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: history of present illness: this is an 82 -year-old female with a history of coronary artery disease, mitral valve repair, status post coronary artery bypass graft in , hypercholesterolemia, diabetes mellitus, and hypertension who presents upon transfer from hospital for evaluation of atrial flutter. the patient was in her usual state of health until one month ago when she noticed increased dyspnea on exertion and a rapid irregular heartbeat, palpated at her radial pulse. she reported fever and chills over the last week and a half prior to admission and presented to hospital emergency department when she was unable to get out of bed secondary to shortness of breath. the patient was diagnosed with congestive heart failure and right lower lobe pneumonia while in outside hospital and found to have subsequent atrial flutter with 4:1 block of questionable duration. she was treated with levaquin and started on a heparin drip. she also had a positive d-dimer greater than 1,000, and a low probability v/q scan on the outside hospital. review of systems: she denies any chest pain, nausea, vomiting, orthopnea, paroxysmal nocturnal dyspnea, diaphoresis. she does report a mild increase in pedal edema, but also denies any palpitations. she presents now to - with improving shortness of breath and comfortable, here only for evaluation of atrial flutter. past medical history: 1. coronary artery disease, status post coronary artery bypass graft in . 2. status post mitral valve repair in . 3. status post appendectomy. 4. hypercholesterolemia. 5. diabetes. 6. hypertension. 7. status post resection of retroperitoneal liposarcoma times two. admitting medications: aspirin 81 mg q day, nph 40 units in am, 26 units in pm, atenolol 50 mg q day, lasix 40 mg q day, cardizem 300 mg q day, and imdur 30 mg q day. allergies: codeine and darvon which cause lightheadedness without syncope. social history: no tobacco, no alcohol, lives with husband. family history: positive for coronary artery disease and diabetes. physical examination: vital signs: temperature 99.2 f, pulse 65, respiratory rate 18, blood pressure 119/69, and pulse oximetry 94% on two liters. blood sugar 115 and 176 pounds. in general: sitting in bed, head of bed at 30 degrees, in no acute distress. head, eyes, ears, nose and throat: pupils were equal, round, and reactive to light and accommodation, extraocular movements intact, oropharynx clear, mucous membranes are moist. neck with left sided bruit, no thyromegaly and jugular venous distention to angle of jaw. lungs: rales halfway up with decreased right lower lobe breath sounds with dullness to percussion. cardiovascular: regular rate and rhythm, ii/vi systolic ejection murmur heard best at the apex with radiation to the axilla. abdomen: soft, nondistended, positive bowel sounds, mild tenderness on the right side. abdomen: mildly protruding with valsalva / cough. extremities: trace bilateral edema with right leg with graft harvest, 1+ pulses in the groin and dorsalis pedis. neurologic: alert and oriented times three, cranial nerves ii through xii intact, normal sensory to light touch and no focal deficits. admission laboratory data: white count 7.9, hematocrit 31.3, platelets 271,000. ptt 42.6. sodium 140, potassium 3.8, chloride 99, bicarbonate 28, bun 17, creatinine 0.6, and glucose 124. calcium 8.6, phosphate 3.7, magnesium 1.8. tsh was pending on admission. chest x-ray on from outside hospital showed: 1) hazy density in the right lower lobe base, suggesting effusion and coarsening of bilateral lower lung markings, a question of pulmonary vascular congestion, 2) slightly greater density along left hilum laterally. echocardiogram from outside hospital on showed mild concentric left ventricular hypertrophy and normal systolic function, mildly hypokinetic base of an inferior wall, ejection fraction of 60%, mildly depressed systolic function, mild left atrial enlargement, mild atrial fibrillation, 1+ mitral regurgitation, 1+ to 2+ tricuspid regurgitation, pulmonary artery systolic pressure 54, right atrium 15 mmhg, 1+ to 2+ pi, and dilated ivc. telemetry at - showed the patient had a heart rate of 60 with a 2:1 atrial flutter. electrocardiogram showed atrial flutter with 3:1 block with right bundle branch block, biphasic t-waves in v2, and no st-t-wave changes. chest x-ray showed bilateral effusions with increased pulmonary vasculature with poor inspiratory effort. assessment: this was an 82 -year-old female with a history of coronary artery disease, mitral valve repair, status post coronary artery bypass graft, hypercholesterolemia, diabetes, and hypertension, also with a recent pneumonia being treated with levaquin, here for electrophysiology evaluation of atrial flutter. hospital course: 1. coronary artery disease: the patient with known disease, no recent chest pain, only shortness of breath, dyspnea on exertion with concurrent pneumonia. the patient was continued on aspirin, lopressor, cardizem, and imdur. she was also started on lipitor secondary to ldl of 132 and triglycerides of 131, and hdl of 30. there were no problems with coronary artery disease during admission. 