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: shortness of breath major surgical or invasive procedure: placement of single chamber pacemaker (ventricular) history of present illness: 88 yo m with a history of paroxysmal a fib, chf, asd, goiter, pvd, polycythemia , chronic gib on warfarin and recently started on atenolol, admitted with complaints of shortness of breath found to have profound bradycardia with high degree heart block. . the patient is a poor historian. a recent discharge summary from an admission starting on at describes symptomatic shortness of breath noted by home np. the patient was treated for worsening anemia (hct 23 on admission down from previous baseline of 35 in ) in the setting of supratherapeutic inr. the patient's hematocrit improved to 27 and inr to 2.4 after 4 u prbcs and 2u ffp. egd during this hospitalization revealed non-bleeding ulcers in the stomach and barrett's esophagus. colonoscopy was negative. the patient was also diuresed at that time for likely acute on chronic chf exacerbation. his dry weight at discharge was 83kg. echo revealed ef>60%. the patient was newly started on atenolol 25mg daily at the time of discharge. acei was not started because of acute on chronic renal failure (cr of 1.9 up from previous 1.5 many months prior). heart rate was 60-80 prior to discharge. the patient was discharged to rehab. . the patient was at rehab for approximately 1 week. at rehab on the day of admission, the patient was noted to have oxygen saturations down to 80% on ra with subjective sob. 4l nc was applied w/ improvement in sats to 88%. hr was found to be 35-42. . the patient initially presented to prior to transfer to . in the ed, the patient was persistently bradycardic to 30-40 with complete heart block vs. high degree av block on ekg. the patient was evaluated by electrophysiology consult team and started on isoproterenol with improvement in hr to 50-60 range. the patient was hemodynamically stable throughout with sbp 100-130 and asymptomatic. . on review of symptoms, 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. he denies recent fevers, chills or rigors. 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: cardiac risk factors: diabetes . cardiac history: prior cad, osh records not currently available chf asd rbbb pvd . other: multinodular goiter gerd with esophagitis and non-bleeding gastric ulcers on recent egd () polycythemia dm, diet controlled nephrolithiasis social history: lived alone and administered his own meds prior to recent hospitalization. had home np. no tob or etoh. family history: family history noncontributory. physical exam: admission physical examination: 97.2 51-59 138-143/58-64 18 96% 6l nc gen: well-appearing elderly man in nad. integumentary: chronic venous stasis changes in the bilateral lower extremities. heent: perrl. pink, moist oral mucosa without lesions. cv: regular rhythm, bradycardic with normal s1 and s2. systolic murmur at the right upper sternal border. pansystolic mrumur at the apex. pulm: bibasilar crackles l>r. abd: soft, nondistended, no masses or organomegaly. ext: no edema. pertinent results: admission labs: 05:20pm blood wbc-3.7* rbc-3.06* hgb-8.5* hct-27.6* mcv-90 mch-27.8 mchc-30.8* rdw-20.6* plt ct-176 05:20pm blood neuts-55.1 bands-0 lymphs-32.2 monos-9.1 eos-2.9 baso-0.7 05:20pm blood hypochr-3+ anisocy-3+ poiklo-1+ macrocy-3+ microcy-2+ polychr-occasional ovalocy-1+ target-2+ 05:20pm blood pt-22.5* ptt-42.7* inr(pt)-2.2* 05:20pm blood glucose-97 urean-40* creat-1.8* na-145 k-4.7 cl-109* hco3-25 angap-16 05:20pm blood calcium-8.3* phos-3.0 mg-2.5 iron-24* 03:20am blood tsh-0.46 cardiac enzymes: 05:20pm blood ctropnt-0.05* 11:57pm blood ck-mb-notdone 11:57pm blood ctropnt-0.05* 08:15am blood ctropnt-0.06* 08:15am blood ck(cpk)-85 11:57pm blood ck(cpk)-96 05:20pm blood ck(cpk)-95 ekg: sinus bradycardia at a rate of 34 with likely atrial tachycardia with high grade av block vs. chb. also right bundle branch block. downgoing t's in v4-v6. no prior for comparison. cxr: pulmonary edema; the markedly abnormal cardiac silhouette suggests either underlying cardiomyopathy or pericardial effusion (or both). 2d-echocardiogram (): the left atrium is markedly dilated. the right atrium is markedly dilated. a secundum type atrial septal defect is present with right to left shunting. there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). the estimated cardiac index is depressed (<2.0l/min/m2). the right ventricular cavity is markedly dilated with depressed free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. the pulmonic valve leaflets are thickened. the main pulmonary artery is dilated. