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: aspirin attending: chief complaint: shortness of breath. major surgical or invasive procedure: pericardial tap and drain history of present illness: mrs. . is a very nice 73 year-old woman with prior history of pafib on coumadin, s/p ppm, with myocardial bridge s/p stend and bleeding 2 weeks ago who comes with sob and was found to hve pericardial effusion and tamponade now s/p pericardiosentesis. patient was in her prior state of health and had a "check up" and was found to have an abnormal perfusion in the anterio-apical region. however, she was able to walk 9 minutes. then, she underwent cardiac cath that showed myocardial bridge 2 weeks ago; she was stented and then started with bleeding. balloon was inflated for 10 minutes and no further bleeding was reported. patient was discharged home on plavix and her home-dose coumadin for pafib. she did not get asa for possible allergy. then, she flew to from 2 days after the procedure and was very active, but 3 days ago started noticing shortness of breath on excertion. patient denies any orthopnea, pnd, chest pain. however, she noted that was gaining 2 pounds daily, despite watching her diet and taking her medications as prescribed. the shortness of breath kept progressive until today morning where she was unable to take a deep breath and went to the er of . she had an echocardiogram done that showed a poericardial effusion with 3cm surrounding all faces of heart; there were signs of tamponade. her inr was elevated and she received 10 mg of po vitamin k. her wbc 10.4, hct 32.6, plt 400, electrolytes 135/4.6 98/26 19/0.8 and gluc of 165. ast 43, alt 53, ap 105, cpk 67, trop t <0.01, nt-probnp 369. given the posibility of bleeding through the myocardial bridge that was stented she was transfered to for further care. in the cath lab her pressures were pcw 35/36/32, hr 109, pa 43/33/38, rv 47/25/30, dp/dt 624, ra 31/31/29, ao 131/88/104. coronary angiogram showed normal , long stent in mid lad and intra-myocardial segment widely patent; 30% of narrowing proximal to stent, no perforation prior o after pericardioscentesis. normal lcx and rca. they drained 970cc of bloddy fuild, which was sent to the lab. she is admitted to the ccu for close monitoring. . 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: past cardiovascular history: 1. cardiac risk factors: -diabetes, +dyslipidemia, -hypertension 2. cardiac history: none. -cabg: none. -percutaneous coronary interventions: 2 weeks ago as per hpi. -pacing/icd: ppm in for "bradycardia" (per pt). past medical history: pafib - diagnosed in rate controlled and anticoagulared. ppm - for "bradycardia" to the 40s symtpomatic obesity history of colon cancer s/p parcial colectomy dyslipidemia . surgical history cholecystectomy appendectomy tonsilectomy parcial colectomy social history: she lives by herself in and has a daughter and a son that live very close to her. she is very active at baseline and works as a realtor. she has prior history of smoker quitting in . has history of 10 pack-year. she drinks alcohol socialy, 1 drink/week on average. denies any illegal drug use. she walks in her treadmil multiple days per week. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. mother with afib, grandfather with cancer. physical exam: vital signs - temp 98.8 f, bp 120/80 mmhg, hr 80 bpm, rr 16 x', o2-sat 100% ra; pulsus 8 mmhg general - well-appearing woman in nad, oriented x3, comfortable, mood, affect appropriate. heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. sem in rusb no radiations. no thrills, lifts. no s3 or s4. abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding. abd aorta not enlarged by palpation. no abdominial bruits. drain in place and bag empty. extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps), no c/c/e. no femoral bruits. skin - no rashes or lesions. no stasis dermatitis, ulcers, scars, or xanthomas. lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, cerebellar exam intact, steady gait 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: on admission: 12:10pm wbc-10.5 rbc-3.29* hgb-10.2* hct-30.2* mcv-92 mch-31.0 mchc-33.7 rdw-13.2 12:10pm plt count-434 12:10pm pt-34.0* ptt-41.8* inr(pt)-3.5* 12:10pm glucose-184* urea n-19 creat-0.7 sodium-135 potassium-4.8 chloride-100 total co2-23 anion gap-17 . pericardial fluid: 03:53pm other body fluid wbc-1833* hct-12.0* polys-61* lymphs-31* monos-8* 03:53pm other body fluid tot prot-5.6 glucose-104 ld(ldh)-839 albumin-3.2 culture: no growth and negative gram stain cytology: negative cytology for malignant cells. . admission echocargrdiogram: the left ventricular cavity is unusually small. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is unusually small. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is a large pericardial effusion. the effusion appears circumferential. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. impression: large, circumferential pericardial effusion with evidence of tamponade physiology. both ventricles are small secondary to external compression. the minimum size of the anterior effusion in diastole is 1.8cm. . post-pericardiosentesis echocardiogram: regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). the mitral valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is a small pericardial effusion. impression: small residual effusion located anterior to the right ventricle. no echo evidence of tamponade. compared with the prior study (images reviewed) of , most of the pericardial fluid has been removed. the right and left ventricles are normal in size and there is no tamponade. . echocardiogram : due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). with normal free wall contractility. there is a trivial/physiologic pericardial effusion. impression: trivial residual pericardial effusion. large pleural effusions. . echocardiogram : there is a promient partially echofilled anterior space which most likely represents a fat pad. there is a prominent left pleural effusion. compared with the prior study (images reviewed) of , the findings are similar. . cardiac cath: coronary angiogram showed normal , stent in mid lad and intra-myocardial segment widely patent; 30% of narrowing proximal to stent, no perforation prior o after pericardioscentesis. normal lcx and rca. hemodynamics: pcw 35/36/32, hr 109, pa 43/33/38, rv 47/25/30, dp/dt 624, ra 31/31/29, ao 131/88/104. . ekg: atrial fibrillation with variable ventricular conduction and a ventricular heart rate of 80 bpm. qrs axis -40 degrees and duration of 120 ms, rq in d3 and acf and d2. transition in v2-v3, itd 30 ms, rbbb morpholoy. . cxr : left pectoral pacemaker in situ. marked cardiomegaly with marked homogeneous opacification of the left hemithorax, presumably, due to a large pleural effusion. only the upper half of the lung parenchyma is ventilated. the rest of the left lung parenchyma is atelectatic. on the right, no evidence of pneumonia or overhydration. the most lateral right part of the hemithorax are not included on the image. brief hospital course: mrs. . is a very nice 73 year-old woman with prior history of pafib on coumadin, s/p ppm, with myocardial bridge s/p stent and bleeding 2 weeks ago who comes with sob, pericardial effusion and tamponade. . #. pericardial effusion - patient with myocardial bridge and stent 2 weeks ago complicated with bleeding requiring baloon tamponade. then, she was started on coumadin 10 mg daily for paroxysmal atrial fibrillation. she traveled from to and started noticing shortness of breath that worsened throughout the days until the day of her admission at osh. inr was supratherapeutic (3.5 in our hospital). pt was given 10 mg of po vitamin k. she had an echocardiogram showing global pericardial effusion without apparent loculations of 3 cm and signs of tamponade. patient was transfered to our medical center for pericardiosentesis given that osh did not have cardiac surgery in case it was needed for bleeding from myocardial bridge and stent. on admission here patient had signs of tamponade on echocardiogram and was taken to the cardiac cath lab. her pressures were pcw 35/36/32, hr 109, pa 43/33/38, rv 47/25/30, dp/dt 624, ra 31/31/29, ao 131/88/104; 970 cc of bloody pericardial fluid were drained (hct of 12). gram stain was negative and culture has been negative so far. there were no malignant cells. patient went to the cardiac care unit for observation overnight with pericardial drained placed. her coumadin was stopped. there was minimal drainage throughout the pericardial drain ant it was pulled 24 hours after insertion without complications. her pulsus has been 5-6 mmhg throughout her admission. serial echocardiograms showed minimal ammount of fluid, but a mass in apex that most-likely represents a clot, but cannot rule out fat pad (to big and distal make it unlikely). however, given patient's recent bleed and history she is at high risk for restrictive/constrictive physiology and constrictive pericarditis in the future. she has positive kussmaul sign. patient had bilateral pleural effusion (l>>>r) with bibasilary atelectases that improved throughout admission. thoracic surgery was consulted regarding her clot and effusion and suggested conservative management. we discussed with patient thoracosentesis and further work up and close monitoring, but she opted out and wants to follow up with her cardiologist. she was able to tell us and manifest her full understanding