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: penicillins / cephalosporins / tetracycline / erythromycin / sulfur attending: chief complaint: chest pain major surgical or invasive procedure: none history of present illness: 60 yo female with extensive past medical history including endocarditis, avr, tvr, pe/dvt, dm2, mild mr, htn, h/o chb s/p ppm placement who presents from rehab facility with 2 wk complaint of chest pain. she describes the chest pain as occuring at rest. she describes it as pressure. she denies radiation. she also describes it as , though currenlty she states her back pain is bothering her much more than her chest pain. she denies any fevers or chills. she does report some lower abdominal pain as well. she denies cough, dysuria, brbpr, or melena. she denies ha, rash. she also reports some mild palpitations. she states that over the last few weeks, she feels more sob, particularly with exertion. she also reports she had some edema in her legs, but improved with lasix. . in the ed, initial vs were: 98.1, 120, 129/78, 15, 100%. patient was given vancomycin 1 gm, morphine 2mg iv x 3, gi cocktail. she had a cta which did not show pe. she also had ct abd/pelvis without any acute pathology. she was afebrile in the ed. she was intially to be admitted to medical floor, but given persistent tachycardia despite 2 l ivfs, she was admitted to the icu for further monitoring. lowest recorded bp was 94/54. vitals prior to transfer were 97.2, 120, 128/82, 16, 100% 3l. prior to transfer, patient had second iv placed and 1 set of blood cultures were sent. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough. denied vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: cad prior mi c-diff gib, resp failure, pna endocarditis bioprosthetic avr,tvr chb s/p ppm (abdominal placement) s/p dvts / pe's mild mental retardation hypertension hyperlipidemia bipolar disorder anxiety / depression copd gerd dm requires insulin sacral decubiti anemia lbp pulmonary opacities seen on ct, concerning for multifocal, pneumonic subtype of bronchoalveolar cell carcinoma. social history: lives in nursing home d/t history of falls on coumadin and multiple medical problems. denies h/o etoh use. smoked 1 pack of cigarettes/day for 16 years. quit 25 years ago. family history: mother died at 71 of mi. had colon cancer. father died @ 80 of chf. had diabetes. physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented, no acute distress c/o back pain heent: sclera anicteric, mm slightly dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, regular, normal s1 + s2, 1/6 systolic murmur at base, rubs, gallops abdomen: soft, obese with large pannus, mild erythema in lower central part of pannus and tender, but no rebound or guarding. bowel sounds present, no organomegaly but difficult to appreciate given body habitus ext: warm, well perfused, 2+ pulses, trace to 1+ edema; chronic venous stasis changes. back: no cvat. no skin breakdown pertinent results: labs on admission wbc-7.8 rbc-4.19* hgb-12.9 hct-37.8 mcv-90 mch-30.9 plt ct-130* neuts-54.6 lymphs-33.5 monos-9.3 eos-1.9 baso-0.7 pt-36.2* ptt-32.9 inr(pt)-3.7* glucose-221* urean-20 creat-1.0 na-138 k-4.2 cl-99 hco3-29 angap-14 calcium-9.3 phos-3.2 mg-2.0 alt-11 ast-16 ld(ldh)-231 alkphos-69 totbili-0.5 albumin-3.8 lactate-2.1* . 01:00pm blood ck(cpk)-159* 08:00pm blood ck(cpk)-122 04:58am blood ck(cpk)-101 01:00pm blood ck-mb-6 ctropnt-<0.01 08:00pm blood ck-mb-5 ctropnt-<0.01 04:58am blood ck-mb-5 ctropnt-<0.01 . labs on discharge wbc-8.6 hgb-12.4 hct-36.7 plt ct-142* pt-23.1* inr(pt)-2.2* glucose-77 urean-30* creat-1.0 na-138 k-4.2 cl-101 hco3-27 angap-14 calcium-9.9 phos-3.2 mg-2.3 . other studies: cxr: 1. no pneumothorax. 2. stable right mid lung opacity, better seen on prior ct. ct abd/pelvis and cta: 1. no evidence for pulmonary embolus or acute aortic syndrome. 2. multifocal mixed solid and ground glass opacities within the right lung, suboptimally evaluated, but not grossly changed compared to prior studies. these are of uncertain etiology, although a chronic or inactive infectious process secondary to histoplasmosis or other fungal organism is a possible consideration. given the lack of interval change, neoplasm is unlikely. 3. no acute intra-abdominal process. chronic changes including cholelithiasis, calcified splenic aneurysm, and hypodense lesion within the spleen from prior abscess are redemonstrated. 4. small fat-containing umbilical hernia. echo: the left atrium is mildly dilated. the right atrial pressure is indeterminate. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). the aortic arch is mildly dilated. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. an eccentric jet of moderate (2+) mitral regurgitation is seen. a bioprosthetic tricuspid valve is present. the leaflets are not well seen, but the gradient is increased (mean 6mmhg). mild tricuspid regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the transtricuspid gradient is higher and the severity of tricuspid regurgitation and mitral regurgitation are reduced. if clinically indicated, a tee would be better able to define the tricuspid valve prosthesis and severity of mitral regurgitation. brief hospital course: this is a 60 yo female with h/o endocarditis, avr, tvr, chb s/p ppm placement, dvt/pe on anticoagulation, mental retardiation, hypertension, dm2, who presented with chest pains, peristent tachycardia, and mild hypotension now resolved. . # chest pain: on admission to the hospital the patient had chest pain. an ekg was performed which showed no ischemic changes, however difficult to interpret given rbbb/lafb. three sets of cardiac enzymes were negative. patient had a therapeutic inr so pe was less likely. cta was also not consistent with pe. an echo was performed which showed lvef of 50-55% and improved regurgitation across the tricuspid/mitral valve. the echo did not reveal any etiology for chest pain. episodes of tachycardia patient experienced while admitted may have contributed to this chest pain. . # tachycardia: patient on admission was tachycardic. ep service interogatted the patient's pacemaker and found the patient to be in a triggered fascicular tachycardia. she has mild palpitations with this rhythm but bp is stable. this rhythm was broken by placing a magnet over the pacemaker. she had multiple other episodes of fascicular tachycardia during this admission. in each, the patient was asymptomatic with normal blood pressure. verapamil was not effective in controlling the tachycardia, and she was switched to propafenone on with no further episodes. she underwent a stress test to evaluate qrs duration (routine with propafenone initiation) by increasing the pacer rate to 110. there was no lengthening of the qrs complex noted with increased heart rates. she will have a pacer interrogation and f/u with dr. from ep in . . # hypertension/hypotension: on presentation to the ed patient was hypotensive with systolic blood pressures in the 100's. at that time lisinopril and lasix were held. during the admission the patient became normotensive lisinopril was restarted at home dose. the lasix dose was changed from 80 mg in the am and 40mg in the pm to 20 mg daily. weight on d/c was 110 kg. . # dm2: patient was continued on her home lantus, nph , and sliding scale. diabetic diet was also continued. during the hospitalization sugars were moderately well-controlled on this regiment. . # h/o dvt/pe, valves: patient was found to have a supratherapeutic inr when she presented for admission. at that time coumadin was held and restarted when inr returned to therapeutic range. there is some concern for the need for coumadin at this time. the patient has bioprosthetic valves which would not require coumadin. further, treatment for dvt/pe in would not continue to this time. unable to contact pcp during hospitalization, should address indications for coumadin on transfer. . # copd: while the patient was hospitalized this issue was stable. patient was continued on home spiriva and atrovent/albuterol nebs. . # chronic lbp: patient has had baseline backpain since mva many years ago, and multiple falls. states pain is at baseline. during the admission we continued her home long acting oxycontin/oxycodone. we also provided warm compresses and lidocaine patches. medications on admission: busipirone 10 mg calcium carbonate 650 mg cholecalciferol 1000 units daily depakote ec delayed release 500 mg nitro sl prn oxycodone 5 mg q3h prn pain nasal spray atrovent prn lorazepam 2 mg qhs prn milk of mag daily prn acetaminophen 650 mg q6h prn albuterol q6h prn warfarin 4 mg daily trilafon 12 mg qhs sorbitol solution daily spiriva daily lisinopril 2.5 mg daily lorazepam 1 mg qhs omeprazole 40 mg daily oxycontin 10 mg oxycodone 5 mg daily at noon insulin- lantus 32 units qhs, nph 56 units qam, nph 14 units qpm insulin ss lidoderm patch ferrous sulfate 325 mg daily furosemide 80 mg qam, 40 mg qpm discharge medications: 1. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 2. oxycodone 5 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain: hold for over sedation or rr < 12 3. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 4. buspirone 10 mg tablet sig: one (1) tablet po bid (2 times a day). 5. calcium carbonate 650 mg (1,625 mg) tablet sig: one (1) tablet po twice a day. 6. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 7. divalproex 125 mg tablet, delayed release (e.c.) sig: five (5) tablet, delayed release (e.c.) po bid (2 times a day): total dose 625 mg . 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. 11. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 12. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 13. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia/anxiety. 14. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for wheezing. 16. guaifenesin dm 10-100 mg/5 ml syrup sig: ten (10) ml po every four (4) hours as needed for cough. 17. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation every six (6) hours as needed for shortness of breath or wheezing. 18. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: repeat every 5 minutes x 3; md should be called if administering. 19. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 20. saline nasal 0.65 % aerosol, spray sig: one (1) nasal spray nasal twice a day as needed for allergy symptoms or dry nares. 21. perphenazine 8 mg tablet sig: 1.5 tablets po qhs (once a day (at bedtime)). 22. mgoh daily prn 23. aluminum magnesium 30 ml prn 24. propafenone 150 mg tablet sig: one (1) tablet po tid (3 times a day). 25. insulin glargine 100 unit/ml solution sig: thirty two (32) units subcutaneous once a day. 26. insulin nph human recomb 100 unit/ml suspension sig: fifty six (56) units subcutaneous in am: 14 units in pm. 27. furosemide 20 mg tablet sig: one (1) tablet po once a day. 28. oxycodone 5 mg capsule sig: one (1) capsule po at noon. 29. insulin regular human 300 unit/3 ml insulin pen sig: as per sliding scale units subcutaneous four times a day. 30. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 31. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: primary: arrythymia (triggered fascicular), hypotension, tachycardia secondary: coronary artery disease status-post myocardial infarction, mild mental retardation, hypertension, hyperlipidemia, bipolar disorder, anxiety / depression, copd, gerd, diabetes mellitus, chronic low back pain discharge condition: hemodynamically stable, afebrile. discharge instructions: you were admitted with chest pain, low blood pressure and rapid heart rate as discovered by your rehab facility. you were briefly treated for an infection as a possible source of these symptoms () but as this was thought to not be the primary problem, your antibiotics were discontinued. additionally, you were found to have a rapid heart rate in an irregular rhythm. the electrophysiology specialists were consulted and helped stop this rhythm. your medications have been changed to help control this rhythm from recurring. you will see dr. next month and he will decide if you need to undergo a stress test again. please take all medications as prescribed. your rehab has been given a list of the medications you should be taking. the following changes were made to your medical regimen. 1. propafenone: a medicine to control your irregular heart rates 2. your lasix was decreased to 20 mg daily please keep all outpatient appointments. seek medical advice if you notice fevers, chills, difficulty breathing, chest pain, lightheadedness, weakness, increasing dizziness, skin redness or pain or any other symptom that is concerning to you. followup instructions: you have follow-up with the electrophysiology specialists: , md phone: date/time: 2:00 provider: clinic phone: date/time: 3:00 primary care physician: , md ( when you arrive back at rehab. procedure: artificial pacemaker rate check artificial pacemaker rate check diagnoses: abnormal coagulation profile coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified paroxysmal ventricular tachycardia other and unspecified hyperlipidemia hypotension, unspecified long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants cardiac pacemaker in situ other chest pain personal history of venous thrombosis and embolism heart valve replaced by transplant lumbago bipolar disorder, unspecified venous (peripheral) insufficiency, unspecified mild intellectual disabilities history of fall right bundle branch block and left anterior fascicular block 

Answer: The patient is high likely exposed to