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: wellbutrin attending: chief complaint: presyncope major surgical or invasive procedure: pacemaker placement chest tube placement history of present illness: mrs. is an 83 year-old woman with a history of htn and a recent diagnosis of 2nd degree av block (mobitz type i) with associated symptoms of syncope who presents for expedited pacemaker placement. she was in her usoh until four weeks ago when she began experienced episodes of light-headedness. the episodes lasted about 30 minutes in duration, were relieved by sitting and lying down, and occured a few times each day. they were not vertiginous in character. her symptoms were initially thought to be related to hypotension secondary to antihypertensives and these medications, which included metoprolol, amlodipine, and lisinopril, were titrated downward. the acei was discontinued on . however, her symptoms persisted and she underwent holter analysis which demonstrated mobitz type i 2nd degree av block and bradycardia. she was scheduled for routine pacemaker placement but her symptoms of syncope became acutely worse yesterday, with several episodes and significantly diminished ability to ambulate, and she was advised to present to the ed for admission. though she has been presyncopal, she has not syncopized. she has, however, had dyspnea with exertion during this time period. in the ed, initial vitals were t: 98.1 hr: 62 bp: 165/72 rr: 18 o2sat: 94ra. she was then admitted for further evaluation and management. on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, or orthopnea. past medical history: 1. hypertension, hyperlipidemia, history of tobacco abuse (stopped smoking in ) 2. chronic obstructive pulmonary disease. 3. osteoporosis. 4. remote history of colon carcinoma, s/p resection 5. peripheral vascular disease status post aortoiliac reconstruction 6. left ventricular hypertrophy with hypertrophic obstructive cardiomyopathy physiology. 7. hearing loss social history: the patient lives with her husband. she has been retired for the last ten years and worked previously in accounting. she denies any alcohol or drugs. she has a significant smoking history and stopped smoking in . she recently lost a son in . family history: mother had diabetes and died at 77 of complications of diabetes and an mi. father died at 52 of a massive mi. brother died at 67 of bone cancer. physical exam: vs - t 97 bp 151/71 hr 62 rr 18 o2sat 100%ra gen: wdwn elderly woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 9 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. hs murmur loudest at apex. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. bibasilar rales. no wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: cn ii-xii intact, and motor intact in ue/le pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: admission labs: 05:00pm glucose-110* urea n-15 creat-0.9 sodium-142 potassium-3.7 chloride-105 total co2-30 anion gap-11 05:00pm ck(cpk)-59 05:00pm ctropnt-<0.01 05:00pm ck-mb-notdone 05:00pm wbc-7.2 rbc-4.11* hgb-12.3 hct-36.0 mcv-88 mch-30.0 mchc-34.2 rdw-13.0 05:00pm neuts-73.6* lymphs-15.7* monos-8.1 eos-1.9 basos-0.6 05:00pm plt count-242 05:00pm pt-12.9 ptt-23.0 inr(pt)-1.1 discharge labs: 08:35am blood wbc-6.5 rbc-3.23* hgb-9.6* hct-28.5* mcv-88 mch-29.8 mchc-33.7 rdw-13.0 plt ct-159 08:35am blood glucose-103 urean-16 creat-0.6 na-137 k-4.1 cl-102 hco3-29 angap-10 08:35am blood calcium-8.8 phos-3.1 mg-2.0 . cxr : impression: ap chest compared to : small left pneumothorax persists, predominantly apical, despite left pleural drain projecting over the lateral aspect of the hemithorax. left pleural effusion is minimal if any. no right pleural effusion or mediastinal widening. no acute pulmonary abnormalities. mild cardiomegaly longstanding. overall lung volumes and the configuration of the chest reflect copd. thoracic aorta is generally large and calcified, but not focally aneurysmal. transvenous right atrial and right ventricular pacer leads are in their expected positions, as far as one can tell from frontal view alone. small amount of subcutaneous emphysema in the left chest wall reflects thoracostomy tube insertion. incidental note is made of azygos fissure, common anatomic variant. cxr : interval improvement of pneumothorax . ekg : sinus bradycardia. atrial bigeminy. there is variation in precordial lead placement as compared with previous tracing of . leads v1 and v2 are similarly placed. since the previous tracing of atrial bigeminy has appeared. brief hospital course: mrs. is an 83 year-old woman with a history of htn, hocm (60 mm hg gradient at rest), and a recent diagnosis of 2nd degree av block (mobitz type i), sa exit block, and variable pr (dual pathway av node) who presents with worsening syncope. . # mobitz type 1: patient was