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: beta-adrenergic blocking agents / calcium channel blocking agents-benzothiazepines attending: chief complaint: found down, delta ms major surgical or invasive procedure: 1. intubation 2. a-line 3. rij temporary pacer wire 4. permanent pacemaker placed history of present illness: this is a 78 yof pmh htn, cabg x 1 vessel , hyperlipidemia, hypothyroidism, brca s/p lumpectomy/xrt and thyroid nodule excision who presents s/p being found down by her family at home. unclear whether there was head trauma however pt was so lethargic and bedridden that family decided to bring her into . in the ed, patient grew increasely unresponsive and was subsequently intubated for airway protection. given atropin, kayexalate, vanco/levo/flagyl. patient was found to have a junctional rhythm and hr in 30's consistent with complete heart block. he had a ppm placed emergently in the ed and was transferred to the ccu for further care. past medical history: 1. brca s/p lumpectomy and xrt 2. thyroid nodule excision 3. htn 4. cabg x 1 vessel 5. hyperlipidemia 6. hypothyroidism social history: lives with her husband, very distant hx, neg etoh. family history: sister ovarian cancer, brother mi at 60 physical exam: t 90.6 hr 79 bp 72/48 rr20 o2sat 100%ra ac 14x500 fio2 1.00 peep 5 gen: patient intubated lying in the bed, diffuse anarsarca heent: ncat, grossly edematous conjunctivae, pupils dilated 4mm neck: supple no lad chest: crackles bilaterally, +wheezes cv: distant heart sounds, rrr, ii/vi holosystolic murmur ab: soft nontender, +bs ext: no cce neuro: spontaneously moving all four limbs pertinent results: 09:45am blood pt-16.8* ptt-26.9 inr(pt)-1.9 10:22pm blood po2-189* pco2-36 ph-7.04* calhco3-10* base xs--20 01:21am na 136 cl 108 bun 36 gluc 306 potassium 5.4 hco3 10 creatinine 2.8 ck: 129 mb: pnd trop-*t*: pnd ca: 6.9 mg: 1.3 p: 6.0 d alt: 51 ap: 47 tbili: 0.9 ast: 71 ldh: 338 : 75 lip: 30 serum asa, etoh, acetmnphn, benzo, barb, tricyc negative hapto: pnd triglyc: pnd wbc 28.2 d hgb 12.7 plat 192 hct 37.8 pt: 15.3 ptt: 32.6 inr: 1.6 fibrinogen: 241 imaging: left shoulder x-ray: calcific tendinitis of the left shoulder. cxr: prominent pulmonary vasculature, consistent with an element of fluid overload. asymmetric perihilar haziness, and faint opacity in the left lower lung zone. abd ct/pelvic ct: extensive retroperitoneal fluid and stranding, which appears to center around the pancreas, with extension along gerota's fascia, and adjacent to the second and third parts of the duodenum. additionally, there is marked bowel wall edema of the entire duodenum, and to a lesser degree, of the proximal jejunum. there is secondary gallbladder wall edema, and free intraperitoneal fluid. the pancreatic contour, however, does appear well circumscribed. these findings may represent changes from pancreatitis, or alternatively, this may represent a focal duodenitis, with secondary changes in adjacent organs. non-con head ct: negative for ich. ruq us: 1. gallbladder wall edema, without any gallbladder distention. this appearance is highly suggestive of changes relating to a non-gallbladder related etiology, such as third spacing of fluid, or inflammation of adjacent organs. 2. no cholelithiasis. echo the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef 70-80%). the right ventricular cavity is dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior report (tape unavailable for review) of , the tricuspid regurgitation is significantly increased. cxr: right central venous catheter has been placed with the tip in the right atrium and no ptx. a retrocardiac density remains unchanged. there are no new consolidations and the pulmonary vascular markings may be subtlely increased versus prior. less density over the right lower lung is noted and likely due to positioning influencing pleural fluid distribution. chest (pa & lat) 1. unchanged appearance of pacemaker. no evidence of pneumothorax. 2. stable left retrocardiac density. unilat lower ext veins left 8:52 am no dvt in the left lower extremity. brief hospital course: this is a 78 yof pmh cad, hypothyroidism, h/o br ca p/w junctional escape rhythm, unresponsive requiring intubation, hyperkalemic, in severe acidosis and arf. temp wire was placed now unpaced and wire removed. pt extubated. arf resolved. now with new afib w/rvr. ppm placed on . . #low grade fevers for 2 days (100.3)- patient completed 1 week of levofloxacin/flagyl for possible abdominal or pulmonary infections contributing to her shock on admission. patient is three days out from pacer placement. received 3 doses iv vancomycin periprocedurally. pt will complete 7 day course of keflex in the setting of new pacemaker placed until . . ## cardiac: #ischemic - h/o cabg x1 vessel. pt with elevated enzymes thought to be secondary to demand. there were no st changes seen on ekg. outpatient bp meds were held in setting of acute renal failure and junctional escape rhythm (incl