of the risk of shortness of breath, recurring bleed, constrictive pericarditis requiring surgery in the near-future. . #. rhythm - patient with pafib rate controlled with diltiazem 120 mg daily and was anticoagulated at home with 10 mg of coumadin. she was supra-therapeutic with inr of 3.5 on admission. her chads2 score is 1 having a ~2% annual risk of stroke, which would be similar to the risk of bleeding with a therapeuric anticoagulation and even higher in supra-therapeutic range. however, given her rencet bleeding into his pericardium with tamponade and recent procedure, we decided to hold anticogaulation for now and resume once her pericardial issues are resolved. patient is in aspirin and plavix, which are not as good a warfarin, but less risk of bleeding as she did this time. she was rate-controlled with her home-dose digoxin 0.25 mg po daily and her diltiazem extended-release was increased to 240 mg po daily given she was having rvr in the setting of atrial irritation after pericardial bleeding. . #. cad - patient with not known cad, myocardial bridge s/p stent and bleeding as above. she had questionable allergy to aspirin, but patient stated anaphylaxis to alka-seltzer. given the superiority of aspirin for coronary artery disease and stents, she underwent aspirin de-sensitation in the icu. she tolerated aspirin 81 mg daily and plavix 75 mg daily without complications. she is also on rosuvastatin calcium 10 mg po daily. no need for acei/ or beta-blocker at this time given no cad, normal ef. . #. pump - patient with no signs of heart failure on exam or echo. . #. dyslipidemia - continuing pt pravastatin as above. medications on admission: plavix 75 mg tablet 1 (one) tablet(s) by mouth once a day digoxin 250 mcg tablet 1(one) tablet(s) by mouth once a day diltiazem hcl 120 mg capsule, sust. release 24 hr one capsule(s) by mouth daily ranitidine hcl 150 mg capsule one capsule(s) by mouth daily rosuvastatin 10 mg tablet 1 (one) tablet(s) by mouth once a day warfarin 10 mg tablet 1 (one) tablet(s) by mouth once a day calcium carbonate-vitamin d3 500 mg (1,250 mg)-400 unit tablet one tablet(s) by mouth daily . allergies: alka-seltzer: angioedema / anaphylaxis. discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 3. rosuvastatin 10 mg tablet sig: one (1) tablet po once a day. 4. calcium 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po twice a day. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. magnesium oxide 140 mg capsule sig: two (2) capsule po bid (2 times a day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: 1.5 tablets po daily (daily). 9. cartia xt 240 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 10. cartia xt 240 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. disp:*90 capsule, sust. release 24 hr(s)* refills:*3* 11. ranitidine hcl 150 mg capsule sig: one (1) capsule po twice a day. discharge disposition: home discharge diagnosis: pericardial effusion pleural effusion atrial fibrillation with rapid ventricular response coronary artery disease discharge condition: stable. o2 sat 90% on ra with activity, 95% on ra at rest. discharge instructions: you had some blood in the lining around your heart called a pericardial effusion. this was drained and has not reaccumulated. however, there is a residual blood clot remaining that may be causing inflammation and leading to fluid buildup in your lungs called a pleural effusion on the left side. this effusion is interfering with oxygen uptake from the lung and is causing your oxygen level to drop when you are active. we did not restart your coumadin in case your cardiologist in fla wants to do any tests. you should continue to take your plavix and aspirin for your stent. please call dr. as soon as you get home to arrange follow up care. you were advised to stay in for treatment but have decided to go home to fla for this. you should get an echocardiogram in weeks and a chest x ray in 1 month. . medication changes: 1. cartia xt was increased to 240 mg daily 2. stop taking warfarin . please call dr. if you have any increased shortness of breath, chest pain, persistant palpitations, pain when you take a deep breath, dizziness or fainting, or any other unusual symptoms. followup instructions: cardiology: phone: date/time: please call dr. as soon as you get home to set up appt. procedure: combined right and left heart cardiac catheterization pericardiocentesis diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion atrial fibrillation percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia unspecified disease of pericardium personal history of malignant neoplasm of large intestine other postprocedural status obesity, unspecified 

Answer: The patient is high likely exposed to