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: no known allergies / adverse drug reactions attending: chief complaint: chest pain, afib with rvr major surgical or invasive procedure: cardiac catheterization pulmonary vein isolation history of present illness: ms is a 62yof with h/o paf on coumadin, cva, htn, hld, who presents with chest pain, afib with rvr, and elevated troponin. started on , when she was riding in a car as passenger and suddenly developed substernal chest pain with diaphoresis. lasted 5 minutes then gradually resolved. no sob or palpitations. for the next day she felt some residual pressure feeling that was constant and did not vary with activity. today she is pain free x24 hours. she waited to be seen because she was visiting on at the time and returned today. she notes she has had this type of pain before when has developed afib. pain was never this severe and never had diaphoresis previously. denies sob, n/v. had been in nsr on at last cardiology appointment. . she initially presented to , where vitals were t97.9 hr: 147 bp: 134/99 resp: 18 o(2)sat: 100 normal. inr 2.6, troponin(t) 0.746. d-dimer was checked and was negative. she was transferred to for further care . in the ed, initial vitals were 98.3 110 114/86 16 99% labs and imaging significant for cxr which showed clear lungs fields with some vascular fullness. patient given metoprolol 15mg iv and 25mg po, and asa 325. . on arrival to the floor, 98.0, 116/85, 123, 16, 99%ra, 69.1kg. she feels well, and denies chest pain or discomfort, sob, or palpitations. she overall feels well. past medical history: 1. cardiac risk factors: (-)diabetes, (+)dyslipidemia, (+)hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: atrial fibrillation basilar artery occlusion/cva residual numbness on the left side hyperlipidemia hypertension osteopenia gerd migraines social history: she has three children, 6 grand-children -tobacco history: never -etoh: 1 glass per day -illicit drugs: none family history: brother has had a myocardial infarction at age 49. otherwise, no family history of atrial fibrillation, although her mother did die of a stroke in her 70s. physical exam: admission exam: vs: t=98.0 bp=116/85 hr=123 rr=16 o2 sat=99%ra general: elderly caucasian female, nad, comfortable heent: ncat. sclera anicteric. perrl, eomi. neck: supple with jvp of 8cm. cardiac: tachycardic, irregularly irregular, no m/r/g lungs: ctab, no w/r/r abdomen: soft, ntnd. no hsm or tenderness. no hsm extremities: warm, well perfused, 2+ pulses globally. no edema. skin: no rashes or lesions discharge exam: vs: 98.5 111/50 52 18 98% ra gen: nad, comfortable, alert and oriented heent: sclerae anicteric, perrl, eomi. erythema in posterior oropharynx with eccymosis left side cv: rrr, nl s1 s2, no mrg resp: ctab, no rales wheezes or rhonchi abd: soft, non-tender, non-distended ext: warm, well-perfused, no edema, 2+ pulses pertinent results: admission labs 07:17am blood wbc-8.0# rbc-3.78* hgb-11.9* hct-36.8 mcv-98 mch-31.6 mchc-32.4 rdw-12.9 plt ct-333 07:17am blood pt-28.1* ptt-39.4* inr(pt)-2.7* 07:17am blood glucose-105* urean-10 creat-0.7 na-138 k-4.2 cl-107 hco3-23 angap-12 07:17am blood calcium-8.8 phos-3.7 mg-1.9 cardiac labs 07:58pm blood ck-mb-8 ctropnt-0.74* 07:17am blood ck-mb-6 ctropnt-0.87* discharge labs 07:20am blood wbc-6.6 rbc-3.36* hgb-10.2* hct-33.0* mcv-98 mch-30.2 mchc-30.8* rdw-12.8 plt ct-304 07:20am blood pt-31.4* ptt-39.7* inr(pt)-3.0* 07:20am blood glucose-92 urean-8 creat-0.7 na-138 k-4.1 cl-104 hco3-27 angap-11 07:20am blood calcium-9.0 phos-3.9 mg-2.1 studies tte : no spontaneous echo contrast is seen in the body of the left atrium, the body of the right atrium, or the right atrial appendage. moderate to severe spontaneous echo contrast is present in the left atrial appendage. lv systolic function appears depressed. right ventircular systolic function is normal with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened with miild (1+) aortic regurgitation. the mitral valve leaflets are mildly thickened with trivial mitral regurgitation. there is no pericardial effusion. impression: moderate/severe sec in the laa. no thrombus identified. depressed lv sytolic function. mild aortic regurgitation. compared with the prior study (images reviewed) of , the findings are similar. cardiac mri : 1. normal size and orientation of the pulmonary veins without cmr evidence of anomalous pulmonary venous return or pulmonary vein stenosis. 