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: history of present illness: the patient is a 76 year-old white female with a past medical history of diabetes mellitus type 2, hypertension, hypercholesterolemia who presented from an outside hospital for evaluation, and possible coronary catheterization and ep study. the patient has had a history of multiple syncopal episodes and mechanical falls over the last few months resulting in multiple emergency department visits. her last admission to the outside hospital was several days to prior to this admission. she was admitted for syncope. at that time she had sudden dizziness and lightheadedness. this was sometimes brought on by standing up. she denies any associated chest pain, shortness of breath, diaphoresis, palpitations, orthopnea, paroxysmal nocturnal dyspnea. she presented again to hospital on the day of admission around noon complaining of episode of syncope at her rehabilitation program. this was possibly associated with seizure activity, although no bystander accounts were available. upon arrival to the outside hospital, her vital signs were temperature 98.8, pulse 42, blood pressure 132/56, respiratory rate 14, oxygen saturation 96% on room air. in the emergency department she had witnessed ventricular tachycardia with positive loss of consciousness and seizure activity. a precordial thump reverted the patient to sinus bradycardia. the ventricular tachycardia then recurred and precordial thump delivered again with reversion to sinus bradycardia. she received two runs of potassium at 10 milliequivalents along with 40 milliequivalents or oral potassium. lidocaine drip was started at 1 mg per hour. no future episodes of ventricular tachycardia were noted. the patient was also noted to have long pauses on telemetry associated with dizziness. she was transferred to the coronary care unit at the outside hospital where she was started on heparin 1200 units per hour without bolus, and lidocaine drip with increase at 2 mg per hour. the patient was then transferred there that day to for possible coronary catheterization and ep study. on arrival here the patient was confused with poor recollection of the days events. she denies chest pain, shortness of breath, dizziness, lightheadedness. past medical history: 1. diabetes mellitus for two years, controlled with oral medication and regular insulin sliding scale. 2. hypertension. 3. hypercholesterolemia. 4. hypothyroidism. allergies: the patient reports allergies to sulfa drugs resulting in rash. medications prior to admission: 1. hydrochlorothiazide 25 mg po q.d. 2. diltiazem cd 180 mg po q.d. 3. enteric coated aspirin 3/25 mg po q.d. 4. levothyroxine 25 micrograms po q.d. 5. lipitor 10 mg po q.d. 6. regular insulin sliding scale. 7. glyburide 5 mg po q.d. 8. elavil 150 mg po b.i.d. 9. celexa 40 mg po q.d. social history: the patient is widowed. she lives alone, across the street from her son. she is a jehovah's witness and does not consent to any blood products during admission. for the past one week she has been enrolled in a rehabilitation program after her last hospital admission for syncope. upon discussion with relatives, it is noted that the patient sometimes has trouble with medication dosages and relatives feel that she may often mix up her medications. physical examination on admission: vital signs temperature 98.7. blood pressure 104/45. pulse 65 to 67. respiratory rate 18. oxygen saturation 95% on room air. general appearance, well developed, obese, white female, disheveled appearing, confused, mumbling, sitting upright. heent erythematous skin ulceration on nasal tip across bridge of nose. pupils equal, round, minimally reactive. oropharynx is clear. oral mucosa is dry. poor dentition. neck supple. no masses or lymphadenopathy. no carotid bruits. jugulovenous pressure at 8 cm of water. lungs clear to auscultation bilaterally. no rhonchi, rales or wheezes. cardiovascular regular rate and rhythm. s1 and s2 heart sounds auscultated. grade 2 out of 6 systolic murmur heard best at the left upper sternal border, no radiation. abdomen soft, nondistended, right upper quadrant with mild tenderness to palpation. positive bowel sounds. extremities skin dry, scaly, no clubbing, cyanosis or edema noted. 2+ dorsalis pedis pulses and posterior tibial pulses bilaterally. pertinent laboratories/x-rays/other studies: on admission complete blood count showed white blood cell 8.4, hemoglobin 13.1, hematocrit 36.3, platelets count 286 with white blood cell count differential 73% neutrophils, 18.9% lymphocytes. serum chemistries showed sodium 139, orthopedics 3.1, chloride 100, bicarbonate 28, bun 25, creatinine 0.9, calcium 9.0. coagulation profile showed pt 12.8, ptt 19.3, inr 1.1. cardiac enzymes showed ck 438, troponin less then 0.3. electrocardiogram at hospital showed sinus bradycardia at approximately 35 beats per minute, left axis deviation, left anterior vesicular block versus old inferior myocardial infarction. right bundle branch block. pr interval not prolonged. no acute st t wave changes. poor r wave progression. rhythm stirps from hospital showed strip number one with baseline artifact, normally conducted beats and then premature ventricular contractions. long pause in several ventricular beats, wide complex at a rate of 200 beats per minute. strips number two and three then showed polymorphic ventricular tachycardia. chest x-ray at hospital with no acute disease. reportedly had transthoracic echocardiogram in with ejection fraction of 55% and stress test in with no eversible ischemia. hospital course: 1. cardiovascular disease: as the patient has risk factors of diabetes mellitus, hypertension, and hypercholesterolemia and possible old inferior myocardial infarction on electrocardiogram it was felt that ischemia was the likely cause of her conduction system abnormalities. coronary catheterization was recommended