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: lorazepam / morphine / penicillins / zosyn attending: chief complaint: "tachy-brady syndrome" major surgical or invasive procedure: -flutter ablation -right subclavian central line with temporary pacer placement -dual chamber pacer placement history of present illness: hpi: ms. is a 75 y/o female with pmh significant for copd/asthma, systolic chf (ef<20%), htn, afib, cri (baseline cr 1.1), and seizure d/o, with recent admission from to , who presents from rehab with afib/aflutter that was difficult to rate control. she was initially admitted to for resp distress thought copd failure and chf, and eventually transferred to ccu for tailored chf therapy. major issues during this extended hospitalization included rate control of a fib s/p failed cardioversion, amiodarone (increased lfts) and procainamide trials without effect, failed rate control as dilt caused hypotension, as well as placement of a trach after development of pneumonia, contained bowel perforation, maroon-colored stools and gi bleed, and management of volume overload. she was subsequently discharged to hospital. discharged on dig 0.25 mcg qd as only nodal blocking . . she now returns from nesh after noted to have hr in 140s (flutter), given extra dose of 12.5 mg po lopressor, and subsequently having a second pause at rehab. . in ed, was noted to have abg with hypoxia/hypercarbia, cxr consistent with mild chf though improved from prior with elevated bun/cr and seeming dry on exam. also with leukocytosis, left shift, bandemia; lactate wnl. troponin t elevated at 0.17 from first set. in ed, ngt and piv placed, received 500cc ns, levaquin 500mg, vanc 1gm, tylenol 650mg. evaluated by cards fellow, felt to be likely infected with early arf. cards fellow recommended decreasing digoxin to 0.125, checking dig level, considering cautious hydration, normalizing electrolytes, avoiding lopressor with consideration of pindolol as an alternative, holding anticoagulation, and consulting ep for possible avn ablation +ppm. past medical history: pmh: afib/aflutter chf (echo : lv ef < 20%. global hypokinesis. 3+ mr, 2+ tr htn copd/asthma ?renal insufficiency (bl cr 1.1), but 0.5 at osh remote hx of seizure h/o gi bleed . social history: . sh: lives at ; daughter is hcp former , no etoh/drug use family history: noncontributory; no known hx of heart/lung dz physical exam: pe vitals: hr 99 bp 111/40(57) vent: tv 500 rr 18 (set at 15bpm) sat 100% on 70% fio2 peep 8 gen: elderly frail caucasian woman lying in bed sleeping in no acute distress, breathing easily via trach, easily arousable heent: perrl, eomi, dry mm (mouth breather) neck: trach site clean with no erythema chest: anterior exam cta bilaterally, no rales appreciated cvs: decreased heart sounds, irreg irreg, no m/g/r appreciated abd: obese, soft, nt, nd, guiaic negative per ed extrem: thin with decreased muscle mass, no edema, r forearm with ecchymosis, mildly tender to palpation neuro: somnolent but arousable, communicating by writing on pad, moving all extremities with no apparent deficits pertinent results: 04:46pm ck(cpk)-19* 04:46pm ck-mb-notdone ctropnt-0.17* 04:46pm ptt-66.2* 01:08pm type-art po2-236* pco2-64* ph-7.34* total co2-36* base xs-6 12:12pm urine hours-random urea n-427 creat-78 sodium-25 09:04am ck(cpk)-18* 09:04am ck-mb-notdone ctropnt-0.21* 07:25am wbc-17.7* rbc-3.71* hgb-11.6* hct-34.7* mcv-94 mch-31.3 mchc-33.5 rdw-15.9* 07:25am pt-13.1 ptt-24.3 inr(pt)-1.1 01:10am glucose-97 urea n-71* creat-0.8 sodium-136 potassium-5.1 chloride-94* total co2-34* anion gap-13 01:10am ck-mb-4 ctropnt-0.17* 01:10am digoxin-1.4 01:10am wbc-20.0*# rbc-3.79* hgb-11.8* hct-35.4* mcv-94 mch-31.2 mchc-33.4 rdw-15.9* 01:10am urine color-yellow appear-clear sp -1.019 01:10am urine rbc-* wbc- bacteria-few yeast-none epi-0-2 trans epi-0-2 01:06am lactate-1.6 . admit cxr: the heart is upper limits of normal in size and the mediastinal contours appear unchanged. there is interval improvement in pulmonary vascular congestion with probable mild persistent congestive heart failure. a focal opacity is seen at the right base, possibly representing atelectasis. there is a small right pleural effusion. no pneumothorax. . admit ekg: aflutter at 150bpm, nl axis, qrs wnl, no q waves, scooped out st vs st depressions in v1-6, ii, iii, avf, ste in avl, avr . echo : lv ef < 20%. global hypokinesis. mild lvh. mild lae. tr gradient 25-36%. severe rv free wall hypokinesis valves: 3+ mr, 2+ tr, no ar. . brief hospital course: a/p: 74 y/o female with chf (ef <20%), h/o afib/flutter s/p failed cardioversion, copd, htn, renal insufficiency, h/o gib, now presenting with atrial flutter/tachycardia to 150s and bradycardia with pauses of as long as secs. unsuccessful ablation therapy. now s/p permanent dual chamber pacer placement. . 