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: no known allergies / adverse drug reactions attending: chief complaint: s/p out of hospital cardiac arrest major surgical or invasive procedure: pulmonary intubation history of present illness: 55m with hx of multiple prior mi's including hx of silent mi, remote cabg, recent aaa repair , afib previously on coumadin (off for ~3 months), and dm c/b toe amputation admitted to the ccu s/p initation of post-arrest cooling protocol. the patient was in the passenger seat of his car with his girlfriend and had just left a va appt for lab work. per his girlfriend he slumped over towards her and then became unresponsive. he did not complain of any pain or abnl sxs prior to becoming unresponsive. he was removed from the car to the sidewalk and a code was called. he was initally shocked by pd for vfib and cpr started. he was shocked again x 1 for vfib and intubated pta. he arrived in the ed in pea and cpr was begun. he received epi 1mg with rosc, however he coded again in the ed requiring a 2nd epi 1mg. he was started on a levophed and dopamine gtt and a left subclavian was placed. total down time prior to arrival to the emergency department was approximately 12 minutes. bs echo in ed showed inferior wall hypokinesis (possibly old) and global hypokinesia. . ros: unable to obtain review of systems as he is sedated, intubated, paralyzed and cooled. per his partner, he was not complaining of any symptoms such as fevers, chills, cough, chest pain, sob, doe, abd pain, n/v/d, bleeding from stools or urine, numbness, weakness, or tingling. past medical history: 1. cardiac risk factors: + diabetes, + dyslipidemia, + hypertension 2. cardiac history: s/p multiple mi, one "large" remote mi and multiple other small silent mi's - cabg: per report, remote - percutaneous coronary interventions: unknown - pacing/icd: unknown 3. other past medical history: - aaa repair - iddm with complications - pafib - "forgetfulness" social history: has girlfriend who has lived with him for 35 years. she is his constant companion and does not leave him alone. pt was confused but functional at home, able to go on vacation, out to dinner and shopping with . was independent in adl's before. family history: unable to obtain as patient intubated and sedated physical exam: admission physical examination: vs: general: intubated, sedated, paralyzed with meds. heent: pinpoint pupils neck: supple with jvp difficult to appreciate. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge physical exam general: 74 yo m nad, sitting in chair heent: perrla, no pharyngeal erythema, no lymphadenopathy, jvp non elevated. chest: ls clear post, bs left base. cv: s1 s2 normal in quality and intensity irreg/irreg no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. no rebound/guarding. foley in place ext: wwp, no edema. neuro: disoriented, oriented to person only, recognizes girlfriend and has intact distant memories. mae, strenghts strong () and equal. overall improving skin: no rash, feet with right great toe amputation, intact calluses on left lateral plantar area. psych: improving, poor memory but much less agitated. pertinent results: admission labs: 04:00pm blood wbc-13.0* rbc-4.65 hgb-13.5* hct-41.0 mcv-88 mch-29.1 mchc-33.0 rdw-12.5 plt ct-186 02:05am blood neuts-87.3* lymphs-8.4* monos-3.9 eos-0.1 baso-0.2 04:00pm blood pt-14.1* ptt-24.5 inr(pt)-1.2* 04:00pm blood urean-18 creat-1.5* 08:10pm blood glucose-300* urean-21* creat-1.4* na-135 k-5.4* cl-103 hco3-23 angap-14 08:10pm blood alt-120* ast-175* ld(ldh)-431* alkphos-55 totbili-0.5 04:00pm blood ctropnt-0.01 10:54pm blood ck-mb-25* ctropnt-0.20* 02:05am blood ck-mb-28* mb indx-5.3 ctropnt-0.17* 03:05am blood ck-mb-17* mb indx-8.3* ctropnt-0.08* 08:10pm blood albumin-3.9 calcium-8.0* phos-3.1 mg-1.2* pertinent labs and studies 06:40am blood vitb12-794 folate-13.9 06:40am blood tsh-2.9 04:00pm blood digoxin-<0.2* 04:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:14pm blood glucose-193* lactate-4.8* na-138 k-4.1 cl-101 calhco3-22 c.diff negative x2 urine culture neg blood culture neg sputum gram stain gnr legionella antigen urine negative urine culture negative echo the left ventricular cavity is moderately dilated. there is mild to moderate regional left ventricular systolic dysfunction with akinesis/thinning of the basal half of the inferolateral and severe hypokinesis of the inferior wall. the remaining segments contract normally (lvef = 35 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: left ventricular cavity enlargement with regional systolic dysfunction c/w cad. mild mitral regurgitation. no