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: ace inhibitors attending: chief complaint: bradycardia/hypotension major surgical or invasive procedure: intubation cardioversion cardioversion history of present illness: the patient is an 82 y.o. woman w/ pmh of htn, afib, presenting with lightheadedness in setting of likely beta blocker or calcium blocker overdose. on admission, she was taking metoprolol tartrate 150mg po twice daily, in addition to diltiazem ext. release 240mg po daily, and nifedipine sust. release 30mg po daily. she lives at home alone, and is self-reliant in terms of administration of her medications. she reportedly was feeling dizzy and tired at home and called ems. upon arrival, ems found her hr was 20-30, sbp in 70's. ekg showed afib at a rate of or t wave changes. she was given atropine 0.5mg and fluids. on presentation to the ed initial vitals were sbp 80's, hr 40's. she was given atropine 1mg x2, hr increased to 60's. given ca gluconate 2g, glucagon 9mg, regular insulin 70 units iv x1 followed by insulin drip at 70 units/hr. hr increased but remained hypotensive. bolused 1.5l of ns, started on dopamine drip. sbp increased to 110, however became hypoxic with oxygen saturation of 84% on 4l and was intubated and transferred to the icu. . of note, the patient has a history of two recent hospitalizations. the first, was secondary to community acquired pneumonia and copd exacerbation. she was treated with levaquin. she was also noted diagnosed with atrial fibrillation during this admission, and started on coumadin, diltiazem, and had her atenolol switched to metoprolol. . her second admission occurred . she presented with bradycardia, diaphoresis, nausea, and reported taking a double dose of her diltiazem. she was also in arf w/ cr. 2.1, lactic acidosis with lactate 10.0, presented with leukocytosis 16->32, and corynebacterium diphtheriae bacteremia, 4/4 bottles. she completed a 14 day course of vancomycin ending . echo during this admission was negative for vegetations. . patient was intubated and unable to provide review of symptoms. per family and report form ed, patient was following commands and able to communicate. past medical history: 1. cardiac risk factors:: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: -cabg: n/a -percutaneous coronary interventions: n/a -pacing/icd: n/a 3. other past medical history: atrial fibrillation cataracts arthritis depression asthma copd hip replacement cataract surgery appendectomy hernia repair anemia of chronic disease social history: lives alone but gets help for meals. husband has been in ( ) for 2 yrs and she frequently visits and feels caregiver . she has three sons. she denies current smoking (remote history), alcohol or drug use family history: father died at age 57 of chf mother died at age 49 of cerebral bleed sister is eight yrs younger and has no known med problems physical exam: vs: t=96.1 bp=110/42 hr=102 rr=14o2 sat= 100% fio2 .50 general: wdwn elderly female intubated, sedated heent: ncat. sclera anicteric. pupils dilated to 6mm and non-reactive. contact lenses in place. oral mucosa dry. neck: jvp unable to assess given rij. cardiac: irregularly irregular. normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, respirations were unlabored, no accessory muscle use. b/l crackles. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. no bowel sounds. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp and pt dopplerable left: carotid 2+ dp and pt dopplerable pertinent results: labs on admission: . hematology: 03:30pm blood wbc-11.2* rbc-3.09* hgb-8.9* hct-26.7* mcv-86 mch- 28.8 mchc-33.4 rdw-14.7 plt ct-371 03:30pm blood neuts-78.4* lymphs-15.1* monos-3.6 eos-2.6 baso-0.3 03:30pm blood pt-28.8* ptt-23.5 inr(pt)-2.9* . chemistry: 03:30pm blood glucose-231* urean-22* creat-1.8* na-138 k-3.8 cl-104 hco3-25 angap-13 08:15pm blood alt-154* ast-234* ld(ldh)-515* ck(cpk)-45 alkphos-106 totbili-0.4 08:15pm blood albumin-3.5 calcium-8.7 phos-2.0*# mg-1.7 . 03:30pm blood ctropnt-<0.01 ck-34 08:15pm blood ctropnt-<0.01 ck-45 03:30pm blood ck(cpk)-34 07:50pm blood type-art po2-414* pco2-45 ph-7.33* caltco2-25 base xs--2 . . microbiology: bl cx - ngtd urine cx (, ) - enterococcus (vre) sputum () - klebsiella pneumoniae (pansensitive) stool () - c. diff positive . ekg (): rate 103, atrial fibrillation w/ rapid ventricular response. poor r wave progression, probably a normal variant. compared to tracing #1, atrial fibrillation has replaced sinus rhythm. . 2d-echocardiogram (): "the left atrium is moderately dilated. the estimated right atrial pressure is 0-5mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size 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 (3) are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. no vegetation seen (cannot definitively exclude)." . radiology: cxr ap () impression: 1. endotracheal tube in place, 2.5 cm above the carina. 