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: vicodin attending: chief complaint: dyspnea and back/neck pain major surgical or invasive procedure: none history of present illness: 78 dm, pad known severe as 0.9cm2 mean gradient of 20mmhg, chf ef 35-40% with regional variation, 3vd cath 1mo ago, rle angioplasty/stent for poorly healing tma now presents with dyspnea and pain. last evening around 10pm, she developed back/neck pain while at rest that subsided somewhat by trying to sleep/rest, but she awoke at 4am with wheezing, concerning enough to call her daughter and present to . her sats were recorded to be in the 70s. she received lasix (20mg iv by report) with improvement in respiratory status, and was transferred to for further management. at the ed, her presenting vitals were 99.9, 90/44 hr 113 rr 21 sat 100% nrb. her bp dropped to 83/47 lowest recorded, and she received a 250cc saline bolus. she was weaned down on her oxygen to 4l nc. given her bp, she was admitted to the cardiac icu for further monitoring. on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. all of the other review of systems were negative. cardiac review of systems is notable for absence of frank chest pain, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. past medical history: as 0.9cm2, gradient 20by echo, 40 by cath diabetes pvd hypertension hypercholesterolemia hypothyroidism svt status post ablation tachycardia, sinus psh: right tma in left tma in ' left femoral/popliteal bypass in r femoral/popliteal bypass in thyroidectomy right hip fracture social history: tobacco use: former smoker alcohol abuse: no history of alcohol abuse. family history: daughter with mi in 50s. physical exam: gen: wdwn elderly female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of *10-12 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. iii/vi sm at rusb. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. wet rales 1/2 up abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: pulses: right: carotid 1+ femoral 1+ popliteal 0+ left: carotid 1+ femoral 1+ popliteal 0+ pertinent results: 08:15am blood wbc-9.0 rbc-2.97* hgb-9.3* hct-27.9* mcv-94 mch-31.4 mchc-33.4 rdw-15.5 plt ct-297 06:55am blood wbc-8.4 rbc-2.87* hgb-9.1* hct-26.3* mcv-91 mch-31.6 mchc-34.6 rdw-15.3 plt ct-391 08:15am blood glucose-208* urean-15 creat-0.8 na-136 k-4.4 cl-101 hco3-28 angap-11 06:55am blood glucose-113* urean-35* creat-0.7 na-139 k-4.0 cl-99 hco3-31 angap-13 08:15am blood ctropnt-0.05* 08:15am blood ck-mb-notdone ctropnt-0.06* probnp-5950* 04:33pm blood ck-mb-notdone ctropnt-0.10* 08:15am blood alt-14 ast-16 ck(cpk)-39 alkphos-40 totbili-0.5 08:15am blood lipase-27 01:41am blood tsh-2.5 11:39am blood %hba1c-5.8 urine cx (): negative blood cx ( x2, x2): ngtd cxr (): interval development of pulmonary edema; repeat pa and lateral when clinically feasible may be beneficial. le u/s (): no dvt of either lower extremity. tte (): the left atrium is elongated. the left ventricular cavity is mildly dilated with severe global hypokinesis (lvef = 25-30 %). the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , global left ventricular systolic function is more depressed (and apprears global) and the severity of aortic stenosis has progressed. no discrete vegetations identified (does not exclude with deformed valves). cxr (): in comparison with the study of , the hemidiaphragms are more sharply seen. the pulmonary vascularity is less pronounced. these findings are consistent with decreasing pulmonary congestion and pleural effusions. some streaks of atelectasis persist, especially at the left base. there is a vague suggestion of an area of increased opacification involving the right mid lung laterally. this could possibly reflect a developing area of consolidation. brief hospital course: 1) acute on chronic systolic heart failure: was diuresed with boluses of furosemide (20-60mg iv) with care to avoid overdiuresis due to her as and subsequent preload dependence. tte showed global lv systolic dysfunction and severe aortic stenosis. her breathing improved with diuresis and she was weaned off o2. her outpatient furosemide was increased from 20mg once a day to 40mg once a day. she was started on lisinopril 2.5mg daily, which can be uptitrated as tolerated. metoprolol was increased from 12.5mg twice daily to 37.5mg three times a day but her blood pressure could not tolerate and she was weaned back to metoprolol 12.5mg po bid. she remained in sinus tachycardia in the 100-110s range, which per patient and daughter has been her baseline for at least 40 years. also, her blood pressure has not tolerated past attempts to control her heart rate with medications. regarding her as, she was seen by ct surgery for avr, and will follow up as an outpatient for this and cabg. 2) pvd: status post recent tma revision with wound vac in place over r dorsal foot. surgery was consulted and felt this wound was not infected. she was discharged with the wound vac in place. 