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: the patient is a 48 year old female with a history of metastatic breast cancer status post lumpectomy and radiation with a history of two recent admissions in and , for bilateral malignant pleural effusions and bilateral pleurodesis requiring home o2 and bi-pap, now presenting with one week of progressive worsening shortness of breath. the patient noted, starting approximately one week ago, progressively worsening shortness of breath at rest with increasing home o2 requirements. two days prior to admission, the patient presented to the emergency department complaining of shortness of breath, increased heart rate, decreased o2 saturations in the low 90s. the patient was evaluated for pulmonary embolism by ct angiogram which was negative with only slight increase in the right pleural effusion and atelectatic changes. the patient was discharged home with home o2 to follow-up with her pulmonologist, dr. . on the morning of admission, the patient saw dr. , reporting worsening shortness of breath, increased o2 requirements from 1.5 to 4 liters, decreased o2 saturations from the mid-90s to the low 90s and increased heart rate above 100. an echocardiogram of the lungs was done showing no change in pleural effusions and the patient was referred to the for transthoracic echocardiogram. the echocardiogram revealed a moderate to large sized pericardial effusion with a right atrial collapse and a right ventricular diastolic collapse, consistent with impaired filling and tamponade. past medical history: 1. metastatic breast cancer diagnosed in : infiltrating ductal carcinoma status post lumpectomy and radiation with axillary node dissection, recurrence ; admission and for bilateral pleural effusions, bilateral pleurodesis requiring home o2. 2. cerebrovascular accident in : small hemorrhagic cerebrovascular accident from a cavernous hemangioma. 3. seasonal allergies. 4. right low anterior rib fracture. medications on admission: 1. xeloda 150 mg p.o. twice a day. 2. claritin q. day. 3. protonix 40 mg p.o. q. day. 4. ativan 0.4 to 1 mg p.o. q. six p.r.n. 5. motrin p.r.n. for rib pain. 6. home o2. allergies: no known drug allergies. social history: the patient has been an intensive care unit nurse here at the for 28 years. drinks alcohol socially. she has a 20 pack year history of tobacco and quit in . family history: the patient has an aunt and great-aunt with breast cancer. her mother died of mixed connective tissue disorder. her father died of hairy cell leukemia. physical examination: vital signs upon admission, temperature maximum of 97.7 f.; heart rate of 104 to 109; blood pressure of 121/89, nap of 102; respiratory rate of 30; pulses 16, 128/112. the patient's o2 saturation is 92 to 97 on four liters. generally, the patient is a thin female, notably short of breath while speaking. heent examination: no scleral icterus. extraocular muscles are intact. pupils are equal, round, and reactive to light and accommodation. mucous membranes were moist. neck examination: at 30 degrees with jugular venous distention approximately 10 centimeters. no carotid bruits noted. lung examination with decreased breath sounds bilaterally at the bases, right greater than left, crackles half way up the right side and a third of the way up the left side. dullness to percussion bilaterally, right greater than left; no wheezes. cardiovascular examination with increased heart rate; normal s1, split s2. no murmurs, rubs or gallops. pulsus paradoxus with radial pulse decreasing with inspiration. pulses at 16. her abdominal examination with normoactive bowel sounds. abdomen was nondistended, nontender. spleen tip was palpable. extremities were warm with normal dorsalis pedis pulses bilaterally. no peripheral edema, clubbing or cyanosis. neurologic examination: the patient is awake, alert and oriented times three with no gross lesions. laboratory data: on , white blood cell count 6.9, hematocrit of 39.2, platelets of 353. sodium 136, potassium 3.9, chloride 99, carbon dioxide 25, bun 15, creatinine 0.4, glucose 104, calcium 9.1. alkaline phosphatase 91, ast 24, alt 14, albumin 3.4, fsh 91. blood cultures negative. ca antigen and . ct angiogram in the emergency , showed no evidence of pulmonary embolus, slight interval increase in right pleural effusion with left loculated atelectatic changes. a lung ultrasound showing no change in pleural effusion. transthoracic echocardiogram showing left ventricular systolic function, mildly decreased septal hypokinesis, moderate to large pericardial effusion, right atrial collapse, right ventricular diastolic collapse consistent with impaired filling or tamponade. on , white blood cell count 5.7, hematocrit 37.5, platelets 329, potasium 4.1. hospital course: in brief, the patient is a 48 year old female with a history of metastatic breast cancer status post two recent admissions for bilateral malignant pleural effusions, bilateral pleurodesis requiring home o2 and bi-pap, now presenting with progressively worsening shortness of breath times one week and transthoracic echocardiogram consistent with pericardial effusion. 1. cardiovascular: the patient with an echocardiogram consistent with pericardial effusion. the patient was taken to the catheterization laboratory on , where the effusion was tapped and drained for 250 cc. of serosanguinous fluid. right ventricular pressure of 33/15, p- a pressure of 35/17, wedge of 21. cardiac output 5.3, cardiac index 3.2. the drain was subsequently pulled on . miss had an ekg upon admission which showed no evidence of electrical alternans and ekg upon discharge which also showed no evidence of electrical alternans. the house officer was called to see the patient in the evening of , for chest pain with inspiration. a pericardial rub was heard. an ekg showed some elevation in pr interval in avr. throughout her hospital course, the patient remained tachycardic, in the low 100s to 110. a follow-up echocardiogram was done revealing normal ejection fraction 45 to 50% and no evidence of pericardial effusion. 2. pulmonary: the patient has a history of malignant pleural effusions likely contributing to her symptoms of shortness of breath. dr. was made aware and recommended no further intervention at this point. the patient was saturating well in the low 90s to 95 range on four liters of nasal cannula which was decreased to two liters prior to discharge. the patient reported subjectively that her shortness of breath had improved somewhat following the tap. she will return home on home o2 and bi-pap. 3. hematology/oncology: the patient has a history of metastatic breast cancer and malignant bilateral pleural effusions, now with a new pericardial effusion which is exudative. cytology has been sent to evaluate if this is, in fact, a malignant pericardial effusion. dr. was made aware that the patient was hospitalized and involved in her care during her inpatient stay. she is scheduled to follow-up with him on tuesday, . she will continue on xeloda and pain control with morphine, percocet, toradol and motrin p.r.n. the patient was discharged home on , with the following medications, discharge diagnoses and instructions. discharge diagnoses: 1. new pericardial effusion, cytology pending. 2. metastatic breast carcinoma with a history of malignant pleural effusions. 3. cerebrovascular accident in . 4. seasonal allergies. 5. history of rib fracture. medications upon discharge: 1. xeloda 1650 mg twice a day. 2. protonix 40 mg p.o. q. day. 3. 60 mg p.o. q. day. discharge instructions: 1. an appointment has been made for miss to follow-up with dr. in hematology/oncology on tuesday, , at 02:30 p.m. 2. it is recommended that the patient have a follow-up echocardiogram to evaluate any further re-accumulation of pericardial fluid. 3. the patient is to call if she has worsening symptoms or shortness of breath, palpitations, chest pain. 4. the patient is to resume all prior medications. no new medications have been added upon this admission. , m.d. dictated by: medquist36 d: 14:56 t: 15:13 job#: procedure: pericardiocentesis right heart cardiac catheterization diagnoses: secondary malignant neoplasm of other specified sites secondary malignant neoplasm of pleura personal history of malignant neoplasm of breast 

Answer: The patient is high likely exposed to