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: calcium chloride / augmentin / unasyn attending: chief complaint: syncope major surgical or invasive procedure: : dual chamber ppm history of present illness: ms. is an 86-year-old woman with history of coronary artery disease, peripheral vascular disease, hypothyroidism, hypertension, and high cholesterol who complains of syncope. . pt with multiple syncopal events in last couple weeks. noted to syncopize today while at grocery store with daughter. backwards and hit her head. bleeding and swelling of posterior head. boarded and collared by ems. the patient says that she lost conciousness very quickly, and does not remember falling. no chest pain or palpitations. she was not hypoglycemic. she has had intermitent lightheadedness and dizzyness over past month, and was seen recently by neurology, with a fairly unremarkable mri. she does endorse several episodes of "fainting" this month where she gets a prodrome of "painful face squeezing" but that did not occur prior to this episode. she denied any bowel or bladder incontinence. in the , report she had sinus brady into the 40s, and felt lightheaded as such. she did not recieve any atropine. . in the ed, initial vitals were 97.2 70 137/62 16 100% ra. . labs were notable for a stat lactate 2.1, cr 1.4, and hct 32.6. a ct of her head was perfomred, which showed no acute intracranial hemorrhage or fractures. mild increase (since ) in the left parietal meningioma, now 2.2 cm , without significant mass effect. left parietal scalp hematoma. . of note, the patient recently was discharged from after a right pt angioplasty . she also had a ct c-spine, which showed no acute c-spine fractures, but multilevel severe djd. . a pelvis xr showed a high riding humeral head may be due to rotator disease, no acute fracture. . a l elbow film read was still pending, but by my read showed no acute fracture. . vitals on transfer were 53, 139/74, 16, 97.8, 98 ra. . review of systems + for prior history fo dvt, and positive for peripheral vascular disease on review of systems, she denies any prior history of stroke, tia, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle palpitations, syncope or presyncope. she does endorse intermittent lower extremity edema that is most notable when she has not urinated. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: -cabg: -percutaneous coronary interventions: -pacing/icd: 3. other medical issues -chronic diarrhea -anxiety -fibroids of the uterus -coronary artery disease -kidney stones -back pain -cervical myelopathy -s/p cholecystectomy -meningioma social history: widowed, lives alone in subsidized housing, independent in all adl's. children live in area. no tobacco. minimal etoh. enjoys and learned english by . has vna at home. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission: vs: t 97.3 bp 166/73 hr 74 rr 22 100% ra general: elderly female in nad. oriented x3. heent: posterior eccymoses on the scale, ttp. sclera anicteric. dry mm. neck: supple without jvd cardiac: pmi located in 5th intercostal space, midclavicular line. 1/6 sem, no s3 or s4 lungs: ctab abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. right heel ulcer is clean and dry, no surroudning erythema. pulses: warm extremities, difficult to palpate pulses manually on discharge: vs: 98, 122/64, 80, 18, 100% on ra; in/1200 out general: elderly female in nad. oriented x3. heent: posterior eccymoses on the scalp, mildly ttp. sclera anicteric. dry mm. neck: supple without jvd cardiac: pmi located in 5th intercostal space, midclavicular line. soft systolic murmur best heard at rusb, no s3 or s4, pacer insertion site clean, no ecchymoses or hematoma lungs: ctab, good air movement abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. right heel ulcer is clean and dry, no surroudning erythema. pulses: warm extremities, good pulses pertinent results: admission: 08:10pm blood wbc-6.0 rbc-3.38* hgb-11.1* hct-32.6* mcv-96 mch-32.7* mchc-34.0 rdw-14.3 plt ct-159 08:10pm blood neuts-63.1 lymphs-27.8 monos-4.0 eos-4.1* baso-0.9 08:10pm blood glucose-102* urean-25* creat-1.4* na-140 k-6.1* cl-107 hco3-26 angap-13 08:10pm blood calcium-10.1 phos-4.1 mg-1.9 08:36pm blood glucose-99 lactate-2.1* na-143 k-4.8 cl-107 discharge: 07:10am blood wbc-5.2 rbc-3.03* hgb-9.9* hct-29.7* mcv-98 mch-32.7* mchc-33.3 rdw-14.1 plt ct-131* 07:10am blood calcium-8.9 phos-3.3 mg-1.7 cardiac enzymes: 08:10pm blood ck(cpk)-160 ck-mb-4 ctropnt-<0.01 02:00am blood ck-mb-3 ctropnt-<0.01 portable ap cxr & pelvis xr () -chest: supine portable view of the chest was obtained. the right costophrenic angle is not fully included on the image. given this, no focal consolidation, large pleural effusion, or evidence of pneumothorax is seen. cardiac and mediastinal silhouettes are stable and unremarkable. degenerative changes are seen at the left shoulder joint with the humeral head appearing high-riding. -pelvis: supine ap portable view of the pelvis was obtained. the osseous structures are underpenetrated presumably due to patient's overlying soft tissue. there is popcorn type calcification in the pelvis most consistent with calcified fibroids. grossly, no acute fracture or dislocation is seen. the pubic symphysis and sacroiliac joints are intact. degenerative changes are likely present in the visualized lower lumbar spine. bilateral iliac and greater trochanter enthesopathy is seen. vascular calcifications are seen. -impression: 1. no acute intrathoracic process. high riding humeral head may be due to rotator cuff disease, although not optimally evaluated on this study. 