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: shellfish / shellfish derived attending: chief complaint: symptomatic palpitations major surgical or invasive procedure: 1. bilateral mini thoracotomy with bilateral pulmonary vein isolation using the atricure synergy system with resection of left atrial appendage. 2. autonomic ganglia stimulation and ablation. history of present illness: ms. is a pleasant 51-year-old woman with past medical history of paroxysmal atrial fibrillation, with history of cva as well as hypertension, who presents today with continued episodes of palpitations as well as an episode recently that could possibly have been a tia, although it is unclear. paroxysmal atrial fibrillation was first diagnosed in . she has been on coumadin since her cva in . she has had symptomatic atrial fibrillation which has not been adequately controlled with antiarrythmics and continues to be quite debilitated by her symptoms. past medical history: past medical history: - atrial fibrillation - hemorrhagic stroke ~, evaluated in , presented with left facial (and drooling), left hemiparesis with limping; residual l eye ptosis - migraine - episodes of dizziness and visual blurring (appears in heme/onc records) - htn - chest pain - symptomatic palpitations - myelodysplastic syndrome versus reactive process manifest as intermittent leukocytosis + thrombocytosis/thrombocytopenia (s/p bone marrow biopsies) - hodgkin's lymphoma at age 14 years s/p cobalt irradiation and splenectomy - skin cancer in region of radiation - thyroidectomy for nodular hyperplasia - parathyroidectomy for adenoma - irregular menses , ? papilloma, freq. vag. infections - depression, anxiety (not well-controlled per patient) - hemorrhoids - colon polyps - b hand/feet neuropathy past surgical history: - ex lap at age 14, ?splenectomy - c/s , via midline incision - skin cancer - thyroidectomy/parathyroidectomy - right eye surgery - l neck surgery/lymph mass removal social history: lives with brother and sister in law. does not smoke, drink alcohol, or illicit drugs. unemployed. family history: family history of htn, cad sister - died in her 40's with a 'massive heart' brother - died young with 'massive heart' physical exam: admission: pulse: 73 resp: 16 o2 sat: 99% b/p right: 145/82 left: 139/76 height: 66" weight:157 general:depressive affect; sniffles today due to allergies skin: dry intact heent: perrla eomi , mild irritation and ptosis left eye;anicteric sclera;op unremarkable neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur-none abdomen: soft non-distended non-tender bowel sounds + ; no hsm/cva tenderness extremities: warm , well-perfused edema: none varicosities: none + spider veins neuro: grossly intact, mae strengths, nonfocal exam pulses: femoral right:2+ left:2+ dp right:1+ left:1= pt :np left:np radial right:2+ left:2+ carotid bruit right:none left:none pertinent results: pre-op 11:55am pt-12.9 inr(pt)-1.1 11:55am plt count-463* 11:55am wbc-8.3 rbc-3.71* hgb-12.0 hct-34.8* mcv-94 mch-32.2* mchc-34.3 rdw-13.4 11:55am %hba1c-5.8 eag-120 11:55am albumin-3.6 calcium-8.8 cholest-181 11:55am alt(sgpt)-202* ast(sgot)-103* alk phos-142* tot bili-0.3 dir bili-0.1 indir bil-0.2 11:55am glucose-100 urea n-18 creat-0.8 sodium-138 potassium-4.1 chloride-106 total co2-26 anion gap-10 discharge 05:52am blood wbc-19.8* rbc-3.41* hgb-10.7* hct-31.7* mcv-93 mch-31.5 mchc-33.9 rdw-13.5 plt ct-394 05:52am blood plt ct-394 05:52am blood pt-12.4 ptt-23.9 inr(pt)-1.0 05:52am blood glucose-126* urean-17 creat-0.9 na-135 k-4.8 cl-102 hco3-26 angap-12 05:52am blood mg-1.9 radiology report chest (portable ap) study date of 10:16 am reason for examination: followup of the patient after removal of the left chest tube. the left chest tube has been removed. there is no evidence of pneumothorax. apical bullous areas cannot be excluded. minimal bibasal atelectasis is present. right internal jugular line tip continues to be in the right atrium and should be pulled back for approximately 2 cm. no right pneumothorax is seen. dr. echocardiography report echocardiographic measurements findings left atrium: no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: no spontaneous echo contrast in the body of the ra. no spontaneous echo contrast in the raa. no thrombus in the raa. right-to-left shunt across the interatrial septum at rest. left ventricle: overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: no atheroma in aortic arch. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: mildly thickened aortic valve leaflets (3). no ar. mitral valve: mildly thickened mitral valve leaflets. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was monitored by a nurse throughout the procedure. the posterior pharynx was anesthetized with 2% viscous lidocaine. 