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: codeine attending: chief complaint: shortness of breath major surgical or invasive procedure: right heart catheterization on by dr. history of present illness: 63yo female with a h/o congenital heart defects (s/p repair primum atrial septal defect, cleft mitral valve with an endocardial cushion defect), afib on coumadin, pulmonary artery htn, dm, hld who p/w 1mo shortness of breath, lower extremity edema, and orthopnea. on day of adission, patient presented to cardiology visit with dr. today for a scheduled appointment regarding her pulmonary hypertension. at the visit patient reported the above symptoms, and under went a tte for evaluation of phtn, which demonstrated pa pressure of 80mmhg (prior was 36mmhg) and severe tr. at the time, her vital signs were hr45 bp150/60 99%ra. patient was sent to the ed for admission for treatment of heart failure and elevated phtn. . in the ed, patient's initial vital signs were 99.1 42 164/48 20 100% 4lnc. ekg showed afib at 46. cxr c/w chf. labs were significant for hct 31.8, cr 0.9, trop<.01, bnp 2646 (no baseline comparison). patient received 20mg iv lasix w good urine output (not recorded). . cardiac review of systems is notable for absence of chest pain, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: -congenital heart disease: asd, cleft mitral valve s/p mitral valve repair and asd repair ( ) -moderate mitral regurgitation (tte ) -moderate to severe tricuspid regurgitation (tte ) -pulmonary hypertension - moderate echo (severe echo ) -tachy brady syndrome s/p pacemaker placement (), spectrax s/p lead fracture in and generator explant 3. other past medical history: -multinodular goiter -atypical lobular hyperplasia, right breast -chronic lymphedema, left leg -permanent atrial fibrillation, on warfarin -cervical hysterectomy with bilateral salpingo-oophorectomy (fibroids, ) -thalassemia trait social history: she lives in mother and works for a managed care company. denies tobacco, denies etoh. family history: mother is living (79 years; dm, lupus). father is deceased (30s or 40s years; mi); she has no siblings and no children. physical exam: on admission vs: 98.2 150/50 46 22 100%2.5l general: nad, aox3, comfortable heent: perrl, eomi, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 6cm cardiac: irregularly irregular, bradycardic, nls1/s2, late peaking holosystolic murmur loudest at rusb, no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ on discharge vs: 97.8 96/69 71 18 100%ra 81.4kg i/o: 0/ (8hr) 1200/4600 (24hr) general: nad, aox3, comfortable heent: perrl, eomi, op clear, mmm, conjunctiva pink. neck: supple with jvp 4cm, prominent v-waves cardiac: irregularly irregular, nls1/s2, late peaking systolic murmur loudest at rusb, no r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. extremities: trace pedal edema bilaterally, no c/c. skin: no stasis dermatitis, ulcers, scars. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: blood counts 01:31pm blood wbc-5.8 rbc-4.49 hgb-9.9* hct-31.8* mcv-71* mch-22.0* mchc-31.0 rdw-16.2* plt ct-170 06:21am blood wbc-6.7 rbc-4.10* hgb-9.1* hct-28.5* mcv-70* mch-22.2* mchc-31.9 rdw-15.9* plt ct-253 coags 01:55am blood pt-25.1* ptt-27.8 inr(pt)-2.4* 06:21am blood pt-18.6* ptt-31.2 inr(pt)-1.7* chemistry 01:31pm blood glucose-125* urean-18 creat-0.9 na-139 k-4.6 cl-108 hco3-21* angap-15 04:59am blood glucose-100 urean-20 creat-1.1 na-139 k-4.4 cl-103 hco3-26 angap-14 06:00pm blood glucose-309* urean-26* creat-1.6* na-135 k-5.4* cl-102 hco3-24 angap-14 06:21am blood glucose-123* urean-23* creat-1.4* na-138 k-4.9 cl-103 hco3-26 angap-14 tte the left atrium is moderately dilated. no thrombus/mass is seen in the body of the left atrium. the right atrium is moderately dilated. 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%). there is no ventricular septal defect. the right ventricular free wall is hypertrophied. the right ventricular cavity is moderately dilated with depressed free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is no mitral valve prolapse. there is mild functional mitral stenosis (mean gradient 6 mmhg) due to mitral annular calcification versus annular ring from prior repair. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the rv appears enlarged with evidence of pressure/volume overload. there is now severe pulmonary hypertension and the degree of tr has increased. the mean transmitral gradient is similar. ccath 1. severe pulmonary arterial hypertension. 2. moderate right ventricular diastolic heart failure. 3. marked elevation in pcw consistent with severe left ventricular diastolic heart pressure, with giant v waves consistent with significant mitral regurgitation. 