2. mild pulmonary edema, with small bilateral pleural effusions. 3. right infrahilar opacity, most probably represents atelectasis, but is incompletely assessed. recommend further evaluation with repeat radiography following appropriate treatment. labs on discharge: 05:21am blood wbc-7.3 rbc-2.84* hgb-8.1* hct-24.3* mcv-85 mch-28.3 mchc-33.2 rdw-15.2 plt ct-323 05:48am blood pt-20.9* ptt-24.8 inr(pt)-2.0* 06:20am blood glucose-155* urean-11 creat-0.9 na-144 k-3.6 cl-107 hco3-27 angap-14 05:20am blood alt-25 ast-16 ld(ldh)-166 alkphos-70 totbili-0.2 brief hospital course: 82f w/ pmh htn, afib, p/w bradycardia and hypotension in setting of likely beta blocker or calcium channel blocker overdose, complicated by pna, uti and c.difficile infections. . # hypotension and bradycardia: likely bb or ccb toxicity. patient has history of similar presentation after overdose of diltiazem. on admission, ekg showed afib with slow rhythm, no heart block, no signs of ischemia. hr improved with atropine. the patient was treated for bb or ccb overdose with calcium gluconate, glucagon, and insulin iv. hr continued to improve but still remained hypotensive. blood pressure eventually improved with dopamine. transitioned to levophed, then weaned. . # hypoxia: likely secondary to acute pulmonary edema. possibly from fluid overload in setting of diminished contractility from bb toxicity, or may be from acute diastolic dysfunction from myocardial ischemia given st depressions in lateral leads. intubated in ccu. hypoxia improved with diuresis, once hypotension resolved. pt extubated on . post extubation, pt became agitated. haldol, ativan and zyprexa have been tried. redirection, zyprexa have been used successfully. since arriving on medical floor, sat 98% on 2l o2 initially and, after one day, with desats to low 90s% on room air. patient continued to be monitored for decompensation from existing copd and asthma, and received fluticasone propionate 110 mcg 2 puff ih , ipratropium bromide neb ih q6h and xopenex 0.63 mg/3 ml throughout her course on the medical floor. in addition, patient was started on lasix due to the onset of le edema and a possible component of congestion from heart due to valvular disease. . # coronaries: no history of cad. precordial st depressions present on ekg upon admission to ccu. likely subendocardial ischemia in setting of hypotension and low systemic diastolic pressures. ces were negative. . # pump: recent echo on with normal lv and rv function, without wall motion abnormalities, lvef 55%. previously hypotensive in setting of bradycardia from likely bb or ccb toxicity. became fluid overloaded/hypervolumic, for which diuresis was started with the net goal of -1-2l, which was achieved w/ lasix. . # rhythm: history of atrial fibrillation on coumadin, metoprolol, nifedipine and diltiazem. cardioverted on , sinus rhythm for 12 hours, then reverted back to afib. began amiodarone , while still on infusion after loading dose. inr therapeutic since . home dose of coumadin was 5mg. coumadin restarted at 4mg, in setting of amiodarone and abx. amiodarone switched to 400mg po bid and on diltiazem 30mg po qid as sole drugs for atrial fibrillation. cardioversion on , which reverted back to atrial fibrillation on , evidenced by ekg on that date. coumadin held due to supratherapeutic inr (>3). coumadin restarted on at dose of 2mg. 5mg is pt's normal dose. lower dose given due to multiple antibiotics (less k+ production) and amiodarone therapy. continue to monitor inr and up titrate as needed as antibiotic courses are finished. pt started on diltiazem to 90mg po qid and metoprolol 37.5mg tid. pt may benefit from cardioversion attempt after amiodarone is fully loaded. if pt becomes tachycardic, may up titrate metoprolol to 150mg total per day. pt has appt w/ cardiology on . will likely bring amiodarone down from loading dose at that time. . # acute renal failure/anuria: likely prerenal in setting of bradycardia and hypotension. pressure increased on pressors. producing scant urine on presentaiton to ccu. mucus membranes dry, may be from hypovolemia vs. anticholinergic effects of atropine. resolved w/ fluids and pressors. . #id: multiple sources of infection: a.) community acquired pna w/ pansensitive klebsiella --> finished ceftriaxone 7-day course (last day ) and azithromycin 5-day course (last day ). b.) ua on admission growing vre, sensitive to linezolid --> finished 7-day course, last doze of linezolid on . completed. c.) positive for c.diff, started on po vanc and flagyl (day 1 on ). legionella urinary antigen negative. diarrhea resolved. po vanc d/c'd on . 