2. normal left ventricular cavity size with severe hypokinesis to akinesis of the basal to mid inferior wall and akinesis of the true apex. the lvef was moderately depressed at 33%. late gadolinium contrast-enhanced cmr images demonstrated patchy transmural late gadolinium hyperenhancement of the basal to mid inferior wall and true apex, sparing a small segment of the distal inferior wall. the findings are consistent with poor (<20%) likelihood of functional recovery of these walls after mechanical revascularization. 3. normal right ventricular cavity size with mild free wall hypokinesis. the rvef was mildly depressed at 37%. 4. the indexed diameters of the ascending and descending thoracic aorta were mildly increased and normal respectively. the indexed diameter of the main pulmonary artery was moderately dilated. 5. mild biatrial enlargement. 6. a note is made of multiple t2 hyperintense lesions in the liver measuring up to 3.6 x 3.0 cm in the hepatic dome (201:15) which are incompletely characterized however most likely represent simple cysts. multiple sub- centimeter simple cysts are noted in the left kidney cxr : portable ap radiograph of the chest was reviewed in comparison to . cardiomegaly is moderate, unchanged. mediastinum is unremarkable. lungs are essentially clear. no pleural effusion or pneumothorax is seen. brief hospital course: ms is a 62yof with h/o paf on coumadin, cva, htn, hld, who presents with chest pain, afib with rvr, and elevated troponin. . # chest pain/nstemi: troponin(t) elevated to 0.7 at , up to 0.87 at . ekg showed lateral twi and some non-specific st changes. cardiac cath on showed 40% lad disease. thus, likely rapid afib was the primary problem, and this caused some degree of stress cardiomyopathy and demand ischemia. it was also possible that this was due to an mi that spontaneously cleared. pe was ruled out with negative d-dimer at osh. tte showed focal wall motion abnormality (though not congruous with lad lesion) and new decrease in ef (45%). the patient remained anticoagulated on coumadin. no plavix was started, but aspirin was increased to 325mg daily. cholesterol panel out of range (per below), last a1c 5.6% . # atrial fibrillation / sick sinus syndrome: she went in and out of rapid afib and sinus bradycardia during this admission, consistent with sick sinus syndrome. tsh on of 1.7. she was initially anti-coagulated with heparin gtt and coumadin. on she had a cardiac mri for staging for a planned pulmonary vein isolation procedure. on she went for pvi, but it was complicated by oropharnygeal bleeding tee probe, and she went to the ccu. the pvi was otherwise successful. in the ccu she was intubated for airway protection and briefly on pressors. she was extubated and off pressors within hours. she was doing well and called out to the floor in stable condition, without any more bleeding. nodal agents were held given her tendency to be in sinus bradycardia when not in atrial fibrillation. on she had an episode of rapid afib that responded to dronadarone and ranolazine. on her qtc found to be prolonged, therefore dronadarone was d/c. . # pump: tte 1 year ago with normal function, now with ef 45% and wall motion abnormality. euvolemic on exam. will need repeat tte in future to assess myocardial recovery after this acute event. . # prolonged qtc: went from 0.4 to 0.53s afer quinidine given on . once off quinidine, qtc back to 0.4ms. prolonged again after starting dronadarone , so this drug was d/c prior to discharge. . # oropharyngeal injury: the patient suffered op injury during intubation for pvi. resistance was met in the pharynx while attempting to place the tee probe, and no attempt was made to place the probe further into the esophagus. the temperature probe was also noted to be displaced. mild oozing was noted, and the pharynx was packed with good effect. the patient was followed by ent who recommended gastrograffin study to investigate possible injury. discussed with ep attending of record who did not feel swallowing study was necessary. the patient's diet was advanced