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: dilantin kapseal / sulfa (sulfonamide antibiotics) / tegretol / fentanyl / thiopental / succinylcholine / vecuronium bromide attending: chief complaint: weight gain major surgical or invasive procedure: picc line placement milrinone infusion admission to the cardiac intensive care unit right heart catheterization history of present illness: mr. is 77m with h/o systolic and diastolic chf, a-fib, cardiac amyloidosis, and multiple myeloma transferred from initially for volume overload and need for lasix drip and chemotherapy. the patient was recently discharged from on , at which time rv biopsy demonstrated cardiac amyloidosis, as well as a bone marrow biopsy with e/o multiple myeloma. echo showed e/o new systolic heart failure on top of preexisting diastolic heart failure and is s/p cardiac catheterization with e/o 50% left main disease, 50% lad stenosis. since discharge, the patient reports weight gain, as well as doe. he denies orthopnea, pnd, palpitations, syncope or presyncope. he waited until he was seen by dr. on where he was noted to have elevated jvd and 3+ le edema. lasix was switched to torsemide 40mg with continued spironolactone 50mg daily. when he initially presented to , the patient was noted to have change in mental status that was attributed to uremia, , and medication side effect from torsemide. he also had a bandemia of 9% and was initially treated for a potential uti. his cxr showed recurrent right pleural effusion. he was treated for acute on chronic systolic and diastolic heart failure with iv lasix but of note this was limited by his bp's. weight prior to discharge from 105kg. while on the service, the patient was being diuresed on lasix drip 30 mg/hour, with diuresis limited by increasing creatinine. after discussion with dr. , it was thought that the patient could benefit from milronone drip in the setting of having a swan placed to measure his wedge and his co. the patient also has an element of systolic failure, which could also be improved with milronone. on transfer to the floor, the patient reports feeling well. past medical history: afib on coumadin diastolic heart failure (ef 60-65%) osa gout gerd with barrett's esophagus hiatal hernia elevated psa erectile dysfunction s/p cholecystectomy () s/p right hip replacement () s/p tailers bunion, fascia release, prosthesis (left foot) () s/p deviated septum repair () s/p tailers bunion removal () s/p multiple laminectomies (, , ) s/p tendon repair right arm () s/p hemorrhoidectomy () s/p pilonidal cyst removal () s/p appendectomy () s/p bone removal left foot () s/p tonsillectomy () social history: the patient is married and worked in the import business and worked for the navy in the shipyards. he never smoked. family history: positive for hay fever. physical exam: admission exam: vs - 97.9 117/63 72 18 98% on ra 105.7kg general - chronically ill appearing male in nad, comfortable, slightly short of breath while speaking heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, jvp at 12, no carotid bruits lungs - bibasilar crackles heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - +bs, soft, nt, distended, no masses or hsm, no rebound/guarding extremities - wwp, 3+ pitting le edema to upper thighs, 2+ peripheral pulses (radials, dps) neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout discharge exam: 24hr i/o: 1236/1620 87.6 ->88 ->89.1 general: well nad,pleasant, well appearing, elderly gentleman in nad, laying comfortably in bed heent: eomi, perrla, no cerivcal lymphadenopathy, 12cm jvp lungs: fine crackles at right base, no wheezing, rhonchi heart - pmi non-displaced, rrr, ii/vi systolic murmur at apex, nl s1-s2, abdomen - +bs, soft, nt, distended, no masses or hsm, no rebound/guarding extremities - 1+ pitting edema to calves, 2+ peripheral pulses (radials, dps), picc line in right arm w/o errythema or tenderness. neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout pertinent results: admission labs: 11:39pm blood wbc-10.8 rbc-3.43* hgb-11.1* hct-35.0* mcv-102* mch-32.3* mchc-31.6 rdw-15.7* plt ct-194 11:39pm blood neuts-80.9* lymphs-8.5* monos-9.1 eos-1.0 baso-0.5 11:39pm blood pt-25.4* ptt-37.9* inr(pt)-2.4* 11:39pm blood