg in (lima to the lad, svg to pda, svg to d1, svg to om1 with jump to om2 & om3) complicated by aortic dissection and bioprosthetic aortic valve replacement --severely depressed left ventricular systolic function, ef 20% --with biv pacemaker implant. --history of r->l fem-fem bypass graft in after failed endovascular repair of aaa, resulting in r iliac dissection --peripheral vascular disease, status post aaa repair at the heart institute in under the care of dr. and dr. . social history: retired fire fighter, lives w/ wife in a ranch house (no stairs) in , ma. family very involved. previous 60 pack-year smoking history, occasional to rare alcohol use. (used to be heavy drinker) denies drug use. family history: some distant family hx of ca, aneurysms in twin brother, no hx cad, dm, htn physical exam: general: a/ox3, irritated w/ questioning heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp at level of ear lungs: ctab, good air movement biaterally. abdomen: nabs. soft, nt, nd. no hsm extremities: bilateral 2+ pitting edema to mid-thigh, unable to palpate dp/pt pulses but feet warm/wp. ankles tender bilaterally w/ no erythema or wamth. skin: no rashes/lesions, ecchymoses. neuro: a&ox3. appropriate. pertinent results: source: cvs other urine chemistry: urean:294 creat:57 na:55 totprot:19 uric-ac:13.7 comments: urine uric-ac: desirable ph greater than 6.5; interpret results accordingly prot/cr:0.3 osmolal:312 source: cvs color yellow appear clear specgr 1.008 ph 5.0 urobil 1 bili neg leuk sm bld tr nitr neg prot neg glu neg ket neg rbc 0-2 wbc bact few yeast none epi 0 06:25a 136 93 50 114 agap=16 3.8 31 2.6 estgfr: 24/29 (click for details) ck: 191 mb: 5 trop-t: 0.07 comments: ck(cpk): verified by replicate analysis ctropnt: ctropnt > 0.10 ng/ml suggests acute mi ca: 8.4 mg: 2.2 p: 4.3 alt: ap: tbili: alb: ast: ldh: dbili: tprot: : lip: urica:6.5 97 9.7 9.0 131 27.4 pt: 16.5 ptt: 34.6 inr: 1.5 4:50p trop-t: 0.06 comments: ctropnt: ctropnt > 0.10 ng/ml suggests acute mi 135 92 46 121 agap=14 4.0 33 2.6 ck: 96 mb: notdone alt: ap: tbili: alb: 3.0 ast: ldh: dbili: tprot: : lip: 95 9.7 9.4 151 28.5 n:78.0 l:14.9 m:5.8 e:1.1 bas:0.4 pt: 15.9 ptt: 34.3 inr: 1.4 - ct abd/pelvis w/o contrast- 1. b/l small-to-moderate pleural effusion with associated atelectasis. 2. increased attenuation of the liver, compatible with history of amiodarone therapy. there are no focal liver lesions and no biliary dilatation. however, the liver does appear somewhat nodular, and correlation with liver function tests is recommended. 3. small perihepatic and perisplenic ascites, with diffuse anasarca of the mesentery and superficial soft tissues, likely reflecting third spacing. 4. marked atherosclerotic disease involving the aorta, renal arteries, celiac axis, and sma. 5. status post endovascular aneurysm repair of infrarenal abdominal aortic aneurysm, with decreased size of the aneurysm sac compared to . 6. diverticulosis without convincing evidence of diverticulitis. 7. marked degenerative change of the lumbar spine. - ct head w/o contrast- 1. no hemorrhage or edema. 2. parenchymal involutional change. 3. severe white matter ischemic change. 01:20pm blood wbc-10.6 rbc-2.83* hgb-8.8* hct-27.4* mcv-97 mch-31.2 mchc-32.2 rdw-19.2* plt ct-161 08:27pm blood wbc-10.9 rbc-2.79* hgb-8.7* hct-26.9* mcv-97 mch-31.2 mchc-32.3 rdw-19.4* plt ct-152 03:47am blood wbc-14.1* rbc-2.72* hgb-8.4* hct-26.4* mcv-97 mch-30.8 mchc-31.8 rdw-20.5* plt ct-100* 06:00am blood neuts-74.3* lymphs-18.6 monos-4.2 eos-2.4 baso-0.5 01:20pm blood neuts-75.9* lymphs-18.5 monos-3.8 eos-1.6 baso-0.3 08:27pm blood pt-16.3* ptt-45.2* inr(pt)-1.4* 03:48am blood pt-19.6* ptt-57.2* inr(pt)-1.8* 10:35am blood glucose-127* urean-68* creat-3.4* na-139 k-4.3 cl-98 hco3-28 angap-17 06:00am blood glucose-103 urean-72* creat-3.5* na-137 k-4.1 cl-99 hco3-28 angap-14 07:14pm blood glucose-92 urean-74* creat-3.4* na-136 k-4.0 cl-100 hco3-24 angap-16 03:33am blood glucose-96 urean-74* creat-3.6* na-135 k-4.5 cl-100 hco3-25 angap-15 