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: bradycardia major surgical or invasive procedure: placement of pacemaker history of present illness: 86 yo male presented to ed in complete heart block. he was at adult day care on the day of admission when staff checked his vital signs around 12:00 noon and found him to have a heart rate in the 30s. his daughter was called and picked up the patient and took him to his pcp where 12 lead ekg revealed him to be in complete heart block. he has had decreased energy for several weeks and has been less active. per his daughter, he is pleasantly confused at baseline and was at his baseline mental status on presentation to the ed and upon transfer to . he denies chest pain, sob, nausea, vomiting, diarrhea, syncope, lightheadeness. he does endorse mild abdominal pain but denies any diarrhea or other symptoms. . at the hospital ed, his vs were t 97.4, p 39, rr 16, bp 184/67, o2 sat 98% 02 on 3 l nc. he was transferred to for temporary transcutaneous pacemaker placement due to complete heart block with wide ventricular escape at 35 bpm. a temporary transcutaneous pacer was advanced to the rv apex via fluroscopic guidance and position was confirmed with fluorscopy. v threshold was set at 0.8 ma and v sensitivity threshold at >20 ms. s: vvi 70, v output 10 ma, v sensitivity 3 mv. . past medical history: 1. hypertension 2. hypercholesterolemia 3. dementia 4. cabg x4 vessels () 5. cva () 6. chf 7. depression 8. hypothyroidism 9. barrett's esophabus 10.eye surgery, unspecified 11. elevated crp, documented in pcp (3.8) social history: social history: social history is significant for the absence of current or prior tobacco use. there is no history of alcohol abuse. patient is a retired pharmacist. moved to from several years ago to live with his daughter. attends daycare. . family history: family history there is no family history of premature coronary artery disease or sudden death. mother: (deceased, cod: pneumonia). father: unknown problem (deceased). physical exam: vs: t 97.6, bp 137/31, hr 37, rr 23, o2 98% on 2l gen: wdwn middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no appreciable jvd. cv: 2/6 sem at rusb and lusb. pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: 08:01pm glucose-115* urea n-26* creat-1.3* sodium-140 potassium-4.8 chloride-107 total co2-24 anion gap-14 08:01pm estgfr-using this 08:01pm calcium-9.1 phosphate-3.3 magnesium-2.5 08:01pm tsh-7.4* 08:01pm wbc-6.2 rbc-3.32* hgb-10.6* hct-31.0* mcv-93 mch-31.8 mchc-34.1 rdw-13.8 08:01pm plt count-229 . study: ct of the head without contrast. there is a large area of encephalomalacia involving the left occipital lobe, vascular territory of the left posterior cerebral artery, multiple areas of low attenuation in the periventricular white matter, indicating chronic microvascular ischemic disease, there is no evidence of acute hemorrhagic changes or shifting of the normally medial structures. punctate dense atherosclerotic calcifications are visualized in the left medial cerebral artery, carotid siphons, and vertebral body basilar systems. prominence of the sulci and ventricles is also noted, likely age related and involutional in nature. prominence of the tip of the basilar artery is also noted, the possibility of arteriosclerotic changes versus aneurysmatic formation are considerations, cta of the head is recommended if clinically warranted. the orbits appear grossly normal, the paranasal sinuses demonstrate normal pneumatization, as well as the mastoid air cells. impression: chronic ischemic changes are visualized on the left occipital lobe with associated encephalomalacia and asymmetry of the left occipital ventricular . multiple areas of low attenuation are demonstrated in the periventricular white matter, likely consistent with chronic microvascular ischemic changes. there is no evidence of acute hemorrhage or subdural hematoma. dense arteriosclerotic calcifications are demonstrated in the carotid siphons, left medial cerebral artery, and vertebrobasilar system as described above. prominent tip of the basilar artery is demonstrated, possibly related with arteriosclerotic changes, a small aneurysm cannot be completely excluded, cta or mra are recommended for further characterization of these findings. these findings were communicated to dr. at the time of this interpretation. . cta head w&w/o c & recons study date of prominence of the ventricles and sulci is related to age-related parenchymal atrophy. periventricular white matter hypoattenuation is consistent with chronic small vessel ischemic disease. there is again calcification of the middle cerebral arteries, carotid siphons, and vertebrobasilar arterial system. there is no hemorrhage, edema, mass effect, or shift of normally midline structures. there is ex vacuo dilatation of the posterior of the left lateral ventricle with surrounding encephalomalacia, consistent with prior infarction. cta head: there is prominence at the tip of the basilar artery, which may represent a patulous basilar artery or a small aneurysm. poor arterial opacification and lack of processed imaging limits evaluation. when processed images are become available, a separated addendum will be provided. impression: 1. prominence of tip of basilar artery may represent patulous basilar artery versus small aneurysm. poor arterial opacification and lack of processed image limits evaluation, but an addendum will be generated. 