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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: colonoscopy on egd history of present illness: 85 f with cad s/p cabg, copd, diastolic chf, htn, afib on coumadin, hypercholesterolemia, hypothyroidism, and obstructive sleep apnea presented to the ed with increasing sob over the past week. patient was in her usoh until when she had a fall resulting in r shoulder dislocation. a week later, she returned to the ed with increased r shoulder pain and chest tightness. she was admitted for r/o mi, found to be in atrial fibrillation and was started on rate control and coumadin. she was discharged to a for a month. since then, she has been living with her daughter. pcp saw her for anti-coagulation f/u on and her hct 29 and inr 1.9. on , inr 6.2 and coumadin was held. over the past week, the patient had increased sob when walking and no sob at rest. she has orthopnea, c/o occasional chest tightness, decreased appetite, and nausea. no vomiting, no abdominal pain, and no brbpr. she had a productive cough and was started on bactrim the day prior to admission. past medical history: 1. hypertension 2. cad d/p 3v cabg 3. hypercholesterolemia 4. hypothyroidism 5. copd on 2lnc at home 6. osa on bipap 7. ? insulin resistance. 8. obesity social history: lives alone, worked as a waitress, 160 pack year smoker, quit 15 years ago, rare etoh family history: h/o thalassemia in family physical exam: physical exam: tmax 100.5 tc 97.8 hr 94; 82-95 bp 137/50's; 101-183/36-69 96-98% 4l nc i/o: 1595/800 (+800), yesterday (-500) gen: pale, appearing stated age, conversant but difficulty hearing and does not respond reliably to questions. skin: 5x5cm ecchymoses on l forearm heent: eomi, peerl, dry oral mucous membranes neck: r ij line removed & dressing over site c/d/i, no cervical lad cv: irregular rate & rhythm, holosystolic murmur, ventricular lift pulm: scattered rhonchi throughout, no wheezes, mild bibasilar crackles abd: protuberant, soft, non tender, no masses, no hsm extr: no edema, warm, well perfused. unable to lift r upper arm above head, no tenderness of r rotator cuff neuro: aox3 can state name "chickie," date , place hospital. 3+ biceps reflexes bilaterally, 2+ patellar reflexes. intact sensation to light touch. 4/5 strength bilaterally on ue and le. pertinent results: admission labs: 06:00pm wbc-7.6 rbc-2.50*# hgb-4.8*# hct-15.7*# mcv-63* mch-19.4* mchc-30.9* rdw-18.5* 06:00pm calcium-8.5 06:00pm glucose-125* urea n-26* creat-1.3* sodium-136 potassium-4.7 chloride-104 total co2-20* anion gap-17 . discharge labs: 07:20am blood wbc-11.9* rbc-3.75* hgb-8.9* hct-28.1* mcv-75* mch-23.6* mchc-31.6 rdw-24.4* plt ct-316 . imaging: cta chest: 1. cardiomegaly with chf and interstitial edema. 2. right lower lobe infiltrate consistent with pneumonia. 3. no evidence of pe or aortic dissection. 4. 5-mm right upper lobe nodule; follow-up ct within 12 months recommended to assess for stability. 5. multiple ulcerated plaques within the descending aorta. 6. cholelithiasis without evidence of cholecystitis. however, the assessment of the gallbladder is extremely limited given the absence of iv and oral contrast. 7. diverticulosis, without evidence of diverticulitis. . cxr: the patient is status post cabg. cardiac and mediastinal contours are stable. there are bilateral interstitial opacities, worse compared to the previous exam. there is no pleural effusion demonstrated on this frontal view. there is no evidence of pneumothorax. there is no focal airspace consolidation. . echo: the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. there are three moderately thickened aortic valve leaflets. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr: no new acute parenchymal consolidations are identified and there is improvement to interstitial pulmonary edema and bilateral basilar atelectasis with remaining subsegmental plate-like atelectasis identified within the bases bilaterally. cardiomediastinal silhouette and hilar contours are unchanged and the patient is again noted to be status post median sternotomy and coronary bypass surgery. a right-sided central venous catheter has been removed and there is no evidence of pneumothorax. . colonoscopy: diverticulosis of the sigmoid colon and descending colon. polyps in the ascending colon, sigmoid colon, rectum, and in the descending colon. brief hospital course: 85 f with cad s/p cabg, copd, osa on cpap 15 qhs, htn, afib on coumadin who presented w/ sob, anemia, and elevated inr. . #respiratory failure/sob: on arrival to ed, she was dyspneic with rr to 24. the patient had increased dyspnea. she was unable to lie supine, so she was intubated for ct scan due to concern for occult bleed as cause for hct drop. micu course was complicated by repiratory distress on due to flash pulmonary edema which resolved with lasix, epinephrine, and methylpredisone. she was extubated on . she was reintubated due to hypoxemia believed to be due to upper airway edema as seen on bronchoscopy which improved w/ methylprednisolone. patient was extubated on . patient was stable on transfer to medicine floor and her respiratory status was stable with o2 sat in the mid-90's on ra or on 2l nc. her respiratory failure was likely her long standing diastolic chf, copd exacerbation, and pneumonia. she should continue with home o2 as needed. . #copd: stable. o2 by nc was titrated to 92-94% given her copd, during daytime patient was at low 90's o2 sat on room air. patient was continued on nebulizer prn and montelukast 10 mg po daily. . #pneumonia: patient had a left lower lobe pneumnia diagnosed on , she was treated with vancomycin and meropenam