14 day course of po flagyl will be completed on . . # transaminitis: alt 154, ast 234, new during this admission. possibly from hepatic toxicity as metoprolol, diltiazem, and nifedipine are metabolized by liver. also be due to hepatic ischemia from hypotension. resolved. . # acid-base: non-ag metabolic acidosis likely from diahrrea and increased saline administration. resolved. . # anemia: iron deficiency anemia. stool guaiac negative. on iron. hct stable and return to b/l (~27). . # hyperlipidemia: lipitor was held for transaminitis, now restarted at usual dose. moving forward: a.) pt should continue metronidazole for c. diff until , which will complete her 14 day course b.) pt's inr subtherapeutic on warfarin dose of 2mg. increased dose to 3mg/day on discharge. usual home dose prior to admission was 5mg. lower dose given due to multiple antibiotics (less k+ production) and amiodarone therapy. inr should continue to be monitored and warfarin may need to be up-titrated as pt comes off of antibiotics. c.) pt was started on amiodarone on on loading dose of 400 mg . pt has cardiology appt on and will likely be decreased to maintenance dose at that time. d.) if pt becomes sustained tachycardic, consider up-titrating metoprolol. medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs po four times a day atorvastatin - 20 mg po daily citalopram - 10mg tablet by mouth once a day clonazepam - 0.5 mg tablet - 1 tablet(s) by mouth once a day diltiazem hcl - 240 mg capsule, sust. release po daily fluticasone-salmeterol - 250-50 mcg/dose disk with device - 1 inhalation twice a day glyburide - 10mg po twice daily hydrochlorothiazide - 12.5 mg po daily metoprolol tartrate - 150mg po twice daily nifedipine - 30 mg tab,sust rel. 1 tab po daily osmotic push 24hr - 1 tab(s) by mouth once a day warfarin - 5 mg tablet - tablet(s) by mouth at bedtime ferrous sulfate - (new) - 325 mg by mouth once a day discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 2. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 3. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 4. insulin lispro 100 unit/ml solution sig: see sliding scale subcutaneous asdir (as directed): see sliding scale. 5. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed. 6. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 7. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 10. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): continue until . 11. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for sore throat. 12. phenol 1.4 % aerosol, spray sig: one (1) spray mucous membrane q4h (every 4 hours) as needed for sore throat. 13. diltiazem hcl 360 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day. 14. warfarin 3 mg tablet sig: one (1) tablet po once a day. 15. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 16. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 17. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. 18. lasix 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: discharge diagnosis: calcium channel blocker toxicity pneumonia c. difficile colitis vancomycin-resistant enterococcus urinary tract infection atrial fibrillation anemia discharge condition: stable, eating, drinking, voiding, having bowel movements, without complaint. discharge instructions: you were admitted for having a low heart rate with lightheadedness and dizziness. when you arrived to the emergency department, you had a very low blood pressure and, after treatment, your lungs filled up with fluid. as a result, you had to be intubated and transferred to the icu. in the icu, you developed a pneumonia, a urinary tract infection, and infectious diarrhea, for which you were given antibiotics. in addition, you were restarted on two medications to slow down your heart rate, and one additional medication to help your heart stay in a normal rhythm. also, you will be discharged on an antibiotic for your diarrhea. you have several appointments scheduled, please attend them all. medications: start diltiazem 360mg tablet once per day start metoprolol tartrate 37.5mg three times per day start amiodarone 400mg twice per day start metronidazole 500mg once per day. please continue until . start furosemide 20mg once per day. if you experience any lightheadedness, dizziness, chest pain, nausea, vomiting, continued diarrhea, loss of consciousness, blood in your stool and/or vomit, please contact your primary care provider . followup instructions: 1. provider: , md phone: date/time: 3:00 2. primary care: dr. , tuesday , 11am. 3. provider: , orthopedic private practice phone: date/time: 11:15 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart other electric countershock of heart diagnoses: acidosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation acute on chronic diastolic heart failure other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled septic shock infection with microorganisms without mention of resistance to multiple drugs iron deficiency anemia, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] chronic obstructive asthma, unspecified hepatitis, unspecified pneumonia due to klebsiella pneumoniae accidental poisoning by agents primarily affecting cardiovascular system poisoning by coronary vasodilators 

Answer: The patient is high likely exposed to