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: pneumovax 23 attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: pacemaker placement history of present illness: 88yo f russian speaking woman with dchf, s/p avr 3 years ago, sss with baseline hr in the 40s, feeling week and tired today with heart rates in the 30s. patient has had "good days" and "bad days" with some days feeling very tired and fatigued and other days feeling more energetic. today, patient felt especially tired. noted dyspnea on exertion and some accompanied chest pressure with exertion and nausea. no dizziness, diaphoresis, syncope, blurred vision. patient called dr and he requested direct admission from home. denies any fevers or chills but does endorse ~5lbs weight loss over the past several months and decreased appetite. . on arrival to the floor, patient felt tired. denied any current nausea, sob, or cp. however systolic bp was 90-100. her hr was 20-30 bpm. on going to the bathroom she described chest pain, , mild substernal with no radiation, that is not positonal and is new for her. she complained of some mild headache and continued to have some baseline orthopnea. labs were drawn and she was admitted to the ccu to be started on a low dose dopamine infusion and is due for ppm implantation in the am. . review of systems as above, also denies abdominal pain, diarrhea, urinary frequency, dysuria, lower extremity edema, cough. . past medical history: 1. cardiac risk factors: dm, hyperlipidemia, htn 2. cardiac history: -aortic stenosis s/p bioavr -diastolic heart failure (ef >75%) -cabg: cad s/p single-vessel cabg (svg-pda) 3. other past medical history: nash gerd reducible umbilical hernia social history: widowed, lives in with family nearby. has vna 3x/wk. -tobacco history: none -etoh: none -illicit drugs: none family history: family hx of heart disease in many members, unable to specify what kind, otherwise non-contributory. physical exam: admission exam: vs: t=94.5 bp=117/44 hr=34 rr=16 o2 sat=98%ra general: wdwn woman in nad. heent: mmm. perrl, eomi. neck: no jvd cardiac: bradycardic with 3/6 harsh systolic murmur heard throughout precordium, nl s1 s2, no s3 or s4 lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm extremities: no c/c/e. 2+dp b/l discharge exam: p62 98% 120/87 general: wdwn woman in nad. heent: mmm. perrl, eomi. neck: no jvd cardiac: bradycardic with 3/6 harsh systolic murmur heard throughout precordium, nl s1 s2, no s3 or s4 lungs: ctab, no crackles, wheezes or rhonchi. cdi pm dressing over left anterior chest wall. abdomen: soft, ntnd. no hsm extremities: no c/c/e. 2+dp b/l pertinent results: admission labs: 10:13pm blood wbc-6.5 rbc-2.60* hgb-8.4* hct-23.5*# mcv-91 mch-32.2* mchc-35.6*# rdw-13.4 plt ct-185 10:13pm blood pt-10.9 ptt-32.1 inr(pt)-1.0 10:13pm blood glucose-124* urean-83* creat-2.7*# na-129* k-6.6* cl-99 hco3-20* angap-17 10:13pm blood ck-mb-3 ctropnt-0.02* 10:13pm blood calcium-7.9* phos-5.9*# mg-2.6 discharge labs: 07:36am blood wbc-5.5 rbc-2.71* hgb-8.9* hct-24.2* mcv-90 mch-32.9* mchc-36.7* rdw-13.0 plt ct-213 07:36am blood glucose-125* urean-44* creat-1.6* na-141 k-4.6 cl-106 hco3-27 angap-13 07:36am blood calcium-8.3* phos-4.5 mg-2.3 ecg on admission the ecg showed extreme sinus bradycardia, with a junctional or fascicular escape rhythm (rate 30-40 bpm)having a rbbb, left axis deviation. this represented a marked change from previous ecgs that showed nsr or sinus bradycardia with short-normal pr interval, and minor, nonspecific intraventricular conduction delay, with qrs duration 110-120 msec. tte : the left atrium is elongated. the right atrium is moderately dilated. the estimated right atrial pressure is at least 15 mmhg. the left ventricular cavity is unusually small. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. a mid-cavitary gradient is identified. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve is not well seen. a bioprosthetic aortic valve prosthesis is present. the transaortic gradient is higher than expected for this type of prosthesis. no aortic regurgitation is seen. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , the aortic valve gradient and max tr gradeint are higher however they were probably underestimated on the prior study. cxr : there has been placement of new left-sided pacemaker with the distal lead tips in the right atrium, right ventricle and appropriately sited. median sternotomy wires are again seen. there are low lung volumes with crowding of the pulmonary vascular markings. there is mild pulmonary vascular congestion. heart size is enlarged but stable. no large areas of consolidation are seen. there are no pneumothoraces. brief hospital course: hospital course: 88yof, russian speaking, dchf (preserved ef), s/p avr 3 years ago, presenting with symptomatic bradycardia and some cp on ambulation. transferred to ccu for dopamine infusion and ppm placement, tolerated the procedure well and was discharged home. . # syptomatic bradycardia: pt with hx of sss w/o pacemaker as she had previously been asymptomatic, now with fatigue, doe and hr in the 30s. sbps were in 90s and the pt had cp but she was alert and interactive. however, ekg and troponins did not suggest any ischemia and the patient went for ppm placement. patient tolerated procedure well with improvement in her hr and systolic pressures, she had resolution of symptoms with pacer placement. post procedural cxr demonstrated no effusions or pneumothroax and correct placment of leads. . # hypotension: patient had episode of hypotension to the 90s and concurrent chest pain. there were no other symptoms or laboratory abnormalities. amlodipine, enalapril were transiently held and started her on dopamine infusion at 5/hr and gave 250+500cc of iv ns. this was felt to be related to her bradycardia and improved after placer placement. # chronic diastolic heart failure: patient had no symptoms or exam findings suggestive of an acute exacerbation though did have pulmonary edema noted on cxr and hyperkalemia. she was given iv lasix dose x1. . # : patient presented with a cr of 2.7, with a k of 6.6 and na of 129. felt to be prerenal in the setting of poor forward flow and kidney hypoperfusion. hyperkalemia was treated with calcium gluconate, kayexcelate, insulin and fluids. cr improved to 2.4 in after pacer placement. # cad: pt had cp but cardiac enzymes and ekg were negative for signs of ischemia. we continued asa 81 and atorvastatin # dm: stable. last hba1c 6.5, oral antihyperglycemics were held on admission and patient was discharged on home metformin and glipizide. # dementia: stable. we continued donepezil 10mg # gerd: stable. we continued omeprazole . transitional issues: -patient is a full code, this should be readressed. medications on admission: amlodipine 5mg daily aspirin 81 mg/day glipizide 2.5 mg/day metformin atorvastatin 20 mg/day donepezil 10 mg/day enalapril 15 mg/day furosemide 30 mg/day esomeprazole discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. disp:*64 tablet(s)* refills:*0* 4. keflex 500 mg capsule sig: one (1) capsule po three times a day for 2 days. disp:*6 capsule(s)* refills:*0* 5. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 6. metformin 500 mg tablet sig: one (1) tablet po once a day. 7. donepezil 10 mg tablet sig: one (1) tablet po once a day. 8. esomeprazole magnesium oral discharge disposition: home with service facility: , discharge diagnosis: symptomatic bradycardia due to sinus node dysfunction (normal av conduction). treated with implantation of permanent pacemaker. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms , you were admitted to for a slow heart beat. a pacemaker was placed that will help keep your heart beating at an acceptable rate. you will need to take antibiotics until sunday . a prescription is below. . weigh yourself every morning, md if weight goes up more than 3 lbs. . while you were here we made the following changes to your medications: we started you on keflex (antibiotic) we started acetaminophen (as needed for pain) . we stopped your amlodipine we stopped your enalapril we stopped your furosemide . . we made no other changes to your medications. followup instructions: department: cardiac services when: thursday at 9:00 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: thursday at 2:00 pm with: , np building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 3:00 pm with: , np building: sc clinical ctr campus: east best parking: garage procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: hyperpotassemia esophageal reflux congestive heart failure, unspecified unspecified essential hypertension coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other and unspecified hyperlipidemia hypotension, unspecified unspecified disorder of kidney and ureter heart valve replaced by transplant sinoatrial node dysfunction chronic diastolic heart failure other chronic nonalcoholic liver disease dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to