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: sulfa(sulfonamide antibiotics) attending: chief complaint: fatigue major surgical or invasive procedure: adapta l addrl1 implantation on history of present illness: 77 year-old woman with history of hypertension here with few days of profound fatigue and found to be in complete heart block with wide escape from the left posterior fascicle at a rate of 20-30bpm and bp of 80-90/40-50s. . in the ed, initial vitals were 97.6 32 91/41 15 96%. ekg signficant for complete heart block with excape at a rate of 20-30bpm. labs signficant for trop-t: 8.13, kidney failure with cr at 4.7(baseline from at 1.1), phos-4.7, k-4.9, na-132, and elevated wbc to 13.24 (80%n, no bands) and a relatively negative cxr. the pateint was initially given dopamine and be came nauseated which resolved with zofran. dopamine is now off. also given 500ml of ns. a cordis was placed with a temporary pacing wire, now paced at 80 with a good bp. a cxr was obtained demonstarting good positioning of corditis without complication. prior to transfer vitals were p-80 bp-89/56, 97% on 2l. . on arrival to the floor, patient had no complaints. she was on 5 of dopamine, which was quickly weaned. past medical history: htn social history: married and lives at home, active. takes active care of her husband and hates being apart from him! family history: non contributory. physical exam: admission exam: general: wdwn woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, jvp not elevated. temporary pacing wire in place via right ij. chest: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. scattered crackles at bases. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge exam: general: wdwn woman in nad. oriented x3. mood, affect appropriate. heent: moist mucosa, no icterus, eomi. neck: supple, jvp not elevated. right neck with resolving rash at site of tegaderm. chest: regular rate, on tele a paced, native ventricular contractions. lungs: clear to auscultation, . abdomen: soft, ntnd. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: palpable b/l le dp/pt neuro: no focal deficits, cn 2-12 grossly intacat. pertinent results: admission labs: 06:00pm blood wbc-13.4*# rbc-4.36 hgb-12.0 hct-38.2 mcv-88 mch-27.6 mchc-31.5 rdw-13.3 plt ct-253 06:00pm blood neuts-80.6* lymphs-11.6* monos-7.3 eos-0.1 baso-0.5 06:00pm blood glucose-153* urean-62* creat-4.7*# na-132* k-4.9 cl-94* hco3-23 angap-20 06:00pm blood ctropnt-8.13* 04:00am blood ck-mb-9 ctropnt-7.13* 06:00pm blood calcium-9.4 phos-4.7* mg-2.3 04:00am blood %hba1c-5.8 eag-120 04:00am blood triglyc-122 hdl-31 chol/hd-5.2 ldlcalc-106 ldlmeas-110 . discharge labs: 07:12am blood wbc-8.8 rbc-3.89* hgb-10.9* hct-33.2* mcv-86 mch-28.1 mchc-32.9 rdw-13.6 plt ct-280 07:12am blood glucose-101* urean-38* creat-1.6* na-142 k-4.0 cl-110* hco3-23 angap-13 . micro: urine culture: no growth blood culture: no growth to date . imaging: portable cxr: there is slight tortuosity and calcification along the thoracic aorta. the heart is probably at the upper limits of normal size. there is vague patchy hilar opacification on each side, which may suggest slight congestion. patchy retrocardiac opacity, probably in the left lower lobe, is most suggestive of minor atelectasis. impression: suspicion for slight congestion, otherwise unremarkable. . echo: a pacemaker wire is seen in the right atrium and right ventricle. the tip of the pacemaker wire appears to penetrate the right ventricular free wall and may protrude beyon the epicardial surface of the right ventricular free wall (through-and-through perforation). the left atrium is dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef = 45%) secondary to hypokinesis of the inferior and posterior walls, and to pacemaker-induced dyssynchrony. the right ventricular free wall thickness is normal. the right ventricular cavity is dilated with depressed free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a small pericardial effusion subtending the epicardial surface where the pacemaker wire tip emerges. there is no sign of cardiac tamponade. compared with the findings of the prior study (images reviewed) of , the following findings are new: (1) pacemaker wire now seen in ra/rv, entering and probably perforating rv free wall (2) small pericardial effusion now seen subtending area where pacemaker wire tip seen (no sign of cardiac tamponade) (3) pacemaker-induced