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: lipitor / lisinopril / iodine / paper tape attending: chief complaint: dypsnea major surgical or invasive procedure: right ij central line history of present illness: 68 yo female with a history of htn, cad s/p cabg, cri, dm, chf ef 20% now presents with dypsnea and weakness. she was admitted for a chf exacerbation, was diuresed 5l and discharged with many adjustments to her medications including changing lasix to torsemide and adding imdur. she left the hospital without reviewing the medication list with the rn and without prescriptions. many attempts were made to contact the patient since discharge but were unsuccessful. over the past few days she was noted by her husband to be have profound fatigue and moderately worse dyspnea. . her husband called ems and she was brought to , sbp 102/52, hr 56, 98%2l. her labs were notable for bnp 3270, trop 0.48, cr 4.4, hct 26.5. she was given 40mg iv lasix and reported minimal urine output. transferred here. in ed sbp 70s, hr 50s, 97%2l. a rij placed, dopamine @ 5 started in ed. given dose of aspirin. no additional lasix given. ekg without changes from prior. cxr showed no pulmonary edema but did show small ptx. . labs notable for new arf 4.2 (from 2.0), na 129, trop 1.09, lactate 3.4, mildly positive u/a for which she received 1 dose of ceftriaxone. . 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. she reports nausea in ed. does report loose stools x1 day. denies abdominal pain. . cardiac review of systems is notable for absence of chest pain. does report dypsnea on exertion, denies paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cad s/p 4v cabg in with lima-lad, svg-diag (known occluded), svg-om1, and svg-rca; non-sustained vt on tele s/p cabg, had intervention to the lima-lad anastamosis in with cypher stent at the anastomosis; cath'd most recently in with instent restenosis of lima-lad prior cypher stent that was successfully treated with taxus stent. 2. dm2 since 3. hypercholesterolemia 4. osteoarthritis: b/l shoulder, knee arthritis with intermittent effusions, rf +; also djd of both knees and l thumb, s/p tkr of l knee 5. dyspnea on exertion x years, followed by cardiology and pulmonology, thought to be most likely related to ischemic cardiomyopathy and cad 6. chf (ef 20-30%) . 1+ mr, 1+tr. small atrial secundum defect 7. hypertension 8. asthma 9. uterine fibroids, has had peri-menopausal spotting, received hrt 10. history of occult blood positive stool 11. myelodysplastic syndrome- wbc 2.0 12. cataracts 13. icd social history: social history is significant for the absence of current tobacco use. she previously smoked ~1 ppd but quit 10 years ago. denies current etoh use. she lives with her husband. they previously owned a restaurant called pit stop bbq. she has four children, one of whom is deceased. family history: mother had dm and cad, but died at 79 from lung ca. father died of an accidental death, but had a h/o cad. physical exam: vs: t=97.3 bp 97/54 hr 72 rr 18 99%2l cvp 23 general: middle aged aa 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. . neck: supple, jvp difficult to assess rij cardiac: normal s1, s2. mild holosystolic murmur heard best at apex lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 1+ edema to ankles bilaterally, warm well perfused skin: marked hyperpigmentation of legs, arms, buttocks, back pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: ekg: v paced rate 58, rbbb, lad, twi v1-v2 (old), st depression v5-6 (old), q waves ii, iii, avf . 2d-echocardiogram: severe global biventricular dilatation and hypokinesis. ef 20-25%. diastolic dysfunction. at least mild mitral regurgitation. mild aortic regurgitation. \asd with left to right flow. . cxr: small left pneumothorax. new right internal jugular catheter. . laboratory data: wbc 2.2 hct 26 plts 102 129 / 91 / 104 / 235 agap=17 ------------ 4.7 / 21 / 4.2 d lactate 3.4 bnp: ck 59 trop 1.09 . u/a: 3-5wbcs, trace leuks, mod bacteria, trace ketones, 100 protein brief hospital course: 68 yo female with h/o cad s/p cabg, dm, asthma, presents with worsening sob and fatigue. . systolic congestive heart failure: pt presents with increasing dypsnea, bnp 57,925 and evidence of fluid overload on exam with jvp to 12cm-all suggesting a low output state. low output state is also likely exacerbated by her anemia and asd. she was started on dopamine as well as lasix drip. central access was obtained on admission and discontinued on . lasix and dopamine drips were weaned following a modest diuresis. she was discharged on increased dose of torsemide and started on hydrochlorothiazide, with oupatient follow up scheduled. . coronary artery disease: on admission, she was without chest pain, ekg unchanged, trop 