0.2 mg of iv glycopyrrolate was given as an antisialogogue prior to tee probe insertion. no tee related complications. cardiology fellow involved with the patient's care was notified by telephone. results were dr. was notified of the results via page. dr. was notified in person of the results. conclusions no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. a very small left to right shunt is seen across the interatrial septum consistent with a tiny atrial septal defect (see clip ). overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no pericardial effusion. impression: no evidence of intracardiac thrombus. very small atrial septal defect. complex atheroma in the thoracic aorta. electronically signed by , md, interpreting physician 19:23 brief hospital course: ms was admitted to the cardiac suregry service for planned bilateral thoracotomies and maze with left atrial appendage ligation. she was heparinized on addmision because of her history of atrial fibrillation. on she was brought to the operting room by dr , please see operative report for details. in summary she had: 1. bilateral mini thoracotomy with bilateral pulmonary vein isolation using the atricure synergy system with resection of left atrial appendage. 2. autonomic ganglia stimulation and ablation. she tolerated the operation well and post-operatively was transferrd to the cardiac surgey icu. she awoke neurologically intact and was extubated. she remained hemodynamically stable and on pod1 her chest tubes were removed and she was transferred to the stepdown floor. on pod2 her paravertebral blocks were removed- following which pain control was acheived with dilaudid. she was restarted on her coumadin and cleared pt for discharge to home with services. her inr will be checked on and the results called to dr at the clinic in , they had followed her inr preoperatively medications on admission: medications at home: alprazolam - - 0.5 mg - 1 tablet(s) by mouth once a day as needed for anxiety atenolol - 25 mg - 1 tablet(s) by mouth twice a day take an extra 25mg if symptomatic palpitations bupropion hcl - 150 mg tablet extended release - 1 tablet(s) by mouth daily fluoxetine - 20 mg - 1 capsule(s) by mouth once a day levothyroxine -100 mcg - one tablet(s) by mouth each day olanzapine - 20 mg - 1 tablet(s) by mouth once a day ***warfarin - 2.5 mg tablet - 1 tablet(s) by mouth daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. alprazolam 0.25 mg tablet sig: 1-2 tablets po qhs/prn as needed for anxiety. 7. indomethacin 25 mg capsule sig: one (1) capsule po tid (3 times a day) for 1 months. disp:*90 capsule(s)* refills:*0* 8. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 10. hydromorphone 2 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: take 1 daily sat and sun then as directed by dr . disp:*30 tablet(s)* refills:*0* 13. wellbutrin sr 150 mg tablet extended release sig: one (1) tablet extended release po once a day. 14. fluoxetine 20 mg tablet sig: one (1) tablet po once a day. 15. zyprexa 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: vna network discharge diagnosis: 1. bilateral mini thoracotomy with bilateral pulmonary vein isolation using the atricure synergy system with resection of left atrial appendage. 2. autonomic ganglia stimulation and ablation. past medical history: - atrial fibrillation - hemorrhagic stroke ~, evaluated in , presented with left facial (and drooling), left hemiparesis with limping; residual l eye ptosis - migraine - episodes of dizziness and visual blurring (appears in heme/onc records) - htn - chest pain - symptomatic palpitations - myelodysplastic syndrome versus reactive process manifest as intermittent leukocytosis + thrombocytosis/thrombocytopenia (s/p bone marrow biopsies) - hodgkin's lymphoma at age 14 years s/p cobalt irradiation and splenectomy - skin cancer in region of radiation - thyroidectomy for nodular hyperplasia - parathyroidectomy for adenoma - irregular menses , ? papilloma, freq. vag. infections - depression, anxiety (not well-controlled per patient) - hemorrhoids - colon polyps - b hand/feet neuropathy past surgical history: - ex lap at age 14, ?splenectomy - c/s , via midline incision - skin cancer - thyroidectomy/parathyroidectomy - right eye surgery - l neck surgery/lymph mass removal discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with dilaudid incisions: bilateral thoracotomy sites - healing well, no erythema or drainage edema-none discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving while taking narcotics, driving will be discussed at follow up appointment with surgeon. no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: - office will call with appointment date and time cardiologist: , md 3:40 primary care dr. , md 8:30.. **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? atrial fibrillation goal inr 2-2.5 first draw results to phone fax dr at clinic in procedure: combined right and left heart cardiac catheterization diagnostic ultrasound of heart excision or destruction of other lesion or tissue of heart, open approach combined right and left heart angiocardiography diagnoses: unspecified essential hypertension atrial fibrillation 

Answer: The patient is high likely exposed to