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: penicillins / codeine / nsaids / levaquin attending: chief complaint: shortness of breath major surgical or invasive procedure: defibrillation history of present illness: 34 yo woman with h/o hypertrophic cmy, multifocal atrial tachycardias s/p failed pvi , c/b pericardial tamponade c window c/b pea arrest x 45 minutes with temporary cvvhd, and recent admission for sob, treated for volume overload, who was admitted with chief complaint of shortness of breath and chest pain. initial vitals in ed showed t 97, hr 55, bp 124/66, rr 19, with o2 sat 100% on 4l. pt. being evaluated by resident in ed, denying cp, when she acutely c/o dyspnea and was noted to have wide complex rhythm on tele and lost pulse. given 2 rds epi, 1 rd atropine, 2 rds bicarb/ca chloride/insulin/d50 for presumed hyperkalemia as initial ekg showed sine wave pattern. also given 2l ivfs. she was coded for 30 minutes after which she regained pulse and ekg showed nsr with wide complex with rbbb. initial bp 202/68. she then developed wide complex ventricular tachycardia with bp 68/p, for which she was defibrillated x 1 200j and started on dopamine. at that point, she returned to nsr and was quickly weaned off dopamine gtt. . she had non-sterile r femoral line placed for access. initial labs (during code) showed k 5.5 on abg (unclear if before or after tx. for hyperkalemia) with abg of 6.92/63/50. bedside tte without pericardial effusion. cxr showed new r>l pleural effusions, and given difficulty of oxygenating, r chest tube placed with estimated 200cc out. she was transiently placed on dopamine gtt for hypotension s/p code, but quickly sbps returned and dopamine weaned. . per patient care referral, pt. c/o nausea and pain at 8:30 this am, with sob, lethargy, diaphoresis. per initial nursing note in , pt. also reports diarrhea, nausea, abdominal pain over last few days. ekg showed sinus bradycardia, with rbbb. pt. reported to weigh 192.9 lbs, which is lb. decrease from admission. vitals were significant for no fever, bp 80s-100s/50s-70s, satting 100% on 2l. pt. with cold extremities, so was transferred to . past medical history: # hypertrophic cardiomyopathy. - cardiac mr on with asymmetric lvh with maximal wall thickness of 19mm at mid septum with focal hyperenhancement consistent with hypertrophic cm. ef 55%. # svt with a fib, left atrial tach and avnrt s/p pulmonary vein isolation on . # questionable history of wpw # tobacco use with bronchitis and associated multifocal a tach. # anxiety # obesity # asthma, ?copd cardiac history: the patient initially presented with syncope at age of l2. at l3, the patient was seen at for history of syncope, chest pain and progressive exercise intolerance. she was found to have hypertrophic cardiomyopathy. she was subsequently cathed. left ventricular end diastolic pressure was found to be 20. she was then started on chronic verapamil therapy. at age l6, she experienced cardiac arrest secondary to complex tachycardia. she was successfully resuscitated. repeat catheterization showed left ventricular end diastolic pressure of 36-40 without outflow tract obstruction. ep showed inducible atrial flutter with a rapid ventricular blood pressure. she was felt to have a rapid antegrade conduction and possible pre-excitation. she was started on norpace. since then, the patient has been stable on verapamil and norpace with occasional palpitations, chest pain and light headedness. social history: currently on disability. 40 pack-year smoker (2ppd x20 years) quit since recent bronchitis. no etoh. regular marijuana use. family history: family history remarkable for hypertrophic cardiomyopathy and congenital aortic stenosis s/p cardiac surgery during infancy. no family history of sudden cardiac death or premature cad. physical exam: vs t 99.4 hr 68 bp 129/79 rr 32 100% on vent ac 100%/tv:480/rr28/peep 14. . gen: pale woman, intubated, without spontaneous facial movements heent: ncat, + periorbital ad conjunctival edema neck: supple, no lad, jvp cv: distant heart sounds. rrr. normal s1 and s2. no m/r/gs. pulm: minimal crackles at bases, but mostly clear. no wheezes. chest tube in place on r lateral chest abd: obese, soft, nondistended, no organomegaly or masses noted ext: trace bilateral lower extremity edema. cool extremities. 