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: history of present illness: the patient is a 77 year old male with coronary artery disease, status post coronary artery bypass graft in 12/99, with peripheral vascular disease, chronic renal insufficiency and congestive heart failure, who is admitted with left sided chest discomfort today, status post taking lopressor 50 mg for an episode of atrial fibrillation. the patient was in his usual state of health until today when he visited with a visiting nurse who noticed an irregularly irregular pulse. the patient went to congestive heart failure clinic at where he normally goes. he was found to be in atrial fibrillation with a rapid ventricular rate in the 160s. he was given lopressor 50 mg, coumadin 5 mg and advised to discontinue his plavix. he took the lopressor of 50 mg at 5:00 p.m. at 6:00 p.m., he developed chest tightness, neck tightness and left sided chest pain two out of ten. ems found him with a heart rate of 72 and regular, blood pressure 60/palpable. he was brought to the emergency department where he received a bolus of normal saline 500 cc times one and was placed on a dopamine drip. past medical history: 1. coronary artery disease, status post coronary artery bypass graft . 2. peripheral vascular disease, status post right femoral popliteal bypass . 3. temporal arteritis times four years on prednisone. 4. status post right toe osteomyelitis, begun on a six week course of vancomycin . 5. chronic renal insufficiency, baseline creatinine 1.9. 6. status post cholecystectomy. 7. steroid induced glucose intolerance. 8. cataract, status post surgery. 9. anemia. medications on admission: 1. quinidine 324 mg b.i.d. 2. zocor 20 mg q.d. 3. celexa 20 mg q.d. 4. keflex day number seven. 5. coumadin 5 mg day number one. 6. enteric coated aspirin 325 mg q.d. 7. captopril 6.25 mg t.i.d. 8. procrit 20,000 units t.i.week. 9. prednisone 10 mg q.d. 10. iron 325 mg q.d. 11. metoprolol 50 mg b.i.d. day number one. 12. plavix 75 mg q.d. discontinued the day of admission. 13. torsemide. allergies: the patient is allergic to procainamide with gastrointestinal symptoms, amiodarone caused agitation and confusion. intravenous dye caused acute renal failure. the patient is allergic to shellfish. social history: the patient lives at home with his daughter. has a past tobacco history and quit. he has a history of recent increase in his alcohol consumption, three to five drinks per day. his primary care physician is . . cardiologist is dr. and his nurse practitioner . review of systems: the patient denies fever, chills, no cough, no shortness of breath, no paroxysmal nocturnal dyspnea, no orthopnea, no lower extremity edema, no angina, and positive lower extremity cellulitis. the patient says this chest pain is the first chest pain he has had in at least one year and denies any chest pain prior to his myocardial infarction. physical examination: on admission, the patient was resting comfortably in a bed, complaining of mild headache. vital signs revealed pulse 84, blood pressure 95/48 on 5 of dopamine, respiratory rate 24, saturating 96% on two liters nasal cannula. head, eyes, ears, nose and throat examination revealed moist mucous membranes. the neck was supple without jugular venous distention. the lungs were clear to auscultation bilaterally. cardiovascular - regular rate and rhythm, normal s1 and s2, decreased carotid upstroke and jugular venous pressure six centimeters. the abdomen is soft, nontender, nondistended with normoactive bowel sounds. extremities revealed no cyanosis, clubbing with minimal edema. laboratory data: on admission, the patient had white count 8.2, hematocrit 39.9, platelets 258,000. sodium 138, potassium 4.9, chloride 102, bicarbonate 16, blood urea nitrogen 73, creatinine 3.9, glucose 131. inr was 1.1 and partial thromboplastin time was 27.4. the cks initially was 34 and increased to 38 and troponin was 0.3 increasing to 1.4. chest x-ray showed cardiomegaly, small left pleural effusion. electrocardiogram showed normal sinus rhythm at 70 beats per minute with right bundle branch block as well as left anterior fascicular block, q wave v1 through v3 and st depressions 1.0 millimeter with t wave inversions in v1 through v6 which are old. other previous history: the patient has a history of an ejection fraction of 35% with 3+ mitral regurgitation, status post coronary artery bypass graft and aortic valve replacement . coronary artery bypass graft anatomy was left internal mammary artery to the d1, saphenous vein graft to the left anterior descending, saphenous vein graft to the om1 and saphenous vein graft to the posterior descending artery. assessment: the patient is a 77 year old with coronary artery disease, status post myocardial infarction, status post coronary artery bypass graft with aortic valve replacement, paroxysmal atrial fibrillation, dilated cardiomyopathy with ejection fraction of 35% and 3+ mitral regurgitation, 1+ aortic insufficiency, pulmonary hypertension with multiple admissions for right greater than left sided heart failure, status post a recent admission , to the for osteomyelitis complicated by a bacteremia on a six week course of antibiotics, recently discontinued two weeks ago, now admitted with hypotension, chest pain in the setting of a beta blocker, treatment for an episode of rapid atrial fibrillation , and likely a hypovolemic state. 