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 / zestril / diovan / hydrochlorothiazide / univasc / verapamil / cimetidine / bactrim / ketoconazole attending: chief complaint: lightheaded major surgical or invasive procedure: - pacemaker placement: adapta addrl1 history of present illness: patient is a 78 yo female with pmhx of a-fib, hypertension, benign bladder tumor presenting with light-headedness and bradycardia. it began on when patient first noticed symptoms. she was placed on koh monitor the following week, which captured an abnormal rhythm. in addition, this am, she woke up dizzy with a pulse she measured to be 38. daughter was called, captured event on koh and brought patient to ed after talking to . captured event was a junctional rhythm. patient denied any chest pain, shortness of breath, headaches, syncope, fever, chills. . in the ed vitals were hr 50, rr 17, bp 138/34, sa02 of 95%. patient was stable. developed some nausea after receiving atropine- was given zofran and ativan. nausea subsided and patient's anxiety was relieved. she was given dopamine 10mg in ed which converted her back to sinus rhythm. attempt was made to wean patient off dopamine but she converted back into junctional rhythm. dopamine restarted and patient returned to sinus rhythm. . on arrival to the ccu, the patient was sleeping. comfortable. still in sinus rhythm with hr of 58. sbp of 138. satting at 92% on 2l nc. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope. reports light-headedness and dizziness. past medical history: ****** cardiac history: ***** # paroxysmal a-fib/flutter/tachy s/p multiple cardioversions (last in and then at ) - followed by dr - on coumadin and dofetilide - prior amio, but stopped d/t pulmonary and thyroid toxicity # valvular disease - followed by dr. . # cad - cardiac cath in with 2vd, mild mr, mod systolic and diastolic dysfunction # transient chf in setting of lad ischemia # -diabetes, -dyslipidemia, +hypertension (baseline sbp in the 150s) . ***** other past medical history: ******* # bladder tumor - ctu on with likely tcc, s/p cystoscopy and cystoscopy for excision # h/o + ppd # amiodarone induced pulmonary fibrosis - restrictive ventilatory defect in with fev1/fvc on 115% predicted # adrenal adenoma (') # hemorrhoids # constipation # h/o pulmonary edema (') # chronic pericardial effusions - not amenable to bx, no tamponade # temporal lobe epilepsy with single seizure (') and none since with carbamazepine therapy # gastritis (hx h.pylori) social history: pt lives with husband; she immigrated from in , minimal english speaking, speaks cantonese; no ivdu/etoh/tobacco; independent of adls. daughter works at as nurse in employee health. family history: non-contributory physical exam: general: in 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: supple with jvp of 2 cm above clavicle. cardiac: bradycardic. regular rhythm. 3/6 systolic murmur heard best at right sternal border. pmi located in 5th intercostal space, midclavicular line. normal s1, s2. no thrills, lifts. no s3 or s4. lungs: bilateral inspiratory crackles to apex. no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no wheezes. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 02:00pm blood wbc-7.5 rbc-3.51* hgb-11.4* hct-34.6* mcv-99* mch-32.5* mchc-32.9 rdw-12.6 plt ct-179 08:55am blood wbc-6.9 rbc-3.27* hgb-10.9* hct-32.1* mcv-98 mch-33.4* mchc-34.1 rdw-12.7 plt ct-142* 05:21am blood wbc-6.4 rbc-3.12* hgb-10.2* hct-31.0* mcv-99* mch-32.8* mchc-33.0 rdw-12.7 plt ct-148* 05:20am blood wbc-7.6 rbc-3.26* hgb-10.5* hct-32.2* mcv-99* mch-32.3* mchc-32.7 rdw-12.6 plt ct-161 06:00am blood wbc-6.8 rbc-3.30* hgb-10.9* hct-32.8* mcv-99* mch-33.1* mchc-33.3 rdw-12.6 plt ct-183 05:20am blood wbc-5.9 rbc-3.04* hgb-9.9* hct-29.8* mcv-98 mch-32.5* mchc-33.3 rdw-12.5 plt ct-166 02:00pm blood neuts-50.9 lymphs-42.0 monos-6.2 eos-0.6 baso-0.4 02:00pm blood pt-26.6* ptt-35.9* inr(pt)-2.6* 02:00pm blood plt ct-179 08:55am blood pt-20.6* ptt-33.0 inr(pt)-1.9* 08:55am blood plt ct-142* 06:23pm blood pt-19.4* ptt-82.4* inr(pt)-1.8* 05:21am blood pt-16.5* ptt-31.2 inr(pt)-1.5* 05:21am blood plt ct-148* 05:20am blood pt-14.4* ptt-29.1 inr(pt)-1.2* 05:20am blood plt ct-161 04:00pm blood ptt-110.5* 10:45pm blood ptt-133.3* 06:00am blood pt-15.8* ptt-80.1* inr(pt)-1.4* 06:00am blood plt