glucose-119* urean-50* creat-1.6* na-138 k-4.3 cl-98 hco3-30 angap-14 04:20pm blood ck(cpk)-31* 04:20pm blood ck-mb-4 ctropnt-0.14* 11:39pm blood calcium-8.7 phos-3.5 mg-2.4 transfer labs: 03:45pm blood pt-27.2* inr(pt)-2.6* 03:10pm blood glucose-100 urean-81* creat-2.3* na-135 k-4.0 cl-91* hco3-31 angap-17 03:10pm blood calcium-8.9 phos-4.8* mg-2.6 11:19am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 11:19am urine rbc-1 wbc-3 bacteri-few yeast-none epi-0 11:19am urine hours-random creat-37 na-74 k-38 cl-88 discharge labs: 04:26am blood wbc-15.9* rbc-3.02* hgb-9.2* hct-28.3* mcv-94 mch-30.4 mchc-32.4 rdw-16.1* plt ct-233 05:32am blood pt-22.4* ptt-36.2 inr(pt)-2.1* 04:26am blood glucose-118* urean-66* creat-1.7* na-131* k-4.6 cl-93* hco3-29 angap-14 06:40am blood alt-22 ast-22 alkphos-93 totbili-0.9 04:26am blood calcium-8.7 phos-3.1 mg-2.3 blood culture, routine (final ): no growth. urine culture (final ): no growth. kappa/lamda: test result reference range/units free kappa, serum 20.0 h 3.3-19.4 mg/l free lambda, serum 2.7 l 5.7-26.3 mg/l free kappa/lambda ratio 7.41 h 0.26-1.65 cardiac cath report : elevated right- and left-sided filling pressures, moderate pulmonary arterial hypertension in the setting of left-sided heart failure, large v waves suggestive of moderate to severe mitral regurgitation. normal cardiac output and index. ekg atrial fibrillation. right bundle-branch block. left axis deviation. left anterior fascicular block. old inferior myocardial infarction. compared to the previous tracing of no significant changes are noted. intervals axes rate pr qrs qt/qtc p qrs t 70 0 148 440/457 0 -70 107 cxr : as compared to the previous radiograph, the patient has received a swan-ganz catheter. the catheter needs to be pulled back given that the tip is projecting over distal parts of the right pulmonary artery. an opacity that pre-existed at the bases of the right upper lobe is no longer visible. however, the lung volumes have decreased and a small pleural effusion is unchanged at the right lung base. unchanged moderate cardiomegaly. the right picc line is constant in position. renal ultrasound: 1. no hydronephrosis. simple bilateral renal cysts. 2. right pleural effusion and trace of ascites seen in the right upper quadrant. 3. arterial and venous flow is documented within each of the kidneys, however, further doppler analysis cannot be performed as the patient is unable to hold his breath. social work: family has met w/ palliative team and wife expresses that the conversation is "premature". pt and wife have not signed dnr and still solidifying long-term plans. pt, wife and are aware of life expectancy ( mos) and reiterated to sw and physician that pt is going to optimize highest level of care and the priority is to be at home. pt and family met w/ infusion home care co. as an option for next steps. physician communicated to pt/family that pt will be consulted on recommendations for home vs rehab. family and pt are continuing to explore all options and continue to look into rehab's that can manage current medications however family has reiterated that going home is their first preference. assessment: family and pt is experiencing difficult adjustment to illness and next steps on the best approach for pt. sw provided empathic listening, guidance on resources that are available, and encouraged pt and family to continue to utilize clinicians to help make an informed decision on where pt should transition to next. brief hospital course: mr. is 77m with history of atrial fibrillation on coumadin, systolic and diastolic heart failure, cardiac amylodosis, and multiple myeloma who initially presented from osh with weight gain and need aggressive iv diuresis, requiring ccu admission for initiation of milrinone drip. . # acute on chronic systolic and diastolic heart failure: patient with baseline restrictive disease secondary to his cardiac amyloid. also with systolic chf first seen with rv free wall hypokinesis. he presented with diffuse peripheral edema, worsening abdominal distention and jvp elevated to 12 cm, consistent with right sided failure. he also presented with right pleural effusion that represented transudate chf. he was initially diuresed with lasix drip and metolazone