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: cardiac catheterization with bms to lcx and om1, ptca of pl history of present illness: mr. is an 83 year-old male with type ii diabetes, hypertension, coronary artery disease s/p stemi in with bms to the lad and in-stent thrombosis managed by ptca who presents from rehab with worsening shortness of breath. he reports that he had been doing well at rehab until recently. he was seen in the office on . at that time he reported persistent fatigue and dyspnea on exertion. his blood pressures at rehab had been lower than usual and his lasix had been held with resulting lower extremity edema, dyspnea on exertion and orthopnea. on the morning of the 10th he was satting 98% on 2l nasal nc. he had a cxr which showed modest congestive heart failure which was worse compared to 1 month prior. he slept well the night of the 10th. on the morning of the 11th he was noted to be more uncomfortable with worsening shortness of breath. he had significant difficulty breathing when ambulating to the bathroom. he received 80 mg po lasix. his shortness of breath persisted and his oxygen saturation decreased to 92% on 6l nc. he was transferred to the emergency room. . in the emergency room his initial vitals were t: 98.7 hr: 77 bp: 124/64 rr: 20-30 o2: 100% on nrb. his initial ekg was a poor baseline tracing but shows likely sinus rhythm, normal axis, normal intervals, no acute st segment changes compared to prior from . he had a chest xray which showed signs of pulmonary edema. his bnp was elevated at 22,059. his first set of cardiac enzymes was notable for a troponin of 0.08. he initially required bipap but was transitioned to nasal cannula. he received aspirin 325 mg, ativan 0.5 mg x 1, lasix 40 mg iv x 1 and was placed on a nitroglycerin drip. his blood pressures were decreased on the nitroglycerin drip and this was discontinued. he was transferred to the floor for further management. . on review of systems he denies lightheadedness, dizziness, chest pain. he reports his shortness of breath is significantly improved since this morning. he denies chest pain, nausea, vomiting, abdominal pain, diarrhea, constipation, dysuria, hemuaturia or leg pain. he endorses worsening lower extremity edema, orthopnea and pnd over the past week. all other review of systems negative in detail. past medical history: # myocardial infarction , s/p cath with ptca and 2 stents placed in proximal lad. c/b cardiogenic shock and vt requiring defibrillation/pacing for heart block # myocardial infarction with two stents placed in the rca in . # rle dvt # diabetes: ha1c 6.4% on . high grade proteinuria x 1 yr. # hypertension # hypercholesteremia # asthma # stage iv chronic kidney disease (baseline creatinine 2.5 to 2.8) social history: social history is significant for a long standing history of smoking prior to his myocardial infarction. he is now residing at rehab and is not currently smoking. he does not use alcohol. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: physical examination at admission: vs: t: 98.6 bp: 118/64 (right) hr: 59 rr: 25 o2: 99% on 5l nc gen: eldlerly male, lying in bed, mild respiratory distress, oriented x 3, mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. + s4 chest: no chest wall deformities, scoliosis or kyphosis. resp were mildly labored with evidence of abdominal respiratory movements. exam with decreased breath sounds throughout, crackles diffusely. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: 2+ edema in feet, no clubbing or cyanosis, trace dp pulses bilaterally. pertinent results: labs at admission: 06:52pm ck(cpk)-46 06:52pm ck-mb-notdone ctropnt-0.09* 10:55am lactate-1.6 10:40am glucose-129* urea n-98* creat-2.8* sodium-140 potassium-4.0 chloride-93* total co2-36* anion gap-15 10:40am estgfr-using this 10:40am alt(sgpt)-15 ast(sgot)-20 ld(ldh)-209 ck(cpk)-44 alk phos-80 tot bili-0.3 10:40am ctropnt-0.09* 10:40am ck-mb-notdone probnp-* 10:40am wbc-9.9 rbc-3.95* hgb-9.3* hct-31.1* mcv-79* mch-23.5* mchc-29.8* rdw-16.4* 10:40am neuts-81.2* lymphs-12.5* monos-4.8 eos-1.4 basos-0.1 10:40am plt count-401 10:40am pt-32.3* ptt-40.5* inr(pt)-3.4* 10:32am urine color-yellow appear-clear sp -1.011 10:32am urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 10:32am urine rbc-0-2 wbc- bacteria-none yeast-none epi-0-2 10:32am urine hyaline-0-2 .. selected radiographic studies: . ruq u/s () the gallbladder is collapsed, demonstrating numerous shadowing stones. no gallbladder wall edema evident. no pericholecystic or perihepatic fluid identified. limited imaging of the liver is unremarkable. impression: no evidence of biloma. . ct /pel () impression: 1. no evidence of retroperitoneal bleeding. 2. unchanged abdominal aortic aneurysm. 3. biliary stent. 4. large bilateral pleural effusions. 5. fluid-fluid levels in the small bowel. correlate for gi bleeding. these may also represent vicarious excretion of contrast material from the recent catheterization procedure where contrast was administered. 