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: diltiazem / vasotec / cardizem / dicloxacillin / vioxx / codeine attending: chief complaint: admitted for left shoulder surgery major surgical or invasive procedure: shoulder arthroplasty central line history of present illness: 76 yo female with h/o cad s/p mi, ischemic cm (ef=21%), oa, cri, and htn who initially presented to for a l shoulder arthroplasty. post-op , the patient developed hypotension with sbp in the 80s and was anuric. she was given ivf (approximately 4 liters total) and transferred to the for further management. in the pacu, she was transiently started on neo, which was stopped on at 4am. she was then stable without complaints. during this interval, the patient also developed a fib with rvr, which was felt to be new. at that point, the patient was evaluated by the med-consult team, and the decision was made to transfer the patient to medicine. . after transfer to medicine, ep evaluated the patient and recommended starting amiodarone and digoxin, with plans for cardioversion in the future after inr for 4 weeks. the patient was started on amio, digoxin, as well as heparin gtt. . the following morning (), the patient became hypotensive at around 11am with bp 80/40 and was anuric. hct had fallen from 28.5 to 22.8 overnight. she received at total of 1.5 liters ns, as well as 2 units prbcs. subsequently, her bp stablized at 106/70, with increased urine output. she was sating in the high 90's throughout this event. the micu team was called for evaluation at this point. approximately 45 minutes later, the patient dropped her bp to 82/58. she received an additional 1l ns which brought her sbp back up to the 100's. the patient was in t- and began to cough, with gurgling breath sounds. patient still satting well at 95-100% on 2l nc. abg was 7.31/40/72, lactate 1.0, hct 26. the patient c/o mild sob and left shoulder pain. the primary medicine team commented that her left shoulder appeared more edematous than it had the evening before. she denied sob, palpitations, nausea, vomiting, brbpr, dysuria. past medical history: past cardiac history: 1. coronary artery disease, status post myocardial infarction in with an left anterior descending stent, status post coronary artery bypass graft; svg-om2, svg-d2, lima-lad. 2. cardiac cath showing patent grafts 3. congestive heart failure: diastolic dysfunction, seen in clinic, recent tte in showed ef=40-45%, mild , nl lv size. 4. p-mibi-moderate severe fixed defect at apex, moderate partially reversible defect in anterior wall, mild fixed defect in septum, no significant change from prior study (ef= 36%). other pmh: 1. hypertension. 2. hyperlipidemia. 3. cva in (post-op cabg). with residual right arm deficits. mri/mra showing old left parietal lobe infarct, decreased flow basilar artery; all unchanged from prior studies 4. history of gout. 5. osa, on bipap 6. colonoscopy -polypectomy of distal sigmoid; path c/w hyperplastic polyp 7. bilateral tkr's 8. s/p hysterectomy 9. s/p cholecystectomy social history: she lives with her daughter. denied alcohol or illicit drug use. quit tobacco use 35 years ago (used to smoke 1.5 ppd) formerly married retired, multiple jobs in past including factory worker, nurse's aide, office assistant daughter assists with cooking/cleaning has vna occasionally walks with cane at times family history: cad, htn mother died breast cancer age 51 physical exam: physical exam upon admission to micu vs - hr 103; bp 98/70; rr = 22; o2 100% 2l nc gen - obese aa female, appears uncomfortable, tachypneic, gurgling breaht sounds, coughing heent - ncat, perrl bilat, eomi, op clear neck: supple, no lad, unable to assess jvp due to habitus cv: irreg, irreg, distant hs, no m pulm: +crackles bilaterally, course breath sounds, no wheezes abd: nabs, soft, nt, nd, obese ext: trace pedal edema bilat, l-shoulder markedly edematous, tender to palpation, bandage c/d/i. neuro: cnii-xii intact, soft touch intact, strength symmetric rectal: guaiac negative brown stool pertinent results: 08:14pm wbc-11.5*# rbc-3.80* hgb-10.5* hct-33.3* mcv-88 mch-27.5 mchc-31.5 rdw-15.0 08:14pm neuts-83.4* lymphs-11.2* monos-2.8 eos-2.6 basos-0.1 08:14pm hypochrom-1+ 08:14pm plt count-362 08:14pm pt-12.9 ptt-27.5 inr(pt)-1.1 12:05pm type-art po2-170* pco2-30* ph-7.38 total co2-18* base xs--5 12:05pm glucose-94 lactate-1.2 na+-139 k+-4.2 cl--111 12:05pm hgb-10.7* calchct-32 12:05pm freeca-1.36* 10:41am type-art po2-169* pco2-40 ph-7.35 total co2-23 base xs--3 intubated-intubated 10:41am glucose-104 lactate-1.8 na+-139 k+-4.3 cl--108 10:41am hgb-11.2* calchct-34 10:41am freeca-1.10* : operative report preoperative diagnosis: left shoulder severe osteoarthritis. postoperative diagnosis: left shoulder severe osteoarthritis. procedure: left