with good effect, but was stopped after increasing creatinine. he was then transferred to the icu for diuresis with milrinone for inotropic effect and pulomary vasodilation allowing right sided unloading. his right heart pressures were monitored by swan-ganz cath with pa pressure 50 to 40s and wedge pressures of 28 to 19 after administartion of milrinone. he diuresed well in the ccu, was transfered to the floor, but after weaning milrinone, he required reinitiation of milrinone in the ccu due to drop off in energy level, urine output an reaccumulation of fluid. he tolerated reinstitution of milrinone infusion well and was transferred to the floor. he was also continued spironolactone and torsemide after period of autodiuresis from ended. over the course of the hospitalization he lost about 40lbs. his discharge weight was roughly equivalent to his dry weight at 89.1 kg (196 lbs). he was counseled on the importance of daily weights and chf management. he will follow up with dr. in cardiology clinic. . : pt developed in the setting of aggressive diuresis. nephrology was consulted and felt this was likely atn vs pre-renal due to hypoperfusion. it was unlikely a sequelae of mm or amyloid as no protein was found in the urine. after discontinuing lasix gtt, he autodiuresed. upon discharge, his creatinine returned to his baseline of 1.7. . community acquired pneumonia: pt developed cough and leukocytosis with cxr findings of right upper lobe infiltrate. he was treated with ciprofloxacin and then levofloxacin caused him to have a supratherapeutic inr above 5. for the remainder of 10 day abx course, his coumadin was held. . # cardiac amyloidosis with restrictive myopathy: the patient has history of cardiac amyloidosis confirmed on rv biopsy, and has resulting restrictive heart disease, with subsequent r sided dilation and r sided heart failure as above. . # multiple myeloma: during his last admission, patient was found to have a monoclonal kappa band and severe hypogammaglobulinemia on spep/upep. he underwent bone marrow biopsy which showed 40% plasma cells. abdominal fat pad biopsy both performed , revealed no amyloid but rv cardiac biopsy was positive for amyloid. he also continued dexamentasone/velcade treatment while inpatient. cycle4 day8 velcade administration on . will continue treatment with dr. . . # coronaries: the patient has history of 3vd s/p nstemi during his last admission. cath from that admission with e/o 50% left main disease, 50% lad stenosis. it was decided that the patient was too high risk for cabg, as well as pci given his amyloidosis and was discharge on medical management of his cad. he was continued on atorvastatin 80 mg daily, asa 162 mg daily, metoprolol 12.5 mg . . # afib: stable. chads score of 2 (age and chf). he was continued on coumadin for goal inr of 2.0-2.5 given for increased risk of bleeding with amyloid. during the hospital course, he reached a supratherapeutic inr ~5 after fluoroquinolones were addded. his coumadin was held for a few days and restarted to maintain appropriate anticoagulation. he will continue inr checks and coumadin management through dr. office. . # bph: stable, continued doxazosin . # gerd/barrett's/hiatal hernia: stable, continued omeprazole, home tums . # depression/sleep: stable, continued amitriptyline, zolpidem. . # gout: stable, continued allopurinol, colchine, tramadol prn . transitional issues: -cycle4 day8 velcade administration on . will f/u with dr. monitored by dr. not amenable to palliative care now -patient is a full code -?depression versus adjustment reaction with depression -discharge and dry weight 89.1 kg (196 lbs). medications on admission: preadmission medications listed are correct and complete. information was obtained from patientwebomr osh records. 