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 attending: chief complaint: cardiac tamponade status post pulmonary vein isolation major surgical or invasive procedure: atrial fibrillation ablation pericardial tap and drain placement history of present illness: ms. is a 47 year old lady with w/ mmp including a. fib/flutter w/ several ablations, dm ii c/b neuropathy, retinopathy, osa, pul htn, copd on home o2 who was admitted to the np service for an elective pvi. . in brief, ms. atrial arrhythmias have been managed with sotalol, diltiazem, toprol and coumadin. she is s/p ablation in . over the past several months she has noted increase in sx of palpitations associated w/ tremors, diaphoresis and dyspnea lasting up to several hours. she was referred for elective pvi. . per ep signout pt underwent her pvi this morning and tolerated the procedure well. she was then planned to be observed overnight however at 3:30pm she was noted to be hypotensive, she also reported feeling nauseated. she was given ivf with no improvement. concern per ep was for cardiac tamponade vs rp bleed. a bedside echo was performed which was of poor quality given the pt's body habitus. a large pericardial effusion was noted, given the concern of postprocedure cardiac tamponade the cath lab was activated by the ep fellow. in the cath lab bloody drainage was noted, 100ccs was drained, pericardial pressures were 28. a drain was left in place, per signout cards recommended holding off on anticoagulation despite recent pvi will need to be addressed in the am. also recommended holding all bp meds as well as sotalol, diltiazem, metoprolol. prior to transfer pt's bp was noted to be in the 130s/80s. . review of systems (+) chest pain w/ inspiration, orthopnea, body aches, peripheral neuropathy, stroke, pulmonary embolism x 2. . on review of systems, she denies any prior history of cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of orthopnea, syncope or presyncope. past medical history: 1. cardiac risk factors: diabetes+, dyslipidemia+, hypertension+ 2. cardiac history: paroxysmal atrial fibrillation s/p pvi () atrial flutter s/p ablation in at 3. other past medical history: pulmonary hypertension interstitial lung disease on 2 liters home o2 prn diastolic chf osa diabetic retinopathy, neuropathy hypothyroidism asthma remote left leg dvt versus superficial thrombophlebitis h.o. pna + ppd in with negative cxr h.o. remote seizure in cva with mid intermittent parasthesia of right hand () pulmonary embolism x 2 occasional right leg weakness pud h.o. gastritis colon polyps s/p resection anaemia uterine fibroids s/p uterine artery embolization depression social history: patient is single with one daughter and one granddaughter. she lives with her family. tobacco: denies etoh: denies family history: dm, htn, cardiac disease physical exam: admission vs: 76 162/76 103 15 97% ra general: nad. fatigued, complaining of generalized chest pain with inspiration. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: unable to detect jvp due to obesity cardiac: difficult to hear heart sounds, normal s1, s2. no m/r/g. drain bright red blood in to pericardial sac. lungs: no chest wall deformities. resp were unlabored, no accessory muscle use. ctab however very distant breath sounds and poor inspiratory effort. no crackles, wheezes or rhonchi. abdomen: soft, obese, non tender. extremities: no c/c/e. no femoral bruits at site of catheter wound on right groin. no hematoma noted or bleeding at site or masses palpated. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 1+ dp 2+ pt 2+ left: carotid 2+ femoral 1+ dp 2+ pt 2+ pulses: w/ doppler = 7 pertinent results: cardiac echo regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is a moderate to large sized pericardial effusion. . following presumed pericardiocentesis, a single cine loop demonstrates only a small residual pericardial effusion. . impression: very limited study. moderate to large pericardial effusion with subsequent improvement following drainage. recommend a follow-up focused study to better assess for success of percutaneous drainage. . cardiac echo there is symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. . impression: very small residual pericardial effusion. grossly normal biventricular systolic function. . cardiac echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. there is abnormal septal motion/position. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . compared with the prior study (images reviewed) of , there is no defintei change. pulmonary hypertension is now detected. . chest xray the cardiac silhouette appears to be enlarged with a relatively smooth and rounded borders that might be consistent with the presence of pericardial effusion. the overall cardiac silhouette is larger than on mri. the patient is currently in interstitial / alveolar pulmonary edema, moderate most likely accompanied by small bilateral pleural effusion. . ecg sinus bradycardia. mild q-t interval prolongation. late r wave progression. lateral limb lead st-t wave abnormalities. since the previous tracing of probably no significant change. . ecg sinus rhythm. st-t wave abnormalities. since the previous tracing the rate is faster. . ecg sinus rhythm. st-t wave abnormalities. since the previous tracing the rate has increased. . ecg sinus rhythm. diffuse st segment elevation most consistent with pericardial disease, although clinical correlation is suggested. additional non-specific st-t wave changes. compared to the previous tracing of st segment elevation is more diffuse. . ecg sinus rhythm. non-specific intraventricular conduction delay. poor r wave progression. non-specific st segment elevation in leads v1-v3. non-specific inferolateral st-t wave changes. cannot exclude ischemia. compared to the previous tracing of t wave inversions are more pronounced in leads v5-v6. st segment elevation may be slightly less pronounced. . ecg sinus rhythm with premature atrial contraction. poor r wave progression. non-specific inferolateral st-t wave changes. compared to the previous tracing of st segment elevation is less pronounced in leads v1-v3. premature atrial contraction is new. . urine culture: negative from and blood culture: negative to date from respiratory culture: consistent w/ contaminant mrsa screen: negative from . 121*1 8 0.7 143 3.8 104 28 15 labs (admission , discharge ) wbc 10.9, 4.3 hmg 11.1, 11.1 hct 34.5, 33.5 plts 295, 251 sodium 141, 143 potassium 3.9, 3.8 chloride 107, 104 bicarbonate 25, 28 bun 15, 8 creatinine 0.8, 0.7 glucose 121, 121 inr 1.8, 2.9 brief hospital course: hospital course ms. is a 47 year old lady with with past medical history including atrial fibrillation, atrial flutter status post ablation, dm ii complicated by neuropathy, retinopathy, osa, pulmonary htn, copd on intermittant home o2 who was admitted to the np service for an elective pulmonary vein isolation. pvi was complicated by pericardial effusion with tamponade requiring pericardial drainage. . # cardiac tamponade: elective pulmonary vein isolation course complicated by pericardial effusion with tamponade. unclear etiology of complication given development of tamponade several hours post procedure, may have been secondary to overheating during ablation versus direct catheter perforation. over 200 cc were initially drained with pulsus of post procedure. ekg without signs of electrical alternans or low voltage post operatively. anticoagulation and antihypertensive and antirhythmic medications were held while drain in place. post operative course further complicated one episode of hypotension that resolved with aspiration of 150 cc of serous bloody tinged fluid. normal saline flushes were started every 4 hours. on hd 3, repeat echo revealed diminshed effusion and drain was pulled. antihypertensive and antiarrythmic medications were restarted. . # paroxysmal atrial fibrillation/aflutter: the patient has a long history of paf with history of prior stroke now on sotalol, diltiazem, toprol and coumadin. (chads score of 4, htn, dm, stroke). antiarrthmics and anticoagulation held in setting of tamponade and pericardial drain placement. coumadin had been bridged to heparin prior to pvi. she was in sinus rhytm on admission. antiarrhythmics and anticoagulation was restarted after pericardial drain pulled. her metoprolol was discontinued and sotolol and diltiazem were continued and coumadin restarted with follow-up inr check. . inactive issues # diabetes mellitus ii: history of insulin dependant diabetes mellitus on lantus at home. diabetic associated complications include diabetic retinopathy and neuropathy. most recent hmga1c unknown. she was continued on home regimen. . # htn: history of hypertension on lisinopril and metoprolol as well as diltiazem and sotolol. antihypertensive medications were held while pericardial drain placed for tamponade. metoprolol was discontinued and lisinopril, lasix, sotolol and diltiazem continued. . # pulmonary hypertension: history of pulmonary hypertension and osa. cialis not on formulary and patient ran out of home prescription. she was treated with