2+ dp pulses bilaterally. neuro: done prior to any sedation or paralytics given. perrl, + doll's, + corneal reflex, + gag reflex, is overbreathing vent. nl. bulk, tone flaccid, some spontaneous movements in distal ues. none noted in les. not withdrawing to pain or sternal rub. reflexes absent in upper and lower extremities. mute to babinski. pertinent results: 11:12pm type-art temp-37.4 po2-206* pco2-25* ph-7.54* total co2-22 base xs-1 11:12pm lactate-7.3* k+-4.0 11:12pm hgb-8.2* calchct-25 08:32pm type-art temp-37.7 po2-353* pco2-32* ph-7.40 total co2-21 base xs--3 08:32pm lactate-9.9* 08:32pm hgb-9.1* calchct-27 o2 sat-98 08:32pm freeca-1.27 08:25pm glucose-119* urea n-32* creat-1.2* sodium-131* potassium-4.6 chloride-92* total co2-15* anion gap-29* 08:25pm alt(sgpt)-128* ast(sgot)-452* alk phos-121* amylase-36 tot bili-1.8* 08:25pm lipase-27 08:25pm albumin-2.8* calcium-10.6* phosphate-6.7* magnesium-1.9 08:25pm wbc-21.1*# rbc-2.74* hgb-8.5* hct-26.9* mcv-98# mch-31.0 mchc-31.7 rdw-20.4* 08:25pm plt count-279 08:25pm pt-93.1* ptt-59.9* inr(pt)-12.2* 06:32pm type-art rates-/29 tidal vol-430 peep-14 o2-100 po2-76* pco2-46* ph-7.07* total co2-14* base xs--16 aado2-604 req o2-97 intubated-intubated 06:12pm type-art tidal vol-400 peep-14 o2-100 po2-30* pco2-59* ph-6.94* total co2-14* base xs--23 aado2-637 req o2-100 intubated-intubated 06:12pm lactate-12.6* 05:27pm po2-50* pco2-63* ph-6.92* total co2-14* base xs--22 05:27pm glucose-216* lactate-16.4* na+-129* k+-5.5* cl--94* 05:27pm hgb-8.2* calchct-25 o2 sat-54 carboxyhb-2.5 met hgb-0.3 05:27pm freeca-1.16 05:23pm glucose-223* urea n-27* creat-1.1 sodium-131* potassium-5.6* chloride-91* total co2-11* anion gap-35* 05:23pm ck(cpk)-55 05:23pm ck-mb-notdone ctropnt-0.03* 05:23pm calcium-9.3 phosphate-6.7*# magnesium-2.1 05:23pm wbc-13.7* rbc-2.66* hgb-8.2* hct-28.5* mcv-107*# mch-31.0 mchc-28.9* rdw-20.4* 05:23pm neuts-63.0 lymphs-34.1 monos-2.3 eos-0.1 basos-0.5 05:23pm plt count-207 07:45am blood wbc-12.2* rbc-2.86* hgb-8.5* hct-28.0* mcv-98 mch-29.8 mchc-30.4* rdw-18.3* plt ct-675* 07:45am blood pt-23.5* ptt-36.5* inr(pt)-2.3* 07:45am blood glucose-87 urean-13 creat-0.7 na-134 k-3.8 cl-91* hco3-32 angap-15 04:28am blood alt-469* ast-362* ld(ldh)-500* alkphos-132* totbili-3.2* 12:00pm blood ck(cpk)-24* 08:25pm blood lipase-27 12:00pm blood ck-mb-notdone ctropnt-0.02* 07:45am blood calcium-8.6 phos-4.1 mg-1.6 04:02pm blood calcium-8.9 phos-3.8 mg-1.9 iron-18* 08:25pm blood albumin-2.8* calcium-10.6* phos-6.7* mg-1.9 04:02pm blood caltibc-260 vitb12-1744* folate-12.4 ferritn-995* trf-200 03:11pm blood osmolal-277 03:34pm blood type-art temp-36.9 fio2-98 po2-86 pco2-41 ph-7.51* caltco2-34* base xs-8 aado2-579 req o2-94 intubat-not intuba 04:11am blood lactate-1.2 04:41pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirub-neg urobiln-1 ph-5.0 leuks-tr 04:41pm urine rbc-0-2 wbc-3 bacteri-mod yeast-none epi-0-2 04:00am urine hours-random k-37 04:00am urine osmolal-364 . bcx negative ucx negative sputum gs/cx negative . chest (portable ap); -76 by same physician : as compared to the previous radiograph, the extent of right-sided parenchymal opacity is minimally resolving. unchanged areas of cardiomegaly. no newly appeared parenchymal opacities. newly placed right chest tube sideport appears outside of the hemithorax with reduced right effusion noted. ngt is within the stomach. . chest (portable ap) 5:51 pm chest ap: moderate cardiomegaly is present. there is bilateral vascular engorgement and perihilar opacities, greater on the right. a small right pleural effusion has developed or increased in size. endotracheal tube tip is 9 mm above the carina. osseous structures are unremarkable. impression: 1. interval development of moderate-to-severe pulmonary edema. 