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: sulfa (sulfonamides) attending: chief complaint: weakness and fatigue, bradycardia major surgical or invasive procedure: permanent pacemaker placement central venous line history of present illness: year old female with a pmh of htn, heart failure, and mitral regurgitation on metoprolol feeling unwell since this am with nausea and dizziness. she has felt weak and tired all day. she states she was feeling well last night. she denies any recent illnesses. she was found to be very bradycardic, and ems was called. she lives at the and recieves her care there. they found her to be hypotensive with bradycardia to the 30's. on arrival to the ed she was found to he normotensive with sbp's in the 130's and hr in 30s. . of note, the patient was recently hospitalized for a compression fracture after a fall. she had a burst fracture of l1 and a compression fracture of l5. she was presrcibed a tlso brace with tylenol and ultram for pain control. she was discharged to a rehabilitation facility. . on the floor she was feeling very tired, with nausea and vomiting. she did not have any chest pain, though she was feeling short of breath. she denied lightheadedness. her vitals remained consistent with the emergency department. hr in the 30's, bp's in the 110-130s, and oxygenation of 98-100% on 4l nc. . on review of systems, she was having significant fatigue and "weakness" today with some nausea and feeling "ill". she vomited in the ed as well as on the floor (guiac positive, coffee grounds). she she denies recent fevers, chills or rigors. all of the other review of systems were negative. . in the ed, initial vitals were hr 36, bp 123/39, rr 18, she was nauseus and dizzy. life pads were placed, she was put on a cardiac monitor and 4l nc. her ekg showed complete heart block. she was nauseus with shortness of breath and vomiting while in the ed. she was given 500cc bolus of ns, 1 mg atropine, 1 mg glucagon, 2amp calcium gluconate, 4mg zofran x 3, and 2mcg/kg/min of dopamine, with limited effect. her vitals remained with a heart rate in the 30's, normo-hypertensive, satting well on 4l nc. past medical history: 1. cardiac risk factors: hypertension 2. cardiac history: (?) heart failure -cabg: -percutaneous coronary interventions: -pacing/icd: 3. other past medical history: (per omr) - hypertension - congestive heart failure, details unknown - mitral valve prolapse - hypothyroidism - gerd - colon cancer s/p hemi-colectomy in - s/p appendectomy - osteopenia - chronic hyponatremia - history of several prior falls - history of vertebral fracture - depression social history: tobacco history: 10 pack year smoking history -etoh: -illicit drugs: (per omr and confirmed by record) patient lives in the facility. at baseline, she ambulates with a walker, and eats her meals at the dining facility. she is a former smoker, who smoked about ppd for 20 years and quit about 25 years ago. she drink alcohol very occasionally. . family history: family history of stroke and cancer in the patient's father. mother had coronary artery disease. physical exam: physical exam on admission: general: elderly woman appearing uncomfortable and tachypneic. oriented x3. heent: ncat. sclera anicteric. perrl. neck: supple with jvp of 10 cm with waves. cardiac: profoundly bradycardic, 2/6 sem. no thrills, lifts. lungs: no chest wall deformities, + kyphosis. mildly tachypneic, resp were unlabored, no accessory muscle use. mildly diminished breath sounds l greater than r. abdomen: soft, nd, tender to palpation in the epigastrum. no hsm. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ radial 2+ left: carotid 2+ radial 2+ . physical exam on discharge: gen: nad, alert and oriented x3 cv: blowing systolic ejection murmur at llsb with radiation to axilla, pacer incision c/d/i no hematoma or bleeding. drsg . lungs: ctab, soft occasional dependent crackles on bilat base, no rhonchi or wheezes. abd: soft, nt, nd, pos bs. ext: 2+ pulses radial, dp, pt, carotids b/l, no cyanosis, no edema neuro: cn grossly intact pertinent results: labs: 08:00am blood wbc-8.9 rbc-2.91* hgb-9.7* hct-31.0* mcv-107* mch-33.4* mchc-31.4 rdw-13.8 plt ct-232 12:00am blood wbc-13.5*# rbc-2.82* hgb-9.6* hct-28.5* mcv-101* mch-34.2* mchc-33.8 rdw-14.0 plt ct-249 03:04pm blood wbc-8.1 rbc-2.95* hgb-10.1* hct-30.2* mcv-102* mch-34.4* mchc-33.6 rdw-14.2 plt ct-251 12:00am blood neuts-83.5* lymphs-10.7* monos-5.3 eos-0.1 baso-0.4 08:00am blood plt ct-232 08:00am blood pt-13.0 ptt-30.7 inr(pt)-1.1 03:04pm blood pt-12.8 ptt-33.4 inr(pt)-1.1 03:04pm blood plt ct-251 12:00am blood pt-13.5* ptt-81.7* inr(pt)-1.2* 08:00am blood glucose-111* urean-13 creat-0.9 na-135 k-4.2 cl-103 hco3-24 angap-12 05:47am blood glucose-209* urean-15 creat-0.8 na-135 k-3.8 cl-102 hco3-27 angap-10 12:00am blood glucose-126* urean-41* creat-2.1* na-134 k-5.0 cl-99 hco3-20* angap-20 05:47am blood alt-50* ast-42* alkphos-94 totbili-0.7 04:41am blood alt-43* ast-47* ld(ldh)-247 alkphos-79 totbili-0.4 12:00am blood ld(ldh)-282* 08:00am blood calcium-8.8 phos-2.5* mg-1.7 05:47am blood albumin-3.6 calcium-7.9* phos-2.1* mg-1.9 uricacd-5.4 04:41am blood albumin-4.0 