total shoulder arthroplasty. anesthesia: general combined with interscalene block. complications: none. estimated blood loss: 150 cc. indications for procedure: this 76-year-old female has been complaining of 1 year of increasing left shoulder pain despite conservative treatment. she is status post left shoulder arthroscopic subacromial decompression by me a year ago. at that time, she was noted to have severe degenerative changes, grade 4, of the glenohumeral articulation. after failure of conservative treatment, she elected to have left total shoulder arthroplasty. description of procedure: the patient was brought to the operating room after left shoulder interscalene block was introduced satisfactorily by the anesthesia service in the preoperative area. she was placed supine on the operating room table and underwent general endotracheal anesthesia without complication. she received 600 mg of clindamycin iv preoperatively. she was placed in modified beach chair position. all bony prominences were well padded. the left shoulder was prepped and draped in the standard sterile fashion. an anterior deltopectoral approach was utilized after infiltrating the skin with 10 cc of 2% xylocaine with epinephrine. the incision was carried sharply through the skin and subcutaneous tissues just lateral to the coracoid process. the deltopectoral interval was developed. a deep retractor was placed. the clavipectoral fascia incised just lateral to the conjoined tendon. the retractor was placed beneath the conjoined tendon medially and the deltoid laterally. the subscapularis bursa was excised. the anterior humeral circumflex vessels were coagulated. a portion of the humeral insertion of the pectoralis muscle was released to gain better exposure. arthrotomy was then performed of the glenohumeral articulation by dissecting through the subscapularis and capsule insertion approximately 1 cm medial to the insertion of the lesser tuberosity using electrocautery. the arm was placed in approximately 40 degrees of retroversion. severe degenerative changes of the glenohumeral articulation. the sagittal saw was then used to remove the humeral head using the osteonics guide as a template. osteophytes were removed with a rongeur. the arm was then extended, and using the osteonics straight reamers, the intramedullary canal reamed up to a size 13 mm. the arm was then placed back on the padded arm table, and attention directed to the glenoid. the humeral head retractor was placed beneath the posterior aspect of the glenoid. the labrum was removed. the biceps tendon was noted to be lacerated, therefore, it was dissected and excised. the osteonics reamer was then used to remove any remaining articular cartilage on the glenoid. the drill was then used to fashion a keyhole in the central portion of the glenoid. an angled curet was used to remove cancellous bone in the glenoid. the glenoid was copiously irrigated with antibiotic solution, thoroughly dried. polymethacrylate cement was mixed and then packed into the keyhole slot for the glenoid, and a #5 glenoid cement keeled osteonics component cemented into place. the cement hardened. the loose and redundant cement was removed. the glenoid was noted to be well fixed. the arm was then extended again, and the real humeral prosthesis, size 13, was press fit into place after successive trial broaches had been used and the fins cut in standard fashion. the prosthesis was placed in approximately 40 degrees of retroversion. various humeral head trials were used, and a size 45 x 15 gave the best soft tissue tension with the ability of us to passively place the patient's arm over her head with external rotation approaching 60 degrees to 70 degrees. the wound was then copiously irrigated. the humeral stem dried thoroughly of liquid, and the real 45 x 15 osteonics humeral head impacted into place. again, trial reduction was noted to be satisfactory. the wound was copiously irrigated with antibiotic solution. the deep retractors were removed. the cephalic vein was noted to have a laceration, therefore, it was tied off with 3-0 silk. the wound was closed in layers using 0 vicryl running for the deltopectoral fascia, 2-0 vicryl for the dermis and running subcuticular 3-0 prolene for the skin. steri-strips were applied along with a dry dressing, sling, and cryocuff. sponge and needle counts were correct x2. the patient was awakened from general anesthesia, extubated without difficulty, and transferred to the recovery room in satisfactory condition having tolerated the procedure without complications. operative report () first assistant: , res preoperative diagnosis: hematoma, left shoulder. postoperative diagnosis: hematoma, left shoulder. procedure performed: washout left shoulder wound. anesthesia: general endotracheal