pericardial effusion. . ct head there is no evidence of acute hemorrhage or mass effect. a hypodensity in the right frontal lobe along the anterior of the right lateral ventricle could represent subacute area of ischemia (2:20). prominence of the ventricles and sulci reflects generalized atrophy. subtle areas of periventricular white matter hypodensity may reflect sequela of chronic small vessel ischemic disease. no concerning osseous lesion or fracture is identified. aerosolized secretions and fluid are seen within the ethmoid air cells and sphenoid sinus as well as within the nasopharynx, consistent with intubation. the maxillary sinuses and mastoid air cells are clear. there are calcifications of the carotid siphons. impression: hypodensity in the right frontal lobe could represent an area of subacute ischemia. . ct chest abd pelvis ct chest: no pulmonary arterial filling defect to suggest pulmonary embolism is seen. the aorta is normal in caliber and configuration without evidence of acute aortic syndrome. there are extensive vascular calcifications involving the coronary arteries and aortic valve. there is moderate cardiomegaly. no pericardial effusion is seen. the lungs demonstrate bilateral dependent opacities, which could represent aspiration. septal thickening is suggestive of pulmonary edema. there is a background of emphysema with upper lobe predominance. no endobronchial lesion is seen. a small amount of secretion/aspiration is seen within the distal trachea extending to the right mainstem bronchus. no lymphadenopathy is identified. an endotracheal tube is in standard position. an esophageal catheter courses into the stomach. a left-sided subclavian central venous catheter is in place with tip in the distal brachiocephalic vein on the left. . ct abdomen and pelvis: there is mild periportal edema. no focal liver lesion is seen. the gallbladder is contracted with small amount of pericholecystic fluid. there is wedge-shaped hypodensity in the lower pole of the leftkidney concerning for renal infarction (3b:158). additionally, in the anteroinferior pole of the right kidney, there is a hypodensity with cortical thinning (3b:160). bilateral rounded renal hypodensities are consistent with simple cysts. the spleen, pancreas and adrenal glands appear unremarkable. loops of small and large bowel are normal in size and caliber. there are dense vascular calcifications. the patient is status post endovascular repair of abdominal aortic aneurysm. hyperdensity external to within the aneurysm sac could represent chronic calcification though endoleak is not entirely excluded (3b:171). distal loops of large bowel and rectum are normal in size and caliber. the bladder is collapsed around a foley catheter. the prostate gland contains punctate calcification, otherwise unremarkable. no free air or abnormal fluid collection is seen. the patient is status post femoral-femoral bypass grafting. a left inguinal testis is partially imaged with adjacent fluid superior to the testis bone windows demonstrate anterior rib fractures involving the second through seventh ribs on the left and the third through seventh ribs on the right. additionally, there is a minimally displaced sternal fracture impression: 1. no evidence of pulmonary embolism or acute aortic syndrome. bilateral dependent opacities could represent aspiration. mild pulmonary edema. 2. hypodensity in the inferior pole of the left kidney concerning for renal infarction. additional ill-defined hypodensity in the anterior inferior pole of the right kidney could represent additional area of infarction of unclear chronicity or chronic scarring. suboptimnal evaluation of the renal vasculature since the abdomen was not imaged with cta technique. 3. bilateral anterior rib fractures and sternal fracture. 4. emphysema. 5. cardiomegaly. no pericardial effusion. 6. status post repair of abdominal aortic aneurysm. high-density material within the aneurysmal sac most likely represents chronic calcification though endoleak is not entirely excluded given lack of non-contrast images. 7. periportal edema and small amount of pericholecystic fluid may be related to fluid resuscitation. 