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: worsening shortness of breath major surgical or invasive procedure: transesophageal echocardiogram; cardioversion; intubation; pacemaker placement history of present illness: the patient is a 79 yof w/ a h/o cad s/p rca stenting, diastolic chf, 1+ mr, htn, hyperlipidemia, previous smoking history, and atrial fibrillation who presents for direct admission from home for progressive shortness of breath. according to pt, her primary complaint is not shortness of breath, but cough x 1 week which has been rarely productive of white sputum. she denies associated fevers, chills, nausea, vomiting, pleuritic pain, weight gain, or dietary indiscretion. she also reports a sore throat over the past 3 days. she recently underwent thoracentesis for a moderate size pleueral effusion on . cytology of the effusion was negative for malignant cells. pt denies recent palpitations, and reports that she has been compliant with all medications. she admits to recent fatigue and 2 pillow orthopnea which has been present for months. . the patient has had a workup in the past with a stress (p-mibi) in which was normal, an echo in with mild lvh, biatrial enlargement and a normal ef, 1+ mr, cta chest in with likely biatrial thrombus ( and ra). he has had pfts c/w restrictive ventilatory defect, a low dlco which was consistent with an interstitial process. past medical history: 1. atrial fibrillation 2. coronary artery disease s/p stent rca, lad (last cath w/no interenable obstructions) 3. hypertension 4. mitral regurgitation 5. hyperlipidemia 6. previous smoking history 7. gastric and duodenal ulcer by egd 8. h.pylori gastric biopsy, treated with prevpac x14 days 9. chf - last echo ef >55%, mod lvh, +mr social history: she lives in with her husband. she ambulates independently without assitive device. she denies any falls. she is independent with adl's and takes care of her home. she smoked 2 packs per day for approximately 20 years but stopped many years ago. she endorses drinking one per night with dinner, occasionally two per night. family history: non-contributory physical exam: vs - 97.5 bp 116/62 p 96 rr 18 95% ra gen: wdwn middle aged female 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; jvp elevated to below the ear when sitting up cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. bilateral expiratory wheezes, faint r sided rales. no crackles, ronchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: on admission: 06:50am blood wbc-6.0 rbc-4.08* hgb-9.0* hct-29.7* mcv-73*# mch-22.1* mchc-30.3* rdw-19.0* plt ct-343 10:45am blood pt-22.4* inr(pt)-2.1* 06:50am blood glucose-86 urean-39* creat-1.3* na-145 k-3.5 cl-104 hco3-31 angap-14 06:50am blood calcium-9.0 phos-3.9 mg-1.9 06:50am blood d-dimer-<150 . on discharge: 04:59am blood wbc-7.1 rbc-3.88* hgb-8.7* hct-28.5* mcv-74* mch-22.4* mchc-30.4* rdw-18.6* plt ct-407 04:59am blood plt ct-407 04:59am blood glucose-80 urean-30* creat-1.2* na-140 k-4.0 cl-100 hco3-32 angap-12 04:59am blood totprot-5.4* calcium-8.5 phos-3.0 mg-2.0 07:33pm blood caltibc-386 vitb12-1228* folate-greater th hapto-127 ferritn-28 trf-297 . echo : moderate to severe spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no thrombus is seen in the left atrial appendage. no spontaneous echo contrast is seen in the body of the right atrium or right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. impression: spontaneous echo contrast is seen in the left atrial appendage but there is no evidence of thrombosis. no significant valvular abnormality. . v/q scan : impression: 1. low probablity of pulmonary embolism. 2. findings most compatible with copd. please clinically correlate. . ct scan chest : impression: 1. stable enlargement of the pulmonary arteries is compatible with history of pulmonary arterial hypertension. 2. 8 mm left lower lung nodule can be followed in six months. 3. resolving bilateral pleural effusions, now small. 4. moderate cardiomegaly and extensive diffuse coronary artery atherosclerotic calcifications are unchanged since . findings were posted to the critical results dashboard on . brief hospital course: patient is a 79 yo f w/ a h/o cad, 1+mr, pfts with restrictive lung disease and possible interstitial process, previous smoking history, htn, afib, and hyperlipidemia who was sent to for direct admission for progressive shortness of breath on , . during her hospitalization, she underwent multiple studies to evaluate her dyspnea including a v/q scan, ct scan, and cardiac echocardiogram. she underwent cardioversion on and became hypotensive with a junctional rhythm requiring intubation and a pacemaker placement, and was transferred to the ccu. she was successfully extubated, and discharged back to the floor, where the rest of her course was uneventful. she was discharged on to home, in good condition, with appropriate outpatient follow-up arranged. her hospital course was notable for: . cardioversion/pacemaker placement: in order to optimize cardiac function with atrial kick, pt was pretreated with sotolol and underwent tee and cardioversion of afib on . after cardioversion, patient developed junctional hr to 45bpm with sbps in 80s. she was placed on dobutamine and hr increased to 80s (sinus vs antrial escape rhythm). off of dopamine, hr and bp decreased with ekg demonstrated qtc of 700. permanent pacemaker placed without complications except requiring intubation for airway