2. calcifications of the intracranial vessels. 3. age-related parenchymal atrophy. 4. chronic small vessel ischemic disease. 5. encephalomalacia of the left occipital lobe, likely from prior infarction. . echo: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). no masses or thrombi are seen in the left ventricle. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild aortic and mitral regurgitation. mildly dilated thoracic aorta. brief hospital course: #rhythm-the patient was transferred to for temporary transcutaneous pacemaker placement due to complete heart block with wide ventricular escape at 35 bpm. a temporary transcutaneous pacer was advanced to the rv apex via fluroscopic guidance and position was confirmed with fluorscopy. v threshold was set at 0.8 ma and v sensitivity threshold at >20 ms. s: vvi 70, v output 10 ma, v sensitivity 3 mv. pt subsequently had a pacemaker placed without complication. he did well and was monitored on telemetry x48 hours post procedure. he was started on metoprolol 12.5mg after the pacemkaer was placed for his known cad. . # pump: overall ef 45% from with global hypokinesis suggesting systolic dysfunction. an echo was done which showed mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). he was started on 40mg lasix prior to discharge. . # cad/ischemia: pt ruled out for an mi. he was continued on his lipitor, plavix, ramipril per home dosing. he was started on metoprolol twice daily and aspirin. . #. hypothyroidism- initially there was concern that the patient may be hypothryoid which could contribute to heart block however tsh was wnl. endocrine consulted at first but pt was on adequate synthroid replacement. he remained on his home synthroid dose and appt made for endocrine followup on discharge. . # pt has dementia at baseline per daughter. . # basilar artery aneurysm/left posterior infarct. given mental status changes, there was initial concern for an intracerebral abnormality (given history of fall at home) and thus ct head was done. it showed no hemorrhage, but there was concern for a basilar artery aneurysm. thus, a cta head was done which showed prominence of the tip of a basilar artery which may represent patulous basilar artery versus small aneurysm. further followup with the patient's pcp regarding this possible aneurysm is recommended; however, no acute neurosurgical interventions were deemed necessary. the patient was also noted to have a large left posterior old infarct with associated encephalomalacia and chronic svid on this scan, likely related to ischemic dementia. medications on admission: 1. reminyl 8 mg po bid 2. zoloft 100 po daily 3. altace 10 mg po daily 4. lasix 20 mg po daily 5. lipitor 10 mg po daily 6. plavix 75 mg po daily 7. hydtrin 5 mg po daily 8. synthroid 175 mcg po daily 9. ranitidine 150 mg po daily 10. kdur 20 mg po dialy discharge medications: 1. sertraline 100 mg tablet sig: one (1) tablet po daily (daily). 2. ramipril 5 mg capsule sig: two (2) capsule po daily (daily). 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 7. galantamine 4 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for alzheimer's disease. 8. terazosin 5 mg capsule sig: one (1) capsule po hs (at bedtime). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 11. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: meadowbrook - discharge diagnosis: primary 1. mobitz type ii heart block . secondary 1. hypertension 2. hypercholesterolemia 3. dementia 4. coronary artery disease 5. hypothyroidism 6. congestive heart failure discharge condition: hemodynamically stable, afebrile discharge instructions: you were admitted to the hospital for an irregular heart rhythm. you had a temporary pacing wire placed and then had a pacemaker placed to help control your heart rate. . there were changes made to your medications. you were started on new medications, including metoprolol 12.5mg twice daily. you were also started on lasix 40mg daily to help maintain your fluid status. . you will need to follow up with device clinic. an appointment was made for you. in addition you should be seen by endocrinology as scheduled. followup instructions: please followup with dr. , your pcp on at 3:30 pm or at least one week after patient leaves rehabilitation. phone . . a followup appointment has been made with endocronologist, provider: , md phone: date/time: 1:40 . ***provider: clinic phone: date/time: 1:30 procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system diagnoses: pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other persistent mental disorders due to conditions classified elsewhere systolic heart failure, unspecified mobitz (type) ii atrioventricular block 

Answer: The patient is high likely exposed to