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: symptomatic bradycardia. major surgical or invasive procedure: pacemaker placement. history of present illness: ms. is a 75 year-old woman with a history of cad s/p cabg, bovine avr, dvt on lovenox, and endometrial cancer s/p xrt who is transferred from hospital for management of symptomatic bradycardia, syncope. she was in usual state of health until the morning of when she had syncope while walking to the cafeteria and fell to the ground. she denied prodrome, sob, lightheadedness or cp prior to the event. she did not have loss of bladder or bowel function (although she has some stool incontinence at baseline). she denied any numbness or tingling, weakness, or amnesia. ros was otherwise negative for fever, chills, headache, cough, dysuria, melena, brbpr. she initially presented to where vitals in the ed were 96.0 hr 60 bp 141/79 rr 18 100% ra. her exam and labs were unrevealing. cxr was negative. head ct showed 3-4 cm hematoma. for reasons that are unclear, she was then transferred to the . at the , she developed bradycardia to the 30s which was found to be sinus arrest with narrow junctional escape. her rate increased spontaneously without atropine and pads were placed. cardiology was consulted and recommended transfer to for ep evaluation. on arrival to , she had a 10 second symptomatic pause on tele while on and transfer to ccu was requested. on arrival to the cvicu, she denied chest pain and dyspnea but noted a dizziness and light-headedness associated with her bradycardic episodes. during evaluation, she had another 10 second pause in which she was unresponsive, followed by spontaneous recovery. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations. past medical history: - avr, bovine - cad s/p cabg - htn - hld - dvt (rle, popliteal and femoral) , on lovenox - endometrial cancer s/p xrt - hysterectomy - tonic clonic seizure thought to be pres - bilateral hearing aids social history: widowed x 5 years, lives in . has two sons and works as telphone operator in the state lab. -tobacco history: quit in -etoh: occasional -illicit drugs: none family history: father died of throat cancer. mother died of cad, sister with disease, hld, htn. physical exam: general: nad heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple, no jvd cardiac: brady, normal s1, s2. 2/6 sem lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles. abdomen: soft, ntnd. midline lower abdominal scar, well-healed. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: 2 + dp left: 2+ dp pertinent results: laboratory results on admission 10:57pm blood wbc-6.2 rbc-3.87* hgb-12.3 hct-34.9* mcv-90 mch-31.8 mchc-35.2* rdw-13.1 plt ct-150 10:57pm blood pt-12.0 ptt-26.6 inr(pt)-1.0 10:57pm blood glucose-114* urean-19 creat-0.7 na-140 k-4.1 cl-105 hco3-26 angap-13 10:57pm blood alt-152* ast-29 ld(ldh)-238 ck(cpk)-87 alkphos-184* totbili-0.9 10:57pm blood ck-mb-notdone ctropnt-<0.01 08:15am blood ck-mb-notdone ctropnt-<0.01 10:57pm blood calcium-8.5 phos-3.7 mg-2.1 10:57pm blood tsh-0.42 laboratory data on discharge 06:45am blood wbc-4.9 rbc-3.80* hgb-11.9* hct-34.2* mcv-90 mch-31.2 mchc-34.7 rdw-13.2 plt ct-159 06:45am blood glucose-89 urean-20 creat-0.8 na-142 k-4.7 cl-108 hco3-27 angap-12 08:15am blood ck(cpk)-75 06:45am blood calcium-8.5 phos-3.1 mg-2.2 ekg sinus bradycardia. left axis deviation. left anterior fascicular block. no previous tracing available for comparison. rate pr qrs qt/qtc p qrs t 56 132 94 440/433 43 -45 19 echocardiography the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. a mechanical aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cxr procedure: chest pa and lateral. reason for exam: assess for lead placement following placement of pacemaker. findings: the new atrial and ventricular pacing leads appear in satisfactory position. mild linear atelectases along the left heart border may be chronic. lungs are are clear. no pleural effusion or pneumothorax. heart size is top normal with previous median sternotomy and aortic valve replacement. impression: no acute cardiopulmonary findings. satisfactory placement of atrial and ventricular pacing leads. brief hospital course: precis ms. is a 75 year-old woman with a history of cad s/p cabg, bovine avr, dvt on lovenox, and endometrial cancer s/p xrt who is transferred from hospital for management of symptomatic bradycardia and syncope. permanent pace-maker was placed without complication. bradycardia and sinus pause were attributed to age-related conduction system