1. tachy-brady syndrome: the pt has past history of atrial flutter/fib. the pt may have gone into aflutter this time secondary to infection vs. hypoxia vs. prerenal failure. on admission the pt's digoxin level was decreased to 0.125 per ep and she was maintained on this level throughout her admission. on ep evaluated the pt for flutter ablation. ep evaluated the pt for atrial ablation which was performed. however, on the pt had recurrent episodes of tachy/brady with hrs as hisg as the 150s and as low as the 30s. the pt was asx during periods of tachy, lightheaded/pre-syncopal during brady, that evening a temporary pacer was placed after gaining consent from the pt's hcp. the following day a permanent dual chamber pacemaker was placed. ep has followed the pacer since placement. the pt's hr has been well-controlled since placement and the pacer was adequate upon ep interrogation. 2. cv #? ischemia: on admission the pt experienced st depressions in inferior leads and v2-v6. however, these changes were felt to be to dig effectc. the pt's troponin was initially slightly elevated. however, the pt's cardiac enzymes contined to cycle down. #pump: the pt has a h/o of significant chf (ef 20% by echo). throughout admission, the pt remained euvolemic-to-hypovolemic on exam. she was diuresed gently as needed. she was started and maintained on lisinopril and hydralazine. #rhythm: as above. . 3. leukocytosis/fever: following permanent pacer placement, the pt spiked a temp to 103 and had elevated wbcs. pan cxs were sent and her right sc cordis was removed. the pt demonstrated no evidence of pna on exam or cxr. blood cxs were all negative, therefore infected pacer lines were felt to be unlikely. the pt was initially treated with keflex. however, her ucx grew out enterococcus. it was also postulated that given her longterm ng, the pt possibly has sinusitis. the pt was started on a 7 day course of augmentin for uti and possible sinusitis. after the pt's initial spike, her temp has trended down and on the day of d/c was 98 off all antipyretics. . 4. resp failure s/p trach: the pt has been at long term for ventilator maintenance and possible weaning. she was a h/o copd. during her stay, potential vent weaning was deferred until til discharge. she was continued on albuterol-ipratropium nebs. she was given supplemental oxygen as required. . 5. arf/cri: upon presentation the pt had an elevated bun and cr. she was pre-renal by fena (0.21%). her renal function resolved shortly after admission. 6. foot pain--the pt had focal 1st to 2nd mtp joint pain. this was ? to plantar nerve inflammation vs. musculoskeletal contractures vs. fx. pt has followed and has recommended longterm rehab and evaluation to clarify the etiology. 7. ppx: the pt was maintained on sq heparin, ppi and bowel regimen. . 8. fen: the pt was maintained on tfs+hydration started via ngt. 9. full code 10. communication--son 11. pt is to be d/c'd back to for further vent management. medications on admission: allergies: lorazepam/mso4 . meds on admission: digoxin 0.25mg qod, 0.125mg qod lopressor 12.5 mg po bid alprazolam 0.125mg prn colchicine 0.6mg qd nexium 20mg qd flovent 2 puffs lasix 60mg qd hydral 25mg q8h riss discharge medications: 1. amoxicillin-pot clavulanate 250-62.5 mg/5 ml suspension for reconstitution sig: five hundred (500) mg po q8h (every 8 hours) for 7 days. disp:*21 doses* refills:*0* 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. digoxin 125 mcg tablet sig: one (1) tablet po once a day. 4. dolasetron mesylate 12.5 mg iv q8h:prn 5. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 6. hydralazine 10 mg tablet sig: one (1) tablet po qid (4 times a day). 7. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 8. furosemide 40 mg tablet sig: two (2) tablet po bid (2 times a day). 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 10. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 11. docusate sodium 150 mg/15 ml liquid sig: one hundred (100) mg po bid (2 times a day). 12. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 13. quetiapine 25 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 14. lansoprazole 30 mg susp,delayed release for recon sig: thirty (30) mg po bid (2 times a day). 15. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 16. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 17. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day): give while on bedrest or not mobile. 18. phenol-phenolate sodium 1.4 % mouthwash sig: one (1) spray mucous membrane q4h (every 4 hours) as needed. 19. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: tachy/brady syndrome s/p pacemaker placement sinusitis discharge condition: stable. requires chronic ventilator, functioning tracheostomy in place. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5 l per day followup instructions: please keep the following appointments: provider: clinic phone: date/time: 11:00 provider: , md phone: date/time: 2:00 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system diagnoses: other primary cardiomyopathies mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation other convulsions atrial flutter chronic kidney disease, unspecified chronic systolic heart failure chronic obstructive asthma, unspecified sinoatrial node dysfunction diseases of tricuspid valve pain in joint, ankle and foot chronic respiratory failure tracheostomy status unspecified sinusitis (chronic) dependence on respirator, status 

Answer: The patient is high likely exposed to