protection complaint of nausea. - transferred to ccu for overnight monitoring and extubation on - patient extubated without event on after arrival to ccu - flipped back into afib but w rate controlled, intermittently paced -discussed pacing and medication regimen with dr. and decided to discontinue dronedarone due to patient preference and low efficacy of medication. ep fellow dr. agreed to returning patient to home medication regimen of diltiazem and metoprolol. -ep fellow, dr. interrogated pacemaker and found patient to be in afib since aproximately 4am. pacemaker settings were changed from atrial sensing/pacing to vvi (ventricular sensing, ventricular pacing) at threshold rate of 70bpm. - pt was dicharged with outpatient follow-up to device clinic scheduled for . #. cough/wheeze: although direct admission was for progressive dyspnea, pt's chief complaint was recent cough and mild throat irritation. likely multiple etiologies given both progressive cardiac and pulmonary disease. pt underwent v/q scan, tee, ct scan which were notable for findings suggestive of pulmonary arterial hypertension (ct scan), an 8mm left lung nodule (ct scan), and resolving pleural effusions (ct scan). her v/q scan was low probability for pulmonary embolus and was notable for findings compatible with copd. the pt was discharged to follow-up with her pulmonologist dr. for further outpatient workup for her cough and dyspnea. at the time of discharge, right heart catheterization was being discussed as a possible future diagnostic modality. . #lung nodule: a lung nodule was incidentally discovered on ct scan and it was recommended that this nodule be followed up with a repeat ct scan in 6 months. . #chf: at the time of admission, the pt was on a regimen of bumex 1mg qd, and lasix 20 mg tid. at the time of discharge, lasix was discontinued and the pt continued on bumex 1 mg qd. the pt was also started on spironolactone 12.5 mg qd and given a prescription for this medication at the time of discharge. . #anemia: labs demonstrated low fe. would consider iron supplements as outpatiend. spep and upep were obtained to r/o multiple myeloma in the setting of weight loss, fatigue, and anemia, and spep was negative. . all other chronic medical issues for this patient were stable during this hospitalization. no changes were made to the pt's outpatient medication regimen other than those described above. the pt was discharged to home on , ambulatory, with stable vital signs, tolerating po, alert and oriented x 3, with appropriate outpatient follow-up arranged. medications on admission: bumex 1mg po daily diltiazem sr 120mg daily advair 250/50 metoprolol 25mg po bid protonix 40mg po daily sertraline 25mg po daily lipitor 40 mg po qd coumadin 4mg daily lasix 20 mg tid ambien 5 mg qhs discharge medications: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 3. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 4. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. bumetanide 0.5 mg tablet sig: two (2) tablet po bid (2 times a day). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. sertraline 50 mg tablet sig: 0.5 tablet po daily (daily). 9. ambien 5 mg tablet sig: one (1) tablet po at bedtime. 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: home discharge diagnosis: primary: atrial fibrillation secondary: congestive heart failure, copd discharge condition: good, vital signs stable, ambulatory, tolerating food and medicines by mouth, alert and oriented x 3. discharge instructions: you were admitted to on after you were sent to the hospital directly by your primary care doctor, dr. . during your hospitalization you received a thorough evaluation for your symptoms of cough and shortness of breath, including multiple imaging studies, blood tests, and consultations with the pulmonary and cardiology specialists. it was initially suspected that your symptoms may be related to your atrial fibrillation. a cardioversion procedure was planned to attempt to place your heart back into a normal rhythm. during this procedure, your heart rhythm became unsteady requiring placement of a pacemaker. a pacemaker was successfully placed, and you were temporarily admitted to the cardiac intensive care unit. on you are being discharged to home in good condition, ambulatory, and with stable vital signs. you are being discharged with appropriate outpatient follow-up arranged to further pursue the etiology of your shortness of breath. it was a pleasure participating in your care. . the following changes have been made in your medications: stopped- lasix 20 mg tid started- spironolactone 12.5 mg qd . no other changes have been made to your outpatient medication regimen. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: multiple follow-up appointments have been made for you. please attend all outpatient follow-up appointments as scheduled: . you have an appointment to have your new pacemaker evaluated: provider: clinic phone: date/time: 9:30 . you have an appointment to see your primary care doctor: provider: , m.d. phone: date/time: 11:40 . please make an appointment to see your pulmonary doctor, dr. , in the next 1-2 weeks. his phone number is: . please make an appointment to see your cardiologist, dr. , in the next 1-2 weeks. his phone number is: md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia iron deficiency anemia, unspecified chronic diastolic heart failure 

Answer: The patient is high likely exposed to