6. persistent contrast within the renal cortex may be related to patient's renal failure and recent contrast administration. . r-sided dedicated rib film () a single non-oblique view shows no gross evidence of fracture or pneumothorax. .. echocardiography: tte () the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe regional left ventricular systolic dysfunction with akinesis of the anterior, septal walls and the distal of the ventricle (multivessel cad). there is hypokinesis of the remaining segments (lvef = 10-15%). a left ventricular mass/thrombus cannot be excluded. the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. moderate to severe (3+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: dilated left ventricle with severe regional and global systolic dysfunction. moderate to severe mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , the findings are similar. .. thallium rest test (): interpretation: following injection of of thallium chloride while the patient was at rest, static and gated spect images were obtained and analyzed. this study was interpreted using the 17-segment myocardial perfusion model. the image quality is limited, with suboptimal signal to noise. the left ventricular cavity size again demonstrates moderate to severe dilation. resting perfusion images at 20 minutes and 4 hours reveal moderate to severe perfusion defects involving the distal anterior, anteroseptal, and anteroapical walls. the 24 hour images show no evidence of tracer redistribution. compared with the study of , there appears to have been no change. impression: 1. stable moderate to severe perfusion defects in distal anterior, anteroseptal and anterolateral walls without evidence of delayed tracer redistribution to suggest myocardial viability. 2. stable moderate to severe ventricular dilation. .. coronary angiography (): comments: 1. selective coronary angiography of this codominant system revealed 2 vessel cad. the lmca had no angiographically obstructive lesion. the lad was diffusely diseased with a patent stent. the lcx had a proximal 70% stenosis and gave rise to two om branches. the om1 was a large branch with an 80% mid vessel stenosis. the pl had an 80% stenosis. the rca was not engaged. 2. limited resting hemodynamics revealed normal to low systemic pressure. 3. left ventriculography was deferred. 4. successful ptca and stenting of the mid om1 with a 2.5 x 15 mm vision bms at 16 atm. successful ptca of the pl with a 2.0 and then a 2.25 x 20 mm voyager balloon at 12 and 8 atm respectively. successful pci of the proximal lcx with a 3.0 x 15 mm vision bms at 16 atm. final angiography revealed no residual stenosis in the stents and a 20-30% residual in the pl, no dissection and timi iii flow. (see ptca comments) final diagnosis: 1. two vessel coronary artery disease. 2. successful stenting of the lcx and the om1. 3. successful ptca of the pl. brief hospital course: in summary, this is an 83-year old male with type ii diabetes, hypertension, coronary artery disease s/p stemi in with bms to the lad and in-stent thrombosis managed by ptca who presents from rehab with worsening shortness of breath found to have evidence of congestive heart failure now with significant improvement after aggressive diuresis. .. # pump / acute on chronic heart failure: he has stage iv congestive heart failure and presented from rehab with an acute exacerbation. a tte performed at admission revealed unchanged ef of % with severe regional and global left ventricular dysfunction. he was diuresed aggressively with lasix gtt as well as chlorthiazide. unfortunately his breathing and hypercarbia worsened to the point that he required intubation and transfer from to . . after extubation, he underwent thallium rest study to investigate whether he might benefit from reperfusion in the setting of known cad and lv systolic dysfunction. the thallium study, performed on , showed a possible area of myocardial viability in the distribution of om1, and it was felt that he would benefit from coronary angioplasty and revasularization. he thus went to the cath lab on after sufficient time to allow his creatinine to return to baseline, and after pre-treatment with n-acetylcysteine and adequate iv hydration. the full cath report is above: bms were placed to his om1 and his lcx with balloon angioplasty of the pl. . after the catheterization and likely d/t the contrast given during, he developed acute on chronic renal failure for which he was diuresed aggressively with iv lasix drip and chlorthiazide twice daily. five days post-procedure his urine output improved and oxygen requirements decreased to current mid to high 90s on 2-4l o2 by nasal cannula, depending on his activity level and position. for his heart failure, he was started on hydralazine and nitro paste. the hydralazine was uptitrated as bp tolerated to a dose of 10 mg four times daily at time of discharge. the nitro paste was switched to po isosorbide dinitrate 10 mg to be taken three times daily. .. # ischemia / coronary artery disease: he is s/p stemi in complicated by in-stent thrombosis, vt/vf requiring cardioversion and pacing. upon admission, he was continued on 325, plavix 75, and atorvastatin 80. his acei was held for concern of acute on chronic renal failure, and his bb was held in the setting of acute decompensated hf. these have both been stopped. current heart failure medical regimen is described above. .. # rhythm / history of vt/vf and atrial fibrillation: at presentation, he was in normal sinus rhythm, being treated with bb, amiodorone and coumadin. as above, his bb was held for acute decompensated heart failure. he was switched to heparin drip in anticipation of coronary angiography, and was subsequently