8. left inguinal testis, partially imaged. bilateral le dupplex reason: status post aortobifemoral repair of abdominal aortic aneurysm. evaluate anatomy prior to cardiac catheterization. findings: a duplex was performed of the aortobifemoral graft. there are triphasic common femoral waveforms bilaterally with velocities of 223 on the right and 137 on the left. impression: patent aortobifemoral graft with bilateral anastomosis to the common femoral arteries. normal waveforms. . labs at discharge: 06:05am blood wbc-6.8 rbc-3.43* hgb-10.1* hct-30.6* mcv-89 mch-29.4 mchc-33.0 rdw-13.7 plt ct-372 06:05am blood glucose-110* urean-12 creat-1.1 na-138 k-4.5 cl-104 hco3-27 angap-12 06:05am blood calcium-8.9 phos-3.3 mg-1.8 brief hospital course: 74m with hx of multiple prior mi's including hx of silent mi, remote cabg, recent aaa repair , afib previously on coumadin (off for ~3 months), and dm c/b toe amputation admitted to the ccu s/p initation of post-arrest cooling protocol. . #vfib arrest: pt had ooh vfib arrest without clear precipitating cause. most likely old ischemia leading to scar and vt/vf. ce elevation at admission was thought to be from shocks. upon arrival to the er, he was in pea and received epinephrine with rosc. he was started on levophed and dopamine and hypothermia protocol was initiated for 24 hours with the arctic sun. he was admitted to the ccu for further monitoring. pressors were weaned during the course of his ccu stay and he was extubated. gerontology team and primary ccu team discussed goals of care and appropriate treatment with , his hcp. his outpatient np was also updated on plan. they decided that an icd would not be in his best interest and that continuing to aggressively treat would not be consistent with his goals of care. plan for now is to discharge to rehabilitation, then home when he is able. he will f/u with ep cardiologist dr. in 2 weeks to discuss possible catheterization and ongoing management. he will follow-up with the np who cares for him at the va after he leaves rehabilitation. . # aspiration pneumonia: patient was intubated in the field, findings suggestive of aspiration noted on cxr. he was initially treated with vancomycin and zosyn which he received for 10 days. at discharge, he is off antibiotics and afebrile with normal wbc. . # delerium/dementia: likely occurred in the setting of multiple new medications and severe illness. this has happened during past hospitalizations per his partner . has moderate dementia per geronotology at baseline. was started on seroquel that has helped agitation, the goal is to wean this medication over the next 4 days after discharge as his mental status has been improving. his girlfriend feels that pt is about 90% recovered from his delerium. unclear how much anoxia during his cardiac arrest is contributing to the mental status changes. at discharge, the patient is confused but cooperative, gets frustrated with care but easily redirected. no restraints needed for 4 days. gerontology feels that his prognosis with moderate dementia is 2-3 years. he was continued on his home memantine and donepezil during this admission. . # cad: he has been ruled out for acute ischemia as ekg??????s are not c/w ischemia and elevated cardiac enzymes were likely related to being resuscitated with chest compressions and defibrillation. no new wall motion abnormality on echo. on asa, metoprolol and atorvastatin. benefit from cardiac catheterization in the future if his mental status improves enough to proceed. this will be discussed at his next outpatient appt with dr. . . # acute systolic dysfunction: lvef of 35%. thought vf arrest. no clinical evidence of chf at present time and without known history. he should have daily weights and follow a low sodium diet. at discharge, he is on lisinopril and long acting beta blocker. weight at dsicharge is 89.5 kg. . # rhythm: possible atrial fibrillation at admission with recent hx of pafib off of coumadin for 3 months. at the time of discharge, he is in nsr with freq apc's and pvc's. coumadin was not restarted. qtc at discharge was 0.46 sec. . # cerebral infarct/renal infarct: these appear to be subacute given the radiographic appearance. unclear what the cause is but concern for embolic phenomena from afib. apical thrombus seen on echo (improved from ). also comlicated by possible endovascular leak from aaa repair site seen on ct which vascular has commented on as likely being calcification and not an acute event. neuro has weighed in on brain imaging and agrees it is subacute stroke and recommends no intervention. currently not anticoagulated at discharge. . # sternal/rib fx's: likely secondary to compressions during cpr. occasional complaints of pain, improved with tylenol during admission. . # transaminitis: likely due to cardiac arrest and shock. improved at the time of discharge. . #urinary retention - required a foley catheter during part of his hospitalization for urinary retention. he was able to void at the time of discharge. he also received tamsulosin during this admission which will not be continued at discharge as his urinary retention had resolved. . # htn: bp was elevated during agitation. on metoprolol and lisinopril and bp well controlled at discharge. . # hld: stable. on atrovastatin at discharge. . # insulin dependent diabetes: normally takes 70/30 insulin at home. now on decreased dose because of persistently low fingersticks. at rehab, he should have fingersticks checked before breakfast and dinner and titrate 70/30 dosing as needed. . transitions of care: 1. f/u with dr. at on to re-assess mental status and decide whether pt can undergo further testing for ischemia. health care proxy has refused icd for now 2. fingersticks as above and titrate 70/30 insulin as needed. 