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: lipitor attending: chief complaint: tachycardia major surgical or invasive procedure: cardioversion history of present illness: 84 year old female with history of atrial flutter, cad s/p cabg , htn presents with asymptomatic tachycardia. patient was previously discharged from hospital on after being admitted on for asymptomatic tachycardia. patient was noted to be in atrial flutter on previous admission that converted back to sinus with fluid administration alone. during her previous admission, patient was seen and evaluted by ep who reccomending continuing current management without change in medications. please see previous discharge summary for furthur discharge info. it appears that 2 days after discharge patient was back in atrial flutter (ie since ) looking at ob/gyn note in omr with hrs in 140s. patient has regular vna services at home, and this morning vna thought that the patient was in afib with heart rate in the 140s. at that time patient with stable bp 112/70. as per vna patient is patient was completely asymptomatic, afebrile, without chest pain or shortness of breath. non specific ecg changes. . patient was transported to our ed for further eval. on arrival to ed her vitals were t 97.1 bp 129/70 hr 143 rr 18 98% ra. patient was in atrial flutter. cardiology was consulted. patient was given iv diltiazem 10 mg x 2 and iv metoprolol 5 mg x 2 per verbal ed signout. patient then dropped her pressures to 88/46 with no change in heart rate and was given total of 3 liters of ns boluses per ed verbal signout. . on arrival to micu her symptoms were t 96.9 hr 140s bp 109/73 rr 15 99% ra. patient denies any fever, chills, nightsweats, cough, cold, chest pain, shortness of breath, pnd, orhtopnea, abdominal pain, dysuria, hematuria, blood in stool or urine, weakness, numbness. her diarrhea has resolved. stable chronic back pain. no other complaints. past medical history: atrial flutter s/p dc cardioversion in , flutter ablation cad s/p cabg x 4 (lima->lad, svg->dm2, svg->om1, svg->pda) cad, s/p prior mi hypertension hyperlipidemia djd, right knee pud (healing pre-pyloric ulcer on egd ) sigmoid diverticulosis anemia peripheral neuropathy chronic lower back pain cystocele complicated by mixed incontinence thallasemia chronic venous insuffiency dub djd, right knee. s/p cataract surgery left eye s/p excision of cyst, right knee social history: widowed. has 2 children living nearby. previous smoker, but quit many years ago. occasional alcohol. family history: positive for diabetes in her sister and cad in her brother. physical exam: vital signs: t 96.9 hr 140s bp 109/73 rr 15 99% ra. general appearance: elderly woman in no distress. pleasant, following commands, able to give history. heent: mmm neck: jvp 8 cm. lungs: fine crackles at right > left lung bases. heart: irregularly irregular, normal s1 and s2, tachycardic abdomen: +bs, soft, ntnd. extremities: trace edema in ble. pertinent results: labs on admission: . hematology: 02:30pm blood wbc-8.4 rbc-5.41* hgb-10.9* hct-35.4* mcv-65* mch-20.1* mchc-30.7* rdw-16.2* plt ct-283 02:30pm blood neuts-59.3 lymphs-29.2 monos-7.3 eos-3.9 baso-0.4 02:30pm blood pt-22.0* ptt-26.1 inr(pt)-2.1* . chemistry: 02:30pm blood glucose-120* urean-23* creat-1.2* na-141 k-4.4 cl-101 hco3-29 angap-15 06:19am blood calcium-8.8 phos-3.1 mg-2.0 02:30pm blood ck-mb-notdone ctropnt-<0.01 02:30pm blood ck(cpk)-74 . ekg narrow complex supraventricular tachycardia, most likely a-v nodal re-entrant tachycardia. compared to the previous tracing of supraventricular tachycardia is new. read by: , intervals axes rate pr qrs qt/qtc p qrs t 143 0 76 326/471 0 16 128 . cxr since , mild interstitial edema is new. prior sternotomy for cabg was performed. there is no significant pleural effusion. heart size is top normal. the aorta is tortuous and calcified. there is no focal area of consolidation. minimal indentation on the right tracheal wall could be due to a thyroid nodule, should be evaluated by if not already known. . cxr portable semi-upright radiograph of the chest: the patient is rotated to the left which limits evaluation of the heart size. the aorta is tortuous and calcified. the hilar contours are unremarkable. there are low lung volumes bilaterally. small amount of left pleural effusion is noted. impression: limited study, but no acute intrathoracic pathology. brief hospital course: 84f w cad (s/p cabg), a-fib and a-flutter (s/p dccv and cavotrunkal isthmus ablation), admitted with asymptomatic tachycardia after discharge on for same issue. . # rhythm - patient with a history of atrial flutter s/p dc cardioversion in , and subsequent empirical cti ablation in the setting of noninducible svt. she was in atrial flutter with hr 140s on admission, therapeutically anticoagulated. coumadin was held and heparin gtt started. ep saw her and recommended cardioversion. she had been therapeutic on her coumadin for the past 8 weeks. cardioversion was successful after one 200 j shock. she