atenolol, cozaar, aldactone, cardizem/cardura). patient was started metoprolol and cozaar in setting of afib w/rvr. continue lipitor. . #pump - shock most likely either cardiogenic versus septic. patient was hypotensive requiring dopamine and levophed drips despite being positive approximately 4-5l of fluid and fluid overloaded on cxr. minimal uop, fluid third spacing. hospital day #2 (hod #2) patient was weaned off pressors and unpaced in 60's. hod #3 patient successfully extubated. given rapid turnaround more likely cardiogenic shock combination of dehydration, renal insufficiency and renally cleared nodal blockers (bb, ccb). no clear source of sepsis. corstim test was negative however given less likely septic picture, stress dose steroids were held and patient was monitored closely. #arrhythmia - temp pacer wire placed to junction escape rhythm/sinus node arrest upon admission. has had pr prolongation on past ekgs. now pacer wire removed and patient in nsr 70's with pr interval 220. patient went into afib w/rvr hr 140's without chest pain on . pt started on metoprolol which was titrated up. ep placed ppm on to facilitate treatment of afib by rate controlling agents. # acidosis: initially, mixed gap and respiratory acidosis with elevated lactate and arf contributing to anion gap acidosis. increased respiratory rate while ventilated, fluid bolused aggressively and received 4amps of bicarb until ph>7.1. patient's acidosis resolved quickly over the course of first night of admission and was likely secondary to increased perfusion. . # respiratory compromise: patient extubated easily. repeat cxr suggests retrocardiac atelectasis tx'd with abx. iss to bedside. now on room air. . # abnormal abd findings on ct/?etiology of sepsis: possible pancreatitis v duodenitis seen on abd ct. ruq us was negative for stones. amylase, lipase and lfts wnl. no intrabd free air. given negative enzymes, less likely acute abdominal process. surgery was consulted, no need for emergent surgery and recommended outpatient egd as follow-up of abd ct findings. patient completed 1 week course of levoquin and flagyl to cover abdominal and pulm organisms. . # s/p fall/found down: concern for head bleed given hx of sah and hx from family that pt might have hit head prior to change in mental status this admission. head ct negative for large ich however pt received iv dye load for abd ct which may obscure smaller bleeds. per family patient at baseline ms. . # arf: baseline 1.1. was 3.9 on admission and oliguric. likely component of prerenal azotemia. now better than baseline at 0.9. . # fen: mildly hypernatremic/hyperchloremic likely to ns fluid resuscitation continue diuresis with lasix as needed, advance cardiac healthy low sodium diet as tolerated, replete lytes. . # access: piv . # ppx: heparin sc, protonix . # dispo: pt consulted and being screened for rehab . #contact: () ( (daughter) ( medications on admission: 1. atenolol 2. cozaar 3. aldactone 4. cardizem/cardura? discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 4. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4-6h (every 4 to 6 hours) as needed. 5. multivitamin capsule sig: one (1) cap po daily (daily). 6. toprol xl 50 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po once a day. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed: not to exceed 4g/day. 8. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 9. olanzapine 5 mg tablet sig: one (1) tablet po daily (daily): please give at 5pm. 10. aspirin 81 mg tablet sig: one (1) tablet po once a day. 11. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 5 days: until . 12. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 13. diltiazem hcl 180 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. discharge disposition: extended care facility: for extended care - discharge diagnosis: primary diagnosis: 1. tachy-brady syndrome 2. atrial fibrillation secondary diagnosis: 3. cad s/p cabg 4. hypertension 5. hyperlipidemia 6. hypothyroidism 7. h/o breast cancer discharge condition: good discharge instructions: please take medications as prescribed. please keep your follow-up appointments. you have had a permanent a-v pacer placed for tachy-brady syndrome. you have been started on a new medication called warfarin which is a blood thinner for your new atrial fibrillation. please check labs (inr/pt) daily. adjust coumadin dose accordingly for goal inr between 2 to 3. followup instructions: provider: clinic phone: date/time: 11:30am provider: , md phone: date/time: 3:30pm location: , , ma md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system arterial catheterization infusion of vasopressor agent diagnoses: acidosis hyperpotassemia mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation aortocoronary bypass status other and unspecified hyperlipidemia atrioventricular block, complete cardiogenic shock hyperosmolality and/or hypernatremia diseases of tricuspid valve 

Answer: The patient is high likely exposed to