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: ibuprofen / penicillins / shellfish attending: chief complaint: shortness of breath major surgical or invasive procedure: cvvh history of present illness: yo m with end-stage renal disease on hd, chf (ef 40%), cad and hypothyroidism who presents with fluid overload, ekg changes and cardiac enzyme elevations concerning for ischemia transferred to the icu for urgent dialysis. . by report of the patient, his sons and on review of his medical records, the patient had progressive shortness of breath for many months. this became abruptly worse approximately 24 hours prior to admission. the patient had profound orthopnea and was forced to sit on the edge of his bed with rapid breathing. his sons asked the patient to go to the hospital but he refused. his shortness of breath symptoms worsened and by morning the patient agreed to come to the hospital. he denies at any point developing chest pain. he notes baseline nausea unchanged and worsening dyspnea on exertion at 12 steps and 2 pillow orthopnea. he describes unchanged peripheral edema and denies weight gain. . the patient initially presented to where he was felt to be volume overloaded with possible anterior st elevation on ekg and positive cardiac enzymes. he received aspirin 81mg x 4, clopidogrel 600mg, lasix 100mg iv, nitropaste 1 inch subsequently changed to a nitroglycerin drip and then discontinued and a heparin gtt. on admission to the floor the patient was hemodynamically stable but in persistent respiratory distress, tachypneic to 24-30 saturating well on 3l oxygen by nc. he was evaluated by the renal consult service who recommended transfer to the icu for semi-urgent cvvhd for fluid removal. . of note, the patient was has difficulty with fluid removal at hd due to hypotension. as a result he had chronic accumulation of fluid. in addition, his outpatient cardiologist was not able to institute a comprehensive cardiac regimen (including beta-blocker). . review of systems: denies fevers, cough, weight loss, nightsweats, melena, hematochezia, rash, arthralgias, myalgias, claudication past medical history: - cad, likely prior silent mi with apical hypokinesis on echo - end-stage renal disease on hd with tunnelled line in place, failed av fistulas, usual schedule mwf. - hypothyroidism - systolic chf, ef 40% - mr - pulmonary hypertension social history: no tobacco, alcohol, or illicit drugs. family history: nc physical exam: vs:97.8 78-83 127-144/51-70 24-30 97-100% 3l gen: elderly gentleman in some respiratory distress. heent: perrl. pink, moist oral mucosa without lesions. cv: mr murmur heard at the apex. pulm: tachypneic. crackles halfway up the lung fields bilaterally. abd: soft, nontender. no masses or organomegaly. ext: trace bilateral lower extremity edema. referred murmur vs. bruit bilaterally in the groin. 2+ femoral pulses. neuro: a&ox3. integumentary: no rashes or lesions. pertinent results: 02:04am blood wbc-4.0 rbc-3.79* hgb-11.4* hct-33.7* mcv-89 mch-30.0 mchc-33.8 rdw-13.9 plt ct-138* 11:05pm blood neuts-87.6* bands-0 lymphs-9.0* monos-2.8 eos-0.5 baso-0.2 11:05pm blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 07:49am blood pt-14.3* ptt-82.7* inr(pt)-1.2* 02:04am blood glucose-97 urean-63* creat-9.1*# na-137 k-5.8* cl-95* hco3-27 angap-21* 01:47am blood glucose-104 urean-42* creat-5.0*# na-133 k-4.5 cl-92* hco3-22 angap-24* 03:15am blood glucose-90 urean-29* creat-3.1* na-132* k-4.1 cl-95* hco3-26 angap-15 07:49am blood alt-48* ast-114* ld(ldh)-352* ck(cpk)-1159* alkphos-93 totbili-0.4 04:40am blood alt-42* ast-67* ld(ldh)-276* alkphos-87 totbili-0.3 07:53am blood ck-mb-25* mb indx-1.4 ctropnt-1.97* 07:49am blood ck-mb-23* mb indx-2.0 ctropnt-2.70* 04:40am blood calcium-9.8 phos-2.9 mg-1.8 02:04am blood tsh-1.3 04:12pm blood type- temp-37.8 ph-7.38 11:17am blood lactate-2.0 04:12pm blood freeca-1.23 cxr : ap single view of the chest has been obtained with patient in sitting semi-erect position. bilateral pleural effusions obliterate the diaphragmatic contours and obscure the lower portions of the heart silhouette. significant cardiac enlargement is most likely present. one can identify a semi-circular calcification within the heart shadow indicative of mitral ring calcium deposits. the thoracic aorta shows extensive wall calcifications in the area of the arch, but the aorta is not significantly widened. the pulmonary vasculature demonstrates an upper zone redistribution pattern and there is perivascular haze on the bases consistent with marked congestion. evidence of discrete local parenchymal infiltrates cannot be identified; however, the possibility of infectious processes in the bases concealed by the congestive pattern and the pleural effusions is possible. the presence of a left internal jugular approach double lumen catheter is recognized seen to terminate in the lower svc just at the junction with the right atrium. in the right apical area, the metallic structures of a stent, presumably in the right subclavian vein are identified. there is no pneumothorax. comparison is made with the next previous available chest examination of . cardiac enlargement and pulmonary congestive pattern with pleural effusions existed already at that time, but these findings have moderately increased. the wide caliber tube on the left side (probably dialysis line) did not exist at that time. impression: progression of left-sided chf with bilateral pleural effusions in elderly gentleman. no new pneumonia identified which however, cannot be completely excluded. brief hospital course: the patient was admitted for urgent cvvh given his obvious clinical volume overload causing dyspnea and relative hypoxia. previously, the dialysis team had been unable to remove enough fluid intermittently without causing significant hypotension. the patient was begun on cvvh by the renal team with an emergent need for levophed to be run concurently through his return dialysis line to support his blood pressure, even during a more gentle cvvh. in addition, he had cardiac enzyme elevations and a newly dropped ef from 40% to 20% on this admission, likely secondary to demand ischemia due to his volume overload. he was initially begun on integrillin and a heparin drip to treat possible occlusive thrombotic heart disease. his oxygenation improved but he was unable to be weened from his vasopressor medications while on cvvh. in discussion with the patient and his family, it was made clear that the patient wanted to return to his previous quality of life, only requiring intermittent hd. however, it was also clear that it was very unlikely he would be able to return to this state. in discussion with the patient and his family, it was decided to make the patient comfort measures only. all non-comfort medications were stopped including cvvh and levophed and the patient was made comfortable using intermittent morphine by iv. the patient expired peacefully surrounded by family approximately 24 hours after discontinuation of pressors and cvvh. medications on admission: levothyroxine 175mcg daily sevelamer 2400mg tid imdur 30mg daily renal cap daily discharge medications: none, expired discharge disposition: expired discharge diagnosis: end stage renal disease on hemodialysis acute on chronic systolic heart failure discharge condition: expired discharge instructions: none, expired followup instructions: expired procedure: hemodialysis diagnoses: end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease cardiogenic shock septic shock old myocardial infarction acute on chronic systolic heart failure diseases of tricuspid valve 

Answer: The patient is high likely exposed to