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: penicillins / ace inhibitors / acebutolol / atenolol / betaxolol / bisoprolol / carvedilol / labetalol / metoprolol / nadolol / penbutolol / pindolol / propranolol / timolol attending: chief complaint: shortness of breath/fatigue major surgical or invasive procedure: 1. left thoracotomy and placement of epicardial left ventricular pacing lead. 2. repositioning automatic implantable cardioverter defibrillator/biventricular pacer generator. history of present illness: mr. is a very ill appearing 63 year old gentleman with a relevant past medical history notable for cardiomyopathy and ventricular tachycardia. he underwent placement of an aicd/ppm in and subsequent lv lead placement in for biventricular pacing for heart failure. he developed a pocket infection and the superficial portion of the lv leads were extracted along with the icd/ppm in . he later underwent reimplantation of his aicd/ppm in but now requires an lv lead for biventricular pacing to help reduce his heart failure symptoms. over the past 1.5 months he has become profoundly dyspneic with minimal activity and has severe peripheral edema. given the worsening of his heart failure symptoms, he has been referred to dr. for lv lead placement for biventricular pacing. past medical history: 1. nonischemic cardiomyopathy, chronic systolic heart failure. 2. mitral regurgitation with pulmonary hypertension. 3. ventricular tachycardia s/p icd implantation 4. copd. 5. morbid obesity. 6. spinal stenosis. 7. right malignant renal tumor, s/p right nephrectomy 8. stage 4 chronic renal failure. 9. hypertension. 10. leg ulcers. 11. gout laparoscopic cholecystectomy in , mini thoracotomy lv lead placement hernia repair icd removal due to pocket infection remimplantation of aicd on - serial # # c154dwk right nephrectomy right ankle skin graft for non-healing ulcer social history: retired truck driver - lives with spouse remote tobacco use (quit when he was 35) no etoh no illicits. family history: no family history of premature cardiac disease. physical exam: pulse:90 sr resp: 24 o2 sat: 100% ra b/p left: 118/74 height: 72" weight: 440.5 general: morbidly obese gentleman sitting in wheel chair. short of breath from moving from chair to wheel chair. nad while sitting. skin: warm, dry and intact. strae noted on abdomen. well healed left thoracotomy. hypertrophic left upper chest pacer pocket scar. well healed right upper chest pacer pocket. severe venous stasis changes of bilateral le's. palor appears mildly cyanotic. heent: ncat, perrla, eomi, sclera anicteric, op benign. right buccal mucosa with likely canker. neck: supple full rom jvd 9cm chest: expiratory wheeze, left > right, diminshed bs at bases bilaterally. poor air movement and insp/exp effort. heart: rrr, distant heart sounds, nl s1-s2, no m/r/g abdomen: soft non-distended non-tender bowel sounds + obese, strae noted. well healed lap cholecsytectomy ports. extremities: warm, severe 3+ edema with blisters, chronic venous stasis changes. varicosities: likely severe but unable to stand. neuro: grossly intact, barely able to stand, walk a few feet or sit which appears mostly related to obesity. + tremors of bilaterall ue's pulses: femoral right:1+ left:1+ dp right: non palp left: non palp pt : non palp left: non palp radial right:1+ left:1+ carotid bruit none appreciated bilaterally pertinent results: admission labs: 09:56am hgb-11.6* calchct-35 09:56am glucose-117* lactate-1.0 na+-142 k+-4.2 cl--100 03:08pm pt-14.6* ptt-33.9 inr(pt)-1.3* 03:08pm plt count-163 03:08pm wbc-7.9 rbc-3.87* hgb-10.0* hct-32.5* mcv-84 mch-25.8* mchc-30.8* rdw-19.2* 03:08pm urea n-71* creat-2.7*# chloride-105 total co2-30 discharge labs: 05:30am blood wbc-5.9 rbc-3.60* hgb-9.5* hct-30.3* mcv-84 mch-26.6* mchc-31.6 rdw-19.2* plt ct-119* 05:30am blood plt ct-119* 02:33am blood pt-14.3* ptt-37.5* inr(pt)-1.2* 05:30am blood glucose-83 urean-72* creat-3.2* na-141 k-4.6 cl-104 hco3-27 angap-15 echocardiography report age (years): 63 m hgt (in): 63 bp (mm hg): 107/71 wgt (lb): 450 hr (bpm): 70 bsa (m2): 2.73 m2 indication: dilated cardiomyopathy. left ventricular function. mitral valve disease. ventricular ectopy. date/time: at 11:01 interpret md: , md echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 20% to 25% >= 55% tr gradient (+ ra = pasp): *30 to 32 mm hg <= 25 mm hg findings left atrium: moderate la enlargement. no spontaneous echo contrast or thrombus in the body of the laa. right atrium/interatrial septum: moderately dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: severely dilated lv cavity. severely depressed lvef. right ventricle: markedly dilated rv cavity. severe global rv free wall hypokinesis. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. no ms. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets. moderate tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. physiologic (normal) pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. conclusions the left atrium is moderately dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity is severely dilated. overall left ventricular systolic function is severely depressed (lvef= 25 %). