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: verapamil / iodine-iodine containing / zoloft / atenolol / toprol xl / norvasc / pindolol / zestril / clonidine / keflex / meclizine / wellbutrin / penicillins / erythromycin base / avelox attending: chief complaint: a-fib with rvr major surgical or invasive procedure: transesophageal echo and cardioversion history of present illness: 84 y/o woman with a history of paroxysmal atrial fibrillation who is here for afib with rvr. the patient has recently had multiple hospitalizations, one for the same complaint and another for a complaint of chronic dyspnea and lightheadedness. she has had multiple cardioversions, the most recent on during which she was also loaded on amiodarone and started on pradaxa. both of these medications had since been stopped due to side effects and ecchymoses. . her most recent hospitalization was seven days ago when she underwent an extensive workup for her dyspnea, however investigations including spirometry, persantine mibi and echocardiogram were all unrevealing for a cause of her symptoms. . this morning the patient reports waking up feeling dyspnea and chest pressure; she checked her heart rate and found it to be in the 140s, and on the advice of her telehealth team came in to be evaluated. her of hearts monitor at the time showed sinus rhythm followed by apcs with a 5 beat run of nsvt, then atrial fibrillation. . in the ed, she was started on a nitroglycerin and heparin drip. her blood pressure proved to be labile and dropped from the 110s systolic to the 80s. cardiology was consulted who recommended metoprolol 2.5mg iv which had some mild effect on her rate. her chest pressure resolved and the nitroglycerin drip was stopped. . on review of systems, she reports intermittent dizziness and dyspnea on exertion at home. she has no history of stroke or tia. no history of recent weight change or edema. no palpitations, syncope or presyncope. past medical history: past medical history: 1. cardiac risk factors: +hypertension 2. cardiac history: - diastolic congestive heart failure - atrial fibrillation s/p cardioversionx5 3. other past medical history: - copd - obstructive sleep-disordered breathing, mild - not on cpap - diverticulosis - benign paroxysmal positional vertigo - anxiety - anemia - mssa sepsis in - pneumonia (~) - hx of c. diff social history: occupation: recently retired entrepreneur (used to own a secretarial/graphics/design company). drugs: denies. tobacco: quit smoking 16 years ago with 80 pack-year history. alcohol: social. other: lives alone; completes all adls, walks with a cane on left at baseline. family history: - father died of myocardial infarction in his 40s. - mother died of congestive heart failure at 88. - otherwise, no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam general: no acute distress, alert and oriented x3 : no conjunctival pallor, pupils equal round and reactive. no scleral icterus neck: jvp at 5cm at 45 degrees. negative hepatojugular reflexes. normal a and v waves. cv: irregularly irregular, no murmurs, rubs, gallops. abdomen: soft, non-tender, non-distended. extremites: no edema. well perfused, capillary refill <1 sec. pulses: 2+ radial, 1+ distal. . discharge exam pertinent results: admission labs 11:53pm pt-16.9* ptt-150* inr(pt)-1.5* 06:25pm ctropnt-<0.01 11:50am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-tr 11:30am ck-mb-3 ctropnt-<0.01 probnp-1521* 11:30am wbc-9.4 rbc-4.40 hgb-13.6 hct-39.0 mcv-89 mch-30.8 mchc-34.8 rdw-13.6 11:30am neuts-74.9* lymphs-17.5* monos-5.2 eos-1.5 basos-0.9 discharge labs pertinent studies ekg atrial fibrillation with rapid ventricular response. diffuse low voltage. compared to the previous tracing of the ventricular response has slowed. otherwise, no diagnostic interim change. cxr (): no acute cardiopulmonary process cxr (): as compared to the previous radiograph, there is no relevant change. borderline size of the cardiac silhouette with mild tortuosity of the thoracic aorta. no pleural effusion. no pulmonary edema. no hilar or mediastinal abnormalities. brief hospital course: 84 y/o woman with history of diastolic chf and paroxysmal atrial fibrillation who presents with chest discomfort, dyspnea and atrial fibrillation with rvr. active diagnoses: # afib with rvr: patient was recently taken off her amiodarone secondary to side effects and has an enlarged left atrium. she likely has paroxysmal atrial fibrillation. after discussion about side effects and benefits of treatment, patient opted to restart amiodarone. she was loaded with 200mg tid. she was rate controlled with metoprolol 25mg po bid and anticoagulated with heparin bridge and warfarin 3mg po daily. metoprolol was discontinued prior to cardioversion. patient was cardioverted on hd8. it was felt that her amiodarone level at this time was adequate to increase the likelihood the patient would remain in sinus rhythm after cardioversion. at the time of discharge, patient's inr was 2.6. patient will have an inr machine delivered to her home and will be instructed on how to use it. she is aware that her goal inr is 2.0-3.0. # dyspnea: unclear etiology; patient is s/p extensive workup without clear etiology. she does report feeling her symptoms more acutely as she falls asleep and when she wakes up, so it is possibly related to her sleep-disordered breathing. not hypoxic during sob episodes. reviewed omr notes and found an issue with lh and dizziness with ipratroprium and spiriva in the past, but these symptoms seemed to persist after stopping the medicine. 