x 7days. bronchoscopy was done on to evaluate the upper airway edema s/p extubation and gram stain showed no microorganisms. patient completed a course of vancomycin and meropenam on . due to leukocytosis, fever, and cough, the patient started on cipro 500mg po q12hrs x7 days and flagyl 500mg po q8hrs 7 days (day 4 of 7) for presumed aspiration pneumonia in setting of 2 intubations/extubations. she should continue this course of antibiotics through . . #obstructive sleep apnea: continue bipap at night. . #chf: secondary to ischemic cardiomyopathy and s/p 3v cabg. diastolic heart failure with ef>55%. patient was contined on lisinopril 30 mg po daily and lasix 20mg po daily. . elevated inr: on presentation to ed, inr was 8.2. inr on was 1.9 and inr was 6.2 on . she was taking coumadin, but coumadin was dc'd on . however, daughter states that patient was taking medications on her own at times, and there was a possibility of accidentally taking extra doses of coumadin since she was not supervised in taking her medications always. in discussion with pcp, was made to d/c the coumadin and start the patient on clopidogrel. . #anemia: on presentation in the ed, her hct was 15.7, and she was transfused 1u prbc, 1u ffp, and given 10u sq vit k. her baseline hct was in the low 30's. ct scan unrevealing and no evidence of dissection or retroperitoneal hematoma. guiaic negative and ogt w/coffee grounds. during her micu course, she received 6uprbc and 10uffp total. she had a normal egd and negative abd ct for retroperitoneal bleed. anemia may be due to extensive ecchymoses on l forearm extending to upper arm that has been persistent since micu course. she has had no trauma to this area. the colonoscopy showed diverticuli and polyps which were biopsied, however, no source for bleeding seen on lower or upper gi scope. prior to discharge, hct was stable in at 28.1. patient should have hct checked at pcp office in 2 weeks to confirm that it is stable. aspirin was also d/c'd for risk of bleeding. . #atrial fibrillation: rate controlled, hr in 70-80's. given possible gi bleed & elevated inr, coumadin was held as confirmed per dr. pcp. continued taking asa 81 and was on diltiazem 360mg er po qam to achieve hr control to the 80's. asa 81 was discontinued and the patient was started on plavix 75mg daily for anti-platlet therapy. pt was well rate controlled at time of discharge. . #cad s/p cabg: no chest discomfort currently. patient continued on atorvastatin 10 mg po daily for hypercholesterolemia. . #htn: well controlled on valsartan 40mg , lisinopril 20 and dilt . #hypothyroidism: continue levothyroxine sodium 75 mcg po daily . #fen: tolerating po intake well with no evidence aspiration on speech and swallow evaluation, regular diet with salt restriction. . #r shoulder pain: s/p dislocation and with decreased rom and weakness. patient should continue pt for rom and mobility. . #depression: was on sertraline 50mg qam and amitryptyline 50mg qpm at home. patient was restarted on sertraline 50mg qam. pcp can determine whether to restart amitryptyline 50mg qpm. . #prophylaxis: ppi, pneumoboots, heparin sc. gi prophy: senna, lactulose, docusate sodium, bisacodyl prn . #full code, daughter is hcp . medications on admission: ecotrin 81mg qam valsartan 160mg qam diltiazem 300mg qam levoxyl 150mcg qam amitryptyline 50mg qpm simvastatin 20mg qpm coumadin 2mg qpm (2 a day, skip 2 days) sertraline 50mg qam singulair 10mg qpm tiotropium bromide 18mcg inh albuterol 0.083%/atrovent 0.02% nebulizer tramadol 50mg prn for pain discharge medications: 1. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 4. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. lisinopril 20 mg tablet sig: 1.5 tablets po daily (daily). 9. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): please continue through . 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po once a day for 2 days: please take through . 11. valsartan 40 mg tablet sig: one (1) tablet po bid (2 times a day). 12. diltiazem hcl 180 mg capsule, sustained release sig: two (2) capsule, sustained release po daily (daily). 13. sertraline 50 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 14. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: nevins nursing & rehabilitation center discharge diagnosis: primary diagnosis: 1. congestive heart failure-diastolic 2. respiratory failure 3. copd 4. hypertension 5. anemia 6. obstructive sleep apnea discharge condition: stable discharge instructions: please follow up with primary care physician. take all medications as directed. please contact your primary care physician or go to the emergency room if you have difficulty breathing, chest pain, fevers, or other concerning symptoms. followup instructions: follow up with primary care physician . in two weeks for follow up of anemia and hematocrit check. please also review medication changes with him. please call his office for an appointment. . provider: , m.d. phone: date/time: 11:30 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation other intubation of respiratory tract endoscopic polypectomy of large intestine transfusion of packed cells transfusion of other serum [endoscopic] polypectomy of rectum diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation other specified forms of chronic ischemic heart disease acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of anticoagulants obesity, unspecified acute diastolic heart failure hemorrhage of gastrointestinal tract, unspecified benign neoplasm of colon diverticulosis of colon (without mention of hemorrhage) benign neoplasm of rectum and anal canal 

Answer: The patient is high likely exposed to