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. preliminary report developed by a cardiology fellow. not reviewed/approved by the attending echo physician. certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:22 radiology report chest (portable ap) study date of 7:22 am final report history: status post cabg. impression: ap chest compared to : two frontal views of the chest fail to image lateral aspect of the left lung base. there is no pulmonary edema. severe cardiomegaly is stable postoperatively and comparable to the preoperative appearance. there is no pulmonary edema. mild right peribronchial opacification could be atelectasis. left pleural thickening which developed postoperatively is unchanged. it would be very useful to get conventional chest radiographs of this patient to assess the significance of left pleural abnormality and the right infrahilar opacification. there is no pneumothorax or mediastinal widening. the course of the right subclavian transvenous pacer and pacer defibrillator leads are not clear, but the tip of the defibrillator projects over the floor of the right ventricle, as before. dr. brief hospital course: mr. went to the operating room and underwent left thoracotomy and placement of epicardial left ventricular pacing lead,and repositioning automatic implantable cardioverter defibrillator/biventricular pacer generator. please see dr operative note for further details. he tolerated the procedure well and was transferred to the cvicu intubated, sedated, in critical but stable condition. he awoke neurologically intact and was extubated without difficulty. acute pain services was following postoperatively due to mr. epidural. he was weaned off the epidural and placed on oral pain medications. home cardiac medications were resumed and due to hypotension his antihypertensives were stopped. all lines and drains were discontinued in a timely fashion. he remained in the cvicu for close observation of his renal function as his creatinine rose transiently from his already elevated baseline. renal was consulted for acute tubular necrosis. he continued to progress and was transferred to the step down unit for further monitoring. physical and occupational therapy was consulted for strength and mobility evaluation. the remainder of his postoperative course was essentially uneventful. on pod# seven he was cleared by dr. for discharge to rehab on telemetry and will follow up for device check with dr . medications on admission: fluticasone-salmeterol - (prescribed by other provider) - 250 mcg-50 mcg/dose disk with device - 1 puff twice a day furosemide - (prescribed by other provider) - 80 mg tablet - 1.5 tablet(s) by mouth twice a day hydralazine - (prescribed by other provider) - 50 mg tablet - 1 tablet(s) by mouth three times a day isosorbide mononitrate - (prescribed by other provider) - 30 mg tablet sustained release 24 hr - 2 tablet(s) by mouth qam losartan - (prescribed by other provider) - 25 mg tablet - 1 tablet(s) by mouth once a day mexiletine - (prescribed by other provider) - 200 mg capsule - 2 capsule(s) by mouth every morning, one tablet every afternoon, one tablet every evening montelukast - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth once a day quinidine gluconate - (prescribed by other provider) - 324 mg tablet sustained release - 2 tablet(s) by mouth qam, one tablet every afternoon, one tablet every evening aspirin - (prescribed by other provider) - 81 mg tablet - 1 tablet(s) by mouth once a day discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. medications lasix currently being held - creatinine conitnues to improve - please resume half normal dose of lasix (120mg twice a day - home dose) when fluid balance even - currently autodiuresing with > 1000 ml negative in 24 hours 8. quinidine gluconate 324 mg tablet sustained release sig: two (2) tablet sustained release po qam (once a day (in the morning)): 2 tabs in am 1 tab in afternoon 1 tab in evening . 9. quinidine gluconate 324 mg tablet sustained release sig: one (1) tablet sustained release po twice a day: please give in afternoon and bedtime - takes 2 tabs in am - see other order . 10. mexiletine 200 mg capsule sig: two (2) capsule po qam (once a day (in the morning)): 400mg in am 200mg in afternoon and at bedtime . 11. mexiletine 200 mg capsule sig: one (1) capsule po twice a day: 400mg in am 200mg in afternoon and at bedtime . 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: three (3) ml inhalation q6h (every 6 hours) as needed for dyspnea. 13. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 14. heart failure and blood pressure medications when able please resume betablocker and home antihypertensives - were held due to blood pressure and renal disease - please add back slowly with goal b/p 110-120 due to heart failure and renal disease 15. dilaudid 2 mg tablet sig: 1-2 tablets po q3h as needed for pain. discharge disposition: extended care facility: tba discharge diagnosis: malfunctioning biventricular pacing system s/p lead placement chronic systolic heart failure stage 3 chronic renal failure hypertension chronic venous stasis disease morbid obesity chronic obstructive pulmonary disease discharge condition: alert and oriented x3, nonfocal thoracotomy incisional pain managed with dilaudid prn activity status: ambulating short distances using walker ~80 ft with assistance left thoracotomy wound healing well, no erythema or drainage discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month until follow up with surgeon no lifting more than 10 pounds for 4 weeks please call with any questions or concerns followup instructions: heart center of - for follow up visit dr for dr at 915 am pcp: . in 1 week # cardiologist: dr. in 1 week - for device check - device clinic aware - please call to verify date and time nephrology dr - tuesday at 945 am procedure: diagnostic ultrasound of heart insertion or replacement of epicardial lead [electrode] into epicardium revision or relocation of cardiac device pocket diagnoses: other primary cardiomyopathies mitral valve disorders congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status mechanical complication of automatic implantable cardiac defibrillator primary pulmonary hypertension morbid obesity 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 personal history of malignant neoplasm of kidney acquired absence of kidney varicose veins of lower extremities with ulcer 

Answer: The patient is high likely exposed to