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: no known allergies / adverse drug reactions attending: chief complaint: palpitations/pre-syncope major surgical or invasive procedure: ep study dual chamber pacemaker history of present illness: this is a 49 yo female who has a history of hypothyroidism, morbid obesity, polycystic ovarian disease, but no know heart disease presenting here with twinges in her chest and lightheadedness. in early she reported to her pcp that she was having episodic lightheadedness and palpitations. in particular she reported an episode of palpitation with her heart racing and a fluttering in her neck. she presented to her pcp where on ecg she was noted to have a wide complex tachycardia with rbbb morphology and left superior axis. she was then referred to the nwh er where she was treated with adensine up to 12mg, metoprolol 5mg, lidocaine 25 and 50mg boluses, and diltiazem 20 and 25mg. she was eventually transferred to er where she was started on an esmolol gtt after which she converted to sinus and remain in sinus throughout her hospitalization at . she was discharged on metoprolol with follow up with ep for possible ep study. . it was unclear if this wide complex tachycardia was svt with aberrency or vt. she was seen by dr. (see his note on ). he continued metoprolol at 100mg daily. an adenosine mibi didn't show any ischemia and her echo was normal. she was started on a holter monitor. . today she presents to the ed after more intermittent episodes of twinges in her chest and lightheadedness. she described 2 episodes where she was sitting on her couch watching her 4 year old daughter and 'blacked out'. she recorded the episode on her holter. the cardiologist from the holter company called her at home and told her to go immediately to the ed for evaluation for long pauses. . in the ed, the patient experience another episode where she passed out, which corresponded with a 15 second pause. the patient also experience two more epiosodes of 12 second pauses with syncope. her hemodynamics were stable with these pauses and did not drop her blood pressure of her o2 sats's. she was urgently taken to the cardiology suite where a temporary pacer was placed with a minimal rate to 60. she was transfer to the ccu for further observation. . on arrival to the ccu, she was chest pain free and denies lightheadness or sob. she complainted of appropriate pain at the site of the pacer insertion site on her neck. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he 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 edema, palpitations, syncope or presyncope. . past medical history: herpes simplex polycystic ovaries hypothyroidism iritis - acute / subacute, unspec infertility - female, unspec etiol obesity - morbid hypomenorrhea/oligomenorrhea cholelithiasis social history: - tobacco history: never - etoh: rare - illicit drugs: no family history: cad-grandfather lung ca in father physical exam: physical examination on admission: general: 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 with jvp of *** cm. cardiac: 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. ctab, no crackles, wheezes or rhonchi. 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. neuro: aaox3, cnii-xii intact, 5/5 strength biceps, triceps, wrist, knee/hip flexors/extensors, 2+ reflexes biceps, brachioradialis, patellar, ankle. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: labs on admission: 05:43am blood wbc-6.6 rbc-3.31* hgb-10.3* hct-29.4* mcv-89 mch-31.3 mchc-35.1* rdw-13.1 plt ct-170 09:29pm blood pt-11.3 ptt-29.8 inr(pt)-1.0 09:29pm blood glucose-101* urean-11 creat-0.7 na-140 k-3.8 cl-107 hco3-21* angap-16 09:29pm blood ctropnt-<0.01 09:29pm blood calcium-9.3 phos-2.9 mg-1.9 09:29pm blood d-dimer-636* 09:29pm blood tsh-1.2 labs on dc: 02:34am blood wbc-7.2 rbc-3.60* hgb-11.1* hct-31.7* mcv-88 mch-30.7 mchc-35.0 rdw-13.1 plt ct-192 02:34am blood pt-12.0 ptt-28.7 inr(pt)-1.1 02:34am blood glucose-103* urean-7 creat-0.6 na-136 k-4.0 cl-107 hco3-21* angap-12 02:34am blood albumin-3.6 calcium-8.1* phos-2.9 mg-1.9 02:34am blood -positive * titer-1:80 cxr : findings: chest pa and lateral radiograph demonstrates unremarkable mediastinal, hilar and cardiac contours. lungs are clear. no pleural effusion or pneumothorax evident. interval placement of a left-sided pacemaker with lead tips positioned in the right atrium and right ventricle. brief hospital course: hospital course: 49f with a recent history of svt vs. vt treated with metoprolol, presenting with symptomatic bradyarrythmias with 12-15 second pauses, who got a temporary pacer for paroxysmal atrioventricular block # paroxysmal atrioventricular block: the patient presented with 3 second pauses resulting in syncope due to non-conducted p-waves. a temporary pm was placed with a back-up rate of 60. lyme serology was -ve. a permanent pacemaker placement was subsequently palced after an ep study. pt was discharged on keflex. ep recs: sinus node: not formally assessed, no abnormalities atria: normal, no inducible arrhythmias av node: dual pathway physiology present. no sustained arrhythmias induced. very poor va conduction with poorly tolerated rv pacing. no paroxysmal av block induced. hps: abnormal hiv with infra-hisian conduction disease evident ventricles: no inducible arrhythmias. no evidence of accessory pathway conduction antegrade or retrograde # h/o svt with aberrancy vs. vt- the patient was on metoprolol 100mg daily for rate control. she was being followed by dr. # hypothryoidism: we continued home medication of levothyroxine 150mcg transitional issues: followup with dr was arranged. pt had an elevated that may require further workup. only med change was addition of keflex. medications on admission: metoprolol succinate oral 100 mg po in the evening levothyroxine (levoxyl) 150 mcg oral tablet 1 tablet po qd fluticasone 50 mcg/actuation nasal spray, suspension 1 spray in each nostril once daily urea (carmol 40) 40 % topical cream apply to feet as directed multivitamin vitamin d 1000 units discharge medications: 1. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. 2. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 3. cephalexin 500 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 2 days. disp:*6 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: high grade av block s/p dual chamber pacemaker 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 the . you presented with problems with your heart rhythm causing you to blackout. you were admitted and got a permanent pacemaker which should prevent such episodes from happening. you were discharged home with followup with your cardiologist, dr , and some medicine changes. the following changes were made to your medications: start keflex 500 mg q8h for 2 days followup instructions: please call to set up an appointment with dr. . please follow up with dr. next week procedure: catheter based invasive electrophysiologic testing initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: unspecified acquired hypothyroidism morbid obesity first degree atrioventricular block polycystic ovaries 

Answer: The patient is high likely exposed to