1.07 likely in setting of acute renal failure. she was continued on aspirin, plavix. her beta blocker was temporarily held. . fatigue: she was admitted with significant fatigue that was most likely multifactorial secondary to chronic heart failure, anemia and myelofibrosis. she was transfused 1 u prbcs, with significant releif of symptoms. . acute on chronic renal failulre: she had a creatinine of 4.2 on admsission, thought to be likely related to poor forward flow in the setting of a chf exacerbation. her creatinine improved with diuresis and was 1.6 on discharge. . pneumothorax: she developed a pneumothorax following rij line placement. this was followed by serial chest x-rays and resolved spontanously. . diabetes: diet controlled at home, she was started on an insulin sliding scale in house. . asthma: she was continued on her home nebs . myelofibrosis: she has chronic amemia and a 26 mo prognosis from myelofivrosis. she is on aranesp injections weekly at home, last documented and missed recent appts. she has a chronically low hct and, as a consequence, has been transfused previously. likely part of her fatigue/weakness may be profound anemia. she was transfused with 1 u prbcs. medications on admission: albuterol 2 puffs q4h prn plavix 75mg daily fluticasone 110mcg 2puffs torsemide 40mg toprol 25mg daily nitro 0.3mg prn aspirin 325mg daily mvi trazodone 25mg qhs digoxin 125 mcg qdaily (per d/c summary should be mwf) spiriva 18mcg capsule i inh daily docusate sodium 100mg pravastatin 40mg daily imdur 30mg daily discharge medications: 1. torsemide 20 mg tablet sig: three (3) tablet po twice a day. disp:*180 tablet(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 5. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 10. epogen injection 11. danazol 200 mg capsule sig: two (2) capsule po twice a day. 12. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 13. spironolactone 25 mg tablet sig: one (1) tablet po once a day. 14. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia. 15. nitroglycerin 0.4 mg tablet, sublingual sig: 1-3 tabs sublingual q 5 minutes x3 as needed for chest pain: call 911 if you still have chest pain after 3 doses. 16. hydrochlorothiazide 12.5 mg tablet sig: one (1) tablet po once a day: please take 30 minutes before am dose of torsemide. disp:*30 tablet(s)* refills:*2* 17. isosorbide mononitrate 30 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* 18. digoxin 125 mcg tablet sig: one (1) tablet po every monday, wednesday and friday. disp:*12 tablet(s)* refills:*2* 19. spironolactone 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 20. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po once a day. disp:*60 capsule, sustained release(s)* refills:*2* 21. outpatient lab work please check k, bun, creatinine, hct on and call results to dr. at and dr. at discharge disposition: home with service facility: vna discharge diagnosis: acute on chronic systolic congestive heart failure: held increased creatinine, will be restarted after d/c. acute renal failure acute on chronic renal failure myelodysplastic syndrome discharge condition: bun=89 creat=2.0 k=3.8 hct=29.6 discharge instructions: you had an exacerbation of your congestive heart failure that caused you to become short of breath. we have adjusted your medicines and you will be seen in the congestive heart failure clinic here. medicine changes: 1.torsemide was increased to 60 mg twice daily 2. hydrochlorothiazide was started to take before first am dose of torsemide 3. digoxin, spironolactone and isosorbide were continued. please stop taking: 1. furosemide 2. metformin weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet, information was given to you at discharge. fluid restriction: 1.5 liters per day or about 7 eight ounce cups. . please check your blood sugars daily before lunch and keep a log to show to your doctors. . please call dr. if you have more trouble breathing, fluid retention, unusual fatigue, chest pain or any other unusual symptoms. followup instructions: cardiology: provider: , : date/time: 9:30 provider: , .d. phone: date/time: 3:00 primary care: provider: , m.d. date/time: 11:00 procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery 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 hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status asthma, unspecified type, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified myelodysplastic syndrome, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iatrogenic pneumothorax acute on chronic systolic heart failure myelofibrosis osteoarthrosis, unspecified whether generalized or localized, lower leg osteoarthrosis, unspecified whether generalized or localized, shoulder region 

Answer: The patient is high likely exposed to