4. mild improvement in pasp, mean pa and modest improvement in pvr with 100% o2 and slightly further with addition of ino, driven by narrowing of av o2 difference. tee mild spontaneous echo contrast but no thrombus is seen in the body of the left atrium and left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no spontaneous echo contrast or thrombus is seen in the body of the right atrium or the right atrial appendage. the right atrial appendage ejection velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. there are simple atheroma in the aortic arch and descending thoracic aorta to 35 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened and there appears to be prosthetic material in the mitral valve annulus consistent prior surgery. there is a 3 mm hg mean gradient across the mitral valve, with an estimated valve area of 2.3 cm2, consistent with trivial mitral stenosis. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened with moderate tricuspid regurgitation. there is moderate pulmonary artery systolic hypertension. impression: trivial mitral stenosis. mild mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary artery systolic hypertension. mild spontaneous echo contrast without thrombus in the left atrium and left atrial appendage. simple aortic atheroma in the arch and descending thoracic aorta. tte there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 75%). the mitral valve leaflets are moderately thickened. there is no mitral valve prolapse. the tricuspid valve leaflets are mildly thickened. moderate-to-severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. compared with the findings of the prior study (images reviewed) of , the apparent pulmonary artery pressure is significantly reduced brief hospital course: hospital course this is a 63-year old female w a history of congenital heart defects (s/p repair primum atrial septal defect, cleft mitral valve with an endocardial cushion defect), a/w worsening severe phtn, hospital course c/b ccu stay for prolonged qt torsades and vt/vf arrest s/p pacemaker placement, diuresed with follow-up echocardiography demonstrating improved pa pressures. . active # pulmonary hypertension: patient was admitted with worsening sob and a tte demonstrated phtn. a r heart cath demonstrated pa pressures of 113/23, pcw 30 with v waves up to 60, moderately responsive to supplemental o2. given elevated wedge with large v waves, there was the question of mitral valve disease versus l heart disease versus worsening primary process as the driving process for this worsening phtn (prior tte in had estimated pulm pressures in 30s). patient was aggresively diuresed with torsemide and spironolactone. tee did not demonstrate evidence of severe mitral valve disease, suggesting that large v waves were artifact. after diuresis of ~10kg, repeat tte estimated pa systolic pressures in the low 40s, suggesting that exacerbation of phtn was to l sided failure. patient was discharged on lasix and spironolactone, with set-up for home o2. . # torsades and vt/vf arrest: patient developed torsades leading to vt/vf arrest on floor on . she had rosc after acls. ep was consulted who felt that a rate related prolonged qt was responsible. a single chamber pacemaker was placed on with normalization of the qt. she was started on po magnesium and metoprolol for treatment of persistant ectopy. . # arf: during diuresis, cr rose to 1.6 (baseline 0.9). metformin was held. diuresis was slowed and at discharge cr was 1.4. patient was instructed to discuss resuming metformin at future pcp . . #dm: patient was continued on ss humalog, acarbose, glyburide, metformin, and pioglitazone, with holding of oral hyperglycemics in the setting of the cath and restarting afterwards. home januvia was nonformulary and restarted at discharge. . #gi bleed: patient had a single episode of blood emesis in the setting of her torsades episode. she was started on ppi. at future outpatient follow-up, the patient could be evaluated for stopping this medication. . # afib: patient's coumadin regimen was continued, but patient's inr became subtherapeutic late in the admission. with consultation from the coumadin clinic, her coumadin was increased to 5mg daily and she was bridged with lovenox. she discharged with script for lovenox and instructed to have her inr checked by her vna on and faxed to the coumadin clinic. . inactive #hld: patient was continued on home simvastatin. . #htn: the patient was continued on home lisinopril . #h/o atypical lobular hyperplasia: patient was continued on home tamoxifen. . #chronic lymphedema: patient was continued on home ultram. . transitional 1. code status: patient remained full code for the duration of this admission 2. pending: no labs pending at time of discharge 3. transition of care: details of this admission were discussed with pcp. was given follow-up