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: dyspnea. major surgical or invasive procedure: none. history of present illness: this is an 82 yo woman with history of type ii diabetes, peripheral vascular disease, hypertension, and hyperlipid who was recently admitted to ccu for respiratory distress in the setting of decompensated heart failure and nstemi. she presented to the ed last night from rehab less than 24 hours post-discharge for increasing shortness of breath. she says that she arrived at rehab yesterday afternoon feeling generally well. she ate dinner after which she developed mild abdominal discomfort that resolved spontaneously. she then felt as if her heart was beating fast, and she also felt tired. there was no chest pain or pressure, lightheadedness or dizziness. she says she was diaphoretic at the time. her daughter, concerned, called 911. en route to the hospital, she was noted to be tachypnic and hypoxic (per ed report). initially in the ed she was hypoxic to mid 60s. she was also hypertensive to 180s initially. ekg showed sinus tachycardia with lad (unchanged). widened qrs (114 ms) with st elevations in anterior precordial leads (unchanged) and st-depressions/t-wave inversions in lateral leads (unchanged). cxr showed bilateral perihilar consolidations worse from two days prior with persistent pleural effusions; overall impression was worsening pulmonary edema, although infection could not be excluded. abg showed 7.43/36/124. lactate was 2.4. labs were notable for white count of 16.1 with 66.2% neutrophils and no bands. bmp showed a bicarb of 21 with anion gap of 12. renal function was normal. of note, her troponin was 2.63 (down from previous 6.41 on ) with flat ck. bnp was 14,871 (no prior for comparison). she was placed on a nitro drip intially; this was quickly weaned off. she was also placed on bipap intially. there were attempts made to wean her to face mask or nasal cannula. however, per ed report she became tachypnic to 30s with these measures, and therefore she was readmitted to the ccu. at time of admission, her sats were 95-96% on nrb, rr 27-32, heart rate in the 90s with systolic bp 110s. in the ed she received aspirin 325 mg x1, levofloxacin 750 mg x1, and lasix 40 mg iv x1. of note, during her previous admission ( to ), she was intubated for respiratory distress secondary to mitral regurgitation which was believed secondary to ischemia. this all had happened after an elective left total hip replacement at . she underwent echocardiogram that showed a new antero-apical wall motion abnormality and underwent cardiac cath that revealed lad disease for which a bare metal stent was placed. she was started on plavix and high-dose aspirin, as well as lovenox with bridge to coumadin for apical akinesis (lvef 30-35%) noted on echocardiogram. she worked with physical therapy for two days without chest pain or dyspnea and was felt to be ready for discharge to rehab. review of systems: currently, patient denies shortness of breath, chest pain or pressure, lightheadedness or dizziness. she denies nausea, abdominal discomfort, cough, or sputum production. past medical history: 1) history of diabetes type ii, although most recent hga1c was 5.8 () off of all medications 2) peripheral vascular disease: s/p left common femoral to below knee popliteal artery bypass with in situ saphenous vein and an open transluminal angioplasty of the anterior tibial and below knee popliteal arteries in . 3) hypertension 4) hyperlipidemia 5) hx of r breast ca s/p lumpectomy 6) depression social history: originally she is from . prior to her discharge to rehab, she lived at home with her husband and was independent in her adls, iadls and very functional. she denies history of smoking, alcohol or drug abuse. her daughter, who lives in , has been recently staying in and has been involved in her care on a daily basis during her two recent admissions to . family history: non-contributory. physical exam: vitals: t 97.9, hr 93-94, bp 119-127/58-66), rr 12-20, sat 90-98% 5l urine output: 400 cc general: elderly woman, generally anxious-appearing, lying comfortably in bed, speaking in complete sentences without pauses, no accessory muscle use or labored breathing heent: nc/at, perrla, eomi neck: supple, no appreciable jvd chest: rrr, normal s1/s2, systolic murmur loudest along left sternal border, radiating toward apex although not audible in axilla lungs: crackles halfway up posterior