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: patient recorded as having no known allergies to drugs attending: chief complaint: hospital to hospital transfer for atrial flutter major surgical or invasive procedure: radiofrequency ablation of right atrial flutter history of present illness: patient is 64 yo male with distant history atrial fibrillation not on anticoagulation who was transferred to ed for management of atrial flutter/atrial fibrillation. patient noted palpitations 1 day prior to presentation to . he checked his bp and which he noted was sbps in 100s and hrs in the 130s. he thought this may be his paf and therefore did not present to the ed. the morning of admission he felt very fatigued and lightheaded, so he called ems and was taken to . there he was given diltiazem and went into sinus rhythm, but was hypotensive with sbps in the 70s. he went back into aflutter and cardioversion with 50 joules was attempted, but was unsuccessful and sbps dropped to the 50s and he was started on neosynephrine and transferred to for further management. . of note, in he had afib after bowel prep for colonscopy and was admitted and started on coumadin, metoprolol and digoxin. the in he underwent surgery to remove a small bowel tumor and his coumadin was stopped at this time. per his report, he was in nsr and therefore was not continnued on coumadin. again in he felt lightheaded and presented to the and was found to be in a fib. he underwent a thallium stress which revealed possible inferior wall ischemia and had cardiac cath on with clean coronaries and preserved ef. he was started on propafenone 150 mg po q8h. he had been feeling well until he devloped the palpitations and fatigue 2 days ago. . in the ed, hr were in the 140s and narrow complex. he was given adenosine and showed a flutter with variable conduction, but in further looking at this, at times it seemed irreuglar and more consistent with atrial fibrillation. he was given 2 l ivf, was weaned off neo drip and give diltiazem 10mg iv without a change and then 20 mg iv with hr 90s-100s but dropped sbp 70s-80s. given that cardioversion was already attempted once at osh, the ed did not feel comfortable cardioverting, and he was tranferred to the ccu for further management. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains. he has had uri sx over the past few days. denies black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope. past medical history: hypertension paf years ago, was on coumadin, but stopped given in nsr colon cancer s/p resection and chemo/radiation small bowel cancer s/p resection in no cad history social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: he does not know his family history because he is adopted. physical exam: vs: t 98.4 , bp 92/51 , hr 120s , rr 16 , o2 100 % on 2 l gen: middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: no jvd cv: tachycardic with irregularly irregualr rate, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. well healed midline abdominal scar ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: ================ admission labs ================ 7.3 \______/ 258 / 38.5 \ neuts-69.6 lymphs-22.7 monos-5.4 eos-2.0 baso-0.3 pt-12.2 ptt-23.9 inr(pt)-1.0 glucose-96 urean-12 creat-1.0 na-141 k-3.8 cl-111* hco3-24 angap-10 ctropnt-<0.01 calcium-8.3* phos-2.1* mg-2.0 tsh-3.7 =================== discharge labs =================== 3.9 \______/ 261 / 35.0 \ neuts-60.7 lymphs-30.1 monos-5.5 eos-3.3 baso-0.3 pt-13.6* ptt-57.9* inr(pt)-1.2* urean-12 creat-1.0 k-4.1 mg-2.2 ============== imaging ============== trans-thoracic echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. =========== ecg =========== atrial flutter with rapid ventricular response. no previous tracing available brief hospital course: 64 year old gentleman with history of paroxysmal atrial fibrillation / atrial flutter, admitted with hypotension, s/p radiofrequency ablation, in improved condition. # atrial fibrillation/atrial flutter: per review of oust ide records, patient had recently undergone outpatient evaluation for initiation on anti-arrhythmic therapy with propafenone. on transfer, patient arrived with neo synephrine for blood pressure support for sbp in 70's with hr in 140's. after ivf boluses, pressor support was weaned off and esmolol drip was started to provide rate control. this intervention however was limited by hypotension and was discontinued. patient tolerated rates of 110's to 140's with systolic pressure above 120. propafenone dose was increased to 225 mg po tid and low dose beta blocker was started. tee demonstrated preserved ef and no structural abnormalities. after 24 hours, patient was taken to ep lab and underwent radiofrequency ablation of an atypical flutter circuit. a second atrial arrhytmia (atrial tachycardia) was found to arise from left atrium, but this was not intervened on during this hospitalization. patient tolerated procedure very well and remained in sinus rhythm thereafter. patient has been instructed to continue anti-arrhythmic therapy with propafenone and toprol xl, for details please see medications section. anticoagulation adressed below. patient will require outpatient stress testing as he will be treated with class ic antiarrhythmic. he will be followed in outpatient clinic by dr and cardiology clinic by dr # anticoagulation : patient is at risk for embolic event both because of paroxysmal atrial fibrillation / atrial flutter and from recent rfa. anticoagulation was achieved with heparin drip during hospitalization and transitioned to lovenox as he is bridged over to coumadin. patient will require close monitoring of inr which will be managed by primary care physician. # fen: patient tolerated a cardiac diet # prophylaxis: heparin drip # code: patient remained full code during this admission. # communication: patient and (friend and hcp) medications on admission: metoprolol 25 mg po qday asa 325 mg po qday propafenone 150 mg po q8h discharge medications: 1. propafenone 225 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 2. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 3. warfarin 2.5 mg tablet sig: two (2) tablet po at bedtime for 3 days. disp:*0 tablet(s)* refills:*0* 4. enoxaparin 60 mg/0.6 ml syringe sig: sixty (60) mg subcutaneous (2 times a day) for 5 doses. disp:*300 mg* refills:*0* 5. aspirin 81 mg tablet sig: one (1) tablet po once a day. 6. warfarin 2.5 mg tablet sig: one (1) tablet po at bedtime: to be started in 3 days after 3 doses of 5 mg. this dose may be adjusted by dr. according to your bloodwork. . disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: 1. typical atrial flutter 2. atypical atrial flutter secondary: 1. hypertension 2. paroxysmal atrial fibrillation discharge condition: stable blood pressure in normal sinus rhythm. o2 saturations stable on room air. ambulating without difficulty. discharge instructions: you were admitted to the hospital for atrial flutter. you had a radiofrequency ablation performed and your propafenone dose has been increased. you have also been started on the blood thinner coumadin due to your atrial flutter. you will take 5 mg every night for 3 days and then decrease to 2.5 mg from then on. this dose may be adjusted by dr. according to your bloodwork. you will need to take lovenox injections for 2 days while your coumadin becomes therapeutic. please note that your aspirin dose has been decreased to 81 mg while you are also on coumadin. you will need to have blood work performed on monday to have your inr checked which measures the effectiveness of your coumadin medication. please go to dr. office to have this test performed. you will need to wear of hearts monitor after discharge from the hospital as you were instructed prior to discharge. you have been scheduled for an exercise stress test as below to assess your tolerance of the increased propafenone dose. please follow up with your your pcp as below as well as with dr. who will be your new electrophysiologist. please call your doctor or return to the hospital if you experience any chest pain, shortness of breath, palpitations, numbness, tingling, weakness, or any other concerns. followup instructions: please go to dr. office on monday at 10 am to have your inr checked. phone: please call dr. office to schedule a follow up appointment as needed. phone: please come to exercise stress lab in , cardiac services to have your exercise stress test performed on at 10:45 am. phone: . no food or caffeine 1 hour prior. comfortable clothing and flat sneakers recommended. please follow up with dr. on 7 at on at 11am. phone procedure: catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach diagnoses: unspecified essential hypertension atrial fibrillation atrial flutter personal history of malignant neoplasm of large intestine personal history of irradiation, presenting hazards to health 

Answer: The patient is high likely exposed to