calcium-9.6 phos-4.3 mg-1.8 12:00am blood calcium-10.2 phos-5.1*# mg-2.0 05:47am blood vitb12-1117* folate-greater th 05:47am blood %hba1c-5.4 eag-108 04:41am blood tsh-1.6 03:04pm blood asa-neg ethanol-neg acetmnp-18 bnzodzp-neg barbitr-neg tricycl-neg 12:18am blood type-mix temp-36.2 po2-33* pco2-31* ph-7.39 caltco2-19* base xs--4 intubat-not intuba 11:54am blood lactate-0.8 03:05pm blood glucose-141* lactate-3.6* na-136 k-5.3 cl-99* calhco3-23 12:18am blood o2 sat-56 . chest (portable ap) study date of single ap supine chest radiograph: cardio-mediastinal and hilar contours are normal. the lungs are clear. mild blunting of the left lateral costophrenic sulcus suggests a small left pleural effusion. no pneumothorax is detected. impression: possible small left pleural effusion. no other acute cardiopulmonary pathology. . portable tte (complete) done conclusions the left atrium is elongated. left ventricular wall thicknesses are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). the aortic valve is not well seen. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. there is mild functional mitral stenosis (mean gradient 4mmhg) due to mitral annular calcification. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . chest (portable ap) study date of findings: the pacer lead is seen in the similar location compared to the film from the prior evening. compared to the prior study there is no significant interval change. . chest (portable ap) study date of right pacer tip is in unchanged position in the right atrium or proximal right ventricle. there is no pneumothorax. small left pleural effusion has increased with increased adjacent atelectasis. there is mild vascular congestion. cardiac size is top normal. . l-spine (ap & lat) study date of two views lumbar spine: there are five non-rib-bearing lumbar-type vertebral bodies. again seen is mild leftward curvature of the lumbar spine. there are compression fractures of the t12, l1, and l5 vertebral bodies. at t12, there is approximately 75% loss of vertebral body height. at l1, there is approximately 85% loss of vertebral body height with mild retropulsion. these levels are unchanged in appearance. at l5, there is superior endplate depression with approximately 30% loss of vertebral body height and no retropulsion. this has minimally increased compared to the prior examination. multilevel degenerative changes are again noted. there is generalized demineralization. pacemaker wires, a left-sided gamma nail and a healed right superior pubic ramus fracture are again noted. . chest (pa & lat) study date of findings: interval placement of dual-chamber pacemaker with lead tips positioned in the right atrium and right ventricle. small bilateral pleural effusions, left greater than right. stable mild interstitial abnormalities. these findings are consistent with pulmonary edema. bilateral upper lobe linear opacities consistent with scarring or fibrosis, unchanged from , . evidence of bilateral upper lobe volume loss. tortuous calcified aorta. irregular calcification of the mitral valve. cardiac silhouette is not enlarged. multiple thoracic vertebral wedge compression fractures, stable since . impression: dual-chamber pacemaker with leads in right atrium and right ventricle. otherwise, unchanged study. . electro physiology impression: successful implantation of st. dual chamber pacemaker. . brief hospital course: year old female with a pmh of htn, (?)chf, and mitral regurgitation, that presented with complete heart block with hr in the 30's with symptoms of nausea, vomiting, dizziness, and shortness of breath. . # heart block: pt was found to be in complete heart block. the most likely etiology was thought to be chronic denvervation. consent was obtained after family discussion and she decided to go ahead with a temporary pacemaker. rij cordis was placed and a pacer wire was passed through the cordis and placed in the rv. she was capturing and pacing at roughly 70-80 bpm's. trial of slowing temporary pacer down demonstrated that pt did not initiate native beats until a rate of roughly 50 bpm. temporary pacer rate was returned to 70 bpm. decision was made to place a pacer after consent from patient and family. st. pacer successfully placed ; no procedural complications and pt did well. . # gi bleed: pt had a small amount of guiac positive coffee ground emesis after arrival to the ccu. possible etiologies include pud, vomiting, and ischemic gut. lactate was high on admission at 3.6 on repeat 2.3 later that evening. pantoprazole 40 iv bid for was started for gi ppx as well as zofran and compazine for nausea. kub was negative for signs of ischemic bowel or bowel obstruction. pt did complain of constipation but this was effectively treated w/enemas and bowel regimen. stool was guaiac negative. pt's symptoms improved after resuming bowel movements and normalized pressures and she was able to eat. . # hypertension: normally she is hypertensive, however, on admission she was normotensive to hypertensive; however, with hr in the 30's she was not having enough co to perfuse her organs. metoprolol initially continued but then stopped because of heart