ct-183 01:00pm blood ptt-69.4* 05:20am blood pt-15.7* ptt-91.6* inr(pt)-1.4* 05:20am blood plt ct-166 02:00pm blood glucose-104 urean-24* creat-2.2*# na-130* k-4.8 cl-96 hco3-26 angap-13 11:28pm blood glucose-134* urean-16 creat-1.0# na-139 k-4.0 cl-102 hco3-25 angap-16 08:55am blood glucose-163* urean-15 creat-1.0 na-136 k-3.9 cl-102 hco3-23 angap-15 06:23pm blood k-3.7 05:21am blood glucose-93 urean-15 creat-0.8 na-139 k-4.6 cl-106 hco3-26 angap-12 05:20am blood glucose-87 urean-15 creat-0.8 na-135 k-4.0 cl-101 hco3-27 angap-11 06:00am blood glucose-106* urean-21* creat-0.8 na-138 k-4.1 cl-100 hco3-27 angap-15 05:20am blood glucose-100 urean-16 creat-0.8 na-138 k-4.4 cl-104 hco3-28 angap-10 02:00pm blood calcium-8.9 phos-5.3*# mg-2.2 11:28pm blood calcium-9.0 phos-3.6# mg-2.3 08:55am blood calcium-8.6 phos-2.9 mg-2.0 05:21am blood calcium-8.7 phos-2.9 mg-2.2 05:20am blood calcium-8.8 phos-3.7 mg-2.0 06:00am blood calcium-9.1 phos-3.9 mg-2.2 brief hospital course: this is a 78 year old female with a-fib, aortic stenosis, hypertension who presented with light-headedness and symptomatic junctional rhythm which required pacemaker placement. . # rhythm: history of paroxysmal a-fib/flutter/tachy. admitted for symptomatic (light-headed) junctional rhythm. hemodynamically stable. initially started on dopamine 10mcg in ed. converted to sinus rhythm. attempted to stop dopamine but she went back into junctional rhythm. was seen by cardiology fellow on admission. patient was placed on telemetry and maintained on dopamine 10mcg on arrival to ccu. that night, she had prolonged pauses on tele ranging from 2.83-3.11 seconds but remained asymptomatic. increased dopamine to 15mcg/min. bp elevated (sbp in 170s). gave 50mg po hydralazine (home dose) and checked pressure before increasing dopamine drip. permanent pacemaker placed on . post-op cxr showed appropriate lead placement, no pneumothorax and no pleural effusion. home metoprolol, dofetilide, and coumadin restarted after procedure. pressures were monitored closely. on am she had a burst of elevated hr (150s). increased metoprolol to 50mg and temporarily held her hydralazine until she returned to sinus rhythm given her sbp of 100s. since then she has remained in a paced rhythm with a rate of 70. denied any complaints except for pain at the pacemaker site. denied chest pain, shortness of breath, lightheadedness, palpitations, dizziness. upon discharge, patient was in paced rhythm and stable. # syncope- had syncopal episode at on 12:28pm while in radiology holding. per daughter, felt dizzy and passed out. unarousable for 30 seconds then came to. aao x 3. denied chest pain, shortness of breath. taken back to floor- ekg, portable chest x-ray, orthostatics were checked. all were within normal limits. no other sycopal episodes during admission. on discharge, patient denied any lightheadedness, dizziness, headache, chest pain, or shortness of breath. # coronaries: had cath in that showed 2vd. not on home statin given normal lipid panel. denied any chest pain or shortness of breath during admission. aspirin was initially continued but was held while patient was receiving coumadin and heparin gtt. will restart aspirin 81mg one week after discharge. # pump: history of htn. ef normal. has pulmonary hypertension caused by lv diastolic dysfunction. initially held home antihypertensives given low hr and relatively low bp on admission (normally runs in 150s). bp rose on admission day so she received her hydralazine. restarted on home metoprolol, felodipine and losartan. hydralazine was held again after low bp readings on . upon discharge, bp stable in 150's (baseline). patient had no symptomatic complaints during admission. # anticoagulation- patient on coumadin 5mg daily at home. inr on admission was 2.6. coumadin initially held for pacemaker placement. restarted afterward at home dose. inr monitored. bridged with heparin gtt with goal inr of 2.0. inr trended up slowly. was 1.4 on day of discharge. gave an extra one time dose of 3mg on day before and day of discharge. since her pacemaker site was oozing, it was decided not to bridge her with lovenox at home due to the increased risk this poses for surgical site bleeding. she is at low risk for thromboembolic event at this time since she is in a paced sinus rhythm, but has a history of paf