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: no known allergies / adverse drug reactions attending: chief complaint: elective pvi complicated by pericardial tamponade major surgical or invasive procedure: pulmonary vein isolation pericardial drain placement right and left heart catheterization transesophageal echocardiogram and cardioversion history of present illness: this is a 52 year old woman with history significant for hypertrophic cardiomyopathy, paroxysmal atrial fibrillation s/p multiple prior cardioversions, af ablation in , and pvi in who is admitted to the ccu with pericardial tamponade status post repeat pulmonary vein isolation procedure. her most recent cardioversion was in and at that time she converted briefly to sinus rhythm and then went back into atrial fibrillation and has remained in it since then, according to her report. she experienced recurrent symptoms with fatigue and was referred for redo pulmonary vein isolation procedure. . patient presented for the procedure on the morning of admission and underwent catheterization via the r femoral. around 11:40 am, she acutely dropped her blood pressures to systolics in the 40s. she was found to be in pericardial tamponade in the setting of her supratherapeutic inr of 4.1. bedside echo was performed and showed a large anterior/apical pericardial effusion with rv diastolic collapse c/w tamponade physiology. a large clot was also visualized. the procedure was prematurely terminated, a pericardial drain was placed. a swan ganz catheter was placed in the left femoral vein for hemodynamic monitoring, and an arterial line in the r femoral artery. she was hypotensive for approximately 15 minutes, requiring neosynephrine briefly before her pressures stabilized after drainage of 300 cc of blood. she received 2 units of ffp. she was transferred to the ccu intubate and sedated on propofol, hemodynamically stable off pressors, for further management. . in the ccu, the patient was intubated and sedated and unable to answer any questions. . past medical history: 1. cardiac risk factors: (-)diabetes, (+)dyslipidemia, (-)hypertension 2. cardiac history: -hocm -atrial fibrillation s/p cardioversion 2 years ago -hypercholesterolemia 3. other past medical history: -asthma/copd -gerd -hepatitis c, genotype iiia; treated with interferon/ribavirin -history of severe depression with suicide attempt, overdoses on seroquel, currently under good control -h/o diverticulosis s/p colectomy -marijuana dependence -tobacco dependence 4. past surgical history - history of rotator cuff injury to the right shoulder () - s/p cholecystectomy (per patient) - s/p incisional hernia repair () - s/p colectomy for diverticulitis (~) - s/p appendectomy - s/p ex-laparotomy for epigastric and abdominal pain (chronic cholecystitis) - found to be in afib during this hospitalization 5. gyn history: currently going through menopause with active hot flashes as above lmp ~2 years ago social history: married. lives in with her husband. does not work; on unemployment. contact for discharge: husband; cell # . tobacco: 5 cigarettes daily and marijuana on weekends etoh: none. denies ivdu since one episode in ; rare and remote h/o cocaine (~20yrs prior) family history: father with mi at 38, died 12 years later in cath lab. mother with asthma but no cardiac disease. five living brothers all without heart disease. otherwise non-contributory. physical exam: on admission: vs: t= 96.6 bp= 123/81 hr= 112 rr= 22 o2 sat= 100% general: intubated, sedated heent: sclera anicteric. perrl. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. dry mmm. neck: supple, jvp appx 15 cm at 30 degrees. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: wheezes bilaterally anteriorly, coarse bs; no rales appreciated. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. numerous tattoos. pulses: 2+ radial, dps and pts b/l . on discharge: vs: t= 97.8 bp= 120/78 hr= 84 rr= 18 o2 sat= 100% general: alert, oriented, nad heent: sclera anicteric. perrl. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. mmm. neck: supple, jvp to mandible. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: cta anteriorly; no rales appreciated. chest: tegaderm dressing over site of previous pericardial drain: no erythema no discharge abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. numerous tattoos. pulses: 2+ radial, dps and pts b/l . pertinent results: on admission: 07:15am blood wbc-7.3 rbc-4.81 hgb-17.0* hct-47.1 mcv-98 mch-35.3* mchc-36.1* rdw-14.5 plt ct-163 10:00am blood pt-40.1* ptt-32.8 inr(pt)-4.1* 07:15am blood glucose-102* urean-10 creat-0.7 na-135 k-7.3* cl-102 hco3-25 angap-15 03:00pm blood calcium-7.8* phos-3.6 mg-1.3* . on discharge: 04:22am blood wbc-5.1 rbc-3.23* hgb-10.8* hct-32.9* mcv-102* mch-33.5* mchc-32.9 rdw-15.7* plt ct-123* 04:22am blood pt-19.2* ptt-38.5* inr(pt)-1.7* 04:22am blood glucose-85 urean-7 creat-0.6 na-140 k-4.0 cl-105 hco3-28 angap-11 04:22am blood calcium-8.6 phos-3.2 mg-1.7 . tfts: 04:28am blood tsh-5.7* 04:28am blood t4-6.3 . anemia work-up 04:28am blood vitb12-greater th folate-16.0 05:43am blood ret aut-2.9 . lactate trend 12:27pm blood glucose-88 lactate-1.3 na-140 k-3.7 cl-110 04:45pm blood lactate-1.0 imaging: serial tte tte focused views during ablation procedure complicated by tamponade. there is a large pericardial effusion (2.2 cm). the effusion is echo dense, consistent with blood, inflammation or other cellular elements. the effusion is predominantly anterior/apical. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. there is a catheter noted in the transatrial position, one in the pericardial space and another in the ivc/ra. after pericardial fluid drainage there is gradual improvement of the size of the pericardial effusion (clip , measuring 1.1 cm) and resolution of the tamponade physiology. there was no significant resting lvot gradient throughout the procedure (patient has known hypertrophic cardiomyopathy). . tte : post-pericardiocenthesis focused views post pericardial drainage. there is a small to moderate sized pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. compared with the post-pericardiocenthesis images of a few hours ago, findings are similar. . tte overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. compared with the prior study (images reviewed) of , the amount of pericardial fluid is slightly less. it has similar appearance (echo dense) and distribution (over the rv free wall and apex). . tte overall left ventricular systolic function is normal (lvef>55%). there is a small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , no change. . tte there is a small pericardial effusion. the effusion appears circumferential. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. no right atrial or right ventricular diastolic collapse is seen. impression: small echodense pericardial effusion without echocardiographic evidence of significant hemodynamic impact. compared with the prior study (images reviewed) of pericardial effusion is similar. . tee: mild spontaneous echo contrast is seen in the body of the left atrium and the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). a large, nonmobile thrombus is seen in the left atrial appendage. there is severe symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). the right ventricular free wall is hypertrophied. there are simple calcified atheroma in the aortic arch and descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened without aortic stenosis. there are filamentous strands on both the upstream and lvot sides of the aortic leaflets (probable noncoronary and left coronary cusps), measuring 0.5-0.6 cm in length (clips 55, 58, 60, 72, 86, 87). the strands on the aortic valve side are consistent with lambl's excresences (normal variant). however, thrombus or vegetation cannot be excluded. no aortic valve abscess is seen. trace central aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. impression: large probable thrombus in the left atrial appendage. filamentous strands on the aortic valve, consistent with lambl's excresences (cannot exclude thrombus vs. vegetation, in the appropriate clinical context). trace aortic regurgitation. mild to moderate mitral regurgitation. small pericardial effusion without echocardiographic signs of tamponade. . cardiac cath: comments: 1. coronary angiography in this co-dominant system demonstrated no obstructive disease. the lmca had no angiographically apparent disease. the lad had up to 30% stenosis with otherwise minor lumen irregularities. the lcx had minor lumen irregularities. the rca had up to 30% stenosis in the mid vessel. 2. resting hemodynamics revealed elevated right and left ventricular filling pressures with rvedp 14 mmhg and lvedp 24 mmhg. the pulmonary artery pressures were elevated with pasp 42 mmhg. the cardiac index was depressed at 1.8 l/min/m2. the pulmonary and systemic resistances were elevated at 347 and 2133 dyn-sec/cm5, respectively. there was systemic arterial normotension and no significant pressure gradient across the left ventricular outflow tract from apex to ascending aorta on catheter pullback despite the asymmetric septal hypertrophy. simultaneous pressure recordings showed no evidence of equalization of the right and left heart pressure recordings. there was no evidence of cardiac tamponade. final diagnosis: 1. coronary arteries are without obstructive disease. 2. elevated biventricular filling pressures without evidence of constriction/restriction or tamponade. 3. moderate pulmonary artery hypertension. brief hospital course: 52 year old f w/ hypertrophic cardiomyopathy, hcv, and paf transferred to the ccu in for treatment of pericardial tamponade in the setting of repeat pvi procedure. . # pericardial tamponade: patient developed large pericardial bleed and tamponade physiology in setting of pulmonary vein isolation procedure in ep lab and supratherapeutic inr of 4.1. given onset of tamponade early in procedure and presence of clot, concern for rv perf as etiology. pericardiocentis performed and drain placed. inr reversed with 5mg of vitamin k. on transfer to ccu patient hemodynamically stable with stable pericardial drain in place. repeat echo with decreased effusion and clot size without sign of active bleeding. effusion monitored with serial tte to assess for resolution. pericardial drain pulled on hd3. pain controlled with tylenol, tramadol and colchicine. pain improved and effusion stable but tte. concern for lower extremity modeling and elevated jvd prompted right heart catheterization to discern volume status in patient with difficult hemodynamics (hocm, effusion). cardiac cath demonstrated 1. coronary arteries are without obstructive disease. 2. elevated biventricular filling pressures without evidence of constriction/restriction or tamponade. 