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: no known allergies / adverse drug reactions attending: chief complaint: pericardial effusion and hypotension major surgical or invasive procedure: - pulmonary vein isolation procedure with ablation history of present illness: this is a 55 year-old woman was diagnosed with paroxysmal atrial fibrillation 2 years ago after developing palpitations, insufficiently controlled with flecainide 100mg and metoprolol. she continue to have increasing episodes of atrial fibrillation, lasting from minutes to hours, occurring 3-4 times per week. she is symptomatic with exertional dyspnea and decreased energy level. due to her increasing symptoms on flecainide, she was referred for pvi. on the morning of admission, she underwent pvi with difficult transeptal access to pulmonary veins. she had transient atypical flutter with low blood pressure, got cardioverted intraoperatively. post-pvi, it was noted that she had small pericardial effusion. plan is to have echo this pm then start pradexa tonight. . when patient arrived to the unit, she was in no acute distress. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: hypertension 2. cardiac history: - cabg: none - percutaneous coronary interventions: none - pacing/icd: none . 3. other past medical history: - paroxysmal atrial fibrillation - hypertension - thyroid nodules s/p biopsy (negative) - w/u for pheocromocytoma d/t admission to for hypertension - partial hysterectomy with bladder suspension 10 years ago - hand tingling in setting of hypertension ? tia - presumptive uti saturday -started cipro 500mg - tonsillectomy as a child social history: the patient is married with 2 children, ages 24 and 20. she works as a dietician and diabetes educator in private practice. she previously smoked for many years and quit 35 years prior. she denies alcohol or recreational substance use. family history: father died of cad at age 65. mother died in her 50s from colon cancer. physical exam: admission exam: vs: t=99 bp=108/72 hr=78 rr=18 o2 sat=100% on mask height 5 feet 8 inches weight: 203 lbs general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: with soft neck collar on. cardiac: rr, 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. extremities: no c/c/e. no femoral bruits, + catheters on exam skin: burn noted on her back. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: 02:34pm blood wbc-7.2 rbc-4.21 hgb-13.6 hct-38.7 mcv-92 mch-32.2* mchc-35.0 rdw-11.8 plt ct-207 . 03:13am blood wbc-7.1 rbc-3.44* hgb-11.2* hct-32.0* mcv-93 mch-32.6* mchc-35.1* rdw-11.6 plt ct-145* . 02:34pm blood pt-12.0 ptt-47.3* inr(pt)-1.1 . 03:13am blood pt-15.3* ptt-48.4* inr(pt)-1.4* . 07:00am blood glucose-106* urean-24* creat-0.9 na-138 k-4.9 cl-106 hco3-23 angap-14 . 03:13am blood glucose-117* urean-13 creat-0.8 na-134 k-4.1 cl-104 hco3-23 angap-11 . 02:34pm blood alt-32 ast-52* alkphos-52 totbili-0.6 . 05:29am blood alt-28 ast-47* ld(ldh)-214 alkphos-42 totbili-0.7 . 02:34pm blood calcium-8.7 phos-3.3 mg-1.7 . microbiologic data: mrsa screen - pending at discharge . imaging studies: 2d-echo - there is a small-sized pericardial effusion. there are no echocardiographic signs of tamponade. . 2d-echo - overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , no change. . cxr - as compared to the previous radiograph, there is a newly appeared small retrocardiac atelectasis. small bilateral pleural effusions might also have newly occurred. no overt pulmonary edema. unchanged appearance of the cardiac silhouette and the mediastinum. brief hospital course: 55f with a pmh significant for paroxysmal atrial fibrillation insufficiently controlled with flecainide and metoprolol, but without previous anticoagulation, who presented as an outpatient with continued worsening of symptoms, who underwent pulmonary vein isolation and ablation on which was notable for a circumferential pericardial effusion seen on echocardiogram with some evidence of hypotension which warranted ccu admission for monitoring. . # pericardial effusion, hypotension ?????? the patient presented with transient intra-op hypotension and some 2d-echo evidence of pericardial effusion following pvi procedure for atrial fibrillation. etiologies considered included: myocardial infarction, severe hypothyroidism, or end-stage renal disease and malignancy can all be precipitating etiologies, but these were deemed unlikely ?????? post-intervention effusion is most likely. she has remained hypotensive in the ccu in the 75-80 mmhg systolic range, which has responded subtly to 3l of resuscitation fluid. her pulsus paradoxus remains < 10 mmhg ( mmhg on serial monitoring) and repeat 2d-echo this admission showed a stable, small pericardial effusion without tamponade physiology. she will have a repeat echocardiogram as an outpatient. she remained hemodynamically stable prior to discharge. . # atrial fibrillation ?????? the patient has a history of paroxysmal atrial fibrillation which has been rate controlled with metoprolol and she has had intermittent rhythm control with flecainide. per her outpatient cardiologist, she has been having increasing episodes of atrial fibrillation lasting anywhere from minutes to hours and she knows when she is in atrial fibrillation immediately, not because of heart racing, but because she feels short of breath and does not have much energy. she is s/p pulmonary vein isolation from as an outpatient with ablation which was complicated by a small pericardial effusion (see above). this remained stable without tamponade physiology on serial echocardiography. she remained in normal sinus rhythm on discharge. her rate was controlled with metoprolol 50 mg xl po daily. her rhythm control ?????? was previously on flecainide and will continue on this medication; pvi procedure went well and she remains in normal sinus rhythm. for her anticoagulation, we started and will continue pradaxa 150 mg