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 / heparin agents attending: chief complaint: weight gain, shortness of breath, volume overload major surgical or invasive procedure: right sided cvl cvvh via femoral line history of present illness: mr. is a 68 yo m with ischemic cardiomyopathy ef < 20%, s/p cabg x2, s/p biv icd recently discharged on for chf admitted with another acute on chronic chf exacerbation. during his recent last hospitalization, we were able to remove several liters of volume but diuresis was limited by advancing azotemia and low blood pressure. he was discharged from the hospital after a minimal diuresis. however, he claims to have felt less bloated and less dyspneic after his treatment. he states that he was doing well after discharge until the last 48-72 hours when he started gaining weight again and having increased shortness of breath. he reports gaining 6 pounds over the last 2 days and reports an increase in abdominal girth/firmness. his weight is 224 pounds currently with a dry weight on discharge of 216 pounds. he did not take any extra doses of lasix at home for this weight gain. his shortness of breath at rest also increased over this same time period. he feels increased dyspnea on exertion as well and as a result feels too weak to walk. he has been making a great effort to reduce the caloric and sodium content in his diet and has come up with an elaborate chart to document his intake. his goal intake is 1200 mg or less of sodium and fewer calories per day. he continues to use his bipap mask at night. otherwise he denies fevers, chills, chest pain, nausea, vomiting, abdominal pain, diarrhea, constipation, hematochezia, melena. he does report recent onset of unsteady gait. . he was a direct admit from home and thus not seen in the ed. past medical history: # cad -s/p mi in , cabg in and redo with porcine mvr4/17/07 -anatomy: lima to distal lad, svbg jump to ladd1 and d3, svbg to om3 - redo coronary artery bypass graft x2 (saphenous vein graft > right coronary artery, saphenous vein graft > interposition to saphenous vein graft> obtuse marginal graft) # chf -severe systolic dysfunction ef 25% # h/o vt -dx in -> had asx vt on tele while hospitalize for urologic tx -single lead icd was placed -had 2-3 episodes of appropriate icd firing -> new lead placed -continued to have shocks -> tried betapace w/o relief -started on amiodarone btw - w/ no further shocks -had biv icd placed in -attempted vt ablation in w/ reload of amiodarone -last shocked: -icd last interrogated: # s/p mitral valve replacement (31mm mosaic porcine valve) # 3+ tr # htn # ckd - baseline mid 2's # dm -insulin dependent # hypothyroidism # hyperparathyroidism # hypercalcemia # osteopenia # hypercholesterolemia # dyspepsia # sleep apnea # obesity # lft abnormalities attributed to nash, possibly amio # hit social history: reports 20 year smoking history of about 1 ppd, quit 30 years ago. very rare etoh use. he is trained as an attorney but works in purchasing companies, predominantly telecommunications and sports teams. married. has 2 adopted boys, aged 18 and 20. family history: mother died of scd in her 40s, though the patient notes that she also suffered from a severe depression at the time and "had lost the will to live". his father died of an mi in his mid 60s. he also has 2 older brothers who have cad and are post-mis. + htn, but no stroke/tia, no cancer and no dm. physical exam: vs: afebrile bp= 115/75 hr= 70 rr= 22 o2 sat= 96% on 2l o2. general: resting comfortably, mild respiratory distress but able to speak in full sentences. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl left pupil slighty larger than right, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, no lad, +jvd below the angle of the mandible sitting at 45 degrees. cardiac: rrr, distal heart sounds, holosystolic murmur most notable in the sternal borders. no thrills, lifts. lungs: well healed midline sternal scar. resp were unlabored, no accessory muscle use. distant breath sounds, crackles at lung bases, no wheezes. abdomen: obese, distended, nontender, no hsm. normoactive bowel sounds. extremities: venous stasis dermatitis bilaterally; cool, dusky extremities which are no different than his baseline. pertinent results: renal us : impression: no hydronephrosis. bilateral simple renal cysts. no obstructing renal stones identified. . ir guided cvl placement : impression: placement