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 / nsaids attending: chief complaint: syncope major surgical or invasive procedure: temporary pacer wire placement permanent pacer placement history of present illness: ms. is a year old female resident of rehab, with history of chf (ef 50%), hypothyroidism, atrial fibrillation, sss, htn, and copd, who presented to the ed s/p syncope. the patient was being helped out of a chair in the morning of when she became suddenly unresponsive, collapsed into the chair, and was noted to be cyanotic with protruding tongue and cold extremities. her blood pressure just after was 130/80. she was given o2 via nc, and awoke about 2 minutes later, becoming responsive, alert and oriented x 3, with warm extremities. of note, she was seen in the ed for a similar episode on when she was found to have a uti and treated with a 7 day course of levaquin. in the ed her ekg was unchanged from baseline, showing pr prolongation, lbbb-type ivcd. her initial bp was 160/116, pulse 94. she was thought to be volume depleted initially and given 1 l ns with plans to discharge back to rehab, however she was then noted to have asystole on telemetry, with spontaneous recovery. she then had a second episode requiring sustained transcutaneous pacing, at which time the ep fellow was called for temporary pacer placement (patient still dnr/dni but wanted a pacer). past medical history: chf (ef 50%) hypothyroidism atrial fibrillation sss htn copd social history: rehab resident. son is health care proxy. family history: unknown physical exam: vs: 98.9, 90, 140/83, rr 22, 96% on 4l gen: obese caucasian female, sedated heent: surgical pupils, dry mm neck: no jvd lungs: cta anteriorly cvs: rr, normal rate, no m/r/g abd: nabs, soft, obese extr: moving all extremities, 1+ bipedal edema. pertinent results: wbc-6.4 hgb-14.7 hct-43.6 rdw-14.1 plt ct-139* wbc-8.4 hgb-13.4 hct-39.6 rdw-14.0 plt ct-116* pt-16.5* ptt-28.9 inr(pt)-1.7 pt-14.8* ptt-26.6 inr(pt)-1.4 glucose-82 urean-44* creat-1.4* na-141 k-4.1 cl-101 hco3-35* glucose-114* urean-38* creat-1.4* na-143 k-3.8 cl-102 hco3-30* calcium-9.1 phos-4.1 mg-2.5 tsh-7.4* t3-39* free t4-1.1 urine color-straw appear-clear sp -1.009 blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg rbc-* wbc-0-2 bacteri-few yeast-none epi-0-2 cxr : single ap bedside exam demonstrates a new transvenous pacing wire, the tip of which overlies the right ventricle. there is no evidence of pneumothorax. the heart is enlarged and the aorta is tortuous and calcified. there is no pulmonary vascular congestion, pleural effusion, or lobar consolidation. degenerative changes are seen at the shoulders. ekg: sr at 91 bpm with pr prolongation (240 ms), lbbb, lad unchanged from . echo : lae, lvh, mildly decreased lv, rv function, mild ai, moderate mr, mild pa htn. cxr : a right internal jugular temporary pacing lead has been placed with the distal tip extending into the right ventricle. this has a slightly more inferior position than the previous temporary pacing lead. the cardiac silhouette is enlarged but stable. there is no evidence of pneumothorax. the lungs demonstrate very minimal patchy atelectasis in the left retrocardiac region and are otherwise clear. impression: status post temporary pacing lead placement with lead extending into right ventricle. this has a slightly more inferior location than on the previous study. it is most likely within the right ventricle, but precise localization is difficult on this single portable projection. clinical correlation suggested. tte : 1. the left atrium is moderately dilated. 2. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. basal lv function appears normal; distal lv was not seen. thus, overall left ventricular systolic function cannot be reliably assessed. 3. the ascending aorta is mildly dilated. 4. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. 5. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. cxr : interval replacement of right internal jugular pacer with left-sided permanent pacer. lead remains in stable position adjacent to the right ventricle. no evidence of pneumothorax. brief hospital course: year old female with history of atrial fibrillation, sss, chf with ef 50%, htn, copd, who presented s/p syncope, with sinus arrest in ed. 1) sss: ms. asystolic episode in the ed is likely also what caused her syncope earlier in the day, and likely secondary to her sick sinus. on the night of admission she had a temporary pacing wire placed into her rv. later that night she unfortunately pulled this wire out. she fortunately had external pacing wires attached in anticipation of the possibility of malfunction of the internal temporary wire, and she was therefore able to be paced externally until a new temporary wire could be placed later that night. the following night she had a permanent vvi pacer placed in her rv, set at 60 beats per minute. she was transferred out of the ccu the following night, and subsequently spent one night on the floor without any hemodynamic instability. the pacer intermittently paces, and on tele she frequently had premature atrial contractions with subsequent pauses, prompting the pacer to fire once or twice. her blood pressure ran between 120 and 130 systolic for the most part. she had one episode of dizziness on the night before discharge at which time her blood pressure and heart rate were normal, and no events were recorded on telemetry. she will follow up in device clinic at building in 1 week. her coumadin was held during the admission for the procedures, and has been restarted on the day of discharge at 5 mg. she will need frequent inr checks until her coumadin becomes therapeutic. her inr on discharge is 1.4. she also had some superficial abrasions just adjacent to the site of her pacer, and has therefore been started on a 10 day course of po keflex, of which she has 8 days left. 2) chf: ms. received 2 l ns during her ed course, initially for presumed dehydration causing syncope, and also for mild hypotension during the placement of the temporary pacer wire. she was maintained on her usual 80 mg po lasix daily, and diuresed 1.8 l on the first day, 1.3 l on the second day, and another 1.4 l on the third day. we therefore have decreased her daily lasix dose to 40 mg, feeling that she does not require as much diuresis. she should have a chem 7 panel in the next week. 3) cad: no known hx of cad, but ekg with qs in inferior leads as well as v1-v4 suggestive of old mis (without true lbbb). she has an asa allergy, and it was not felt that her predicted life span warranted starting any new medications. 4) htn: the patient was occasionally hypertensive to 140s systolic during the admission, however it was not felt that new medications were warranted. 5) copd: continued inhalers, advair. she was maintained on 3l via nasal cannula with o2 sats 97%. 6) hypothyroidism: the patient's tsh was found to be elevated, however her free t4 was within normal limits. therefore, no changes were made in her synthroid dose. she should have her tsh and free t4 checked again at rehab to assure that her dose does not need any adjustments. 7) ppx: she receieved sq heparin for prophylaxis of dvts. medications on admission: coumadin lasix 80 daily sl ntg prn aldactone 25 daily albuterol/atrovent detrol lactase levoxyl meclizine 12.5 daily advair caco3 feso4 discharge medications: 1. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 2. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 3. cephalexin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 8 days. 4. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 5. warfarin sodium 5 mg tablet sig: one (1) tablet po daily (daily): patient will need to have frequent inr checks initially, with coumadin titration to inr . 6. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: syncope sick sinus syndrome asystole secondary: atrial fibrillation congestive heart failure chronic obstructive lung disease hypothyroidism hypertension discharge condition: good, stable. patient on 4 l oxygen via nasal cannula. transfers to chair with assistance. discharge instructions: resume all of your previous medications with one exception: we have decreased your lasix dose to 40 mg daily rather than your previous 80. please show up for your appointment listed below. followup instructions: you have an appointment in device clinic: at 12 pm in 7. she should have someone with her for the appointment, as they will provide teaching about her pacemaker at the visit. procedure: insertion of temporary transvenous pacemaker system initial insertion of single-chamber device, rate responsive initial insertion of transvenous lead [electrode] into ventricle diagnoses: congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation atrioventricular block, complete 

Answer: The patient is high likely exposed to