2. endotracheal tube 9 mm above the carina and should be withdrawn 2 cm. . ecg study date of 4:29:28 pm sinus rhythm. the p-r interval is prolonged. the qrs interval is profoundly prolonged at 200 milliseconds and raises consideration of hyperkalemia. compared to the previous tracing qrs interval prolongation is new. tracing #1 . ecg study date of 4:46:36 pm probable sinus rhythm with a sinusoidal pattern consistent with severe hyperkalemia or agonal rhythm. clinical correlation is advised. compared to the previous tracing these findings are new. tracing #2 . ecg study date of 5:08:10 pm probable sinus rhythm with a sinusoidal consistent with severe hyperkalemia or agonal rhythm. compared to the previous tracing there is no significant change. tracing #3 . ecg study date of 5:14:06 pm probable ectopic atrial rhythm. the qrs is profoundly prolonged consistent with severe hyperkalemia. compared to the previous tracing agonal rhythm is no longer present. tracing #4 . ecg study date of 5:17:34 pm probable sinus rhythm. the p-r interval is prolonged. the qrs duration is profoundly prolonged consistent with severe hyperkalemia. compared to the previous tracing qrs interval prolongation persists. tracing #5 . ecg study date of 6:42:16 pm sinus rhythm. left axis deviation. non-specific intraventricular conduction delay. diffuse non-specific st-t wave changes. compared to the previous tracing multiple severe abnormalities have improved. tracing #6 . chest (portable ap); -77 by different physician : in comparison with study of , the right chest tube has been removed. no evidence of pneumothorax. otherwise, little overall change. the right-sided parenchymal opacification persists, as does the retrocardiac opacification consistent with atelectasis and effusion. the other tubes remain in place. . chest (portable ap) 8:10 am as compared to the previous radiograph, the monitoring and support devices are in unchanged position. unchanged position of the right-sided chest tube, the side port of the chest tube is still in the thoracic wall and slightly outside the lung. the right-sided parenchymal opacity is further resolving. subtle increase of the retrocardiac atelectasis. otherwise, no newly-appeared parenchymal opacities. no evidence of pleural effusions. . echo : conclusions the left and right atria are moderately dilated. there is moderate symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no valvular or resting lvot gradient. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). the estimated pulmonary artery systolic pressure is high normal. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the magnitude of tricuspid regurgitation and the estimated pulmonary artery systolic pressure have decreased. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. . ecg study date of 8:57:12 am sinus rhythm. the p-r interval is 120 milliseconds. left axis deviation. non-specific intraventricular conduction delay. diffuse non-specific st-t wave changes. compared to the previous tracing there is no significant change. tracing #7 . chest port. line placement 2:06 pm findings: in comparison with earlier films of this date, there has been placement of a right subclavian picc line with its tip in the upper portion of the svc. the opacification at the right base is slightly less prominent and there has been a better inspiration. the endotracheal tube and nasogastric tubes have been removed. . ecg study date of 11:22:44 am sinus rhythm. peaked p waves consistent with right atrial enlargement. right bundle-branch block. compared to the previous tracing of right bundle-branch block has appeared. clinical correlation is suggested . chest (pa & lat) 11:19 am pa and lateral views of the chest: the heart remains enlarged, and there are new, ill-defined airspace opacities at both bases, most likely due to edema given the rapid time appearance. pulmonary vasculature remains slightly engorged. a focus of linear opacity in the left lung base is likely atelectasis. the upper lung zones remain relatively well aerated with no focal consolidation or pneumothorax. a right picc terminates at the origin of the svc. impression: interval increase in pulmonary edema, with persistent cardiomegaly and fluid overload. . ecg study date of 4:45:32 am