1. cardiovascular - the patient has known coronary artery disease, status post myocardial infarction, coronary artery bypass graft, no angina, with prior myocardial infarction, aura at home over the last year, presents now with complaints of chest discomfort in the setting of atrial fibrillation and hypotension, may be related to atrial fibrillation symptoms or demand ischemia related to decreased blood pressure. troponin and cks were negative on admission. troponin eventually increased to 3.7 possibly consistent with a non q wave myocardial infarction secondary to a demand ischemia from hypotension. his electrocardiogram was unchanged. his hypotension may be secondary to hypovolemia consistent with diarrhea as well as increasing diuretic dose as well as a beta blocker dose given yesterday. the patient is now in normal sinus rhythm. quinidine dose was within normal limits at the clinic yesterday. the plan is to continue aspirin and heparin until rule out myocardial infarction, titrate off dopamine as blood pressure improves with normal saline boluses, hold his ace and diuretic while hypotensive, continue quinidine, hold coumadin if remains in normal sinus rhythm, consider echocardiogram to evaluate for any worsening of function to explain worsening paroxysmal nocturnal dyspnea symptoms and weight gain, continue zocor. 2. pulmonary - pulmonary hypertension reportedly increased right greater than left sided heart failure symptoms. the lungs are clear. saturation within normal limits in room air. 3. renal - chronic renal insufficiency with creatinine around 2.0 at baseline. recently worsening secondary to possibly vancomycin treatment or torsemide. acute renal insufficiency on admission here could be consistent with hypotension in the setting of a prerenal state. 4. infectious disease - the patient has a history of chronic osteomyelitis of the right toes complicated by recent bacteremia. no active infection evident at this time. hypotension may also represent possible sepsis if infection inadequately treated. will send blood cultures, urine cultures. hold antibiotics at this time. 5. gastrointestinal - epigastric discomfort likely secondary to gut edema, abdominal distention from right heart failure, no nausea or vomiting. positive diarrhea in the setting of long antibiotic course. reports recent increase in alcohol use. will send c. difficile, guaiac stools, start zantac, will check liver function tests given history of etoh use. 6. hematology - the patient has chronic anemia on procrit. hematocrit increased on admission likely reflecting dehydration. platelets and coagulation studies are within normal limits. heparin as above. follow hematocrit with hydration. 7. endocrine - on chronic prednisone for temporal arteritis. the patient was given stress dose steroids in the emergency department without effect. will continue standing dose of prednisone. 8. prophylaxis - on zantac and heparin. 9. lines - will place a left a line, peripheral intravenous times two, foley. 10. disposition - full code. hospital course: the patient was stable after admission except for mildly decreased systolic blood pressure with decrease to 70s but responded to a fluid bolus at 4:00 p.m. the patient continued to be in normal sinus rhythm with episodes of atrial fibrillation, continued to be treated on quinidine and anticoagulation was held. the patient was transferred to the floor once he was weaned off dopamine and his creatinine began to decrease. after arrival to the floor on , the patient was placed on telemetry and noted to have a run of 10 beats of asymptomatic ventricular tachycardia at 4:00 a.m. on . the patient also went into atrial fibrillation where he remained throughout the remainder of the evening and morning with rates of between 120 to 160. the patient was felt to have possible benefit from electrophysiology study, possibly with an icd placement. however, since the patient is mainly followed by cardiology at , it was decided to discuss transferring the patient to the . other recommendations that we were considering at this time included changing the quinidine to dofetilide or seeing if the patient can tolerate amiodarone. also we discussed the possibility of placing the patient on heparin drip if he was still in atrial fibrillation after 24 hours. for his coronary artery disease, the patient was continually treated with aspirin and zocor. the patient continued to deny chest pain although he remained in atrial fibrillation with increasing rate on movement around the room. the patient has a history of pulmonary hypertension, however, he continued to have good oxygen saturation in room air. his creatinine decreased throughout the course of the hospital stay, however, it was still 3.2 on , continue to hold his ace inhibitor for now. the patient has a history of osteomyelitis in his right toes. the patient was started on keflex during hospitalization which will be continued for seven days. the patient had complained of some bloated feeling that he says he often gets with his congestive heart failure exacerbation and denies diarrhea. disposition: the patient was decided to be transferred to after attending to attending conversation and the transfer will probably take place in the afternoon of . condition on discharge: guarded. discharge status: transferred to . discharge medications: 1. zocor 20 mg p.o. q.d. 2. celexa 20 mg p.o. q.d. 3. aspirin 325 mg p.o. q.d. 4. procrit 20,000 units monday and friday. 5. iron 325 mg p.o. q.d. 6. zantac 150 mg p.o. q.d. 7. multivitamin one tablet p.o. q.d. 8. quinidine 325 mg p.o. b.i.d. 9. prednisone 10 mg p.o. q.d. 10. keflex 500 mg p.o. b.i.d. times three days. , m.d. dictated by: medquist36 procedure: arterial catheterization diagnoses: other primary cardiomyopathies subendocardial infarction, initial episode of care mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft peripheral vascular disease, unspecified giant cell arteritis 

Answer: The patient is high likely exposed to