degeneration. hospital course by problem bradycardia on the day of admission, ms. had a 10 second symptomatic pause. atropine (0.5 mg iv) was given and dopamine started with no further pauses, but a subsequent bradycardic episode to 40s bpms. atropine was again given (1 mg iv), however on this occasion she was sleeping and it was unclear whether this bradycardia was symptomatic. various causes of this were excluded including electrolyte disturbance, ischemia (enzymes flat), hypothyroidism (tsh normal), attributed to senile degeneration of the conduction system with possible contribution by atenolol. on the following day, a permanent pacemaker was placed (please see dr. note for further specification of this device and settings). chest x-ray films showed good lead placement without physiologic or radiographic evidence of complication. she will follow-up with dr. on at 12:30 clinic. lovenox was syncope attributed to bradycardia or sinus pause. no head injury was sustained. hypertension ms. antihypertensives were held in the setting of bradycardia and hypotension. after pacer placement and restoration of good ventricular rates, ms. blood pressure remained within the normal range (80s to 130s). half-doses, relative to pre-admission, were given and hctz was not restarted. these all may require up-titration after discharge. deep venous thrombosis course of lovenox was to be stopped in this year and was not. therefore this medication was stopped prior to pacer placement and not restarted. there was initially some confusion about whether this was to continue indefinitely in the context of endometrial cancer, but this was resolved by discussion with her pcp. coronary artery disease post-cabg. no evidence of ischemia during the admission, based on history, symptoms, ekg and enzymes. statin was continued and atenolol continued at half the pre-admission dose. endometrial cancer treated with xrt and hysterectomy. non-active and no related investigations or treatment during the admission. medications on admission: atenolol 100 mg po daily simvastatin 80 mg po daily lisinopril 40 mg po daily loperamide 2 mg po daily prn hctz 25 mg po daily lovenox 90 mg po daily discharge medications: 1. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 2. loperamide 2 mg tablet sig: one (1) tablet po once a day. 3. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 2 doses. disp:*2 capsule(s)* refills:*0* 4. atenolol 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. simvastatin 80 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary diagnosis: sick sinus syndrome - bradycardia with 10 second pauses secondary diagnosis: hypertension deep vein thrombosis status post endometrial cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you came to the hospital because you fell. you were found to have a slow heart rate with long pauses. you were given a pacemaker which will prevent this from happening in the future. you tolerated the procedure well. please refrain from lifting more than 5 pounds raising your left arm above your shoulder for 6 weeks. there are no restrictions on your right arm. keep the dressing dry for 4 days, after that you can remove the dressing and take a shower, leaving the steristrips in place. do not use soap over the site. you can return to work after dr. says it is ok. the following changes have been made to your medication list: **start keflex 500 mg every 6 hrs for 2 doses ** decrease lisinopril to 20 mg a day ** decrease atenolol to 50 mg a day ** stop hctz (please talk to your primary care doctor g) ** stop lovenox shots (please talk to your primary care doctor about restarting) please follow up with your primary care doctor and your cardiologist (see below). it was a pleasure taking part in your care. followup instructions: please follow up with your primary care doctor, dr. . we have made an appointment for you on wed, at 12:10 pm. if this time does not work, please call to reschedule. please also follow up with dr. in cardiology. you have an appointment scheduled for at 12:30 at the office. please call ( for directions or if you need to change this appointment. md procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: unspecified essential hypertension coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of malignant neoplasm of other parts of uterus long-term (current) use of anticoagulants personal history of venous thrombosis and embolism heart valve replaced by transplant sinoatrial node dysfunction 

Answer: The patient is high likely exposed to