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: lightheadedness major surgical or invasive procedure: pacemaker placement history of present illness: 75 yo female history of htn, hl, cad s/p mi, and chronic afib on warfarin transferred to the ccu for chb in the setting of chronic afib. her afib has been notoriously hard to control with high doses of atenolol and diltiazem twice daily. . for the past 48 hours, she has felt extreme lightheadedness, nausea, and weakness in bilateral legs and in the center of her low back. she reports shortness of breath without chest pain. her shortness of breath is improved with laying flat. she reported palpitations today followed by lightheadedness. she denies losing consciousness. she denies taking an extra dose of nodal blockade today. her last doses were this morning. she was seen at the atrius today where they sent her to nwh ed. there she was given glucagon with no response except subsequent nausea and vomiting. she was transferred to and admitted to 3 where ekg revealed some wide qrs complexes concerning for a lower junctional rhythm. she was tranferred to the ccu for further monitoring. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. she had her flu shot a few weeks ago at her annual well visit. . cardiac review of systems is notable for paroxysmal nocturnal dyspnea and presyncope. she reports the absence of chest pain, dyspnea on exertion, orthopnea, ankle edema, or syncope. she denies any history of chf, diabetes, or stroke. . past medical history: 1. cardiac risk factors: (-)diabetes, (+)dyslipidemia, (+)hypertension 2. cardiac history: coronary artery disease, inferior myocardial infarction in with angioplasty and stenting of rca - cabg: none - percutaneous coronary interventions: none - pacing/icd: none 3. other past medical history: - aortic valve insufficiency - atrial fibrillation, chads = 2, previously hard to control - hyperlipidemia, not currently on therapy: previously on simva, taken off b/c off dilt, then on crestor but intolerant due to nausea - hypertension - fatty liver - obesity - colonic polyps - esophageal reflux - osteopenia - anxiety - arthritis in hands - s/p right total knee replacement , left knee tkr - right ankle surgery with hardware - ovarian cyst removal - tubal ligation - tonsillectomy as a child social history: lives alone in in marlbourough for over 55 people. has a maltese name . performs all of her own iadl's and adl's independently including driving. - tobacco history: 1-1.5 ppd for 25 years, quit - etoh: 2 drinks per night at 5pm with friends - illicit drugs: none. family history: - mother: multiple strokes - father: mi at 79, d.84 - brother: mi at 55 physical exam: admission physical exam: vs: 97.6, 38, 112/52, 24, 95% 4lnc general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple without jvd. no bruits. cardiac: pmi located in 5th intercostal space, midclavicular line. irregularly irregular and bradycardic. normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: +bs, soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. back: no rashes, no reproducible pain or tenderness extremities: wwp, no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: cn 2-12 intact, 5/5 strength in ue and le . discharge physical exam: vs: temp 98.3, hr 72-81, rr 18, bp 129-164/79-108, o2 sat 96% ra general: nad. oriented x3. mood, affect appropriate. heent: conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple without jvd. no bruits. cardiac: irregularly irregular. normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. left pacer site with no ecchymosis, mild swelling and tenderness. dressing with no bleeding. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: +bs, soft, ntnd. no hsm or tenderness. back: no rashes, no reproducible pain or tenderness extremities: wwp, no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ neuro: cn 2-12 intact, 5/5 strength in ue and le pertinent results: admission labs: 06:38pm glucose-106* urea n-23* creat-0.9 sodium-137 potassium-4.8 chloride-103 total co2-21* anion gap-18 06:38pm wbc-8.5 rbc-3.97* hgb-13.3 hct-38.9 mcv-98 mch-33.5* mchc-34.2 rdw-13.8 06:38pm pt-21.5* inr(pt)-2.0* . pertinent labs: 06:15am blood ck-mb-1 ctropnt-<0.01 06:38pm blood ck-mb-1 ctropnt-<0.01 . discharge labs: cxr impression: 1. the heart is borderline enlarged given ap technique. the aorta is somewhat unfolded and tortuous. the lungs are grossly clear with the exception of linear opacity at the right base which likely reflects subsegmental atelectasis. no pulmonary edema, pneumothorax, or pleural effusions are appreciated. brief hospital course: assessment and plan: 75 year old female with history of htn, hl, cad s/p mi, and chronic afib on warfarin presented with lightheadedness and nausea found to have complete heart block on ekg. . # symptomatic bradycardia: the patient presented with symptomatic bradycardia in atrial fibrillation, and was found to have a heart rates in the 30-40s. all of the patient's home nodal blockade medications, including atenolol 100 mg and dilt 180 mg , were held on admission. the patient was also given glucagon, which did not really have much effect on her heart rates. the patient was ruled out for mi with negative cardiac enzymes. her bradycardia could be secondary to worsening conduction delays due to aging. the patient had pacer pads placed; she also had one episode of hypotension, which responded to a 500cc ns bolus. the patient was also seen by ep and it was decided that a pacemaker should be placed. the patient has a chads of 2 and her coumadin was held prior to the procedure, but was restarted the night prior