2. congestive heart failure: the patient presented with rales on examination. ejection fraction was 60% per outside hospital echocardiogram. the patient also with trace bilateral lower extremity edema. for these two reasons, the patient was started on diuresis with a goal of one liter negative per day with lasix. she also was started on captopril which was increased as tolerated to a final discharge dosage of 12.5 mg po tid. 3. electrophysiology: the patient presented with atrial flutter, 3:1 block, rate controlled throughout admission. she was continued on heparin drip. she remained stable while in atrial flutter without any complaints of lightheadedness or chest pain or palpitations. before electrophysiology study a transesophageal echocardiogram was done to rule out clot. the patient alternated between 2:1, 3:1, and 4:1 rate controlled atrial flutter. during admission, her lopressor dose was increased to 50 mg po bid, discontinuing her cardizem. the patient went to electrophysiology lab for atrial flutter ablation on hospital day five. upon termination of flutter and alternating right bundle branch block and left bundle branch block was revealed, as well as 3:2 and 2:1 arteriovenous block were also demonstrated to occur below his ....................bundle. a temporary pacing wire was inserted and left in place while the patient transferred to the cardiac care unit for stabilization pending permanent pacemaker implantation the following morning. the patient continued to be intermittently ventricular paced at around 50 ventricular beats per minute, alternating with sinus rhythm with left bundle branch block. the following day she returned to electrophysiology lab where a ddd pacer was successfully implanted. the patient was then transferred to the floor for further management. the following day, the patient was noted to be in a sinus versus atrial tachycardia, ranging between 110 and 120 beats per minute. she did not complain of any chest pain, shortness of breath, or lightheadedness. her blood pressure was stable in the 130s systolic. she did not have a pulsus paradoxus. her lopressor dose was increased to 75 mg po bid and her clinical status was monitored. the patient then was noted to have an alternating regular rhythm with a retrograde ventricular atrial conduction with atrial inhibition / block. electrophysiology was made aware and is planning on reprogramming the patient's pacemaker. the patient was also started on ancef for a total of 48 hours after pacemaker placement, last dose to be on . the patient is also to restart coumadin on . 4. endocrine: the patient with insulin dependent diabetes. she was continued on her home nph dose and followed with a regular insulin sliding scale. her tsh was noted to be normal. no other problems were noted. 5. pulmonary: the patient transferred after right lower lobe pneumonia had been treated with iv levaquin at outside hospital for a total of five days. the patient noted improving shortness of breath. she was saturating 94% on two liters upon admission. her chest x-ray showed bilateral effusions. she was continued on po levaquin for a total of a ten day course. she was weaned off her o2 as was tolerated. she denied any cough or shortness of breath during hospital stay. on day seven of admission, the patient reported bilateral lower extremity tenderness, left more than right. she had a positive sign, no cords were palpable. she denied any shortness of breath, but deep vein thrombosis / pulmonary embolism was considered at that time secondary to patient also manifesting a fever of 100.7 f with no known source, no systemic complaints of infection. she denied any dysuria, cough, shortness of breath, fever or chills, headache, sore throat, nasal congestion, diarrhea. therefore it was believed that this fever could possibly be secondary to calf deep vein thrombosis, also explaining the patient's increased atrial rate as secondary to pulmonary embolism perhaps. the patient had been immobile since time of outside hospital admission ten days prior. she had been on heparin drip for a large portion of hospital stay, but this was still considered as a possibility. lower extremity non-invasive dopplers were scheduled, but were not available at the time of dictation. if the dopplers were positive, the patient would receive a ct scan angiogram for follow-up of possible pulmonary embolism. test results were pending at this time. disposition: at the time of this dictation, the patient's symptoms had all resolved. she was asymptomatic secondary to atrial tachycardia with simultaneous pacemaker activity. it was intended that electrophysiology would follow-up with pacemaker reprogramming in am, duplex bilateral lower extremity dopplers were pending. coumadin is to be restarted on , and the patient is likely to be discharged on the morning of . discharge medications: at the time of dictation were lopressor 75 mg po bid, imdur 30 mg po q day, lasix 40 mg po q day, captopril 12.5 mg po tid, lipitor 10 mg po q day, aspirin 81 mg po q day, nph 40 units q am, 26 units q pm, regular insulin sliding scale, coumadin 5.0 mg po q day starting on . discharge diagnoses: 1. atrial flutter ablation. 2. ddd pacemaker placement. follow-up: the patient is to follow-up in device clinic on . the patient is also to follow-up with her primary care physician, . in two to four weeks. the patient is to arrange visit in . discharge status: we were planning to discharge to rehabilitation where the patient should receive qid fingersticks, inr checks should be drawn, and coumadin adjusted for a goal inr of 2.0 to 3.0 every two days. the patient with allergies to codeine and darvon. , m.d. dictated by: medquist36 procedure: diagnostic ultrasound of heart other esophagoscopy catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled aortocoronary bypass status atrial flutter right bundle branch block other left bundle branch block 

Answer: The patient is high likely exposed to