for further evaluation of her coronary anatomy along with electrophysiological studies of her conduction system. the risks and benefits of these studies were explained, however, the patient refused both of these studies. therefore she was managed medically for her possible history of ischemia with aspirin and continuation of lipitor. heparin was discontinued as the patient did not have active evidence of ongoing ischemia on her electrocardiogram and was chest pain free. cardiac enzymes were cycled and the patient ruled out for myocardial infarction. as the patient was hemodynamically stable on admission she was continued on telemetry. initially a temporary pacing wire was not placed. the patient maintained regular sinus rhythm with only occasional drop beats and was hemodynamically stable. she was transferred out of the coronary care unit to a regular floor on . however, on the early morning of the patient had bradycardia with occasional drop beats. telemetry showed 2 to 1 heart block. she then complained of feeling lightheaded. transcutaneous pacing pads were placed. afterward the patient had an episode of complete heart block continuing into asystole. at that time she was noted to have seizure activity. she spontaneously converted to type 2 degree av block. she was returned to the coronary care unit and had a temporary pacing wire placed via right internal jugular central line. she underwent permanent st. ddd pacemaker placement on . she tolerated this well. she maintained a paced rhythm in the 70s to 80s with hemodynamic stability. lisinopril 5 mg po q.d. was added for antihypertensive effects. metoprolol 12.5 mg po q.d. was added for antiarrhythmic properties. echocardiogram was performed on to assess ejection fraction, to asses for focal wall motion abnormalities and for further evaluation of murmur heard on clinical examination. results are the left atrium is normal in size, the left ventricular wall thickness, cavity size and systolic function are normal with a left ventricular ejection fraction 60 to 70%. right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular in flow pattern suggests impaired relaxation. there is a trivial/physiologic pericardial effusion. 2. diabetes mellitus: the patient was monitored with regular finger stick blood glucose testing and regular insulin sliding scale. her glyburide was held initially and was added back on . finger sticks ranged from 70s to 140s on this admission. 3. hypothyroidism: as suboptimally controlled hypothyroidism could have contributed to the patient's bradycardia. thyroid function was tested. tsh was markedly elevated at 26 with a free t4 of 0.6. as a result the patient's levothyroxine dose was increased to 50 micrograms po q.d. she will need outpatient follow up of her thyroid function. 4. psychiatric: the patient reportedly on celexa and elavil as an outpatient. these medications were discontinued as they were felt to contribute to her altered mental status and confusion on admission. additionally, the elavil could contribute to prolonged qt interval and complete heart block. the patient was instructed as she should discontinue her celexa and elavil after discharge. 5. code status: the patient initially stated that she did not want to be intubated and only wanted to be resuscitated for 7 to 10 minutes. after further discussion she changed her code status to full code. her family members including her health care proxy agreed with this. condition on discharge: fair. heart rate was stable, paced at 70 to 80 beats per minute. hemodynamically stable. felt by physical therapy to require rehabilitation program. discharge status: the patient was discharged to a rehabilitation program at life care center of . discharge diagnoses: 1. status post st. ddd pacemaker placement. 2. symptomatic sinus bradycardia. 3. ventricular tachycardia. 4. complete heart block. 5. asystole. 6. hypertension. 7. diabetes mellitus. 8. hypercholesterolemia. 9. hypothyroidism. discharge medications: 1. aspirin 325 mg po q.d. 2. lipitor 10 mg po q.d. 3. regular insulin sliding scale. 4. levothyroxine 50 micrograms po q.d. 5. lisinopril 5 mg po q.d. 6. ambien 5 mg one to two tablets po q.h.s. as needed for insomnia. 7. senna one tablet po q.h.s. as needed for constipation. 8. glyburide 5 mg po q.d. 9. metoprolol 50 mg one quarter tablet po b.i.d. 10. colace 100 mg po b.i.d. 11. keflex 500 mg po q.i.d. for five days. follow up plans: the patient was discharged to life care center at where she will receive rehabilitation therapy. after discharge from rehab the patient will likely return home. she is to discard all of her previous outpatient medications and take only those medications prescribed after this hospital admission. she should avoid elavil as it could lead to dangerous abnormalities in her heart rhythm. she was instructed that she no longer needs to take hydrochlorothiazide or diltiazem for her blood pressure as we have now prescribed new medications for this purpose namely lisinopril and metoprolol. she was instructed that she should not operate any heavy machinery including a motor vehicle for the next six months. under no circumstances whatsoever should she drive a car. both she and her family members were instructed of this restriction. additionally she was instructed to call dr. office at for an appointment with in one to two weeks after discharge from the life care center. additionally, she already has an appointment for monitoring of her pacemaker with -s. spiback, nurses at the clinical center cardiac services office. phone number on at 9:30 a.m. , m.d. dictated by: medquist36 d: 03:43 t: 08:25 job#: procedure: venous catheterization, not elsewhere classified initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism paroxysmal ventricular tachycardia other specified cardiac dysrhythmias atrioventricular block, complete 

Answer: The patient is high likely exposed to