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: lisinopril / atenolol / hydrochlorothiazide / nsaids / nifedipine er attending: chief complaint: syncope . major surgical or invasive procedure: pacemaker placement eeg history of present illness: patient is an 89 y/o f w/ pmh of hypothyroidism, rls who presents with 2 episodes of syncope in the last 24 hrs. yesterday at ~5 pm the patient's son witnessed an episode while pt was sitting having cofee. per the son, the patient suddenly appeared glassy-eyed, stared, then her eyes rolled back to the left and she dropeed her coffee from her right hand. she quickly became alert after he slapped her face and then she was back to baseline. there was no witnessed seizure activity, no incontinence, no acute focal neuro sx, and no headache. the patient reports that at 2 am she got up to go to the bathroom and suddenly found herself on floor. she hit the back of her head but otherwise felt normal afterwards. she dressed herself and called her son. she denies any history of syncope, however she reports that over the last year she has felt intermittantly "unsteady" on her feet, however she denies recent falls, vertigo, pre-syncope, palpitations or lightheadedness. on arrival to the floor the patient was being interviewed and stated "it's happening again" and was noted by the housestaff to become unresponsive for a brief moment. telemetry revealed bradycardia with hr in 20s for a few seconds. she was then transferred to ccu for closer monitoring. the patient currently feels tired but otherwise feels well. . per pcp, had previous admission w/ neuro eval neg for seizure, cva. however, has never had holter monitor or echocardiogram. has been on increasing mirapex x years for rls, recently added magnesium. rarely has taken an extra mirapex, not recently. . in the ed, initial vitals: 96, 163/80, 72, 16, 98% on ra. she was asymptomatic at that point. ct head and cxr w/o acute change. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. past medical history: 1. cardiac risk factors:: (-) diabetes, (+) dyslipidemia, (+)hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none . other past medical history: -seen by dr. intermittently since for restless legs syndrome. on mirapex. on last recorded visit in , reportedly had "dizziness" thought to be secondary to orthostatic hypotension. -hypertension -dyslipidemia -hypothyroidism -spinal stenosis s/p surgical repair ~10 years ago -polymyalgia rheumatica (in remission) -osteoporosis -degenerative joint disease -left cataract extraction -ercp w/ sphincterotomy () . psurgh: -hernia repair -s/p surgical repair for spinal stenosis ~10 years ago -laparascopic cholecystectomy () -carpal tunnel repair social history: has never smoked, occasional alcohol (at most 1 glass of wine/week), denies ivdu, other drugs. lives by herself in near her son and his wife and kids. family history: mother- question of cancer, living dm, brother and sister- died of "cardiac problems" physical exam: vitals: t: 98.4 p: 71 bp: 133/64 rr: 13 sao2: 96% ra general: elderly woman, appears younger than stated age, awake, alert, nad. heent: nc/at, perrl, eomi without nystagmus, no scleral icterus noted, mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated pulmonary: lungs cta bilaterally cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. lymphatics: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. -sensory: no deficits to light touch throughout. -cerebellar: no nystagmus, dysarthria, intention or action tremor -dtrs: 2+ biceps, triceps, brachioradialis, patellar and 1+ ankle jerks bilaterally. plantar response was flexor bilaterally. pertinent results: labs on admission: . 01:00pm blood wbc-7.0 rbc-3.91* hgb-13.4 hct-35.3* mcv-90 mch-34.2* mchc-37.8*# rdw-13.5 plt ct-264 01:00pm blood neuts-79.8* lymphs-16.1* monos-3.5 eos-0.5 baso-0.2 02:30am blood pt-13.9* ptt-31.8 inr(pt)-1.2* 02:10pm blood glucose-109* urean-13 creat-0.8 na-133 k-5.4* cl-97 hco3-32 angap-9 02:10pm blood calcium-10.2 phos-3.6 mg-2.3 . others: 02:10pm blood tsh-1.5 01:00pm blood ctropnt-<0.01 02:30am blood ck-mb-6 ctropnt-<0.01 02:30am blood ck(cpk)-250* . . radiology: ct head (): impression: no acute intracranial process. no fractures. . chest x-ray - satisfactory position of the pacemaker and its leads. hyperinflation. prior granulomatous exposure. extensive coronary artery calcifications. . eeg - impression: this telemetry showed a normal background in wakefulness and in sleep there were no clearly epiltiform discharges. some sharp paroxysmal activity in the left central region appeared best correlated with the patient moving by video, thus most likely representing movement artifact with motion of left central and parietal eeg leads against the pillow. several different types of movement were associated with these eeg changes, they did not show definite spike and slow wave discharges. brief hospital course: ms is an 89 f w/ pmhx of hypothyroid, prior syncopal episodes of unknown etiology presents w/ syncope and high degree av block, now s/p temporary pacer placement. . #) syncope: initially concern for cardiac arrythmia vs. neurologic. patient's telemetry demonstrates increased vagal tone during asystolic episode where p-p intervals also increased during the high degree block. this may suggest seizures with increased vagal outflow as an etiology, which fits clinically with the episodes of ??????blank stares?????? that patient??????s son describes. with bradycardia and av block, initially patient had temporary pacemaker placed which was then replaced