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: midazolam / lisinopril / naprosyn / indocin attending: chief complaint: aortic root to right atrial fistula major surgical or invasive procedure: pulmonary vein isolation: dr. on history of present illness: this 57 year old man has a long standing history of atrial arrhythmias s/p flutter ablation, pvi in and again in , and multiple cardioversions. he has been most recently managed on amiodarone. he was last here at on when he complained of dyspnea on exertion and fatigue for several weeks. he underwent successful cardioversion and had his coumadin switched to pradaxa due to difficulty maintaining adequate inr levels. plans were made for repeat attempt at ablation in . he developed recurrent atrial tachycardia shortly following his cardio version on . he underwent successful dccv of atrial tachycardia on with prompt return to sinus rhythm. . today, pt had planned repeat pvi attempt with ch, but 2nd transeptal went to aortic root above ncc. case stopped. tee color flow doppler revealed small fistula between the right atrium and aortic root with l to r flow. 1u platelets ordered but not yet given. , md surgery consulted and will patient shortly. patient was left intubated and sent to ccu for repeat tee ~1500 to re-evaluate fistula in hopes that it will have closed. last pradaxa am dose. . ros: unable to obtain. . please note that patient is intubated at time of admission and therefore details of history are obtained from his electronic medical record. past medical history: 1. cardiac risk factors: - diabetes, - dyslipidemia, + hypertension 2. cardiac history: 1. recurrent symptomatic atrial fibrillation 2. multiple recent dc cardioversions most recent was 3. pvis, last before admission was 4. recurrent symptomatic left atrial tachycardia following pvi - cabg: none - percutaneous coronary interventions: none 3. other past medical history: - hypertension - arthritis involving knees - anxiety - hepatitis c with elevate lft's: as of -> hepatitis c genotype is 1. hep c vl 2,200,000 international units/ml. hepascore is 1.00 with a 65% probability that the patient has cirrhosis. most recent abdominal ultrasound was obtained on , and did not demonstrate any hepatic lesions. the spleen was 15.5 cm and a recanalized paraumbilical vein. there was no ascites noted. social history: occupation: retired nurse from the va system. tobacco: denies etoh: he averages 6 drinks a day; he reports going a couple days at a time without any alcohol and denies any prior dt's. reports drinking "too much" in general and has considered detox before. home services: denies family history: fh: no family history of arrhythmias. no family history of liver or gi disease. physical exam: exam on admission: vs: t=95.8 bp= 127/59 hr=64 rr=14 o2 sat= 100% on 100% fio2 vent settings: cmv with tv 600, peep 5, rr 12, fio2 100% general: intubated and sedated. heent: ncat. sclera anicteric. pinpoint pupils, symmetric. neck: supple, unable to assess jvp. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: clear anteriorly. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge exam: general: alert and orriented. heent: ncat. sclera anicteric. pupils reactive and symmetric. neck: supple, unable to assess jvp. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: clear anteriorly. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs : wbc-3.6* rbc-3.98* hgb-13.5* hct-38.2* mcv-96 mch-34.0* mchc-35.4* rdw-16.6* plt ct-58* pt-15.6* inr(pt)-1.4* glucose-118* urean-16 creat-1.1 na-136 k-3.5 cl-95* hco3-34* angap-11 . post-procedure initial tee : a mobile 0.3 x 0.3 cm structure consistent with probable thrombus (or other small mass) is seen in the the left atrium attached to left atrial wall to the left and posterior to the aortic root . a trans-septal catheter is seen and following withdrawal there is residual left-to-right shunt across the interatrial septum. left ventricular global systolic function is normal. there are simple atheroma in the aortic arch and descending thoracic aorta. no thoracic aortic dissection is seen. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. there is an echodense region along the posterior border of the aorta, adjacent to the non-coronary cusp consistent with a hemotoma that measures 1.8 cm at the widest. there is a 2mm wide jet of color doppler flow through the hematoma from the aortic root into the right atrium. the mitral valve leaflets are mildly thickened. there is a trivial/physiologic pericardial effusion. impression: aortic root to right atrial communication with associated hematoma. small left atrial mass as described above. . repeat tee : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. a small, approximately 1 x 3 mm mobile structure consistent with possible thrombus is seen attached to the wall of the left atrium (clip ), although independent motion is not appreciated. right atrial appendage ejection velocity is good (>20 cm/s). 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%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. the aortic valve leaflets (3) are mildly thickened with good leaflet excursion. trace aortic regurgitation is seen. there is an echodense region along the posterior border of the aorta, adjacent to the non-coronary cusp consistent with a hematoma that measures 2.3 cm at the widest. there is a 3-5mm wide jet of color doppler flow from the aortic root into the right atrium. ] the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. impression: aortic root to right atrial communication with associated hematoma. very small left atrial mass suggestive of thrombus as described above. compared with the prior study (images reviewed) of the color doppler jet appears slightly wider and is now continous throughout the cardiac cycle. the left atrial mass is smaller in size. the previously appreciated interatrial shunt is no longer appreciated. repeat tte : the left atrium is mildly dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. right atrial appendage ejection velocity is good (>20 cm/s). a left-to-right color flow signal is seen across the interatrial septum at rest across the mid-interatrial septum consistent with a small secundum atrial septal defect. overall left ventricular systolic function is normal (lvef>55%). there are simple atheroma in the aortic arch and the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened with good leaflet excursion. mild (1+) aortic regurgitation is seen. there is an echodense region along the posterior border of the aorta, adjacent to the non-coronary cusp consistent with a hematoma that measures 1.3x1.5 cm. there is ~3 mm wide continuous jet of color doppler flow from the aortic root into the right atrium ]. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. impression: stable aortic root to right atrial communication with associated hematoma. small secundum-type asd with left to right flow at rest. mild to moderate mitral regurgitation. mild aortic regurgitation. compared with the prior study (images reviewed) of the left atrial mass is no longer seen and may have represented the tip of the "warfarin ridge.". the aortic root to right atrial communication and associated hematoma appear similar. the degree of mitral and aortic regurgitation are both increased. brief hospital course: primary reason for hospitalization: 57yom with h/o l atrial tachycardia/a-fibb, etoh, hcv, now s/p attempted pvi c/b transseptal puncture to aortic root with aortic root to ra fistula. active issues: # fistula: on admission to ccu he received 1u ffp and 3u platelets (platelet count >100). ct surgery was notified and began pre-op eval in the event that he would need open surgical repair of the fistula. his blood pressure was tightly controlled with sbp<100 to reduce pressure gradient between aortic root and right atrium. repeat tee on hd#2 showed slight enlargement of the fistula. he had a tte to determine if the fistula could be monitored with serial ttes, however it could not be visualized on tte. he was extubated on hd#2 and restarted on his home medications. on hd5, a repeat tee was performed which showed stable aortic root to right atrial communication with associated hematoma. small secundum-type asd with left to right flow at rest. mild to moderate mitral regurgitation. mild aortic regurgitation. . # rhythm: procedure was terminated fistula, so patient continued to be in atrial fibrillation. his pradaxa was held due to concern he may need open surgical repair of the fistula (last dose pradaxa am). he was restarted on his amiodarone on hd 1. pradaxa was held on discharge and will need to be restarted in 2 weeks. his rate was controlled in the 80s. . # h/o etoh: he was started on a ciwa scale after extubation and weaning of sedation due to concern for withdrawal given heavy reported etoh history. this was discontinued a day prior to discharge and the patient did well. . stable issues: # htn: stable. his home bp meds (lasix, losartan, hctz) were initially held while on propofol but restarted on hd#2 post-extubation. his hctz was increased to 25 mg and he was started on amlodipine 10 mg for better blood pressure control. . # gerd: stable. he was continued on his home omeprazole. . # anxiety: stable. he was continued on his home anxiety meds (alprazolam, sertraline). . # arthritis: continue home pain medications (vicodin, celebrex) as needed for arthritis pain. transitional issues: -patient maintained full code status throughout hospitalization. -patient will need to be restarted on anti-coagulation in 2 weeks. - follow up with dr. in 1 week medications on admission: alprazolam - 0.5 mg tablet - 1 by mouth up to 2 times a day as needed amiodarone - 200 mg tablet - 1 by mouth three times daily celecoxib - 50 mg - 1 capsule(s) by mouth daily prn dabigatran etexilate - 150 mg capsule - 1 po bid furosemide - 20 mg tablet - 1 tablet(s) by mouth once a day prn hydrocodone-acetaminophen - 7.5mg-750 mg tablet - 1- tablet(s) by mouth twice daily prn as needed for knee pain losartan-hydrochlorothiazide - 100 mg-12.5 mg tablet - 1 po qd omeprazole - 20 mg capsule, delayed release(e.c.) - 1 po qd sertraline - 50 mg tablet - 1tablet(s) by mouth once a day discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po tid (3 times a day). 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 3. sertraline 50 mg tablet sig: one (1) tablet po once a day. 4. celebrex 50 mg capsule sig: one (1) capsule po once a day as needed for pain. 5. alprazolam 0.5 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 6. hydrocodone-acetaminophen 7.5-750 mg tablet sig: one (1) tablet po twice a day as needed for pain. 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 8. furosemide 20 mg tablet sig: one (1) tablet po once a day as needed for leg swelling. 9. pradaxa 150 mg capsule sig: one (1) capsule po twice a day. 10. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. losartan 100 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: aortic root- left atrial fistula high blood pressure gastroesophageal reflux disease arthritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. it has been a pleasure participating in your care. you were admitted because there is a hole connecting your aorta with one of the of your heart. this connection does not seem to be enlarging so we do not think you need surgery to fix it at this time. you will need to follow-up with dr. who will continue to follow this issue. during your hospitalization we held your blood thinner, pradaxa. you can restart it now at your home dose. . we made the following changes to your medications 1. increase your hctz to 25 mg daily 2. added amlodipine 10 mg daily for blood pressure control followup instructions: name: , : internal medicine location: center address: , , phone: appointment: thursday at 2:10pm . department: cardiac services when: monday at 10:20 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: left heart cardiac catheterization diagnostic ultrasound of heart other electric countershock of heart diagnoses: esophageal reflux unspecified essential hypertension chronic hepatitis c without mention of hepatic coma atrial fibrillation hematoma complicating a procedure alcohol abuse, unspecified accidental puncture or laceration during a procedure, not elsewhere classified anxiety state, unspecified other specified cardiac dysrhythmias long-term (current) use of anticoagulants accidents occurring in residential institution acquired cardiac septal defect accidental cut, puncture, perforation or hemorrhage during heart catheterization 

Answer: The patient is high likely exposed to