recently found to have 2nd degree av block (mobitz type i) on holter monitor with associated symptoms of presyncope. overall, patient had multiple rhythm abnormalities based on holter study, including sinus bradycardia (26-71 bpm, average 50 bpm), atrial ectopy, and ventricular ectopy. she underwent pacemaker placement but became hypotensive during the procedure and was started on dopamine. this was discontinued after a few hours but she was transferred to the ccu because a cxr demonstrated a small left pneumothorax after the procedure. a chest tube was placed, with reduction in the size of the pneumothorax, and was later pulled prior to transfer back to the cardiology floor. . # pneumothorax: as noted above, patient developed a ptx after pm placement. a chest tube was placed and repeat cxrs showed gradual resolution of the ptx. she was discharged on 3 additional days of keflex after having cefazolin in house to prevent infection. . # cad: patient had no evidence of ischemia. per report, she had a negative stress mibi in though there is no documentation in omr. she was continued on her outpatient regimen except as described above with intermittent cessation of metoprolol during hypotension. . # hypertension: normotensive during hospitalization except for episode of hypotension during pm placement. of note, she was previously on ccb, acei, and bb, but the acei was discontinued during initial treatment for syncope, before she was diagnosed with mobtiz type i. amlodipine was held for hypotension and lisinopril was started. she was discharged on this regimen. amlodipine can be restarted if her blood pressures are difficult to control, but they were stable this admission. . # hyperlipidemia: continued on simvastatin . # osteoporosis: continued on outpatient regimen with ca/vit d, bisphosphanate . # stool impaction: had fecalithe in rectal vault. was manually disempacted without bleeding or complications on . afterwards had warm tap water enema. she was discharged with senna and colace. medications on admission: amlodipine 10 qd metoprolol 25 qd simvastatin 40 qd plavix 75 qd alendronate 70 qweek tiotropium bromide (spiriva) inhaler qd asa 325 qd alprazolam 0.25 mg po bid:prn calcium/vit d 600/125u mvi qd discharge medications: 1. alendronate 70 mg tablet sig: one (1) tablet po qmon (every monday). 2. alprazolam 0.25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): for constipation. disp:*60 capsule(s)* refills:*2* 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed: for constipation. disp:*60 tablet(s)* refills:*2* 12. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 13. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 3 days: please take 4 times daily until all of your antibiotics are used up. if you miss a dose, please keep taking. disp:*12 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: syncope due to cardiac arrhythmia . secondary diagnosis: hypertension, hyperlipidemia, osteoporosis, hearing loss discharge condition: stable vital signs, at baseline discharge instructions: you were admitted because of syncope, or passing out. we believe that this was due to an abnormal rhythm in your heart. we fixed this by placing a pacemaker which will set the rhythm for you. you experienced some complications of your pacemaker placement, but are recovered now. you were also constipated while in the hospital. . please take your medications as prescribed. we have stopped your amlodipine (norvasc). we have started you on a new blood pressure medication called lisinopril. please take lisinopril 5mg daily. we also gave you a prescription for two medications to prevent and treat constipation, senna and colace. finally, you will need to take an antibiotic called keflex (cephalexin) 500mg four times per day for three more days. . if you have pain from your pacemaker and chest tube surgeries you can take tylenol and ibuprofen (advil) according to the package directions. . congratulations on quitting smoking. information was given to you on admission regarding smoking cessation and preventing relapses. . please attend your follow up appointments. . please come back to the emergency room or call your doctor or chest pain, palpitations, shortness of breath, swelling or bleeding by your chest tube or pace maker, weakness, diarrhea, or other concerning symptoms. followup instructions: provider device clinic phone: date/time: 2:00 . provider , : date/time: 2:30 . provider , md, mph: date/time: 10:10 . provider: , m.d. phone: date/time: 1:20 procedure: insertion of intercostal catheter for drainage initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified other specified cardiac dysrhythmias iatrogenic pneumothorax osteoporosis, unspecified other second degree atrioventricular block other impaction of intestine 

Answer: The patient is high likely exposed to