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: patient recorded as having no known allergies to drugs attending: chief complaint: bradycardia major surgical or invasive procedure: pacemaker placement history of present illness: 84 yo man with spinal stenosis and a cardiac history significant for hyperlipidemia and stable asymptomatic rbbb, who initially presented to an osh for elective laminectomy on . the patient had been in his usoh until , walking miles per day with no cp, sob, palpitations, lightheadedness or syncope, when his back pain became unbearable and he elected to undergo laminectomy. following surgery on , the patient was noted to be bradycardic to 20s on the morning of pod#1 but remained asymptomaticand otherwise hemodynamically stable. he was initially thought to be in complete heart block by ekg but that impression was later revised to 2:1 heart block. he was transferred to for further evaluation and for possible pacemaker placement, and on admission continued to deny any history of cp/sob/doe, dizziness, syncope, palpitations or orthopnea. past medical history: hyperlipidemia stable rbbb, lad on past ekgs; no cardiac interventions l3 - l5 stenosis with pseudoclaudication s/p laminectomy hyperlipidemia, on statin bph, nocturia x3, on flomax gerd ptsd, stable per records s/p l knee arthroscopy s/p benign neck tumor excision social history: married, retired truck driver and former milkman -tobacco history: 35 pack-year history, quit 39 years ago -etoh: "occasional" family history: - brother with cad and - brother with pacemaker - father with pacemaker - mother with heart disease physical exam: vs: t= 98.8, bp= 114/50, hr= 45, rr= 22, o2 sat= 96% . general: wdwn male in nad, comfortable and conversant. oriented x3. mood, affect appropriate. . heent: well-healed scar over occipital scalp from "war wound," otherwise ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. . neck: supple with jvp of 5 cm at 30 degrees. . cardiac: pmi located in 5th intercostal space, 2cm left of midclavicular line. irregular rhythm but normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. . lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. . abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. . extremities: trace pedal edema. no c/c. no femoral bruits. . skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: labs 06:25am blood wbc-7.1 rbc-3.80* hgb-11.4* hct-33.5* mcv-88 mch-30.0 mchc-34.1 rdw-13.3 plt ct-187 05:44pm blood neuts-79.5* lymphs-13.4* monos-6.2 eos-0.7 baso-0.2 06:25am blood plt ct-187 06:25am blood pt-13.8* ptt-27.3 inr(pt)-1.2* 06:25am blood glucose-121* urean-27* creat-1.2 na-138 k-3.9 cl-103 hco3-25 angap-14 06:25am blood calcium-8.6 phos-2.5* mg-1.8 05:44pm blood tsh-1.2 =========== studies =========== tte the left atrium is 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%). the right ventricular cavity is dilated with depressed free wall contractility. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , the right ventricle appears dilated with depressed function and there is mild pulmonary artery systolic hypertension seen. chest pa and lateral () reason for exam: 84-year-old man with status post pacer, evaluate for lead position. since yesterday, left-sided dual-chamber pacemaker ends in expected position. there is no pneumothorax. the aorta is tortuous. basilar opacities are likely due to atelectasis. minimal elevation of the right hemidiaphragm is unchanged. there is no other change. the study and the report were reviewed by the staff radiologist. ecg () sinus bradycardia with probable wenckebach mobitz type i a-v block. right bundle-branch block. non-specific st-t wave abnormalities. no previous tracing available for comparison. brief hospital course: this is an 84 yo man with spinal stenosis and a cardiac history significant for hyperlipidemia and stable rbbb, s/p elective laminectomy and developed bradycardia and hypotension on pod#1, with heart block on ekg, and was then transferred to for further evaluation and treatment. . rhythm: ekg and tele tracings today show dropped beats with various conduction patterns including 2:1 block and a likely type i second degree av block/wenkebach pattern. the patient remained asymptomatic throughout these episodes while monitored on telemetry. a medication related conduction abnormality was considered, but felt to be unlikely given that his amlodipine had been held at for low bp prior to the onset of heart block and he had recieved no other nodal blocking agents. prior ekgs pre-op show stable 1st-degree hb, rbbb and left-axis deviation without lvh which was concerning for lafb, and probably type i wenkebach 2nd degree hb. there is no prior record of bradycardia, and the 2:1 block with low hr on admission was concerning for possible progression of his conduction disease. a tsh was checked and was within normal range, and thus given the patient's extensive fascicular conduction disease, a pacemaker was placed on . the patient was given antibiotics pre and post procedure. he will continue on levoflox for 3 days after discharge. his cxr showed proper placement of his pacemaker. the patient will have follow-up with dr. on . the patient was called at his home to let him know of the scheduled appointment. . coronaries: no hx of cad, no sx of acs. on baby aspirin daily at home, which was continued. on admission, the patient's amlodipine, spironolactone and cozaar were held given that he remained normotensive to slightly hypotensive. he was continued on his statin throughout this hospitalization. the amlodipine was restarted on discharge given normotensive to hypertensive pressures. . pump: no hx of chf; last echo showed normal ef. clinically slightly volume up, on spironolactone at home. initially the patient's spironolactone was held given his low/normal blood pressures on arrival. a tte on confirmed a lvef of >55%. . crf: cre stable since at 1.5-1.6, and remained stable throughout this hospitalization. . bph: the patient was continued on his tamulosin during his hospitalization. medications on admission: home medications: . amlodipine 5 mg po daily spironolactone 25 mg po daily pravastatin 20 mg po daily omeprazole 20 mg po daily asa 81 mg po daily flomax 0.4 mg daily cozaar 50 mg daily vitamin e daily . medications on transfer from . trazodone 100 mg po qhs dilaudid 0.5-1.0 mg im q3h for breakthrough pain aspirin 81 mg po daily cefazolin 1g po q8h pravastatin 20 mg po daily omeprazole 20 mg po daily multivitamin 1 tab po daily senna 2 tabs po qhs apap 650 mg po q4h prn: pain discharge medications: 1. pravastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for back pain. 6. tylenol-codeine #3 300-30 mg tablet sig: 1-2 tablets po every six (6) hours as needed for severe pain: do not take more than 12 tabs in 24 hours. disp:*20 tablet(s)* refills:*0* 7. senna 8.6 mg tablet sig: one (1) tablet po once a day as needed for constipation. 8. colace 100 mg capsule sig: one (1) capsule po once a day as needed for constipation. 9. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 10. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 3 days. disp:*3 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary: heart block (wenkebach), status post pacemaker placement secondary: l3 - l5 stenosis with pseudoclaudication status post laminectomy hyperlipidemia benign prostic hypertrophy gastroesophageal reflux disease post traumatic stress disorder status post left knee arthroscopy status post benign neck tumor excision discharge condition: stable. discharge vs: t 98.3, bp 145/85, hr 68, rr 16, sao2 98-100%ra discharge instructions: you were transferred to this hospital becuase you developed a slow heart rhythm following your back surgery. you were seen by our electrophysiologists who determined you needed a pacemaker which was placed without any complications. new medications: - levofloxacin is an antibiotic medication that you should take for the next 3 days to avoid infection from your recent procedure - senna and colace are medications that help relieve constipation - you should take acetaminophen (tylenol) for your back pain, and use the prescription for tylenol #3 if the regular tylenol is not enough. stop taking: cozaar spironolactone when you get home, please call your back surgeon, dr. , from the to make a follow-up appointment. his phone number is (. followup instructions: - provider: . (:45am) - provider: , pcp. : . date/time: , 1:15 - provider: , surgery. phone: ( procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: esophageal reflux hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia other specified cardiac dysrhythmias other second degree atrioventricular block 

Answer: The patient is high likely exposed to