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: ventricular tachycardia pericardial effusion major surgical or invasive procedure: pericardial window chest tube placement ep study history of present illness: patient is an 83 yo man with pmhx cad s/p multiple stents, afib, chf with ef 15-20% s/p prophylactic aicd , htn, hyperlipidemia who was transferred from for vtac ablation. patient initially presented to with slow stable vt and again with recurrent vt with rates 140s. at that time, he was symptomatic with diaphoresis, generalized weakness, malaise and dizziness. denies syncope or presyncope, cp, abd pain, nausea, vomiting, palpatations. he was at that time started on amiodarone which was subsequently stopped for an acute rise in lfts. in addition, patient noted to have pericardial effusion and underwent pericardial window at . during his stay at , patient had several episodes of vt and was subsequently transferred to today for vtac ablation. during the procedure, extensive mapping was done and the earliest activation was found to be -2 ms so it was deduced that the focus of vt was epicardial so ablation was not done. . on transfer to ccu, initial vs were t 97.8 bp 108/64 (baseline bp 80-90s systolic) hr 76 r 15 o2 sat 100% 5 liters. patient reported that he felt well, denied dizziness, cp, sob, palp, n/v/abd pain. . at , chest tube (s/p pericardial window) was pulled and led to a right pneumothorax. chest tube was re-inserted and pneumothorax resolved over two days. he subsequently developed episodes of nausea and diarrhea. c. diff was sent and found to be negative x 3. he also had episodes of hypoxia with o2 saturations in the low 80s. his blood pressure at times decreased to systolics in the 70-80 range. an echo taken on showed a larger pericardial effusion in comparison to an echo from . . he was subsequently taken to surgery on for a pericardial window for pericardial effusion and tamponade. approximately 1250 cc of fluid was removed from the pericardium with some improvement in hemodynamics. post-op, he was taken to the csru. overnight in the csru, he has been on pressors to maintain hemodynamic stability. he had a couple of episodes of rapid ventricular response in the setting of his chronic afib. on , he had drops in his oxygen saturation to the 80s. . on review of symptoms, he 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. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. past medical history: vt cad s/p multiple stents chf with ef 15-20% pericardial effusion s/p pericardial window icd for primary prevention htn hypercholesterolemia pvd social history: social history is significant for the absence of current tobacco use. smoked cig per day x 20 years and quit in . occasional etoh, few beers per month. no illicits family history: daughter died at 52 of arrythmia. no family history of cad or cancer. physical exam: vs: t 97.8 , bp 110/64, hr 73, rr 15, o2 100 % on 5 liters gen: wdwn middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. dry mm. neck: supple with jvp of 10 cm. cv: pmi displaced to left, midclavicular line. irregular, normal s1, s2. no s4, no s3. hsm loudest at apex. midline scar with drain- no erythema or drainage from incision site. chest: anterior exam was clear to auscultation. no use of accessory muscles. abd: +bs, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. dp and pt were dopplerable. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: 05:47pm type-art o2 flow-3 po2-89 pco2-46* ph-7.41 total co2-30 base xs-3 05:30pm glucose-123* urea n-16 creat-1.0 sodium-135 potassium-4.8 chloride-99 total co2-29 anion gap-12 05:30pm estgfr-using this 05:30pm wbc-7.3 rbc-3.99* hgb-12.8* hct-38.4* mcv-97 mch-32.2* mchc-33.3 rdw-14.2 05:30pm neuts-72.1* lymphs-15.4* monos-8.8 eos-3.6 basos-0.1 05:30pm plt count-190 05:30pm pt-20.1* ptt-150* inr(pt)-1.9* hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:01am 7.0 3.35* 10.8* 32.3* 97 32.4* 33.5 15.8* 219 inr = 3.1 renal & glucose glucose urean creat na k cl hco3 angap 04:01am 90 21* 1.1 139 3.9 94* 42*1 7 . the left atrium is markedly dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. lv systolic function appears depressed. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is severe mitral annular calcification. there is moderate thickening of the mitral valve chordae. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , the pericardial effusion has been drained. pleural fluid: negative for malignant cells pericardium pathology: biopsy specimen shows chronic congestion and inflammatory changes. echo summary: conclusions: the left atrium is markedly dilated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. lv systolic function appears depressed. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is severe mitral annular calcification. there is moderate thickening of the mitral valve chordae. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. . cxr findings: a single portable image of the chest is compared to the prior examination dated . allowing for differences in technique, there is no significant interval change. the supporting lines are stable. a left chest tube is again noted at the left apex. no apparent pneumothorax is seen. persistent bilateral pleural effusions are noted associated with bibasilar opacities. the cardiac silhouette remains enlarged. mitral valve annular calcifications are again seen. there is perihilar fullness associated with loss of definition of the pulmonary bronchovasculature likely reflects underlying mild edema. persistent subcutaneous emphysema is noted overlying the left chest wall. impression: stable examination as described above with no apparent pneumothorax. . c. cath () comments: 1- right heart catheterization was atttempted via the rij. despite obtaining access instantly, the guidewire did not advance into the svc, suggesting possible rij occlusion. 2- we then performed the rhc via r femoral vein access. elevated filling pressures were noted with mpcwp of 22 mmhg. 3- moderate pulmonary arterial hypertension (57/37 mmhg). 4- preserved cardiac index (2.33 ml/min/m2). final diagnosis: 1. elevated filling pressures. 2. preserved cardiac index. . liver gallbladder us () impression: 1. normal liver echotexture, without a focal lesion seen. however, cirrhosis cannot be entirely excluded by ultrasound. there is no evidence of portal hypertension. 2. the gallbladder contains several shadowing stones and sludge. 3. cyst at the upper pole of the right kidney. 4. bilateral pleural effusions. . ct chest () impression: 1. moderate to large pericardial effusion, nonhemorrhagic by measurement with possible right failure. 2. pulmonary hypertension. 3. severe coronary artery disease. marked left more than right atrial enlargement. 4. bilateral right more than left pleural effusion with loculated right basal hydropneumothorax. the chest tube position is not optimal for its evacuation. 5. left breast soft tissue mass. further evaluation with dedicated imaging is recommended for differentiation of assymetric gynecomastia from neoplastic disease. 6. subpleural left more than right anterior upper lobe interstitial abnormality which might represent either early stages of interstitial disease or sequela of breast treatment (if obtained). 7. small amount of intraperitoneal fluid. 8. tubular soft tissue mass in the anterior upper abdominal wall most likely represents sequela of remote pericardial drain. . portable abdomen, 10:10 am on history: chf, now with nausea, vomiting, and diarrhea. impression: ap abdomen reviewed in the absence of prior abdominal images: the colon is moderately distended and appears to be displaced superiorly, both the cecum, and a portion of the transverse colon or splenic flexure. the small bowel is not dilated. clinical and radiologic followup is recommended to exclude possibility of developing torsion. findings were discussed by telephone with dr. covering for dr. at the time of dictation. . brief hospital course: 83 year old male with cad, chf (ef 15-20%), prophylactic icd , and ventricular tachycardia presented to from after a pericardial window procedure to treat refractory pericardial effusion. at , he was evaluated for vt ablation which did not find an endocardial focus---thus, concluding focus was most likely epicardial. also found to have recurrent pericarial effusion, pleural effusions, hypoalbuminemia. he had no further episodes of ventricular tachycardia, but did remain in chronic atrial fibrillation. he had transient episodes of hemodynamic instability as well low oxygen saturation. he also had a right pneumothorax after chest tube removal () which resolved after re-inserting a chest tube. in the ccu, he developed a worsening pericardial effusion with tamponade physiology. he was then taken for surgery for a new/revised pericardial window. he recovered in the cardiac surgury recovery unit, and was transferred to the ccu for further care. during his second ccu stay, he was hemodynamically stable and had oxygen saturation in the high 90s on room air, and was subsequently transferred to the general