3. moderate pulmonary artery hypertension. at time of discharge patient hemodynamically stable without signs of tamponade physiology on exam. . # respiratory failure: patient was intubated and paralyzed for the pvi procedure. on arrival to the ccu patient continued on ac ventilation 500/12/50% with abg ph7.25 pco251 po2132 c/w respiratory acidosis. current respiratory compromise may be more related to copd given she is currently hd stable. patient extubated shortly after arrival to the ccu. home copd medications continued. throughout stay patient complained of dyspnea on exertion though remained with minimal oxygen requirement. patient saturating> 95% on ra prior to discharge. outpatient issues: -- outpatient pulmonary consult. . # paroxysmal af: patient admitted for pvi procedure which was aborted to pericardial effusion. ekg on admission showed atrial tachycardia with variable block. patient monitored on telemetry with predominant rhythm: af with rates in the low 100s. at home rate controlled with ... and anti-coagulated with coumadin. on admission, coumadin held as inr supratherapeutic at 4.1. in house patient rate controlled with verapamil, disopyramide and carvedilol 25mg po bid. home disopyuramide decreased from 400mg tid -> 300mg tid. attempted tee/cardioversion was deferred as tee with evidence of atrial clot. decision made to continue anticoagulation and follow-up as an outpatient. prior to discharge patient transitioned from coumadin to pradexa. at time of discharge patient adequately rate controlled (hrs in 80s). outpatient issues -- continue rate control with verapamil, disopyramide and carvedilol -- continue anticoagulation with pradexa . # large probable thrombus in the left atrial appendage. seen and documented on tee. cardioversion deferred in setting of clot. per ep appropriate to continue anticoagulation as planned for treatment of atrial fibrillation. outpatient issues: -- continue to follow with tte as outpatient . # copd: patient with moderate to severe emphysema on ct chest from . no pfts in our system. on admission and intermittently during hospitalization patient with extensive wheeze on exam. patient not on standing copd medications as an outpatient. treated with standing and prn nebulizers in house. smoking cessation strongly encourage. outpatient issues: -- pulmonary follow-up and pfts as an outpatient -- continue to encourage smoking cessation . . # hypertrophic cardiomyopathy- no signs of obstructive pathology on serial tte obtained in house. as an outpatient on verapamil. started beta blocker (carvedilol 25mg po bid) in house. . # hepatitis c. per report has been treated with interferon in the past. stable and per record cleared. outpatient issues -- hepatology follow-up . # insomnia. continued on home seroquel. . code: full (confirmed with hcp, husband ) . comm: : ; cell medications on admission: disopyramide 400 mg tid seroquel 100-150 mg qhs prn for insomnia verapamil sr 120 mg daily coumadin 4.5 mg on all days except for 3 mg on wednesday discharge medications: 1. dabigatran etexilate 150 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. disopyramide 100 mg capsule sig: three (3) capsule po q8h (every 8 hours). 3. verapamil 120 mg tablet extended release sig: one (1) tablet extended release po q24h (every 24 hours). 4. seroquel 100 mg tablet sig: 1-1.5 tablets po qhs as needed for sleep. 5. carvedilol 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*1* discharge disposition: home discharge diagnosis: pericardial tamponade paroxsymal atrial fibrillation/tachycardia hypertrophic cardiomyopathy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital after a complication of your pulmonary vein isolation procedure. you had a bleed around your heart for which you were treated with the placement of a pericardial drain and close monitoring. while you were in the hospital you underwent numerous ultrasounds of your heart as well as heart catheterization which did not show further accumulation of blood around your heart. you had a cardioversion before you were discharged. . we have made the following changes to your medications: - stop taking coumadin for your atrial fibrillation - start taking dabigatran 150mg tablet for your atrial fibrillation, please take 1 tablet twice daily. - change your dose of disopyramide to 300 mg three times daily for your atrial fibrillation - start taking carvedilol 25 mg tablet for your atrial fibrillation, please take one tablet twice daily . please continue to take the rest of your regular medications withou change. it was a pleasure taking care of you at the . we wish you a speedy recovery. followup instructions: name: , m. location: healthcare - upper falls address: , , phone: appointment: friday 11:45am department: cardiac services when: thursday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube pericardiocentesis atrial cardioversion angiocardiography of right heart structures pulmonary artery wedge monitoring diagnoses: acidosis abnormal coagulation profile tobacco use disorder chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma cardiac complications, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases accidental puncture or laceration during a procedure, not elsewhere classified unspecified disease of pericardium acute respiratory failure cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidents occurring in residential institution cardiac tamponade procedure not carried out for other reasons 

Answer: The patient is high likely exposed to