and could go into afib at home. the risks were discussed with patient and daughter with full understanding. they agree with and prefer the plan as opposed to bridge with heparin and staying in hospital until inr is 2.0. given strict instructions on inr follow-up for saturday am as well as monitoring pacemaker placement site for bleed. # acute renal failure- inital cr in ed was 2.2. thought to be pre-renal given low hr (and co). however, we re-checked cr in pm and it was 1.0. repeated and again was 1.0. determined that lab from ed was an error. good uop and stable bun/cr over course of admission. no signs of fluid overload. cr on discharge is .8. # hyponatremia- initial na+ in ed was 130. thought to be due to low circulating volume given cardiac status. however, it was re-checked in pm and came back to be 139. determined that it was also a lab error. na+ remained within normal limits throughout admission. # anemia- hct 34 on admission. trended down slightly while in hospital. most likely due to phlebotomy. no signs of bleed in stool. patient stable with no complaints on discharge. # nausea/vomiting- patient experienced nausea/vomting in ed after receiving atropine. did not give zofran/compazine/phenergan due to qt-prolongation. no more complaints of nausea/vomiting during admission. # pain- patient experienced pain at pacemaker site. was given prn tylenol and oxycontin during admission with symptomatic relief. code: full code- discussed with daughter . comm: (daughter)- (son)- dispo: home medications on admission: carbamazepine 200mg po daily clonazepam 0.5mg qam, 1mg qhs prn dofetilide 250mcg felodipine 10mg q24 furosemide 10mg qam hydralazine 50mg tid losartan 100mg daily metoprolol 50mg daily trazadone 50mg qhs warfarin 5mg daily asa 81mg daily calcium/vit d metamucil daily discharge medications: 1. carbamazepine 200 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po daily (daily). 2. clonazepam 0.5 mg tablet sig: one (1) tablet po qam (once a day (in the morning)): 2 pills at bedtime. 3. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 4. metamucil powder sig: one (1) packet po once a day. 5. losartan 100 mg tablet sig: one (1) tablet po once a day. 6. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 7. felodipine 10 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 8. furosemide 20 mg tablet sig: 0.5 tablet po once a day. 9. dofetilide 250 mcg capsule sig: one (1) capsule po q12h (every 12 hours). 10. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain: for pain at the pacer site. 11. calcium citrate + d 315-200 mg-unit tablet sig: two (2) tablet po twice a day. 12. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 13. outpatient lab work please check pt/inr on saturday , call results to dr. at discharge disposition: home discharge diagnosis: junctional rhythm hypertension acute renal failure chronic diastolic dysfunction: ef 55% atrial fibrillation discharge condition: stable discharge instructions: you had a slow heart rate and required a pacemaker. no pools or showers for one week. you may take a bath but the pacer dressing needs to stay dry. no lifting your left arm over your head or carrying anything heavier than 5 pounds for 6 weeks. we have put a pressure dressing over the pacer site. you may remove this in days if there is no more bleeding. . medication changes: 1. do not take aspirin for one week. please restart on . 2. take warfarin 5 mg friday and saturday. check the inr on saturday and follow the directions of dr. (or covering physician) 3. stop taking hydralazine 4. increase the toprol xl to 100 mg daily . please call dr. if you notice increasing bleeding at the pacer site, more pain . weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet followup instructions: device clinic phone: date/time: 11:00 . cardiology: np with dr. phone: date/time: at 10:00 am. . primary care: provider: , phone: date/time: wednesday at 9:40am. procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases atrial flutter other and unspecified hyperlipidemia postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants sinoatrial node dysfunction syncope and collapse chronic diastolic heart failure localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy cardiac rhythm regulators causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to