3) cad: plan is for patient to undergo cabg once her right foot wound has healed. she was treated with asa, clopidogrel, atorvastatin, and metoprolol. she had no evidence of acute ischemia during her hospitalization. 4) fevers: cxr did not suggest pneumonia, urine culture was negative, and blood cultures were negative to date at discharge. no evidence of leg dvt on ultrasound. her fever curve trended down and she had no leukocytosis. 5) anemia: chronic and stable. she was transfused 1 unit prbcs in case anemia was contributing to her tachycardia, although her hr remained elevated. 6) dm: her oral hypoglycemics were held while in house and she was monitored on riss. she was transitioned back to her po meds at discharge. her other chronic medical problems remained stable and she was continued on her outpatient regimen. medications on admission: atorvastatin 40mg po daily clopidogrel 75 mg daily fenofibrate nanocrystallized 48 mg daily furosemide 20 mg po daily glimepiride 4 mg levothyroxine 150 mcg daily metformin - 1,000 mg metoprolol tartrate - 12.2mg po bid pentoxifylline 400 mg sustained release tid pioglitazone 45 mg tablet daily potassium chloride 20meq daily alendronate 75mg po weekly sitagliptin 100 mg tablet daily medications - otc aspirin 325 mg daily docusate sodium - 100mg po bid ferrous sulfate 325 mg vitamin b comp & c no.3 - (prescribed by other provider) - dosage uncertain discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. escitalopram 10 mg tablet sig: one (1) tablet po daily (daily). 5. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 6. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. glimepiride 4 mg tablet sig: one (1) tablet po daily (). 8. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 9. sitagliptin 100 mg tablet sig: one (1) tablet po daily (). 10. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 11. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day). 12. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 13. pioglitazone 45 mg tablet sig: one (1) tablet po once a day. 14. colace 100 mg capsule sig: one (1) capsule po twice a day. 15. micro-k 10 meq capsule, sustained release sig: two (2) capsule, sustained release po once a day. 16. tricor 48 mg tablet sig: one (1) tablet po once a day. 17. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po twice a day. discharge disposition: home with service facility: vna carenetwork discharge diagnosis: primary diagnosis: 1. congestive heart failure exacerbation 2. peripheral disease 3. sinus tachycardia 4. hyperlipidemia 5. type 2 diabetes mellitus discharge condition: stable. patient is tolerating room air and is back to her baseline condition. discharge instructions: you were admitted to the hospital with shortness of breath. this was thought likely related to your congestive heart failure. your breathing improved with increased doses of your diuretic. you were also evaluated by the surgeons who did not think your foot infection looked infected. you should continue to follow-up with your outpatient cardiologist, surgeon, and cardiothoracic surgery team when you are discharged. . we have made the following changes to your medications: - furosemide (lasix) - we have increased this medication from 20mg once a day to 40mg once a day - we held your metformin and pioglitazone while you were in the hospital. you may restart these medications once you return home. - potassium supplementation as before . please return to the hospital if you developed shortness of breath, chest pain, increased lower extremity swelling, changes in your weight, fevers, shaking chills, night sweats, nausea, vomiting, diarrhea, palpitations, or passing out. weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 poounds in 3 days. adhere to 2 gm sodium diet fluid restriction: 1.5 liters a day or about 6 cups per day followup instructions: please follow-up with your surgeon and the lab at your previously scheduled appointments: - provider: lab phone: date/time: 1:00 - provider: , md phone: date/time: 1:45 . cardiology: dr. : please make an appt to see dr. the week of . procedure: application of other wound dressing diagnoses: other iatrogenic hypotension anemia of other chronic disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension aortic valve disorders depressive disorder, not elsewhere classified other specified forms of chronic ischemic heart disease nausea with vomiting other specified cardiac dysrhythmias hypotension, unspecified cardiogenic shock osteoporosis, unspecified fever, unspecified acute on chronic systolic heart failure backache, unspecified disorder of bone and cartilage, unspecified other atherosclerosis of native arteries of the extremities ulcer of heel and midfoot cervicalgia chronic total occlusion of artery of the extremities other amputation stump complication amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to