1. atenolol 12.5 mg po daily 2. aspirin 162 mg po daily 3. calcium carbonate-vitamin d3 *nf* 500mg (1,250mg) -600 unit oral qam 4. multivitamins 1 tab po daily 5. torsemide 40 mg po bid 6. omeprazole 20 mg po bid 7. spironolactone 50 mg po daily 8. amitriptyline 30 mg po hs 9. doxazosin 4 mg po hs 10. zolpidem tartrate 5-10 mg po hs 11. allopurinol 100 mg po qhs 12. colchicine 0.6 mg po hs 13. guaifenesin dose is unknown po frequency is unknown 14. warfarin 5 mg po daily16 15. tramadol (ultram) 50 mg po qid pain 16. nitroglycerin sl 0.3 mg sl prn cp 17. gaviscon *nf* ( -mg tr-alg ac-sod bicarb;<br>aluminum hydrox-magnesium carb) 80-14.2 mg oral prn indigestion discharge medications: 1. hospital bed 2. milrinone 0.26 mcg/kg/min iv infusion rx *milrinone in d5w 20 mg/100 ml (200 mcg/ml) 0.26 mcg/kg/min continuous infusion disp #*1 mutually defined refills:*12 3. amitriptyline 30 mg po hs 4. aspirin 162 mg po daily 5. gaviscon *nf* ( -mg tr-alg ac-sod bicarb;<br>aluminum hydrox-magnesium carb) 80-14.2 mg oral prn indigestion 6. multivitamins 1 tab po daily 7. omeprazole 20 mg po bid 8. spironolactone 12.5 mg po daily rx *spironolactone 25 mg 0.5 (one half) tablet(s) by mouth daily disp #*30 tablet refills:*3 9. torsemide 40 mg po daily rx *torsemide 20 mg 2 tablet(s) by mouth daily disp #*60 tablet refills:*3 10. warfarin 4 mg po daily16 rx *warfarin 2 mg 2 tablet(s) by mouth daily disp #*60 tablet refills:*3 11. zolpidem tartrate 10 mg po hs:prn sleep 12. milk of magnesia 30 ml po q6h:prn constipation rx *milk of magnesia 400 mg/5 ml 30 ml(s) by mouth every 6 hours disp #*1 bottle refills:*3 13. sarna lotion 1 appl tp daily:prn itchy rx *sarna anti-itch 0.5 %-0.5 % apply to itchy skin daily disp #*1 bottle refills:*3 14. senna 1 tab po bid:prn constipation rx *senna 8.6 mg 1 tablet by mouth twice daily disp #*60 tablet refills:*3 15. simethicone 40-80 mg po qid:prn bloating rx *simethicone 80 mg 1-2 tablets by mouth four times a day disp #*120 tablet refills:*3 16. calcium carbonate-vitamin d3 *nf* 500mg (1,250mg) -600 unit oral qam 17. nitroglycerin sl 0.3 mg sl prn cp 18. allopurinol 100 mg po qhs 19. outpatient lab work inr check on with results faxed to dr. at . icd-9 427.31 discharge disposition: home with service facility: discharge diagnosis: primary -acute on chronic systolic heart failure -amyloidosis with restrictive myopathy -multiple myeloma -community acquired pneumonia -hyponatremia -acute kidney injury -atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure caring for you while you were at . you were admitted for treatment of your congestive heart failure. our testing suggested this was a result of the effects on your heart from your multiple myeloma. you were started on a medication called milrinone that helped your heart pump better and given medications to help you urinate off all the excess fluid. your weight was decreased by about 40 pounds. we tried to stop the milrinone infusion, but your clinical picture worsened without this medication and it was determined that you will need it chronically infusing from now on. home services to assist with this have been set up for you. you also continued to recieve therapy for your multiple myeloma while and inpatient and will continue to see dr. as an outpatient. you were discharged on diuretics (torsemide) in order to keep your weight down. your discharge weight was 89.1 kg (196 lbs), you should call dr. office at if you notice your daily weight goes up by more than 3 lbs in a day or if you notice worsening swelling in your legs, shortness of breath while walking or any other symptoms that concern you. followup instructions: department: cardiac services when: tuesday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/bmt when: tuesday at 3:30 pm with: , np building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: tuesday at 3:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: pulmonary artery wedge monitoring injection or infusion of cancer chemotherapeutic substance pulmonary artery pressure monitoring central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery esophageal reflux acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified hyposmolality and/or hyponatremia gout, unspecified atrial fibrillation other chronic pulmonary heart diseases depressive disorder, not elsewhere classified diaphragmatic hernia without mention of obstruction or gangrene alkalosis old myocardial infarction long-term (current) use of anticoagulants multiple myeloma, without mention of having achieved remission acute on chronic combined systolic and diastolic heart failure other amyloidosis nutritional and metabolic cardiomyopathy 

Answer: The patient is high likely exposed to