2. suboptimal pelvic radiograph due to underpenetration due to patient's overlying soft tissue. given this, grossly no acute fracture is seen. however, if clinical concern is high, consider additional imaging. ct c-spine w/o contrast () no acute cervical spine fracture. multi-level moderate to severe degenerative changes of the cervical spine. ct head w/o contrast () 1. no acute intracranial hemorrhage or fractures. 2. small left parietal scalp hematoma. 3. mild interval increase in a partially calcified left parietal meningioma since . elbow (ap, lat & oblique - ) no acute fracture or dislocation is seen in the left elbow. there is no joint effusion. minimal degenerative changes with spurring is seen at the articular margins of the ulna and distal humerus. soft tissue are not adequately assessed in this study. an iv access tubing overlies the left elbow. portable chest () normal heart, lungs, hila, mediastinum and pleural surfaces. tte : () the left atrium is elongated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). there is no left ventricular outflow obstruction at rest or with valsalva. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild mitral regurgitation with normal valve morphology. no structural cardiac cause of syncope identified. chest: () chest radiograph technique: single portable upright chest view was reviewed in comparison with prior chest radiograph from . findings: patient received a new left pectoral pacemaker with each lead terminating into the right atrium and right ventricle respectively. there is no pneumothorax. both lungs are clear. there are no lung opacities of concern. there is no pleural abnormality. heart size, mediastinal and hilar contours are normal. brief hospital course: 86f w/ cad, pvd, htn, hld, hypothyroidism who presented with syncope, found to have sss now s/p dual chamber st. pacemaker on . . . # syncope s/p pacemaker: pt had syncopal episode. found to have sss with multiple sec pauses on telemetry. dual chamber ppm placed. pt subsequently had two episodes of vasodepressor episodes yesterday while using bathroom. reverse hysteresis was turned on. the pacer was functioning well with a sensing and v sensing in the 60s-70s with a pacing and v pacing at 60bpm on discharge. the patient was continued on metoprolol after ppm placement. orthostatics were negative. echo demonstrated no structural abnormalities to account for syncope. . # pvd: pt remained on clopidogrel 75 mg daily and aspirin 325 mg daily for peripheral vascular disease s/p r pt angioplasty. . # hypertension: - continue hctz . # dyslipidemia: - continue simvastatin . # aocki: - patient's cr at baseline after ivf. . # hypothyroidism: - levothyroxine. . # anemia: - stable . # left parietal scalp hematoma/lac: - stable, ct head was negative . # diabetes: - held home meds and placed on iss in-house. . code: confirmed full emergency contact: daughter . transitional: 1) f/u with clinic medications on admission: oxycodone-acetaminophen 5-325 mg q4h prn pain docusate sodium 100 mg omeprazole 40 mg daily clopidogrel 75 mg daily aspirin 325 mg daily hydrochlorothiazide 25 mg daily metformin 1000 mg meclizine 12.5 mg tid allopurinol 200 mg daily simvastatin 10 mg daily levothyroxine 50 mcg daily glyburide 5 mg metoprolol tartrate 25 mg tid discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 6. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 7. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 8. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 9. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 10. silver sulfadiazine 1 % cream sig: one (1) appl topical (2 times a day). 11. glyburide 5 mg tablet sig: one (1) tablet po twice a day. 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 13. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 1 doses: please give one dose on then stop. discharge disposition: extended care facility: livingcenter - heathwood - discharge diagnosis: primary: sick sinus syndrome s/p ppm, syncope secondary: pvd, htn, hld, hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you at . you were admitted for an episode of syncope and were found to have significant pauses of your heart. a permanent pacemaker was placed to prevent episodes like this from recurring in the future. the following changes were made to your medications: stop omeprazole stop meclizine decrease allopurinol 100mg daily followup instructions: department: when: thursday at 9:10 am with: , md. post clinic building: sc clinical ctr campus: east best parking: garage *this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: cardiac services when: thursday at 10:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: vascular surgery when: thursday at 1:10 pm building: lm campus: west best parking: garage department: vascular surgery when: thursday at 1:55 pm building: lm campus: west best parking: garage department: vascular surgery when: thursday at 2:30 pm with: , md building: lm bldg () campus: west best parking: garage md, procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension unspecified acquired hypothyroidism anxiety state, unspecified diarrhea sinoatrial node dysfunction atherosclerosis of native arteries of the extremities, unspecified 

Answer: The patient is high likely exposed to