01:20pm blood glucose-131* urean-76* creat-3.7* na-135 k-4.5 cl-100 hco3-24 angap-16 08:29pm blood glucose-108* urean-78* creat-3.7* na-133 k-4.4 cl-97 hco3-23 angap-17 03:47am blood glucose-113* urean-63* creat-3.2* na-134 k-4.3 cl-99 hco3-20* angap-19 06:25am blood ck-mb-5 ctropnt-0.07* 12:45pm blood ck-mb-5 ctropnt-0.05* 07:14pm blood ck-mb-notdone ctropnt-0.04* 03:33am blood ck-mb-notdone ctropnt-0.05* 03:54pm blood type-art po2-39* pco2-46* ph-7.42 caltco2-31* base xs-4 07:19pm blood type-art po2-202* pco2-41 ph-7.43 caltco2-28 base xs-3 10:26pm blood type-art po2-124* pco2-40 ph-7.43 caltco2-27 base xs-2 04:38am blood type-art po2-77* pco2-39 ph-7.44 caltco2-27 base xs-1 01:28pm blood type-art temp-37.1 po2-82* pco2-38 ph-7.43 caltco2-26 base xs-0 intubat-not intuba 08:54pm blood type-art po2-87 pco2-36 ph-7.44 caltco2-25 base xs-0 03:58am blood type-art po2-71* pco2-38 ph-7.35 caltco2-22 base xs--3 07:19pm blood lactate-1.3 10:26pm blood k-3.9 04:38am blood lactate-2.0 01:28pm blood lactate-2.3* 08:54pm blood lactate-2.9* 03:58am blood lactate-4.2* 10:26pm blood freeca-1.06* 08:54pm blood freeca-1.05* 03:58am blood freeca-0.85* brief hospital course: mr. is a 76-year old gentleman with known coronary artery disease, congestive heart failure, peripheral vascular disease and hypertension who was recently () discharged after aggressive diuresis for chf exacerbation, who re-presents to hospital due to marked family concern that patient is not doing well at home as he has become more lethargic. 1. lethargy- mr felt more tired than usual and has not changed any medications except for torsemide since his last admission. urinalysis and culture were sent, and u/a showed bacteria and leukocytes. urinary tract infection could contribute to his change in mental status so he was started on a 7 day course of double strength bactrim 1 tab . a ct head was done to rule out any acute intracranial process and this returned negative. , urine culture grew out coagulase negative staphylococcus, so iv vancomycin was initiated. blood cultures were drawn prior to antibiotic administration to assess for possible bacteremia, as this could contribute to his hypotension and mental status change. mr. was screened for rehab and had a bed at for , but he triggered on for changes in mental status. head ct done at the time showed no acute intracranial process. he triggered again on for hypotension (70/40) which resolved with minimal intervention, and again on for respiratory rate above 30 (as per nursing, rr was 32). however, when re-checked rr was 19. ekg was obtained which was unchanged from patient's baseline. stat chest x-ray was done to assess for any potential source of infection; however, this too was unchanged from baseline. his mental status resolved on its own spontaneously on and his altered states of consciousness was most likely delerium attributed to narcotic use for his bilateral ankle pain as it was discovered he received 2.5mg oxycodone at 12 midnight and at 0800 on . this was discontinued and strictly enforced that he could only have lidoderm patches and tylenol for pain. he was agitated and disoriented when he came out of his hypoactive delerious state and was given iv fluids and 0.5mg iv haldol x4 for a total of 2mg iv haldol. he rested comfortably with his family overnight and was more responsive in the morning of , becoming very anxious and concerned for his mortality and for the care of his family. 2. ankle pain- increasing bilateral ankle pain with no history of trauma. nightfloat thought this may due to gout flare, so allopurinol was continued and colchicine added although no podagra, no hot swollen joints or appreciable effusion. pain was controlled with lidoderm patches, around the clock tylenol and liquid oxycodone for breakthrough pain, with symptomatic relief. lidoderm patches were discontinued on , as increasing pain could be due to allodynia, as patient was getting continuous patches without a patch-free period. morphine was given by night team despite patient's increasing lethargy so strong pain medications were strictly prohibited by primary team. ankle pain seemed to resolve with conservative medical management. 