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: history of present illness: the patient is a 73 year old male transferred from to for permanent pacemaker placement. the patient presented to with three days of shortness of breath, pedal edema on , and on electrocardiogram there, the patient was found to be in complete heart block with escape rhythm in the 30s. the patient was also in congestive heart failure. he has chronic renal insufficiency with a baseline creatinine of approximately 2.3. last night electrocardiogram showed normal sinus rhythm at 80 beats per minute, first degree av block, right bundle branch block, left axis deviation. temporary pacemaker wires were placed on , with 70% capture noted as per discharge summary. the patient was noted to have four beat run of ventricular tachycardia prior to wire placement as well. given both pacing needs and history of ventricular tachycardia, the patient was transferred to the for pacer defibrillator placement. upon arrival to , it was noted that the patient's pacer was capturing only 30% of the time at bedside. dr. was called urgently for bedside wire evaluation with fluoroscopy. it was noted that the wires were noted to be in the right ventricular outflow tract and they were repositioned in the right ventricular apex. the patient was stable and capturing with threshold of 1.5 mv of current. past medical history: 1. ischemic cardiomyopathy. 2. porcine aortic valve replacement five years ago. 3. coronary artery bypass graft times four five years ago. 4. left ventricular aneurysmectomy 5 years ago. 5. history of nonsustained ventricular tachycardia. 6. chronic obstructive pulmonary disease/emphysema. 7. chronic renal insufficiency. 8. diabetes mellitus, diet controlled. medications on admission: 1. aspirin 325 mg p.o. once daily. 2. paxil 20 mg once daily. 3. digoxin 0.125 mg once daily. 4. captopril 6.25 mg twice a day. 5. lipitor 10 mg p.o. once daily. 6. furosemide 60 mg once daily. 7. lorazepam 0.5 mg. 8. zaroxolyn 2.5 mg monday, wednesday and friday. 9. potassium chloride 50 meq once daily. 10. combivent nebulizer four times a day. 11. trusopt eye drops. 12. xalatan eye drops. primary care physicians: dr. , and dr. . physical examination: heart rate 70 beats per minute paced, blood pressure 102/60, oxygen saturation 98%, respiratory rate 23, moist mucous membranes. jugular venous pressure elevated to 10. the pacing wires were in place. lungs - expiratory wheezes with poor air flow. heart - regular rate and rhythm, s1 and s2. the abdomen was soft and nontender. extremities - +1 lower extremity edema bilaterally. neurologically, the patient is alert and oriented times three. laboratory data: on presentation, digoxin level was 2.13. hematocrit was 39.7. white blood cell count 5.2, platelet count 195,000. creatinine 2.2, blood urea nitrogen 83. sodium 138, chloride 93, bicarbonate 27, potassium 4.0, magnesium 2.6, ck 124, troponin 0.061. electrocardiogram showed bigeminy. old electrocardiogram from , complete heart block, right bundle branch block. hospital course: the patient is a 73 year old male with complete heart block and history of ventricular tachycardia transferred from with temporary pacing wires for permanent pacemaker/possible aicd placement. on the night of admission the patien developed progressive respiratory distress due to pulmonary edema, and was intubated and sedated. chest x-ray confirmed pulmonary edema. right heart catheterization showed cardiac output of 5.1 and cardiac index of 2.75. the patient had initially been started on dopamine and neo-synephrine for hypotension status post the intubation. pacing wire remained functional in the 70s. on , the dopamine was weaned off. on , neo-synephrine was weaned off. the patient went to the electrophysiology laboratory and had a biventricular permanent pacemaker placed with no complications. discussions had been made with the patient (prior to intubation) and the family regarding the possible placement of an icd. both the patient and family felt that this was not compatible with the patient's wishes. on , the patient was weaned from the ventilator successfully being alert and in good spirits. he had been placed on a lasix drip prior to being extubated with a diuresis of 3.5 liters. during this period, the patient also had an echocardiogram on . the patient was found to have a left ventricular ejection fraction of 20%, tr gradient of 45, left atrium elongated, right atrium was mildly dilated. catheter pacing wire was seen in the right ventricle and/or right atrium, left ventricle wall thickness normal, cavity was mildly dilated, several global left ventricular hypokinesis, no mass or thrombi seen in the left ventricle, right ventricular cavity is mildly dilated, right ventricular systolic function appeared depressed, + mitral regurgitation, moderate 2+ tricuspid regurgitation and moderate pulmonary artery systolic hypertension. the patient is a 73 year old male who presents with an ejection fraction of 20%, chronic obstructive pulmonary disease, with complete heart block, status post permanent pacemaker, also history of ventricular tachycardia, but the patient's family wanted him to be do not , not resuscitate. as a result, he did not have an aicd placed. rhythm - complete heart block - he is status post permanent pacemaker placement with no events. the patient has a follow-up appointment on , at 10:30 a.m. at device clinic, . the patient was noted to have brief episodes of atrial fibrillation, however the decision was made not to initiate coumadin at this time due to risk of falling and anemia and the relatively short periods of time that the patient has been in atrial fibrillation. this will be readdressed in the future. coronary artery disease - aspirin, statin, low dose zestril for congestive heart failure. the patient was on 0.125 mg digoxin once daily. the patient should have a digoxin level checked on monday, . the patient will be discharged on a dose of lasix p.o. if the patient should have any weight gain, his primary care physician should be . the patient should be followed up and have his coreg started as an outpatient in the outpatient cardiology setting if his blood pressure tolerates it for his heart failure. pulmonary - the patient has chronic obstructive pulmonary disease and has received atrovent nebulizers here and is on singulair as well and uses a combivent inhaler. renal - the patient's creatinine was 1.3 on the day of discharge. it seemed to be relatively stable throughout his stay. he actually presented with a higher creatinine of 2.2 at the time of admission. infectious disease - the patient received vancomycin peripacemaker wire adjustment and pacemaker placement. he then will be on keflex for seven days postprocedure until . discharge diagnoses: 1. congestive heart failure. 2. complete heart block, status post permanent pacemaker placement. 3. chronic renal insufficiency. 4. chronic obstructive pulmonary disease. 5. type 2 diabetes mellitus. 6. coronary artery disease, status post coronary artery bypass graft. 7. porcine aortic valve replacement. 8. ischemic cardiomyopathy. discharge follow-up: device clinic, i.e., clinic, building, seventh floor at 10:30 a.m., , on . medications on discharge: 1. aspirin 325 mg once daily. 2. paxil 20 mg once daily. 3. digoxin 0.125 mg once daily. should have level checked two to three days status post discharge. 4. zestril 2.5 mg p.o. once daily. 5. keflex 500 mg p.o. q12hours until . 6. lasix 30 mg p.o. twice a day. 7. lipitor 10 mg p.o. once daily. 8. dorzolamide 2% ophthalmic solution one drop o.u. twice a day. 9. latanoprost 0.005% ophthalmic solution one drop o.u. q.h.s. 10. combivent one to two puffs q4hours. 11. singulair 10 mg p.o. once daily. the patient should have blood urea nitrogen and creatinine as well as potassium monitored frequently and have his potassium repleted as needed given the diuretic usage. , m.d. dictated by: medquist36 d: 11:52 t: 12:20 job#: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation other specified forms of chronic ischemic heart disease atrioventricular block, complete heart valve replaced by transplant 

Answer: The patient is high likely exposed to