of temporary hemodialysis catheter via the right common femoral vein access with the tip of the catheter at the lower ivc and the catheter is ready to use. . unilat upper extremity vein : impression: no evidence for left upper extremity dvt. . labs on discharge: 05:45am blood wbc-8.3 rbc-4.22* hgb-12.8* hct-39.1* mcv-93 mch-30.4 mchc-32.8 rdw-17.3* plt ct-175 05:45am blood glucose-112* urean-77* creat-2.5* na-138 k-4.2 cl-97 hco3-31 angap-14 . labs on admission: 05:35pm blood wbc-10.3 rbc-4.94 hgb-14.9 hct-46.3 mcv-94 mch-30.3 mchc-32.3 rdw-16.2* plt ct-111* 05:35pm blood glucose-205* urean-125* creat-4.4* na-130* k-6.1* cl-93* hco3-25 angap-18 brief hospital course: mr. is a 68 yo m with ischemic cardiomyopathy, ef 20%, s/p cabg x 2, s/p biv icd recently discharged on for chf, directly admitted from home with an acute on chronic chf exacerbation for aggressive diuresis. . # pump: patient has history of acute on chronic systolic heart failure ischemic cardiomyopathy, ef 20%. he is s/p mitral valve repair in with improvement in cardiac function since. now coming in approximately kg above his dry weight. in the ccu, patient was continued on lasix bolus and gtt, along with milrinone bolus and gtt. he was continued on metolazone 5 mg . cvvh was started via r femoral line and continued for several days until it clotted off. through this time, patient was continued on low dose neosynephrine as needed to support blood pressure with goal map of 55. when cvvh line clotted off (), patient was re-initiated on lasix gtt and metolazone with good uop of 100-200 cc/hr. patient was net -15 l fluid removal on discharge. patient was continued on bb to prevent ectopy. ep was contact about the possibility of lv pacing, as patient has severe lv/rv dysynchrony on echo. it was felt that given his nyha class iv status as well as prior use of lv pacing which was not very successful, the risks outweighed the benefits. however, patient's pacemaker hr was increased to 90 to improve forward flow. patient approached new dry weight of 110kg (came in at 121 kg). his k+ goal was kept near 5-5.5 with aggressive supplementation. on discharge, patient told to stop his lasix (160 mg ) and carvedilol (25 mg ). instead, he will take torsemide (80 mg ) and metoprolol succinate (50 mg daily in am). he was also discharged on potassium supplements 40 meq tid. patient was informed to check his weights on a daily basis, nutrition care was discussed with patient as well. if patient starts gaining weight (i.e. lbs), he is to take metolazone 5 mg tablet and call clinic. he has f/u with on in clinic. . # coronaries: extensive history of cad s/p cabg x 2, last cath in with lima widely patent, svg to om with proximal 30% stenosis, svg jump graft to d1 and distal diag patent. no acute issues. patient was continued on asa 81, lipitor 20. no acei given acute on chronic renal failure. . # rhythm: currently in nsr on admission, has biv ppm/icd. does have h/o vt with icd firing provoked by k <4.8. monitored on telemetry without events, continued on bb to prevent ectopy, and continued on amiodarone. biv icd rate was increased to 90 to increase forward flow, as noted above. . # acute on chronic renal failure - likely combination of chronic systolic heart failure and poorly controlled dm, baseline creatinine 2.4-2.9. on discharge, cr was 2.5. as above, pt was continued on cvvh for diuresis via r femoral line. renal us showed no obstructive cause for elevated cr. lisinopril and aldactone were held in setting of arf on ckd. . # hypokalemia - potassium 6.1 on admission, but for most of admission potassium level was repleted with approximately 100-150 meq per day, given aggressive diuresis. his goal k+ was between 5 and 5.5. on discharge, patient to take 40 meq potassium tid. . # type ii dm - hba1c 3/09=7.5, 8/09=9.2; followed by dr. of the but not recently. patient was continued on outpatient regimen of 75/25 45 units qam, 50 units qpm with nph 45 units at bedtime, with good control. . # hypothyroidism - continued on home dose levothyroxine . # osa - patient kept on his cpap at night. his settings were adjusted and he transitioned to a full face cpap, as per respiratory therapy. . # anxiety - continued home dose ativan prn and ambien for sleep. . # left hand swelling - one episode of left hand swelling, resolved the next day. lue us was negative for dvt. medications on admission: allopurinol 100 mg tablet 1 (one) tablet(s) by