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: sulfamethoxazole/trimethoprim / codeine / antihistamines attending: chief complaint: shortness of breath major surgical or invasive procedure: ep study, pacer placement history of present illness: 80 yo f h/o rheumatic heart dz mitral stenosis, as, ar, cc: shortness of breath ********** hpi: pt is a 79 y/o female with rheumatic heart disease, rapid atrial-fibrillation, strong smoking history, and copd who presents with shortness of breath. she had a recent admission for jaw/chest pain where found to have only a 40% proximal lad lesion but was noted to be in rapid afib and was discharged on diltiazem for rate control. she was discharged with of hearts monitor. she was subsuquently seen by dr. in cardiology clinic where she was again found to be in rapid a-fib, with a rate near 150; admission for cardioversion was discussed at length, but the patient refused, so she was started on metoprolol 50mg , aspirin, and warfarin. . the pt continued to have sob and palpitations so she sought further care in . the pt denies any chest pain. in the ed, the pt briefly required non-invasive ventilatory support for the sob. cxr showed pulmonary edema. ecg revealed a-fib at 140's-150's with st depressions v4-v6 and trop leak to 0.24 c/w demand ischemia. iv dilt was started in the , cardiology consultant recs and the pt was transferred to the medicine floor. . on the medicine floor, the telemetry showed a-fib with rates to 150's, with periods of asystole lasting for a couple of seconds, during which the pt reported dizziness and nausea. the pt was transferred to the ccu for further monitoring and management. the plan at the ccu was to place a temporary pacer wire so that rate control therapy could be safely started once a back-up rhythm could be guaranteed by the temporary pacer. venous cannulation was unable to be acheived at the bedside. however, during the attempts to place the venous cannula, the pt converted to sinus rhythm at 70-80 bpm. . past medical history: coronary artery disease multinodular goiter constipation h/o atypical chest pain chronic bronchitis chronic low back pain s/p tah-bso cigarette smoking hypercholesterolemia panic disorder social history: lives with son, denies etoh. smoker (current) ppd x 60 yrs.. family history: non-contributory physical exam: pe t bp hr rr o2sats gen: nad, breathing with mask heent: perrl and a, eom intact, moist mucous membranes, neck: no masses, +jvd b/l, no carotid bruits lungs: decr. breath sounds at bases, wheezes throughout, no crackles heart: irreg rate, nl s1/s2, no m/r/g abd: soft, nt/nd, +bs ext: no cyanosis, clubbing, min. symmetric le edema, 2+ rad/dp pulses neuro: a&ox3, non-focal pertinent results: cath : taxus to 80% rca lesion . cath : rhc: pa 25/15. pcwp 15. co/ci/svr = 5.35/3.65/942 1.0. mean gradient 22. mitral area 2.0 gradient 8. 3+ ai, 2+ mr rca: patent lad: 40% proximal discrete lcx: patent . cxr : pulmonary edema congestive heart failure. . echo : conclusions: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. there is moderate aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the mitral valve shows characteristic rheumatic deformity. there is moderate thickening of the mitral valve chordae. there is a minimally increased gradient consistent with trivial mitral stenosis. moderate to severe (3+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (tape reviewed) of , the severity of mitral regurgitation has increased and the estimated pulmonary artery systolic pressure is higher. the transaortic valve gradient is also increased. . 08:29pm ctropnt-0.20* 08:29pm wbc-10.4# rbc-3.65* hgb-10.4* hct-31.4* mcv-86 mch-28.6 mchc-33.1 rdw-14.6 08:45am glucose-118* urea n-28* creat-1.1 sodium-140 potassium-4.0 chloride-104 total co2-22 anion gap-18 08:45am calcium-9.6 phosphate-4.5 magnesium-1.8 08:45am ctropnt-0.24* 08:45am ck(cpk)-124 03:10am ck-mb-5 ctropnt-0.04* probnp-6646* 03:10am digoxin-<0.2* 03:10am pt-14.7* ptt-27.6 inr(pt)-1.4 brief hospital course: a/p: 79 yo f with valvular heart failure as area 1.0 gradient 22, ms area 2.0 gradient 8, 3+ai, 2+mr, copd and rapid afib, presenting with sob/chf exacerbation. the pt was found to be in rapid a-fib on admission, developed long symptomatic ventricular pauses with rate control therapy, pacemaker was placed successfully in order to safely rate control. . # rhythm: the pt described symptoms of increased fatigue and sob on admission. she was noted to be in rapid afib. she was initially rate controlled with dilt and metoprolol on the medicine floor. however, the pt was noted on the telemetry to have periods of seconds of asysole, during which she felt light-headed and nauseous. the pt was transferred to the ccu for more intensive monitoring. attempted placement of catheter for temporary pacer was not successful, though pt converted to nsr. the pt was counseled regarding the benefits of permanent pacemaker so that the heart rhythm could be more successfully controlled, and she was amenable to this solution. the device was implanted successfully without complications. in terms of medical therapy amiodarone for rate control and to attempt maintenence of sinus rhtyhm. for medical therapy, beta blocker and digoxin were used for rate control. amiodarone was added to maintain sinus rhythm, but was later discontued after the pt developed symptoms of mental status changes which may have been at least partly exacerbated by the amio. anti-coagulation for stroke prophylaxis was pursued with coumadin with a heparin bridge. . 