maintained on heparin gtt for acute renal failure and anticipated need of tunneled line placement for hd. when it became clear that his kidneys were recovering from the contrast-dye insult and there would be no indication for urgent hemodialysis, his warfarin was restarted. at time of discharge he has therapeutic inr for over two days. . throughout the hospital course, he was monitored on telemetry and continued on his outpatient amiodorone. .. # respiratory distress: as above, he developed hypercarbic respiratory failure and was intubated from to . after extubation and stabilization on 4l nc, he was transferred to the floors. however, post cath procedure, he again developed volume overload (likely d/t his contast-related nephropathy and arf) and was re-transferred to the ccu, where he was placed on nrb overnight. with diuresis and bronchodilator therapy, he was quickly weaned off nrb to nc. his urine output gradually increased and he was transitioned back to 2-4l nc and transferred back to the floors on . . bronchospasm was treated with alb/ipra nebulizers as needed. there was never concern of pneumonia or infectious pulmonary process. serial cxrs showed bilateral pleural effusions, and although the idea of thoracentesis was entertained, this was never acted upon d/t the liklihood that the effusions would re-accumulate and that the most effective approach remained aggressive diuresis. . at time of discharge he is back on his home regimen of ipratropium inh four times daily. he is on o2 by nc, 2-4l to maintain o2 sats above 92%. .. # history of acute cholecystitis: at time of presentation, he had a percutaneous cholecystostomy tube which was intermittently draining small amounts of fluid. there were no complications until the night of , at which time he became agitated and pulled out the bilary catheter. a ruq u/s was performed which showed collapse of the gallbladder with no intra or peri-cholecystic fluid, no fat-stranding and no evidence of bilary duct dilatation. surgery was consulted regarding possible replacement of the biliary catheter, but as there was no target to aim for (i.e. a collapsed gallbladder) and no signs on physical exam or laboratory data to suggest active infection, we decided on watchful waiting. there were no further complications during hospital course. the site of the previous cholecystostomy tube healed well and his transaminases remained wnl. .. # urinary tract infection: he had two separate urine cultures on and that showed >100,000 colonies of mrsa and pan-sensitive enterococcus. this was in the setting of normal ua, no symptoms, and no fevers. because he had a persistent low-grade leukocytosis (), non-resolving, we decided to begin a seven day course of vancomycin. he completes this on the day of discharge. .. # acute on chronic renal failure: his creatinine at admission was 3.8 from a baseline of 2.6 to 2.8. the presumed cause was poor renal perfusion given his acute decompensated chf. after diuresis, his creatinine improved to baseline such that we were comfortable proceeding with coronary cath. post-procedure, his creatinine trended up to peak at 4.9, at which point it stabilized and began decreasing. simultaneously his urine output began to come back on a lasix gtt and chlorthiazide. renal was consulted but d/t improving renal function there was never a need for urgent hd. hyperkalemia was treated with kayexalate prn. . # type ii diabetes mellitus: oral agents were held at admission. he was kept on regular insulin sliding scale. at time of discharge he is started back on home glipizide. . # anemia: baseline hematocrit of 30-35. there was concern when his hematocrit dropped to mid 20s post-cath that he may have internal bleeding. a ct /pelvis was then performed which was completely negative for occult bleed. stool guaiac was also negative. his hematocrit remained stable in the mid to high 20s. per renal recs, he was started on erythropoietin, in addition to the iron supplement on which he presented, for anemia related to stage iv ckd. . # anxiety / depression: he is an anxious man at baseline requiring regular nursing and physician . certainly this baseline anxiety was exacerbated by his acute illness and hospitalization. psychiatry was consulted for recommendations regarding management while in house. per their recommendations he was started on zyprexa both standing and prn doses. this helped significantly with his agitation. meanwhile, he was continued on home celexa for his h/o depression. trazadone and lorazepam were held. his discomfort associated with breathing distress and back pain (see below) was treated with morphine 0.5-1mg q4h prn, from which he also derived considerable benefit. at time of discharge, his anxiety disorder is being treated with standing and prn zyprexa. his citalopram has been continued. his discomfort associated with shortness of breath can be treated with morphine liquid. if he becomes agitated, family in the past has hired overnight companions to stay with patient. . # pain: he intermittently complained of left and right-sided shoulder to back pain, as well as right-sided rib pain that was reproducible with palpation. cxr and dedicated rib films were repeatedly negative for acute fracture. shoulder joint exams were unremarkable. we believed the pain to be d/t musculoskeletal strain and/or inflammation resulting from inactivity and the