to the procedure. throughout the hospitalization, the patient's heart rate trended up and the morning prior to the procedure, the patient's heart rates were in the 70-80s. the patient had the pacemaker placed on , and tolearated the procedure well. post procedure, she was started on vancomycin while in patient, and she was discharged on keflex 500 mg qid for another two days. the patient also had a post procedure cxr the morning after procedure, which was normal. she was also instructed to wear a sling at night for one week post procedure. she will follow up as an outpatient in device clinic, as well as following up with dr. as an outpatient. . # atrial fibrillation: the patient has been in slow atrial fibrillation while in the ccu. her home medications included dilt 180 mg and atenolol 100 mg . as her medications began to wash out, the patient's heart rates began to increase. she still had her pacemaker placed and the patient was discharged on her home nodal agents, without any changes made in her medication. she will follow up with dr. as an outpatient and medication titration will be done as needed. her coumadin was restarted. . # cad: the patient has a history of mi in with rca stent. she was ruled out for mi as the cause of her symptomatic bradycardia. we continued the patient on asa during this hospitalization, however, the patient's lisinopril was held because she was a little bit hypotensive. the patient's beta blocker was also held because of her bradycardia. . # pump: the patient appeared euvolemic on exam, and does not have any history of heart failure. strict i/os were measured and daily weights were followed. the patient's lisinopril and beta blocker were held. . chronic issues: # gerd: the patient was continued on her home ranitidine. # insomnia: the patient was continued on her home lorazepam # ibs: the patient's florastor was restarted upon discharge. . transitional issues: - depending on the patient's heart rate/symptoms, consider titrating down her nodal agents in the outpatient setting. however, now that she has the new pacemaker, she should no longer have bradycardic episodes. - echo revealed moderate mr, will need repeat tte in one year. medications on admission: - lorazepam 0.5 mg qhs prn insomnia - ranitidine hcl 150 mg qhs - warfarin 2.5 mg four days per week, 1.25 three days per week - atenolol 100 mg - diltiazem hcl 180 mg - lisinopril 10 mg daily - florastor - nitroglycerin 0.4mg prn cp - never used - aspirin 81mg daily - multivitamin capsule po (multivitamins) 1 po qd - calcium carbonate tablet 650mg po as directed discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po hs (at bedtime). 3. warfarin 2.5 mg tablet sig: one (1) tablet po days (tues/wed/fri/sun). 4. warfarin 2.5 mg tablet sig: 0.5 tablet po days (mon/thurs/sat). 5. atenolol 100 mg tablet sig: one (1) tablet po twice a day. 6. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po twice a day. 7. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 8. florastor 250 mg capsule oral 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. calcium carbonate 650 mg calcium (1,625 mg) tablet sig: one (1) tablet po once a day. 12. acetaminophen 500 mg tablet sig: two (2) tablet po three times a day for 5 days. 13. oxycodone 5 mg tablet sig: one (1) tablet po four times a day as needed for pain. disp:*10 tablet(s)* refills:*0* 14. keflex 500 mg capsule sig: one (1) capsule po four times a day for 2 days. disp:*8 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: atrial fibrillation av nodal dysfunction symptomatic bradycardia . secondary diagnosis: hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. chest pain free. discharge instructions: dear ms. , it was a pleasure taking care of you while you were hospitalized at . you were admitted to the hospital because you were feeling very light-headed, and you were found to have a heart rate that was very low. we gave you medications that would help counter the effects to some of your home medications. we also had the doctors with heart rates see you, and it was decided to go ahead and insert a pacemaker into your chest to make sure that your heart rate does not become too slow. .. you had the pacemaker placed and it is working properly. you tolerated the procedure well. please wear the sling at night for a week. you will also take an antibiotic for 2 days to prevent an infection at the pacer site. please call dr. for any increase in swelling, pain, redness or bleeding at the pacer site. no lifting more than 5 pounds with your left arm for 6 weeks, no driving for one week. . we made the following changes to your medicines: 1. start acetaminophen (tylenol) extra strength 2 tablets three times a day for pain. you can take an oxycodone as needed if the pain is not relieved by the acetaminophen. 2. start cephalexin (keflex) four times a day for the next 2 days to prevent an infection at the pacer site. followup instructions: name: , f. md location: -primary care address: , , phone: appt: at 3:20pm . location: ---dept of cardiology/device clinic address: , , phone: appt: at 4pm . name: , md location: -cardiology address: , , phone: appt: at 11:40pm procedure: initial insertion of single-chamber device, rate responsive initial insertion of transvenous lead [electrode] into ventricle diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension atrial fibrillation percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia other specified cardiac dysrhythmias atrioventricular block, complete pulmonary congestion and hypostasis insomnia, unspecified irritable bowel syndrome 

Answer: The patient is high likely exposed to