's reviewed with team. during admission the patient did have intermittent shortness of breath with some wheezing. chest xray was unconcerning for pneumonia, white blood cell count was within normal range and the patient was afebrile throughout admission. dyspnea likely related to both her atrial fibrillation and copd. for her copd she was given atrovent nebulizer treatments and started on spiriva. chronic issues: # dchf: no evidence of acute chf exacerbation. she was continued on her home lasix. # anxiety: home alprazolam was continued. sw also asked to evaluate and recommended outpatient counseling. transitional isses: -patient maintained full code status throughout hospitalization -continue amiodarone 200mg po bid, with monitoring of pfts, tfts, and lfts -continue coumadin with inr monitoring (goal 2.0-3.0) -follow up with outpatient cardiologist dr. medications on admission: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. alprazolam 0.25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. alprazolam 0.25 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)) as needed for anxiety/insomnia. 4. furosemide 40 mg tablet sig: one (1) tablet po once a day. 5. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. discharge medications: 1. outpatient lab work please check chem-7, inr on with results to dr. at phone: 2. fingerstick inr please use fingerstick inr machine to monitor inr thanks 3. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). disp:*45 tablet(s)* refills:*2* 4. alprazolam 0.25 mg tablet sig: one (1) tablet po tid (3 times a day). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 6. ipratropium bromide 0.02 % solution sig: one (1) vial inhalation q6h (every 6 hours) as needed for wheezing. 7. xopenex 1.25 mg/3 ml solution for nebulization sig: one (1) vial inhalation every four (4) hours as needed for shortness of breath or wheezing. 8. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: ten (10) ml po five times a day as needed for cough. 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*2* 10. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day): take twice daily for one week, then decrease to once daily. disp:*60 tablet(s)* refills:*2* 11. warfarin 2 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. tessalon perle 100 mg capsule sig: one (1) capsule po three times a day as needed for cough. disp:*90 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: atrial fibrillation with rapid ventricular response. chronic diastolic congestive heart failure chronic obstructive pulmonary disease obstructive sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a rapid heart rate with the atrial fibrillation and needed to restart amiodarone and undergo another cardioversion. you will need to continue to take the amiodarone to keep you in a regular rhythm. your shortness of breath with walking seems to be better and the wheezing and cough has been stable with the addition of spiriva. you were restarted on coumadin and arrangements were made for a inr machine to be delivered to your house and training will be provided. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. your furosemide was increased to 60 mg daily on and your weight at discharge is 157 pounds on our scale. you can talk to dr. about adjusting your furosemide according to your weight at home. . if you have a coughing or wheezing spell at home, please try a nebulizer with the ipratroprium and xopenex. if that does not help completly, you can take robitussin cough syrup with dextromethoraphan every 4 hours. you may also try ice chips or tessilon perles as needed. if you have chest pain from the coughing that is only when you cough or take a deep breath, use a warm pack for local relief and take tylenol every 6 hours. if you are dizzy or lightheaded at home, please change position slowly and do not stand or sit up quickly. you can check your blood pressure at home but continue to take your medicine unless your top blood pressure number is less than 90. please also talk to dr. about undergoing another sleep study and getting a new cpap machine. it is important to treat your sleep apnea to help your medical issues. . we made the following changes to your medicines: 1. discontinue aspirin 2. increase furosemide to 60 mg daily 3. start spiriva to treat your wheezing and breathing 4. start amiodarone to keep you in a regular heart rhythm 5. start warfarin to prevent a stroke. your goal inr is between 2.0 and 3.0. 6. start robitussin cough syrup and tesselon perles for your cough followup instructions: primary care: department: primary care name: dr. when: wednesday at 11:30 am location: medical care affiliates address: , , phone: . cardiology: department: cardiac services when: monday at 3:00 pm with: , md building: campus: east best parking: garage department: cardiac services specialty: electrophysiology when: wednesday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage pulmonology: department: when: monday at 2:00 pm department: pulmonary function lab when: monday at 1:40 pm with: pulmonary function lab building: campus: east best parking: garage department: medical specialties when: monday at 2:00 pm with: dr. building: sc clinical ctr campus: east best parking: garage procedure: diagnostic ultrasound of heart other electric countershock of heart diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation anxiety state, unspecified long-term (current) use of other medications other chest pain chronic diastolic heart failure cardiomegaly 

Answer: The patient is high likely exposed to