strain of lying on his back and side in bed for such a prolonged period of time. we treated the pain with tramadol, morphine, and lidocaine patches. . # bph: currently not being treated. . # he was kept on a cardiac, diabetic diet. dvt prophylaxis was not an issue as he was anticoagulated on heparin gtt or coumadin during entirety of hospital course. gi prophylaxis with famotidine and bowel regimen. his code status, which was addressed with both son and patient, remained full code throughout. medications on admission: atorvastatin 80mg daily carvedilol 3.125mg flomax 0.4mg hs clopidogrel 75mg daily citalopram 20mg daily aspirin 325mg daily lorazepam 0.5mg hs prn lasix 80mg qam, 40mg qpm digoxin 0.125mg daily amiodarone 200mg daily glipizide 2.5mg daily trazodone 25mg daily ferrous sulfate 324mg daily coumadin 5mg daily gabapentin 200mg tid metolazone 2.5mg discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 7. glipizide 2.5 mg tab,sust rel osmotic push 24hr sig: one (1) tab,sust rel osmotic push 24hr po once a day. tab,sust rel osmotic push 24hr(s) 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. calcium carbonate 500 mg tablet, chewable sig: tablet, chewables po bid prn as needed for heartburn. 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 12. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). adhesive patch, medicated(s) 13. tramadol 50 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for pain. tablet(s) 14. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 15. hydralazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp <80. 16. chlorothiazide 250 mg tablet sig: two (2) tablet po daily (daily). 17. furosemide 40 mg tablet sig: three (3) tablet po bid (2 times a day). 18. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day): hold for sbp <80. 19. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day) as needed. 20. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day). 21. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). 22. morphine 10 mg/5 ml solution sig: 0.5-1 ml po q4h prn as needed for shortness of breath or anxiety. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: -------------------- congestive heart failure with ef of around 15% coronary artery disease ckd w/ probably due to contrast nephropathy acute choleycystitis s/p choleycystotomy tube . secondary diagnoses: atrial fibrillation hypertension hyperlipidemia dyslipidemia anxiety/depression benign prostatic hypertrophy discharge condition: vital signs stable. o2 sats mid 90s on 4l. weight 66.4 kg. discharge instructions: you were admitted because you were short of breath and were having problems with your thinking. we believe this was because your heart failure had worsened. we attempted to remove fluid to help your breathing and you also had a blocked vessel reopened in your heart. your kidneys temporarily failed after the catheterization procedure, probably due to the contrast dye, but then recovered on their own. you are being discharged to rehab to complete your recovery. . your heart medications have been changed. we have started you on two new medicines to help your heart. these are isosorbide dinitrate and hydralazine. we have also started you on two medicines to help you urinate and decrease the amount of fluid in your body. these are lasix and chorathiazide. . during this hospitalization, you were diagnosed with anxiety disorder. this condition may cause you to become restless and worried at times. this has been treated with reassurance and alteration in some of your medications. ativan and trazadone were stopped. olanzepine was started at a standing dose, which you should take regularly throughout the day, and at an as needed dose, which you should take when you become anxious. . please keep all scheduled follow-up appointments as these are important to maintain your health. . > 3 lbs. please adhere to a 2 gm of sodium per day and 1.5 liter of fluid per day diet. please call your doctor or report to the emergency room if you have fevers to >101, increased shortness of breath, chest pain, inability to tolerate food by mouth, or any other concerning changes to your health. followup instructions: cardiology: provider: , md phone: date/time: at 4:20pm. . nephrology: provider: , md phone: date/time: at 9am. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube non-invasive mechanical ventilation transfusion of packed cells transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: anemia in chronic kidney disease coronary atherosclerosis of native coronary artery pure hypercholesterolemia mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation infection with microorganisms resistant to penicillins hematoma complicating a procedure other chronic pulmonary heart diseases hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) dysthymic disorder other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure alkalosis methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site old myocardial infarction cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pressure ulcer, lower back calculus of gallbladder without mention of cholecystitis, without mention of obstruction hypoxemia abdominal aneurysm without mention of rupture accidents occurring in residential institution urinary complications, not elsewhere classified acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to