3. please schedule appt with , np from va once pt is ready to be discharged from rehab. 4. please consider scheduling appt with , md ( home. 5. please discuss code status in the next few days, would like pt to be full code at present. 6. wean off seroquel in the next 4 days. medications on admission: - amlodipine 10mg po daily - ascorbic acid 500mg po daily - aspirin 81mg po daily - donepezil 10mg po daily - insulin 70/30 (nph/reg) 40u qam 20u qpm - lisinopril 5mg po daily - metoprolol succinate 200mg po daily - niaspan 1000mg po daily - omeprazole 20mg po daily - pravastatin 40mg po daily - metformin 1000mg - vitamin e 500iu po daily *study drug (could be placebo) - memantine 5mg po daily *study drug (could be placebo) discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. donepezil 10 mg tablet sig: one (1) tablet po once a day. 3. insulin nph & regular human 100 unit/ml (70-30) suspension sig: thirty six (36) units subcutaneous once a day: 36 units before breakfast, 15 units before dinner. 4. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 5. metoprolol succinate 200 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day: hold sbp < 90, hr < 55. 6. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 7. memantine 5 mg tablet sig: one (1) tablet po daily (). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 10. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 11. quetiapine 25 mg tablet sig: 0.5 tablet po 2200 (). 12. quetiapine 25 mg tablet sig: 0.5 tablet po daily (daily): in am. 13. outpatient lab work please check chem-7 and cbc on friday discharge disposition: extended care facility: and rehabilitation center - discharge diagnosis: sudden cardiac death from ventricular fibrillation delirium urinary retention aspiration pneumonia acute systolic dysfunction subacute cerebral infact sternal and rib fracture insulin dependent diabetes mellitus discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you collapsed and your heart was in a dangerous rhythm called ventricular fibrillation. you were shocked out of this rhythm. your body temperatuve was cooled to prevent damage to your brain and you are recovering well. you were treated for a pneumonia and you do not need oxygen anymore. we don't know exactly why your heart went into this rhythm but you are too confused to undergo any further testing at this time. you will see dr. in a few weeks to evaluate your ability to undergo testing. you will also be seen by dr. to evaluate your thinking and memory after you are home. your heart is weak after the event, please weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1. stop taking amlodipine, vitamin c, niaspan, vitamin e 2. increase aspirin to 325 mg daily 3. increase lisinopril to 30 mg daily 4. change prevastatin to atorvastatin to lower your cholesterol 5. start taking seroquel to help you stay calm 6. decrease insulin 70/30 to 36 units in the am and 15 untis in the pm followup instructions: department: cardiac services when: friday at 1:40 pm with: , md building: sc clinical ctr campus: east best parking: garage . department: behavioral neurology when: please call after you are home to make an appt with: , md ( campus: east best parking: garage md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: acidosis unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status pulmonary collapse other and unspecified hyperlipidemia closed fracture of sternum pneumonitis due to inhalation of food or vomitus anoxic brain damage long-term (current) use of insulin old myocardial infarction ventricular fibrillation cerebral artery occlusion, unspecified with cerebral infarction examination of participant in clinical trial closed fracture of multiple ribs, unspecified vascular disorders of kidney other specified retention of urine heart disease, unspecified other accident caused by striking against or being struck accidentally by objects or persons dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to