fields abdomen: soft, non-tender, normal bowel sounds extremities: trace pitting edema to ankles bilaterally; feet warm and well-perfused neurological: aaox3, moving all extremities at time of discharge, her oxygen saturations are in the mid to high 90s on ra. her blood pressures have been well-controlled with systolic blood pressure ranging from 110 to 130. there is no lower extremity pitting edema. pertinent results: 02:30am type-art peep-5 o2-100 po2-124* pco2-36 ph-7.43 total co2-25 base xs-0 aado2-570 req o2-92 intubated-not intuba comments-niv 14/5 1 01:45am urine color-yellow appear-clear sp -1.024 01:45am urine blood-tr nitrite-neg protein-30 glucose-tr ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:45am urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi- 01:45am urine hyaline-0-2 01:30am lactate-2.4* 01:15am glucose-390* urea n-32* creat-0.7 sodium-139 potassium-4.6 chloride-106 total co2-21* anion gap-17 01:15am ck(cpk)-72 01:15am ctropnt-2.63* 01:15am ck-mb-notdone probnp-* 01:15am wbc-16.1*# rbc-3.77* hgb-10.9* hct-33.8* mcv-90 mch-28.9 mchc-32.3 rdw-13.9 01:15am neuts-66.2 lymphs-28.4 monos-2.2 eos-2.9 basos-0.4 01:15am plt count-543* 01:15am pt-13.3 ptt-34.3 inr(pt)-1.1 06:20am glucose-115* urea n-25* creat-0.7 sodium-142 potassium-4.0 chloride-109* total co2-26 anion gap-11 06:20am calcium-8.3* phosphate-2.8 magnesium-2.1 06:20am wbc-9.9 rbc-3.37* hgb-10.3* hct-29.9* mcv-89 mch-30.6 mchc-34.4 rdw-13.8 06:20am plt count-437 06:20am pt-13.6* ptt-31.6 inr(pt)-1.2* 01:15am blood wbc-16.1*# rbc-3.77* hgb-10.9* hct-33.8* mcv-90 mch-28.9 mchc-32.3 rdw-13.9 plt ct-543* 06:20am blood wbc-9.9 rbc-3.37* hgb-10.3* hct-29.9* mcv-89 mch-30.6 mchc-34.4 rdw-13.8 plt ct-437 01:15am blood neuts-66.2 lymphs-28.4 monos-2.2 eos-2.9 baso-0.4 01:15am blood plt ct-543* 01:15am blood pt-13.3 ptt-34.3 inr(pt)-1.1 06:20am blood plt ct-437 06:20am blood pt-13.6* ptt-31.6 inr(pt)-1.2* 01:15am blood ck(cpk)-72 01:15am blood ctropnt-2.63* 01:15am blood calcium-8.5 phos-5.2*# mg-2.0 02:30am blood type-art peep-5 fio2-100 po2-124* pco2-36 ph-7.43 caltco2-25 base xs-0 aado2-570 req o2-92 intubat-not intuba comment-niv 14/5 1 01:30am blood comment-green top 01:30am blood lactate-2.4* transthoracic echocardiogram : conclusions the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction with severe hypokinesis of the distal halves of the anterior septum, anterior and inferior walls as well as apex. the remaining segments contract normally (lvef = 30-35 %). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal left ventricular cavity size with extensive regional systolic dysfunction c/w multivessel cad (mid-lad and pda distributions). increased pcwp. moderate mitral regurgitation. pulmonary artery systolic hypertension. clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibotor or . based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. cxr 1. pulmonary edema with effusions, progressive in comparison to two days prior. 2. calcification of the ascending aorta that appears new from recent prior studies. repeat chest radiograph is recommended to evaluate for change in contour of the ascending aorta. : left hip plain films recent hip replacement. clips are seen in the soft tissues. massive vascular calcifications. normal position of the joint replacement. no evidence of fracture or dislocation left hip ultrasound direct ultrasound examination was performed around the surgical site in the anterior and posterior aspect of the left upper thigh. allowing for mild obscuration from the surgical dressing, there is no large hematoma. there is expected mild post-operative soft tissue edema. impression: no large hematoma seen around the left hip surgical site. : ct abdomen and pelvis: abdomen: the liver, spleen, adrenal glands, and pancreas are normal. the gallbladder is distended, maximum diameter of which measures 4.7 cm. there is no pericholecystic fluid collection and the gallbladder wall thickness is normal. no intra- or extra-hepatic biliary duct dilatation seen. simple cyst seen in the mid pole of left kidney measuring 2.1 x 2 cm. the right kidney is normal. no hydronephrosis. extensive atherosclerotic calcifications are seen in the abdominal aorta and the iliac arteries. no free fluid. the ivc and aorta are of normal caliber. no evidence of retroperitoneal hematoma. pelvis: significant artifact seen in the lower pelvis from beam hardening due to bilateral hip prosthesis. no free