by permanent pacemaker. there were no additional events on telemetry. neurology was consulted. patient had eeg placed which was read as normal. neurology impression was that episode of syncope was all completely replated to cardiac arrythmia and apparently patient has had previous eeg which was also normal. patient to follow up with cardiology and neurology on discharge. . # coronaries: no history of coronary disease. denies any history of chest pain. ecg without ischemic changes and no change from prior. troponins negative x2 and they were taken 12 hours apart. patient has previously had lipids checked in which demonstrated ldl < 100 and currently no indication for antilipid . . # pump: patient appears euvolemic on exam. no h/o chf and no prior tte. on admission patient got echo which demonstrated mild-moderate mitral regurgitation. mild pulmonary artery systolic hypertension. increased pcwp. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. no structural cardiac cause of syncope identified. . # rhythm: patient has history av delay and now with documented high degree av block on tele and multiple syncopal events. patient initially got temporary pacemaker and now is now s/p permanent pacemaker placement. patient was not previously on any nodal agents. after temporary pacer placed, no addition events on telemetry. . # hyponatremia - patient with na of 130 this morning which improved prior to discharge to 134 with 500 cc normal saline bolus so likely hypovolemic hyponatremia. ordered urine lytes, serum osms which were not drawn prior to discharge. . #) hypothyroidism: last tsh in normal. tsh on admission was 1.5. patient was continued levothyroxine at outpatient dose. . #) hypertension: patient denies, however listed in problem list. was on atenolol and ace in past, not currently on antihypertensives. of note, patient was noted to be hypertensive during pacemaker procedure to the 200s requiring hydral however subsequently was normotensive. did not discharge patient on any additional medications. would monitor clinically as outpatient and consider addition of low dose acei if patient requires anti-htn in the future . #) rls: continue outpatient mirapex . #) osteoporosis: continue fosamax, calcium, vitamin d . #) prophylaxis: taking po, sc heparin, bowel regimen . #) fen: p.o. diet as tolerated, replete lytes prn . #) code: full medications on admission: fosamax plus d- 70 mg-2,800 unit tablet weekly levothyroxine - 75 mcg tablet - 1 tablet(s) by mouth every day except wednesdays pramipexole - 1 mg tablet qhs. calcium 600 + d(3) 600mg-400 unit tablet daily vitamin b-12 2,000 mcg tablet daily fiber 625 mg tablet - 1 tablet(s) by mouth once a day magnesium - (otc) - 250 mg tablet qhs - 1 tablet(s) by mouth at bedtime for restless legs multivitamin with iron-mineral - (otc) - dosage uncertain discharge medications: 1. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 2. pramipexole 1 mg tablet sig: one (1) tablet po qhs (). 3. calcium 600 + d(3) 600-400 mg-unit tablet sig: one (1) tablet po once a day. 4. cyanocobalamin 500 mcg tablet sig: four (4) tablet po daily (daily). 5. fiber tablet sig: one (1) tablet po once a day. 6. magnesium oxide 250 mg tablet sig: one (1) tablet po at bedtime. 7. multivitamin with iron-mineral oral 8. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 3 days. disp:*12 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: syncope, first degree av block s/p pacemaker placement . secondary: hypertension dyslipidemia hypothyroidism spinal stenosis s/p surgical repair ~10 years ago polymyalgia rheumatica (in remission) osteoporosis degenerative joint disease left cataract extraction ercp w/ sphincterotomy () discharge condition: afebrile, vital signs stable discharge instructions: you were admitted to the hospital with syncope and found to have complete av block. you underwent pace maker placement. in addition, you were evaluated by neurology and underwent a eeg. . there were no changes made to your medications while you were in the hospital. . we have made you follow up appointments with cardiology for device clinic as well as routine follow-up in addition to neurology follow-up. it is very important you continue to follow up with us here at the . . you should return to the ed if you experience any worsening shortness of breath, chest pain, or abdominal discomfort. it has been a pleasure taking of you at . followup instructions: you need to follow up with device clinic in 1 week. in addition, you need to follow up with ep in 3 months which we have also made for you below. you device clinic appointment is for tuesday at 11:30 am 7. we have made you an appointment for tuesday -1 pm with dr. . . in addition, you have an appointment with your primary care provider already scheduled below. provider: , - adult medicine (sb) phone: date/time: 3:00 . you should follow up with neurology as an outpatient. you missed your appointment with dr. while you were in the hospital. we have made you a new appointment with neurology. provider: , .d. phone: date/time: 1:00. please call if you are unable to make any of these appointments. procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system diagnoses: polymyalgia rheumatica pure hypercholesterolemia unspecified essential hypertension hyposmolality and/or hyponatremia unspecified acquired hypothyroidism unspecified fall other specified cardiac dysrhythmias atrioventricular block, complete osteoporosis, unspecified syncope and collapse restless legs syndrome (rls) 

Answer: The patient is high likely exposed to