coarse atrial fibrillation. minimal left axis deviation with right bundle-branch block. compared to the previous tracing of atrial fibrillation has replaced normal sinus rhythm. coarse atrial fibrillation is stated by some to be more frequent with valvular heart disease than coronary heart disease. . ecg study date of 3:17:28 am coarse atrial fibrillation with a rapid ventricular response. left axis deviation with probable left anterior fascicular block. probable right bundle-branch block. non-specific st-t wave changes. compared to the previous tracing of no significant change. tracing #1 . ecg study date of 8:21:56 am coarse atrial fibrillation/atrial flutter with a rapid ventricular respo nse. compared to the previous tracing no significant change. tracing #2 . ecg study date of 8:15:26 am atrial fibrillation with rapid ventricular response. compared to the previous tracing no significant change. tracing #3 brief hospital course: 34 yo woman with hypertrophic cardiomyopathy, multifocal atrial tachycardia, atrial fibrillation/flutter, h/o avnrt, with multiple previous cardiac arrests with pea arrest, likely hyperkalemia. . # s/p pea arrest: etiologies include hyperkalemia, vs. other acidosis which precipated hyperkalemia. unsure of what precipitated hyperkalemia. patient was receiving kdur supplements at , however this still should not have been enough to cause her degree of hyperkalemia. patient has been hypokalemic since admission, and has required k supplements. during resuscitation patient had two lines placed which were non-sterile. she was therefore given prophylactic vancomycin and aztreonam until the lines could be removed. the lines were removed after two days, once her inr was reversed with iv vitamin k. she did not develop any ekg findings suggestive of hyperkalemia throughout her hospitalization. she did not develop any further episodes of ventricular tachycardia throughout her hospitalization. she will need follow up of her electrolytes as per discharge orders. . # fluid status: patient was total body fluid overloaded throughout her hospitalization, requiring iv lasix to improve urine output. she was eventually transitioned to her home dose of lasix 80mg po daily. her lasix dosing was increased to 80mg po bid on , as she still had an oxygen requirement and was still reporting edematous extremities. . # rhythm. history of multiple atrial tachyarrhythmias s/p recent failed ablation. anticoagulated w/ coumadin as outpatient given frequent at with rvr. the patient developed atrial flutter on . this was treated with amiodarone, verapamil and increased doses of metoprolol. an ablation was considered to be unnecessary at this time given her history of complications with procedures. her coumadin was restarted, and eventually increased to 4mg po daily, which is double her home dose, to be titrated according to inr goal . she should have her inr drawn according to discharge orders, on . . # respiratory status: she was extubated on , and was weaned to 96% o2 saturation on 4l. cxr showing possible rll opacity vs. fluid overload. her montelukast and atrovent was continued. . # fever: unclear etiology. had persistent leukocytosis at previous admission, s/p 10 day course with aztreonam and clinda, finished on . spiked temp to 101.9 . however, her leukocytosis persisted during this admission. she was pan cultured and cultures have been negative. she was not started on another regimen of antibiotics during this admission after completing her previous 10 day course. . # weakness: pt evaluated ms. and recommended rehab placement. however, she refused. she also refused to attempt climbing , her ability to do so was not able to be evaluated. she was sent home in an ambulance and with help to get into her house. . # anxiety: sertraline, bupropion, clonazepam were continued. . # fen: patient required thin liquid diet. . # code: full medications on admission: amiodarone 200 mg lasix 80mg qdaily warfarin 2.0 mg tablet qdaily verapamil 40 mg po q8h metoprolol tartrate 100 mg tid calcium acetate 667 mg tid montelukast 10 mg daily pantoprazole 40 mg daily clonazepam 1 mg tid bupropion 75 mg daily sertraline 150 mg daily trazodone 25 mg ascorbic acid 500 mg dulcolax 30mg q6hprn magnesium hydroxide 30ml 16hprn docusate sodium 100 mg ferrous sulfate 325 mg qdaily senna 8.6 mg tablet sig: one (1) tablet po bid b complex-vitamin c-folic acid 1 mg qdaily percocet 5-325 mg 1-2 tablets twice a day as needed acetaminophen 650mg q4h prn kdur 20meq qdaily discharge medications: 1. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 2. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). disp:*60 capsule(s)* refills:*2* 3. sertraline 100 mg tablet sig: 1.5 tablets po daily (daily). 4. bupropion 75 mg tablet sig: one (1) tablet po daily (daily). 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. verapamil 40 mg tablet sig: one (1) tablet po q8h (every 8 hours). 8. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. disp:*1 bottle* refills:*0* 9. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 10. clonazepam 1 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for anxiety. 11. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 12. warfarin 2 mg tablet sig: two (2) tablet po daily16 (once daily at 16). disp:*60 tablet(s)* refills:*2* 13. labwork sodium, potassium, chloride, bicarb, bun, creatinine, glucose, magnesium, phosphorus, calcium, and inr on . please fax results to his pcp, . (office fax:, phone:) and to his cardiologist, dr. (office fax:, phone:). 14. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) inhalation four times a day. disp:*1 inhaler* refills:*0* 15. percocet 5-325 mg tablet sig: 1-2 tablets po twice a day as needed for pain. disp:*14 tablet(s)* refills:*0* 16. ascorbic acid 500 mg tablet sig: one (1) tablet po twice a day. 17. docusate sodium 100 mg capsule sig: two (2) capsule po twice a day. 18. ferrousul 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 19. senna 8.6 mg capsule sig: one (1) capsule po twice a day. 20. b complex plus vitamin c oral 21. folic acid 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: vna discharge diagnosis: primary hyperkalemia hypertrophic obstructive cardiomyopathy atrial flutter/atrial fibrillation discharge condition: good discharge instructions: you were admitted to the hospital with shortness of breath. shortly after presentation you were found to be in cardiac arrest, possibly secondary to elevated potassium. it is unclear what precipitated the hyperkalemia. . please follow-up as below. . please continue to take your medications as prescribed. do not take your k-dur unless otherwise instructed by a physician at later time. your metoprolol was changed to toprol xl. your amiodarone was decreased. your lasix was increased, as was your warfarin, and your calcium acetate. please discuss all of your medications with your primary care provider and your cardiologist. you may benefit from an increased dose of toprol xl. your whole medication regimen will need to be monitored closely and changed accordingly. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet . you should call your primary care provider, . , or your cardiologist, dr. , or return to the emergency department if you experience palpitations, chest pain, shortness of breath, loss of consciousness, fever greater than 101.5 degrees f, or any other symptoms that concern you. followup instructions: please follow up with your pcp . . an appointment has been set up for you on , at 2:30. phone: please follow up with dr. nurse . an appointment has been set up for you on at 2pm. phone: other appointments: provider: , m.d. phone: date/time: 1:40 procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube other electric countershock of heart arterial catheterization cardiopulmonary resuscitation, not otherwise specified diagnoses: acidosis hyperpotassemia abnormal coagulation profile unspecified pleural effusion acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure atrial flutter paroxysmal ventricular tachycardia anxiety state, unspecified cardiac arrest hypoxemia obesity, unspecified chronic obstructive asthma, unspecified leukocytosis, unspecified 

Answer: The patient is high likely exposed to