fluid seen in the pelvis. calcified fibroid seen in the uterus. air noted within the urinary bladder, likely secondary to foley catheterization. scattered colonic diverticulosis without evidence of diverticulitis. the visualized large bowel is otherwise unremarkable. there is a large hyperdense collection seen in the region of the left gluteal muscle extending inferiorly along the posterior aspect of the thigh. this measures approximately 9.5 x 6.2 x 4 cm. given patient's recent left hip replacement, this likely represents a hematoma and it measures 67 hounsfield units. the lowermost extent of the hematoma is not evaluated on this examination. bilateral total hip replacements noted. degenerative changes are seen in the thoracic or lumbar spine. at l1-2 and t12-l1, there is reduced disc space with vacuum phenomenon. impression: 1. hyperdense collection in the left gluteal region extending inferiorly along the posterior aspect of the femoral shaft, representing hematoma. findings were called to dr. at 2:44 p.m. on . 2. bilateral moderate pleural effusions with atelectatic changes of lung bases. brief hospital course: assessment and plan: in summary this is an 82 yo woman with a history of type ii diabetes, peripheral vascular disease, hypertension, and hyperlipidemia recently admitted to the ccu for respiratory distress in the setting of decompensated heart failure and nstemi, now presenting for acute worsening of shortness of breath. # hypoxia: her hypoxia was likely secondary to flash pulmonary edema in the setting of hypertension. it is not clear what precipitated the hypertension, although she was documented to have a systolic blood pressure of 180 upon arrival to the emergency room. she was treated with supplemental oxygen, intravenous lasix for diuresis and the dose of her metoprolol was increased for better blood pressure control. eventually with this regimen her oxygen was weaned off and her respiratory function improved significantly. she will be discharged on lasix 40 mg daily and her renal function and electrolytes should be followed at rehab and the lasix dosing adjusted accordingly. she has been receiving prn of mg iv lasix once daily to help with diuresis, and she has responded very well to this regimen. her most recent creatinine is 0.7 to 0.8, with a bun ranging from 26 to 31. # hypertension: as above, metoprolol was adjusted during this admission aiming for a target systolic blood pressure less than 130. she was continued on lisinopril 20 mg daily and the lasix dose was adjusted as above. with these treatments, her blood pressure was consistently at target. # leukocytosis: on admission she had an elevated white count but was afebrile without bandemia or localizing signs of infection. she received one dose of levofloxacin in the emergency room but this was discontinued and her white count normalized. # coronary artery disease: she is s/p perioperative mi with bms in lad. this admission there were no new ischemic changes on ekg. her cardiac enzymes were downward trending from her prior admission. she continued to take aspirin, plavix, simvastatin, and metoprolol. # apical akinesis: she was noted to have apical akinesis on her last echocardiogram and she was being anticouagulated with coumadin for a six month course; however she developed a hematoma in her left lateral gluteus following a fall; please see ct findings above for full report. orthopedics service was consulted and felt that the hematoma had stopped bleeding; they did not believe that surgical intervention was necessary, and they felt that her anticoagualation could be resumed. thus we have restarted her coumadin, and due to the bleed we have decreased the lovenox dose to 40 mg daily (prophylactic dose given the recent hip replacement), until her coumadin levels are therapeutic. dr. in cardiology clinic can decide on the duration of anticoagulation and the plan for follow-up echocardiogram. she has been referred to the heart failure clinic with a plan to follow up with dr as her outpatient cardiologist. inr should be checked in rehab at the discretion of the rehab physician, she should follow up with the after discharge from rehab. her most recent inr was 1.0 on (down from 1.2 and 1.4 on and , respectively, in the setting of holding her coumadin. coumadin was restarted on at a dose of 3 mg daily. # s/p left hip replacement: she had a left hip replacement at prior to her previous admission. communication