lv dyssynchrony is now present (4) inferior posterior wall hypokinesis now present (5) rv is now dilated and hypocontractile . pa/lat cxr: left-sided battery pack with pacemaker lead wires terminating in the right atrium and right ventricle without change in position. bilateral pleural effusions are present. mild pulmonary edema from is mostly resolved. brief hospital course: this is a 77 year old female with past medical history significant for hypertension presenting in complete heart block s/p temporary pacemaker placement and kidney failure (acute vs. ckd). # complete heart block - etiology a recent mi given elevated trop to 8 with inferior q-waves on ekg leading to complete heart block. dual chamber permanent pacer placed and set to 80 bpm. pa/lat cxr showed appropriate positioning. pt received 4 doses of prophylactic iv vancomycin. no abx on discharge. completed physical therapy that suggested home with pt. ep interrogated the pacer on discharge and was ok with discharge. . # completed inferior mi - given q waves and lack of st changes and elevated troponins, pt had mi in the near past, reports chest discomfort a week or so ago. echo showed ef 45%. we started medical management with , 325, atorva 80, metop xl 25, echo showed inferior posterior wall hypokinesis, and ef 45%. pt was without chest pain during her admission. . # acute kidney injury with possible ckd - cr 4.7 on admission. cr 1.6 on discharge. we treated her with gentle ivf, renally dosing meds, avoiding nephrotoxins, and fixing her conduction system allowing appropriate forward flow. the etiology is unclear given unknown baseline cr, mostly like it is atn to poor forward flow. on discharge we restarted . . # htn - we initially held all home bp meds (dilt, hctz, telmasartan) during the admission given her low bps. patient was instructed to restart telmasartan, and she was started on metoprolol. . ### transitions of care: - bp has been low during hospital stay, consider starting acei for remodeling benefit as outpatient. medications on admission: 1. zolpidem tartrate 10 mg po hs:prn insomnia 2. ranitidine 150 mg po daily 3. hydrochlorothiazide 25 mg po daily 4. diltiazem extended-release 300 mg po daily 5. micardis *nf* (telmisartan) 80 mg oral daily 6. simvastatin 20 mg po daily discharge medications: 1. ranitidine 150 mg po daily 2. aspirin 325 mg po daily rx *aspirin 325 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 3. atorvastatin 80 mg po daily rx *atorvastatin 80 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 4. clopidogrel 75 mg po daily rx *clopidogrel 75 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 5. zolpidem tartrate 10 mg po hs:prn insomnia 6. hydrocortisone cream 1% 1 appl tp qid itching apply to rash on right neck 7. micardis *nf* (telmisartan) 40 mg oral daily this is one half your dose 8. metoprolol succinate xl 25 mg po daily hold sbp < 100, hr < 60 rx *metoprolol succinate 25 mg one tablet(s) by mouth daily disp #*30 tablet refills:*2 discharge disposition: home with service facility: national health solutions discharge diagnosis: complete heart block hypertension ventricular perforation with pacer wire. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you had an abnormal heart rhythm called complete heart block and needed a temporary pacing wire that was changed to a permanant pacemaker to help your heart beat normally. your blood pressure was low during this time but is normal now. you had a heart attack before you came in to the hospital so we have started some medicines to help your heart recover from the heart attack. followup instructions: . department: cardiac services when: wednesday at 1 pm with: , md building: campus: east best parking: garage . department: cardiac services when: monday at 3:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage . name: , md specialty: primary care location: hospital address: 1400 vfw parkway, , phone: please call dr. office and make an appointment to be seen within 1 week of your discharge from the hospital. let them know you will need a post-hospitalization appointment. procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system diagnoses: acute kidney failure with lesion of tubular necrosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified atrioventricular block, complete old myocardial infarction 

Answer: The patient is high likely exposed to