block. after pt had pacemaker placement, she was restarted on valsartan 80mg and metoprolol xl 50mg daily for bp control. . # macrocytic anemia: investigated nutritional deficiencies including b12 and folate which were normal. . # compression fractures: pt was recently hospitalized for compression fractures, sent to rehab and then . she required a tlso brace. her pain was being controlled with acetaminophen and tramadol and was continued inpatient for pain management. repeat spine xray was unchanged (see results for full impression). . # depression: stable. continued home regimen of mirtazipine and bupropion. . # hypothyroidism: continued home dose of levothyroxine. # glucose control: patient had elevated fasting glucose as high as 200. hba1c was checked which was 5.4%, therefore no oral glycemic or insulin regimen was started. . # right carpal-metacarpal joint pain: differential includes arthritic flare verses inflammatory arthropathy, no effusion or increased warmth. treated conservatively with acetaminophen and tramadol as needed. . pt was dnr/dni during entire admission. medications on admission: - acetaminophen 1000 mg po tid - tramadol 25 mg po q6h prn pain. - docusate sodium 100 mg capsule po bid - senna 8.6 mg po hs - cholecalciferol (vitamin d3) 800 unit po daily - calcium carbonate 500 mg tablet, chewable po tid - multivitamin tablet 1 tablet po daily - polyvinyl alcohol-povidone 1.4-0.6 % 1-2 drops ophthalmic - aspirin 81 mg tablet chewable po daily - bupropion hcl 100 mg tablet sustained release po bid - valsartan 80 mg tablet po bid - fluticasone 50 mcg/actuation spray, suspension 1 spray nasal daily - levothyroxine 50 mcg tablet po daily - metoprolol succinate 50 mg tablet sustained release 24 hr po daily - mirtazapine 15 mg tablet po hs - ranitidine hcl 150 mg tablet po hs - heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) tid discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day) as needed for pain. 2. tramadol 50 mg tablet sig: 0.5 tablet po every six (6) hours as needed for pain. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg capsule sig: one (1) capsule po at bedtime. 5. cholecalciferol (vitamin d3) 400 unit capsule sig: two (2) capsule po once a day. 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. bupropion hcl 100 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 10. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 11. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 12. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 13. artificial tears drops sig: 1-2 drops ophthalmic four times a day as needed for dry eyes. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 16. valsartan 40 mg tablet sig: three (3) tablet po bid (2 times a day): hold sbp < 100. 17. outpatient lab work please check cbc in 3 days discharge disposition: extended care facility: center for rehab & sub-acute care - discharge diagnosis: primary: bradycardia associated with complete heart block acute kidney injury urinary tract infection secondary: hypertension discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you came to the hospital because you were experiencing a slow heart rhythm that was making you feel fatigued, weak and nauseous. you were found to be in heart block (i.e. your heart was not conducting electrical impulses properly to maintain a normal heart beat) with a very slow heart rate. it was determined that you needed a pacemaker to relieve your symptoms. initially, a temporary pacemaker was placed with good effect which was later followed by placment of a permanent pacemaker. you recovered well and were discharged in stable condition from the hospital. . your kidney function was worse than normal when you were admitted. because of the slow heart rate, your kidneys were not getting enough blood flow. after the temporary pacemaker was placed, your kidney function was improved and is now normalized. also, you were found to have a urinary tract infection. you did not have symptoms, but you had a low grade fever, so we gave you antibiotics for this. . the following changes were made to your medications: - please start taking pantoprazole instead of ranitidine. - increase the valsartan to 120 mg twice daily . weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. . it was a pleasure taking care of you and we wish you a speedy recovery. followup instructions: department: cardiac services when: monday at 10:30 am with: , np building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage . department: cardiac services when: wednesday at 2:00 pm with: device clinic for wound check building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system diagnoses: esophageal reflux mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism personal history of tobacco use depressive disorder, not elsewhere classified constipation, unspecified atrioventricular block, complete streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] hematemesis aftercare for healing traumatic fracture of vertebrae chronic diastolic heart failure other abnormal glucose unspecified deficiency anemia pain in joint, forearm 

Answer: The patient is high likely exposed to