po bid ?????? she did have some nausea with this medication. we optimized her electrolytes and monitored her via telemetry. . # arthritis ?????? we continued her home medication of oxycodone-acetaminophen 1-2 tabs po q4h prn pain and toradol dosing. she had no acute issues or new symptoms. . # hypertension - we held her home lisinopril and spironlactone medications given her tenuous blood pressures, but we continued her metoprolol dosing with good effect. . # urinary tract infection - she was completing her final day of a ciprofloxacin course on given an outpatient positive urine dipstick. no dysruria or hematuria complaints this admission. no urine culture data in our system. afebrile without leukocytosis this admission. . transition of care issues: 1. the patient will have outpatient laboratory studies checked (including her lfts, inr and cbc with electrolytes) which will be followed-up by her primary care physician. 2. she will have repeat 2d-echocardiogram imaging, that will be followed-up by dr. , to evaluate her small and stable pericardial effusion. 3. at the time of discharge, she had no pending laboratory evaluations. her mrsa swab from admission to the icu was pending on discharge. she had no pending radiologic imaging studies at discharge. 4. your primary care physician will determine (in addition to your cardiologist) the need for resuming your spironolactone and lisinopril medication once your blood pressure stabilizes. 5. she had a small burn from a grounding pad placed during her procedure that was treated with silvadene dressings and was healing well at discharge. 6. she will have follow-up with dr. and her primary care physician, an outpatient. medications on admission: 1. conjugated estrogens (premarin) 0.625 mg/gram cream (1 gram) intravaginally twice daily 2. flecainide 150 mg po in the am, 75 mg po in the pm 3. lisinopril 40 mg po daily 4. metoprolol succinate 50 mg po daily 5. spironolactone 25 mg po daily 6. aspirin 325 mg po daily 7. calcium carbonate 500 (1250 mg) po daily 8. docusate sodium 100 mg po bid 9. omega-3 fatty acid-vitamin e discharge medications: 1. outpatient lab work please check inr, alt, ast, total bilirubin, electrolytes, cbc. please send results to , e. phone: . fax number: 2. premarin 0.625 mg/gram cream sig: one (1) gram vaginal twice weekly. 3. flecainide 50 mg tablet sig: three (3) tablet po breakfast (breakfast). 4. flecainide 50 mg tablet sig: 1.5 tablets po hs (at bedtime). 5. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*0* 7. calcium carbonate 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po once a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. omega-3 fatty acids-vitamin e oral 10. silver sulfadiazine 1 % cream sig: one (1) appl topical (2 times a day). disp:*2 tubes* refills:*0* 11. dabigatran etexilate 150 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 12. indomethacin 50 mg capsule sig: one (1) capsule po three times a day for 1 weeks. disp:*21 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses: 1. paroxysmal atrial fibrillation 2. hypotension . secondary diagnoses: 1. essential hypertension 2. chronic low back pain discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: patient discharge instructions: . you were admitted to the coronary care unit at on 6 regarding management of your atrial fibrillation. you underwent a successful pulmonary vein isolation procedure with ablation and restoration of your normal heart rhyhm. you had some low blood pressure and evidence of a small collection of fluid around the heart (pericardial effusion) which was serially imaged and appeared stable. you will follow-up with dr. as an outpatient in 6-weeks and have repeat 2d-echo imaging to assess the fluid, as an outpatient. you will also see your primary care physician next week. overall you were feeling well prior to discharge. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: . * upon admission, we added: start: indomethacin by mouth for 5-days total (end date ) start: dabigatran 150 mg by mouth twice daily start: silver sulfadiazine (1% cream) 1 application applied twice daily to burn on back, as needed . we changed: decreased your aspirin from 325 to 81 mg by mouth daily . * the following medications were discontinued on admission and you should not resume: hold: lisinopril (until discussing this with your cardiologist or pcp) hold: spironolactone (until discussing this with your cardiologist or pcp) discontinue: ciprofloxacin . * you should continue all of your other home medications as prescribed, unless otherwise directed above. followup instructions: department: primary care name: dr. when: monday at 11:00 am location: of address: , , phone: . department: cardiology name: dr. when: dr. office is working on a hospital follow up appointment for you in 6-weeks after your hospital discharge. if you have not heard from the office in 2 business days please call the number listed below. location: address: , 7, , phone: . you have an outpatient repeat 2d-echocardiogram (heart ultrasound) scheduled in 1-week on thursday, at 2:00 pm. . department: cardiac services when: thursday at 2:00 pm with: echocardiogram building: sc clinical ctr campus: east best parking: garage procedure: other electric countershock of heart excision or destruction of other lesion or tissue of heart, endovascular approach diagnoses: other iatrogenic hypotension urinary tract infection, site not specified unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation atrial flutter cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure lumbago acute pericarditis, unspecified arthropathy, unspecified, site unspecified burn [any degree] involving less than 10 percent of body surface with third degree burn, less than 10 percent or unspecified other specified misadventures during medical care erythema [first degree] of back [any part] 

Answer: The patient is high likely exposed to