floor. . cardiac #rhythm / vt no recent sustained ventricular tachycardia on amiodarone + mixelitine. his liver function panel was flat, thus no evidence of amio induced lft abnormality. he remained in chronic afib with a ventricular rate near 100. patients primary cardiologist was contact and updated prior to discharge. - for rate control, beta blockade was increased to (metoprolol 50 mg po bid). - he was started on amiodarone (goal > 10g) at a dosage of 200 mg . after , his amiodarone should be changed to 200 mg daily. - he was also started on mexelitine, 150 mg (tid), which should be discontinued by . - he remained on digoxin - icd in place for pacing and defibrillation; set for rate correction / overdrive pacing when hr > 120 bpm - he has chronic atrial fibrillation. warfarin 1.5 mg po hs was held at the time of discharge because of a high inr. his inr should be checked so that coumadin can be restarted once he reaches an inr < 2.0. - his electrolytes were continuously checked and repleted. please check magnesium and potassium and replete as needed. . #ischemia / cad he has a history of cad s/p stenting. a recent cath is without evidence of new treatable stenosis. metoprolol and statin was continued. ace-inhibitor was held due to low blood pressures. metoprolol was continued for rate control benefits in the setting of chronic atrial fibrillation and rapid ventricular response, and to prevent icd firing in response to rapid afib. . #pump / chf likely ischemic cardiomyopathy, however mixed myopathy possible given ef is decreased out of proportion to cad. at the time of discharge, respiratory status improved as he had an o2 sat in the 90s on room air. however, he had persistent lower extremity edema (to his knees) and an elevated jvp. - he was continuously diuresed with a final lasix dose of 40 mg po bid. please follow daily weights. . #pericardial effusion unknown etiology. extensive workup at . now s/p pericardial window with 1250 cc removed at . echo of shows no evidence of new pericardial effusions. cytology and culture of pericardial fluid was negative for bacteria, fungus, afb. - he will be followed by ct surgery for wound care of left chest tube site. in the interim, dry sterile strips should be applied. wound sutures will be resorbed/fall off without need for removal. - he was previously on colchicine to treat the effusions, but this was discontined as he began to develop nausea and vomiting. . #lower extremity edema he has had persistent lower extremity edema that did not resolve, but did slightly improve by day of discharge. the etiology is unclear but may be secondary to heart failure, hypoalbuminemia, or vascular/lymphatic disease. - continue diuresis with lasix, and dvt prophylaxis . #pneumothorax he had a pneumothorax from () after right chest tube removal. a right sided chest tube was reinserted with subsequent resolution of the pneumothorax. this chest tube was removed several days later without complication. in addition, he had a left sided chest tube placed at time of repeat pericardial window. a chest x-ray from () shows no evidence of pneumothorax following left chest tube removal. . #diarrhea/nausea he had transient episodes of diarrhea and vomiting after starting colchicine treatment. c. diff test was negative, and colchicine was discontinued. - speech and swallow test for nausea and swallowing difficulty recommened thin liquids and soft solids as tolerated. . #pvd he has a history of atherosclerosis that is secondary to hyperlipidemia. peripheral pulses were dopperable bilateral (dp/pt). aspirin and statin were continued. . #skin care/decubutus - evaluated by wound care nurse n for decubutus. recommendations are as follows: pressure relief, turning and repositioning every 1-2 hours, heels off bed surfaces at all times, limit sit time to one hour at a time and sit on a pressure relief cushion, 4" foam. elevate le's while sitting, moisturize lower extremities and feet with aloe vesta moisture barrier ointment. foam cleanser to perianal tissue, coccyx, scrotum, medial thighs. pat tissue dry. apply a thin layer of citric acid clear to the intergluteal and right gluteal ulcer daily and prn. apply antifungal citric acid clear ointment to the scrotum, medial groin and thighs daily and prn. . #access on the day of discharge, his picc line was discontinued. he had a foley catheter removed on the day of discharge. . #fen hypoalbuminemia- now on cardiac diet. -speech and swallow evaluated patient and recommended thin liquids and soft solids. -k and mg repleted as necessary . #ppx -continue ranitidine, restart coumadin once inr is therapeutic as it is currently being held as his inr was supratherapeutic. . code: full . medications on admission: current medications: toprol xl 150 mg digoxin 250 mcg alt with 125 mcg qd lasix 20 mg qd lisinopril 5 mg qd colchicine aldactone 25 mg qd zocor 25 mg qd coumadin discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. mexiletine 150 mg capsule sig: one (1) capsule po q8h (every 8 hours): discontinue this medication on . disp:*60 capsule(s)* refills:*0* 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*6* 5. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day): please continue at 200 mg until , and then change to only 200 mg daily. disp:*60 tablet(s)* refills:*6* 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 7. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*6* 8. toprol xl 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:*6* 9. digoxin 125 mcg tablet sig: one half tablet po once a day: please take 0.0625mg daily (one half of a pill daily).* tablet(s)* refills:*2* discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis:pericardial effusion, ventricular tachycardia . secondary diagnosis:congestive heart failure, pleural effusions, lower extermity edema, acute renal failure atrial fibrillation diarrhea discharge condition: fair discharge instructions: please take all medications as directed, a complete list is enclosed with this paperwork. . you were admitted to the hospital because of an abnormal heart rhythm called ventricular tachycardia. this rhythm was evaluated in the electrophysiology lab but it could not be ablated. you were started on amiodarone and mexiletine in order to prevent this heart rhythm. continue to take these medicines as directed. the amiodarone dose should be decreased to 200mg daily on . you should stop taking mexiletine on . you will follow up with dr. who will advise you further about treatment for this rhythm. . you are on a medicine called coumadin, your inr (blood test to measure coumadin level) should be checked frequently and the dose of this medication should be adjusted accordingly. . in addition, you had a pericardial effusion (fluid in the heart sac), this fluid was drained by opening up the sac (similar to the minor surgery that you had before you came to this hospital). in addition you had a chest tube placed on the left side at the time of the pericardial window to help drain the fluid. please apply dry sterile dressings to left chest tube wound site. you have absorbable sutures and steri-strips on your left chest from the pericardial window, please allow the strips to fall off on their own. the sutures underneath will absorb on their own. . you were evaluated by speech and swallow while you were in the hospital. they recommend that you follow a diet that is soft solids and thin liquids. . you have a pressure sore on your buttocks. you were evaluated by the wound nurse in the hospital. they recommended pressure relief, turning and repositioning every 1-2 hours, heels off bed surfaces at all times, limit sit time to one hour at a time and sit on a pressure relief cushion, 4" foam. elevate le's while sitting, moisturize lower extremities and feet with aloe vesta moisture barrier ointment. foam cleanser to perianal tissue, coccyx, scrotum, medial thighs. pat tissue dry. apply a thin layer of citric acid clear to the intergluteal and right gluteal ulcer daily and prn. apply antifungal citric acid clear ointment to the scrotum, medial groin and thighs daily and prn. . if you have any signs of chest pain, shortness of breath, high fevers, significant diarrhea/vomiting, weight gain, worsening leg swelling, blood in your urine, loss of conciousness, light-headedness please contact your physician . followup instructions: ep (dr. at 3:00pm. office is in , building . phone # . dr. (cardio-thoracic surgery) 2pm, phone # . procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified excision or destruction of other lesion or tissue of heart, endovascular approach pericardiotomy cardiac mapping right heart cardiac catheterization diagnoses: unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iatrogenic pneumothorax long-term (current) use of anticoagulants diarrhea other disorders of plasma protein metabolism atherosclerosis of native arteries of the extremities, unspecified acute pericarditis, unspecified fitting and adjustment of automatic implantable cardiac defibrillator chronic ulcer of other specified sites 

Answer: The patient is high likely exposed to