anesthesia. complications: none. estimated blood loss: 75 cc. indications for operation: this 76 year old female is status post a left total shoulder arthroplasty by me 2 days ago. today she was noted to have a falling hematocrit and swelling of the left shoulder. concern was for an expanding hematoma. after explaining to her and her family the treatment options, i recommended that she had exploration of the left shoulder wound with washout of hematoma. description of operation: the patient was brought to the operating room and placed supine upon the table. she underwent general endotracheal anesthesia without complication. the left shoulder was prepped and draped in standard sterile fashion. she was given 60 mg of clindamycin iv preoperatively. the edges of the wound were opened. there was noted to be an extensive amount of clotted blood throughout the wound, including superficial and deep fascia. the deltopectoral interval was also opened. there was noted to be diffuse, mild oozing from multiple muscle points. this was coagulated with electrocautery. no gross vascular bleeders were encountered. gelfoam with thrombin was used help stop the bleeding along the inferior aspect of the wound. the wound was copiously irrigated with antibiotic solution and closed in layers using 0 vicryl running for the deltopectoral fascia, 2-0 vicryl for the dermis, and staples for the skin. the patient tolerated the procedure without complication and was transferred back to the intensive care unit in intubated fashion. , m.d. cxr (): the patient is status post sternotomy, with mild-to-moderate cardiomegaly. there is prominence of upper zone vessels, with diffuse vascular blurring consistent with chf. there is blunting of both costophrenic angles consistent with small pleural effusions. there is increased retrocardiac density consistent with left lower lobe collapse and/or consolidation. compared with earlier the same day, the small pleural effusions are new. echo (): 1. the left atrium is normal in size. the left atrium is elongated. 2.left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed. resting regional wall motion abnormalities include mid and distal septal akinesis. 3.right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the aortic valve leaflets are mildly thickened. no aortic regurgitation seen. 5. mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 6.there is no pericardial effusion. brief hospital course: the patient was admitted electively for l shoulder arthroplasty and underwent this procedure on . post-op, the patient was noted to be in atrial fibrillation. she was started on a heparin gtt and transfered to the medical service. electrophysiology evaluated the patient and recommended starting amiodarone and digoxin, with plans for cardioversion in the future after inr for 4 weeks. the patient was started on amio, digoxin, as well as heparin gtt. . the following morning (), the patient became hypotensive at around 11am with bp 80/40 and was anuric. hct had fallen from 28.5 to 22.8 overnight. she received at total of 1.5 liters ns, as well as 2 units prbcs. subsequently, her bp stablized at 106/70, with increased urine output. she was sating in the high 90's throughout this event. the micu team was called for evaluation at this point. approximately 45 minutes later, the patient dropped her bp to 82/58. she received an additional 1l ns which brought her sbp back up to the 100's. the patient was in t- and began to cough, with gurgling breath sounds. patient still satting well at 95-100% on 2l nc. abg was 7.31/40/72, lactate 1.0, hct 26. the patient c/o mild sob and left shoulder pain. the primary medicine team commented that her left shoulder appeared more edematous than it had the evening before. she denied sob, palpitations, nausea, vomiting, brbpr, dysuria. the patient's icu course was significant for the following issues: 1) hypotension: given drop in hct and increased swelling of left shoulder after heparin gtt started, hypovolemia to acute blood loss into her shoulder was suspected. the patient was taken back to the or for revision of operative site (left shoulder), which revealed some oozing but no clear vessel responsible for major bleed. pt was sent back to the unit intubated and sedated. calculated hct from abg was ~23, and given the pt's poor iv access (1 peripheral iv), the a right subclavian central line was placed while the pt was intubated and sedated. 