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures. brief hospital course: the patient was admitted with bradycardia with high degree heart block. atenolol use in the setting of acute renal failure likely worsened his bradycardia, but it was felt that his underlying conduction disorder had worsened and that he would benefit from placement of a pacemaker. he was on a dopamine drip prior to placement of the pacemaker but was weaned off after the procedure. a single chamber ventricular pacemaker was placed on . he had significant blood losses during the procedure, requiring transfusion of one unit of prbc's. his hct remained stable after the transfusion. heparin for his afib was restarted the morning after the procedure, and coumadin was restarted 48 hours after pacer placement. eh was also started on aspirin 81 mg qd. on admission, his heart failure had been exacerbated by the bradycardia, and he had evidence of volume overload with crackles on lung exam. he was aggressively diuresed and had improvement in his volume status. he was discharged on lasix 40 mg qd, to be further adjusted as an out-patient. he was admitted with acute on chronic renal failure likely secondary to hypoperfusion with his bradycardia (cr 2.0 on admission; baseline uncertain but pt has history of dm and vascular disease). creatinine improved somewhat with control of his chf exacerbation and placement of the pacemaker. he was discharged with cr 1.3. issues for follow-up: (1) please measure daily weights. mr. cardiologist will make adjustments to his lasix medication according to his weights. (2) please check inr, cbc, and chem-10 on at the rehab facility. please fax results to dr. (cardiologist) at . he will make any needed changes to mr. medications. medications on admission: home medications (at time of most recent discharge ): warfarin 3mg daily kcl 10meq daily lasix 40mg tthsasu, 60mg mwf protonix 40mg twice daily - newly prescribed atenolol 25mg daily - newly prescribed discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twelve (12) hours. 2. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily): for your blood pressure. . 3. warfarin 5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)): please adjust dosage to inr goal of 2.0 - 3.0. . 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): for your blood pressure. . 5. cephalexin 500 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 2 days: please continue through (last dose to be given on ). 6. lasix 40 mg tablet sig: one (1) tablet po once a day. 7. aspirin 81 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: bradycardia secondary diagnoses: congestive heart failure-- diastolic gastroesphageal reflux disease diabetes mellitus-- diet controlled discharge condition: stable-- heart rate in the 50 - 60's; satting in the mid to upper 90's on 2 liters supplemental oxygen; breathing comfortably. discharge instructions: you were admitted for a slow heart rate and received a pacemaker. because your heart rate was low, you had an exacerbation of your heart failure, requiring removal of fluid from your body with medications. several changes were made to your medications while you were in the hospital: (1) you should no longer take atenolol. (2) you were started on two new medicines (amlodipine and metoprolol) to control your blood pressure. (3) your coumadin (also called warfarin) was increased to 5 mg each night. this will need to be adjusted to your blood levels, which should be followed closely. (4) you were put on three days of cephalexin (an antibitoic) after your procedure. you only need to take this through . (5) your lasix dose is now 40 mg daily. you shoud follow-up with yoru cardiologist to see how this medicine should eb adjusted accoridng to how much fluid you are retaining. (6) you were started on aspirin, to help prevent clotting. followup instructions: you have the following appointments: (1) provider: clinic phone: date/time: 9:30 -- this is to follow-up on your new pacemaker. (2) you have appointment to see dr. , your cardiologist, on wednesday, at 2:30 pm. their phone number is (. (3) you will have blood work drawn on and faxed to dr. office. he will make any neccessary changes to your medications after he sees these results. procedure: initial insertion of single-chamber device, rate responsive initial insertion of transvenous lead [electrode] into ventricle diagnoses: esophageal reflux mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure chronic kidney disease, unspecified other specified cardiac dysrhythmias atrioventricular block, complete ostium secundum type atrial septal defect tricuspid valve disorders, specified as nonrheumatic leukocytopenia, unspecified 

Answer: The patient is high likely exposed to