sildenafil while inpatient and discharged with refill of cialis. . # obstructive sleep apnea: history of osa and pulmonary hypertention. she use cpap at home 2-3 times per week. she was continued on nightly cpap here and encouraged to use it nightly when discharged. . # hld: history of hyperlipidemia. she was continued on simvastatin. . # hypothyroid: history of hypothyroid on levothyroxine. tsh normal in 11/. she was continued on levothyroxine. . # depression: history of depression. she was continued on sertraline. . # anemia: prior iron studies have demonstrated mild iron deficiency anemia. acute hematocrit drop from 38 to 34 in the last two weeks may reflect blood loss from procedure and complication today. . transitional issues - medical management: discontinue metoprolol - follow up: primary care, cardiology - code: full medications on admission: diltiazem 360mg daily furosemide 40mg daily levothyroxine 176mcg qsunday levothyroxine 88mcg ,,wed,,fri,sat lisinopril 40mg qam reglan 10mg tid omeprazole 20mg qam sertraline 100mg qhs simvastatin 20mg qhs sotalol 120mg adcirca 40mg qam trazadone 150mg qhs warfarin 7.5 lantus 34u qhs iss discharge medications: 1. diltiazem hcl 360 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 2. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 3. lantus 100 unit/ml solution sig: thirty four (34) units subcutaneous once a day. 4. humalog 100 unit/ml solution sig: sliding scale subcutaneous four times a day. 5. levothyroxine 88 mcg tablet sig: two (2) tablet po on sunday: one tablet daily all other days. 6. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 7. metoclopramide 10 mg tablet sig: one (1) tablet po tid (3 times a day): before meals. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 10. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 11. sotalol 80 mg tablet sig: 1.5 tablets po bid (2 times a day). 12. tadalafil 20 mg tablet sig: two (2) tablet po once a day. 13. trazodone 100 mg tablet sig: 1.5 tablets po at bedtime. 14. ibuprofen 400 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for chest pain. 15. outpatient lab work check inr and chem-7 on wednesday and call results to dr. at phone: fax: 16. warfarin 7.5 mg tablet sig: one (1) tablet po once daily at 4 pm. discharge disposition: home with service facility: vna discharge diagnosis: atrial fibrillation/atrial fluuter/atrial tachycardia s/p pulmonary vein isolation and atrial tachycardia ablation pericardial effusion pericarditis diabetes mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had an ablation to prevent the reoccurance of your atrial fibrillation and atrial tachycardia. you have been in a normal rhythm since this procedure. we want you to have an event monitor to monitor your heart rhythm for 3 weeks after the procedure. you will then see dr. in 6 weeks with a cardiac mri in about 4 weeks. the ablation was complicated by a collection of fluid around your heart that needed to be removed and a drain put in temporarily. an echocardiogram was done on the day of discharge which did not show any reaccumulation of fluid. you also had a fever but urine and blood cultures do not show any evidence of infection. . we made the following changes to your medicines: 1. continue warfarin at 7.5 mg daily. get your inr checked on 2. discontinue metoprolol succinate for now 3. start ibuprofen as needed for any chest soreness followup instructions: name: , c. location: - address: , , phone: appt: this friday, at 2pm department: cardiac services when: wednesday at 3:20 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 3:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: pericardiocentesis excision or destruction of other lesion or tissue of heart, endovascular approach arterial catheterization cardiac mapping diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified congestive heart failure, unspecified unspecified acquired hypothyroidism cardiac complications, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes atrial flutter pulmonary collapse other and unspecified hyperlipidemia unspecified disease of pericardium long-term (current) use of insulin cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure personal history of venous thrombosis and embolism obesity, unspecified chronic obstructive asthma, unspecified diastolic heart failure, unspecified hemopericardium diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy other dependence on machines, supplemental oxygen cardiac tamponade other disorders of impulse control 

Answer: The patient is high likely exposed to