2. chf: pt was initially found to be in acute chf with pulmonary edema on cxr and increased o2 needs. this was assessed to be a-fib with rvr in setting of significant valvular heart disease. pt had low bp 90-120/40-50, when she was in rapid a-fib and on several bp meds, isordil, lisinopril 40, lasix 100 iv. the pt was diuresed gently and gradually brought to euvolemic state with medical therapy. echo was repeated to evaluate for any changes since the previous echo in may and revealed no significant changes. . 3 cad: the pt did have a slight troponin elevation which peaked at 0.24. this was likely secondary to demand ischemia in setting of rapid afib and low bp that she had on hd#1. the were so symptoms of anginal pain. no area at risk per cath . asa, plavix, lipitor were continued. . 4. mental status changes: in the post-operative setting, after the device was placed, the pt devloped symptoms of acute delirium. she had fluctuating levels of consciousness as well as some agitation, particulalrly developing at night. the delirium was thought to be to post-operative setting, multiple medications including opiates, benzodiazepines, amiodarone, as well as a tenuous baseline status. the medication regimen was simplified and over the subsequent couple of days, the pt returned to her baseline mental status. . 5. fen: na-restricted diet, fluid restriction. 6. chronic lbp: continue oxycodone/oxycontin. 7. ppx: anti-coagulated. 8. code: full. 9. dispo: the physical therapist evaluated the patient and recommended rehab. the physician team as well as the nursing staff impressed upon the pt that rehab was the safer option than returning home. the pt remained adamant that she wished to return home without rehab. medications on admission: 1. coumadin, though pt was not therapeutic on admission 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 3. ipratropium bromide 18 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 4. diazepam 2 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. furosemide 20 mg tablet sig: 0.5 tablet po daily (daily). 7. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 8. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 10. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 11. oxycodone 20 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po qam (once a day (in the morning)). 12. oxycodone 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po midday (). 13. oxycodone 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po qpm (once a day (in the evening)). 14. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 15. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 16. cardizem cd 240 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. discharge medications: 1. medical supply one hospital bed. pt weight 48 kg. height 5 foot 3 inches 2. commode one commode 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 6. ranitidine hcl 150 mg capsule sig: one (1) capsule po once a day. 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. lasix 20 mg tablet sig: one (1) tablet po once a day. 9. toprol xl 50 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po once a day. disp:*90 tablet sustained release 24hr(s)* refills:*0* 10. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*14 tablet(s)* refills:*0* 11. outpatient lab work please have you inr check blood test on . discharge disposition: home with service facility: vna discharge diagnosis: atrial fibrillation chf exacerbation discharge condition: good discharge instructions: please take all medicines as directed below. please weigh yourself daily and call your doctor if your weight increases by more than 3 lbs. restrict your fluid intake to less than 1.5 l daily. followup instructions: provider , md where: phone: date/time: 2:00 provider , m.d. where: cardiac services phone: date/time: 2:45 . electrophysiology device clinic, cardiac services 1:30 pm . . provider fern, where: phone: date/time: 10:20 procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle non-invasive mechanical ventilation transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux tobacco use disorder unspecified pleural effusion unspecified essential hypertension acute kidney failure, unspecified acquired coagulation factor deficiency chronic airway obstruction, not elsewhere classified atrial fibrillation rheumatic heart failure (congestive) mitral valve insufficiency and aortic valve stenosis sinoatrial node dysfunction backache, unspecified delirium due to conditions classified elsewhere 

Answer: The patient is high likely exposed to