appointments with pcp, , pulmonary, and device clinic. patient was arranged to have vna and home o2. medications on admission: acarbose 25 mg tablet three times a day amoxicillin before dental procedure atenolol 25 mg tablet once daily glyburide 5 mg tablet - two tablets by mouth twice a day lisinopril 20 mg tablet - 1 tablet by mouth once a day metformin 1,000 mg tablet - one tablet by mouth twice a day pioglitazone 15 mg tablet - 1 tablet by mouth once a day simvastatin 20 mg tablet - 1 tablet by mouth daily sitagliptin 100 mg tablet - 1 tablet by mouth once a day tamoxifen 20 mg tablet - 1 tablet by mouth every day ultram 50mg tablet - one twice a day warfarin 5 mg tablet - take up to 2 tablets by mouth a day or as directed by clinic vitamin d 1000 mg twice daily. discharge medications: 1. acarbose 25 mg tablet sig: one (1) tablet po three times a day: with meals. 2. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*0* 3. glyburide 5 mg tablet sig: two (2) tablet po twice a day. 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. pioglitazone 15 mg tablet sig: one (1) tablet po daily (daily). 6. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 7. januvia 100 mg tablet sig: one (1) tablet po once a day. 8. tamoxifen 20 mg tablet sig: one (1) tablet po once a day. 9. tramadol 50 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for pain. 10. warfarin 5 mg tablet sig: as directed tablet po once daily at 4 pm: take as directed by coumadin clinic / primary care doctor. 11. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po twice a day. 12. oxygen 2-3 l nc continuous pulse dose for portability dx: pulmonary hypertension, heart failure 13. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 14. lovenox 120 mg/0.8 ml syringe sig: one (1) 120mg subcutaneous once a day for 5 doses: please continue until inr at goal of . disp:*5 units* refills:*0* 15. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 16. torsemide 20 mg tablet sig: 1.5 tablets po once a day. disp:*45 tablet(s)* refills:*0* 17. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 18. outpatient lab work at your doctors visit, please have have the following labs checked: na, k, hco3, cl, bun, cr, mg discharge disposition: home with service facility: vna discharge diagnosis: primary pulmonary hypertension secondary congestive heart failure atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , it was a pleasure taking care of you at . you were admitted with shortness of breath and elevated pulmonary artery pressures on an echocardiogram. you were treated with diuresis (to help remove some of the fluid), blood pressure control (to help decrease the strain on your heart), and oxygen therapy (to help decrease the strain on your heart). your symptoms improved and you were ready for discharge. while you were here, your heart beat went into an irregular rhythm, and you needed to have a pacemaker placed. during your hospitalization the following changes were made to your medications: -started torsemide (a diuretic) -started spironolactone (a diuretic) -started metoprolol (heart rate control) -started magnesium -started omeprazole -started home oxygen therapy -started lovenox -increased warfarin -stopped metformin **please follow up with your primary care doctor to discuss the possibility of restarting this medication** please see below for your recommended follow-up appointments. followup instructions: device clinic thursday at 11am - building: sc clinical ctr campus: east best parking: garage primary care when: thursday at 10:00 am with: fern, rnc building: sc clinical ctr campus: east best parking: garage cardiology when: thursday at 10:00 am with: , m.d. building: sc clinical ctr campus: east best parking: garage you have been placed on a cancellation list. they will call you at home with a sooner appointment. procedure: diagnostic ultrasound of heart other electric countershock of heart cardiopulmonary resuscitation, not otherwise specified right heart cardiac catheterization initial insertion of transvenous lead [electrode] into ventricle initial insertion of single-chamber device, not specified as rate responsive artificial pacemaker rate check diagnoses: mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases paroxysmal ventricular tachycardia other and unspecified hyperlipidemia atrioventricular block, complete cardiac arrest long-term (current) use of anticoagulants hemorrhage of gastrointestinal tract, unspecified disorders of magnesium metabolism chronic diastolic heart failure tricuspid valve disorders, specified as nonrheumatic other lymphedema personal history of surgery to heart and great vessels, presenting hazards to health sickle-cell trait unspecified nontoxic nodular goiter 

Answer: The patient is high likely exposed to