with her orthopedic surgeon related that she was full weight-bearing and she was evaluated by pt with a recommendation for rehab. she had a fall without head trauma the day prior to her last discharge, which she only informed the housestaff about on the day of her readmission. at the time of this admission, it was noted that she had a drop in hematocrit to 22 from her baseline of 30. she was transfused two units of prbcs. heparin and lovenox were temporarily held. she had a ct abdomen/pelvis and was found to have a bleed in her left lateral gluteus. she was seen by orthopedics with a recommendation for conservative management; they felt that the bleed would tamponade itself off, and given her stable hematocrit and improving clinical exam, this was felt to be the case. her lovenox dose was decreased from 60 mg to 40 mg daily (prophylactic dose). coumadin was restarted. she received tylenol and morphine with a bowel regimen for pain control. she will follow up with her orthopedic doctor within 2 weeks of her hip replacement. # anemia: she had a fall in her hematocrit in the setting of her left lateral gluteal hematoma. she was transfused 2 units of blood and her hematocrit remained stable after that. # anxiety / history of depression: the patient previously had been treated with prozac 20 mg daily but refused this medication during this and her previous hospitalization. # disposition: she is discharged to a rehab facility. # code status: full. medications on admission: medications (at discharge on ): - aspirin 325 mg qday - clopidogrel 75 mg qday - warfarin 3 mg qday - simvastatin 80 mg qday - multivitamin qday - ranitidine 150 mg qday - lisinopril 20 mg qday - enoxaparin 60 mg qday - acetaminophen 325 mg q6h prn - metoprolol 50 mg sustained release qday - lasix (dose not clear) discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 9. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 10. enoxaparin 40 mg/0.4 ml syringe sig: one (1) injection subcutaneous daily (daily). 11. coumadin 3 mg tablet sig: one (1) tablet po once a day. 12. lasix 40 mg tablet sig: 1.5 tablets po once a day. 13. acetaminophen extra strength 500 mg tablet sig: two (2) tablet po three times a day. 14. metoprolol succinate 50 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. 15. oxycodone 5 mg capsule sig: capsules po every six (6) hours as needed for pain: please do not drink alcohol or perform activities that require fast reaction while taking this medication. discharge disposition: extended care facility: rehab - discharge diagnosis: primary diagnoses acute exacerbation of chronic heart failure left hip hematoma secondary diagnoses hypertensive emergency coronary artery disease s/p mi with stent to lad s/p left hip replacement discharge condition: stable, alert and oriented to person, place and time. discharge instructions: you were admitted to the hospital because you were having difficulty breathing. you were found to have worsening of your heart failure in the setting of high blood pressure. during this admission you were also found to have a bleed in your left thigh. you received a blood transfusion, we decreased the of some of your anticoagulation medicines, and the bleeding stopped. the following changes were made to your medications: -we added furosemide 40 mg once daily -we added trazodone 50 mg at bedtime as needed for insomnia -we added tylenol and oxycodone for leg pain (please only continue the tylenol for two weeks before re-evaluation by a physician) -we changed the lovenox dose to 40 mg subcutaneous daily -we changed the metoprolol to metoprolol succinate 150 mg daily up more than 3 lbs. followup instructions: -cardiology: dr. phone: date/time: 9:00. building, , . -orthopedics: dr : tuesday at 11:30am , telephone: -primary care: , md, mph: date/time: 11:20 procedure: non-invasive mechanical ventilation diagnoses: coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of breast unspecified fall peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status pulmonary collapse dysthymic disorder other and unspecified hyperlipidemia surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation acute on chronic systolic heart failure precipitous drop in hematocrit subendocardial infarction, subsequent episode of care leukocytosis, unspecified hip joint replacement unspecified hypertensive heart disease with heart failure contusion of buttock 

Answer: The patient is high likely exposed to