mouth once a day amiodarone 200 mg tablet 1 tablet(s) by mouth daily atorvastatin 20 mg tablet 1 tablet(s) by mouth daily carvedilol 12.5 mg tablet 1 tablet(s) by mouth twice daily cinacalcet 30 mg tablet 1 (one) tablet(s) by mouth daily digoxin 125 mcg tablet one tablet(s) by mouth every other day on hold as of folic acid 1 mg tablet one tablet(s) by mouth daily furosemide 80 mg tablet two tablet(s) by mouth twice a day on hold asof8/18/09 gabapentin 300 mg capsule 1 capsule(s) by mouth daily insulin lispro protam & lispro dosage uncertain isosorbide mononitrate 30 mg tablet sustained release 24 hr 1 tablet(s) by mouth once a day levothyroxine 175 mcg tablet 1 tablet(s) by mouth once a day lorazepam 0.5 mg tablet 1 tablet(s) by mouth q6 as needed for anxiety metolazone 5 mg tablet 1 tablet(s) by mouth three times per week on hold as of nitroglycerin 0.4 mg tablet, sublingual 1 to 2 tablet(s) sublingually as needed oxycodone-acetaminophen 5 mg-325 mg tablet one or two tablet(s) by mouth every 6 hours as needed for pain pantoprazole 40 mg tablet, delayed release (e.c.) 1 (one) tablet(s) by mouth once a day potassium chloride 10 meq tab sust.rel. particle/crystal 4 tab(s) by mouth three times a day for severe low k+ on hold as of sertraline 100 mg tablet 1 tablet(s) by mouth once a day spironolactone 25 mg tablet 1 tablet(s) by mouth twice a day zolpidem 10 mg tablet one tablet(s) by mouth hs aspirin 81 mg tablet, delayed release (e.c.) one tablet(s) by mouth daily cholecalciferol (vitamin d3) 400 unit capsule 2 capsule(s) by mouth once a day discharge medications: 1. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 4. gabapentin 100 mg capsule sig: one (1) capsule po hs (at bedtime). 5. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. sertraline 100 mg tablet sig: one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for sleep. disp:*30 tablet(s)* refills:*0* 10. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 14. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 15. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 16. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 17. metolazone 5 mg tablet sig: one (1) tablet po once a day as medication. disp:*30 tablet(s)* refills:*0* 18. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. disp:*30 tablet(s)* refills:*0* 19. insulin lispro protam & lispro 100 unit/ml (75-25) suspension sig: 45 units at breakfast, 50 units at dinner units subcutaneous once a day. 20. insulin nph human recomb 100 unit/ml suspension sig: 25 units at bedtime units subcutaneous once a day. 21. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po three times a day: please take 40 meq potassium supplements three times a day. 22. torsemide 20 mg tablet sig: four (4) tablet po twice a day. disp:*240 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: acute on chronic congestive heart failure discharge condition: stable, ambulatory discharge instructions: you were admitted to the hospital for fluid overload due to your known congestive heart failure. you underwent aggressive diuresis in the ccu and were able to put out a total of 15 liters of fluid. diuresis was stopped when you reached your new dry weight of 110 kg. please weigh yourself every morning and call your doctor if your weight increases by more than 3 lbs. adhere to a 2 gm sodium diet and try to restrict your fluids. . medication changes: 1. take potassium supplements 40 meq three times a day 2. stop carvedilol (coreg) 3. stop lasix 4. start metoprolol succinate 50 mg daily 5. start torsemide 80 mg twice a day 6. take metolazone 5 mg if your weight starts to increase (for example, if your weight goes up by lbs, take 5 mg metolazone and call the clinic). . please seek medical attention for increasing shortness of breath, chest pain, abdominal pain, increasing weight (as noted above), or any other concerns. followup instructions: please follow-up with the appointments listed below: . provider , : date/time: 10:30 . provider , m.d. date/time: 12:10 procedure: hemodialysis venous catheterization for renal dialysis diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status hypopotassemia chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease anxiety state, unspecified long-term (current) use of insulin automatic implantable cardiac defibrillator in situ heart valve replaced by transplant acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to