3. congestive heart failure- mr. presented with 2+ pitting edema on his bilateral lower extremities from feet to mid-thighs bilaterally, which is how he appeared on previous discharge (much improved from beginning of last admission). we continued his outpatient medication regime including torsemide . he has follow-up with dr. in heart failure clinic. mr. also complained of abdominal pain which is likely related to intestinal congestion from his right-sided heart failure. a ct abdomen was conducted; it ruled out an acute intra-abdominal process and showed mesenteric edema. 4. acute vs. chronic renal failure- mr creatinine had risen quite bit since his last discharge (2.6-->2.8-->3.2) which could be due to active diuresis and decreased po intake as he notes he has not been drinking fluids or eating much. he has been given multivitamins, encourage to take po and given carnation plus supplements. on since cr was 3.2, mr. was given a 250cc bolus of ns and transfused 1 unit of prbcs over 3 hours. some small rise in creatinine could be attributed to bactrim use. nsaids were avoided and lisinopril was held for renal function. he was given d5ns on . 5. patient transferred to ccu on for ionotropic report and diuresis. on arrival to the ccu, patient was difficult to arouse but followed commands and a&o x 1. shortly after arrival to the ccu, mr. had several further episodes of self-terminating vt with signs of decreased responsiveness and bp falling to 60s. episodes resolved within 30 seconds without intervention, with bp returning to the 80s systolic. he was started on lasix drip at 25mg/hr and milrinone gtt .5mcg/kg/hr. in addition, patient required phenylephrine for pressure support. patient had minimal output to lasix gtt (5-7cc/hr). continued to experience shortness of breath and hypoxia (was placed on nc plus facemask). mental status remained stable- patient oriented to person and place. family was with patient throughout the day. renal consulted for low uop and decided to initiate cvvh that evening. temporary dialysis line placed aroun 7pm and dialysis initiated shortly thereafter. lasix drip was stopped. milrinone was continued at .25mcg/kg/hr. map trended down to 50's in the evening. patient was anxious/agigtated. at midnight, map was 51 and patient was mentating. house officer paged at 3pm for low bp. map down to 47- patient maxed out on phenylephrine. milrinone was discontinued. dopamine gtt started with minimal response. bp continued to trend down and then patient went into vt. he was coded and passed away at 0500. medications on admission: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 2. amiodarone 200 mg tablet sig: 1.5 tablets po daily (daily). 3. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 4. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. trazodone 50 mg tablet sig: 1.5 tablets po hs (at bedtime). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: one (1) cap po dinner (dinner). 9. allopurinol 300 mg tablet sig: 0.5 tablet po daily (daily). 10. colchicine 0.6 mg tablet sig: one (1) tablet po once (once) for 1 doses. 11. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 12. oxycodone 5 mg/5 ml solution sig: one (1) po once mr1 (once and may repeat 1 time) for 1 doses. 13. torsemide 20 mg tablet sig: three (3) tablet po bid (2 times a day). discharge disposition: expired discharge diagnosis: congestive heart failure coronary artery disease discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified atherosclerosis of aorta hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status chronic kidney disease, unspecified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia atherosclerosis of renal artery cardiac pacemaker in situ heart valve replaced by transplant diverticulosis of colon (without mention of hemorrhage) 

Answer: The patient is high likely exposed to