without complication. the patient was d/c with ent follow-up to ensure pharyngeal healing. . # urinary tract infection: have contributed to sympathetic tone and helped create afib w/ rvr. completed 3 day course of macrobid, ua cleared and patient became asymptomatic. . # gerd: continued home omeprazole 40mg daily. of note, her "gerd" are occuring only when she is in rapid afib, so she may not have gerd but rather symptomatic arrhythmia. if resolve after pvi, would consider decreased ppi or stopping it all together and trying an h2 blocker in the future . # hyperlipidemia: on simvastatin at home, changed to atorvastatin this admission. last chol panel: : total 181, trig 113, hdl 47, ldl 106. goal ldl < 70. . # osteopenia: continued calcium . ========================================= transitional issues - of hearts monitor started prior to discharge for planned 2 week monitoring; results to be reviewed with dr - ent follow-up to assess pharyngeal healing - inr supratherapeutic during admission, warfarin dose reduced; this will require further adjustment - dronadarone was d/c due to prolonged qtc, please continue to monitor qtc on discharge - if gerd resolve, consider stopping ppi or switching to h2 blocker medications on admission: esomeprazole magnesium - (prescribed by other provider: ) - 40 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth unclear of dose propranolol - 80 mg capsule,extended release 24 hr - 1 capsule(s) by mouth once a day simvastatin - 40 mg tablet - 1 tablet(s) by mouth daily (daily) sucralfate - 1 gram tablet - 1 tablet(s) by mouth four times a day warfarin - (prescribed by other provider) - 2 mg tablet - 1.5 tablet(s) by mouth qday medications - otc acetaminophen - (prescribed by other provider) - dosage uncertain calcium carbonate-vitamin d3 - (otc) - dosage uncertain multivitamin - (prescribed by other provider) - dosage uncertain discharge medications: 1. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. sucralfate 1 gram tablet sig: one (1) tablet po four times a day. 7. aspirin 325 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. warfarin 1 mg tablet sig: 1.5 tablets po 6x/week (mo,tu,we,th,fr,sa). 9. warfarin 1 mg tablet sig: one (1) tablet po 1x/week (). 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: no more than 2 gram/day. 11. ranolazine 500 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po bid (2 times a day). disp:*60 tablet extended release 12 hr(s)* refills:*2* discharge disposition: home discharge diagnosis: atrial fibrillation with rapid ventricular rate stress/tachycardia induced cardiomyopathy. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs , it was a pleasure taking care of you at . you were admitted for chest pain and atrial fibrillation. you had a cardiac catheterization, which showed no major blockages in your heart's arteries. we did find reduced function in your heart, likely from a rapid heart rate due to the atrial fibrillation. you had a pulmonary vein isolation procedure, which should prevent you from going into atrial fibrillation in the future. during your procedure the back of your mouth was bruised. our ent team was consulted and will see you after discharge to ensure your healing. the following changes were made to your medications ** stop propranolol ** stop simvastatin ** start atorvastatin ** start aspirin ** start ranolazine ** change warfarin dose, as your inr was high followup instructions: department: healthcare of when: tuesday at 11:00 am with: , md building: (, ma) campus: off campus best parking: parking on site department: otolaryngology-audiology when: monday at 11:30 am with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: tuesday at 1:20 pm with: , md building: campus: east best parking: garage department: cardiac services when: friday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage md procedure: coronary arteriography using two catheters catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping diagnoses: esophageal reflux urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation other and unspecified hyperlipidemia hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits disorder of bone and cartilage, unspecified takotsubo syndrome 

Answer: The patient is high likely exposed to