was subsequently hemodynamically stable with wandering atrial pacemaker in the 80s. amiodarone was started at 200mg tid, and coumadin was restarted at 1mg (half home dose because of known interaction with amiodarone). she will need outpatient pfts for baseline on amiodarone as well as regular inr checks / coumadin dose adjustments. her amiodarone will be tid for 5 days, then for 14 days, then once a day. . # coronaries - patient with a history of cad s/p cabgx4 in . no acute issues. pt discharged on aspirin 81mg daily, toprolxl 150mg daily. enalapril reduced to 5mg po daily due to increased creatinine. simvastatin switched to pravastatin 80mg daily due to interaction with amiodarone. . # pump ?????? she had chronic systolic congestive heart failure (lvef=30-35% on tte in 8/). she initially appeared euvolemic. after receiving 3 l of fluid in the ed, she developed acute respiratory distress several hours after her cardioversion. bp was elevated to 200/120, she was transferred back to the ccu overnight. shortness of breath improved with iv lasix, and she was thought to have had flash pulmonary edema. pt's symptoms resolved and she was restarted on home medications and sent back to the regular cardiology floor. . # acute renal failure - cr on admission was 1.2, up from baseline of 0.9-1.0, likely pre-renal from recent diarrhea and poor forward flow from heart failure. ace inhibitor was held, then restarted on a lower dose (enalapril 5mg daily). . # thalassemia - low mcv and normal serum iron level were consistent with a known diagnosis of thalassemia. hematocrit on admission was 35 which is relatively stable. . # hyperlipidemia - discharged on pravastatin. . # thyroid nodule- seen on cxr, needs follow up as out pt. tsh was 1.7 at baseline before starting amiodarone. . pt will be discharged home with vna. cardiology and pcp follow up are planned, as well as a thyroid and pfts. her pcp will be following her inr. medications on admission: warfarin 2 mg daily aspirin 81 mg tablet daily metoprolol succinate 150 mg daily enalapril maleate 10 mg tablet daily simvastatin 80 mg daily furosemide 40 mg daily gabapentin 300 mg daily lidocaine 5 %(700 mg/patch) patch daily omeprazole ec 20 mg capsule daily nitroglycerin 0.3 mg sl prn lorazepam 0.5 mg qhs prn for insomnia calcium-cholecalciferol (d3) 500 (1,250)-200 mg-unit estradiol 0.01 % (0.1 mg/g) cream vaginal multivitamin daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. metoprolol succinate 100 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po daily (daily). 3. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). 4. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 5. pravastatin 20 mg tablet sig: four (4) tablet po daily (daily). disp:*120 tablet(s)* refills:*2* 6. amiodarone 200 mg tablet sig: one (1) tablet po as directed: take one pill three times a day through , then take one pill twice a day for 2 weeks, then take one pill once a day. disp:*51 tablet(s)* refills:*2* 7. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: adhesive patch, medicateds topical daily (daily). 11. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 12. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po daily (daily). 13. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. discharge disposition: home with service facility: vna discharge diagnosis: atrial flutter . coronary artery disease hypertension hyperlipidemia discharge condition: hemodynamically stable discharge instructions: you were admitted to the hospital with asymptomatic tachycardia (heart rate into 140's). you were found to have an arrhythmia called atrial flutter. you were treated with cardioversion. . you should follow up with your physicians as detailed below. you should have your inr checked regularly. you should have your lung function tested and have your thyroid function followed while on amiodarone. . we changed your medications as follows: 1. started amiodarone, the dose will be three times a day through , then twice a day for 2 weeks, then once a day there after 2. changed simvastatin 80mg daily to pravastatin 80mg daily due to interactions w amiodarone 3. decreased your warfarin to 1mg po daily . if you have chest pain, shortness of breath, lightheadedness, dizziness or any other concerns, please call your physician . followup instructions: you will be contact for outpatient pulmonary function tests for baseline levels on amiodarone therapy. . provider: phone: date/time: 1:45 thyroid to eval for nodule. . provider: , md phone: date/time: 11:15 . provider: , md phone: date/time: 11:30 . provider: , md phone: date/time: 3:30 @ procedure: other electric countershock of heart diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation aortocoronary bypass status atrial flutter other and unspecified hyperlipidemia unspecified hereditary and idiopathic peripheral neuropathy acute on chronic systolic heart failure other thalassemia venous (peripheral) insufficiency, unspecified 

Answer: The patient is high likely exposed to