2u prbc given, pt extubated the next am without complication. gi bleed thought to be unlikely given guaiac negative. sepsis was also thought to be unlikely given no apparent infectious source, afebrile, and normal wbc. the patient was initially given boluses of ivf. she was subsequently started on dopamine gtt for bp support and for tailoring of her heart failure. serial hct were checked and noted to be stable. over the course of her hospitalization, the patient was transfused 6 units prbcs. her anticoagulation was initially held. the patient's blood pressure improved with diuresis and her dopamine was weaned off on . her bp has been stable since that time with sbps in the 110 range and map > 60. she was re-started on her carvedilol and her other bp meds should be re-started on her other home meds (diovan, aldactone) as tolerated. . 2) resp distress: the patient was thought to be mildly volume overloaded. she was intubated in the operating room but quickly extubated. she was weaned off oxygen prior to discharge. . 3) chf: the patient was diuresed with iv lasix while on dopamine for bp support. her volume status improved and her creatinine returned to baseline. her heart failure regimen of carvedilol, diovan, aldactone will need to be re-initiated as her bp tolerates at rehab. an echocardiogram on revealed an ef of 45% to 50%. 4) atrial fibrillation/flutter: the patient had a history of paroxysmal atrial fibrillation/flutter. post-op, she was started on amiodarone and digoxin for rate control and she was started on a heparin gtt for anticoagulation. she was monitored on telemetry. the plan had been for cardioversion in weeks after full anticoagulation. after discussion with the orthopedic physicians and cardiology, the patient was re-started on coumadin on the date of discharge () and was not to be bridged with lovenox given the risk of bleeding. her goal inr is . her coumadin will need to be titrated to reach this goal. her amiodarone was stopped in the setting of absent anticoagulation. she should be re-started on amiodarone 200mg qd once anticoagulated. she will need follow up with electrophysiology and inr checks after discharge from rehab. . 5) acute on chronic renal failure: the patient was thought to be in acute renal failure from atn form hypotension vs. heart failure. her creatinine improved with management of her hypotension and heart failure. medications were renally dosed. she was at her baseline renal function (1.3) at the time of discharge. 6) cad: the patient was continue on lipitor, aspirin. she was re-started on her bb and her diovan should be re-started as her bp tolerates. . 7) gout: her allopurinol was held in the setting of acute renal failure, but was re-started prior to discharge (renal dosed). . 8) gerd: the patient was continued on protonix. 9) code: the patient remained a full code throughout this admission. 10 follow up: the patient will need to follow up with her primary care provider and with orthopedic doctors . she will also need to be set up with inr checks and follow up with her cardiologist upon discharge from rehab. . completed by , ed1 medications on admission: aldactone 25 mg qd allopurinol 100 mg qd coreg 6.25 mg coumadin 5 mg qd, 7.5 mg q friday lipitor 20 mg qd lasix 80 mg qd aspirin 81 mg qd kcl 10 meq qd diovan 80 mg qd discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain/fever. 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. digoxin 125 mcg tablet sig: 0.5 tablet po daily (daily). 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. furosemide 20 mg tablet sig: one (1) tablet po daily (daily): titrate up to 80mg qd . 9. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime): 5 mg qd except friday 7.5 mg qd. 11. aspirin 81 mg tablet sig: one (1) tablet po once a day. 12. allopurinol 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: s/p shoulder arthroplasty blood loss anemia atrial fibrillation congestive heart failure hypotension acute/chronic renal failure hypertension gout discharge condition: good, stable blood pressures off pressors x 48 hours discharge instructions: take all your medications as directed. follow up with your primary care doctor and with the orthopedic doctor as below. followup instructions: you have a follow up appointment with dr. np on monday at 9:30 am in his clinic. if you need to change your appointment call . provider: , orthopedic practice where: orthopedic practice date/time: 9:30 provider: , m.d. where: center phone: date/time: 8:30 follow up with np on thursday, at 10:30 am. provider: , : phone: date/time: 10:40 md procedure: other incision of soft tissue other total shoulder replacement diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified gout, unspecified atrial fibrillation hematoma complicating a procedure old myocardial infarction unspecified disorder of kidney and ureter urinary complications, not elsewhere classified unspecified late effects of cerebrovascular disease knee joint replacement chronic diastolic heart failure osteoarthrosis, localized, not specified whether primary or secondary, shoulder region 

Answer: The patient is high likely exposed to