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: hypotension in ep lab prior to pacemaker implantation. major surgical or invasive procedure: pacemaker placement () history of present illness: mr. is a 77 y/o m with pmh notable for hypertension, dyslipidemia and bifasciular block who was scheduled to undergo ep study and probable pacemaker implanation dur to recurrent unheralded syncope in the context of bifasicualar block. ep study was performed on the morning of (please see separate procedure report for details) and it was decided to proceed with pacemaker placement. the right ventricular ep catheter was left in place for back-up pacing prior to pacemaker insertion. during the initial surgical dissection into the deltopectoral groove, the patient became acutely bradycardic to < 50 bpm (as evidenced by back-up pacing, which was set at 50, from baseline in the 70's-80's) and hypotensive reaching down to a nadir of 40's systolic. there was no loss of consciousness and the patient remained converant - he in fact denied any symptoms including discomfort at all at the time, although he appeared ashen. he was given atropine and dopamine with good recovery of his heartrate and blood pressure. from these drugs however he then became tachycardic, impeding evaluation of the pacemaker, so he was changed from dopamine to neosynephrine, which mainatined blood pressure in the 110-130s systolic. hypotension (but not bradycardia) recurred without it. initial repeat hematocrit from the ep lab was 38.1 (down from 44), although he was also bolused fluids with the hypotension. fluroscopic examination of his heart borders did not suggest cardiac effusion or tamponade. his right femoral venous access site for the ep study appeared benign. he was transferred to the ccu for i.v pressor administration and further evaluation of persistent hypotension. on arrival to the ccu, the patient is alert, oriented, and talkative. he reports no current symptoms. he specifically denies chest pain, dizziness, lightheadedness, abdominal or back pain, lower extremity edema, leg pain or numbness, or any other complaints. he denies shortness of breath, cough, congestion, orthopnea, and pnd. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, 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: dyslipidemia gastroesophageal reflux disease with hiatal hernia hypertension s/p bilateral total knee replacements arthritis bifascicular block recurrent syncope with moderate trauma x 1. social history: social history is significant for the absence of current tobacco use. he is married and lives with his wife; he has grown adopted children. he drinks alcohol occasionally. family history: he has a family history of diabetes, hypertension, and heart disease; both parents are deceased. physical exam: vs: t 96.8, bp 134/79, hr 81, rr 12, o2 98% on 1l nc gen: wdwn elderly male in nad, breathing comfortably. oriented x3. mood, affect appropriate. pleasant and conversive. heent: ncat. sclera anicteric. perrl, eomi. no op lesions, oral mucosa dry. neck: supple, no jvd, no bruits. cv: rr, normal s1, s2. no s4, no s3. no murmurs or gallops. chest: l ant chest - pacemaker in place, no bleeding, hematoma, or edena. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. no flank pain or discoloration. ext: no c/c/e. no femoral bruits. has sheath in place in right groin. no oozing or hematoma. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; dp non-palpable, appreciated by doppler left: carotid 2+ without bruit; femoral 2+ without bruit; dp non-palpable, appreciated by doppler pertinent results: laboratory data: (admission) na: 137; k 4.4; cl 104; hco3 25; bun 22; creat 1.3; gluc 100 . wbc: 9.1; hbg: 15.1; hct 44.0; plt 283 ekg demonstrated nsr at 60, normal axis, rbbb, lahb. . cxr () status post placement of left-sided dual-chamber pacemaker with atrial and ventricular leads in situ. no pneumothorax. no evidence for chf. probable lvh. the left cpa is not completely included on the film. . echocardiogram () overall left ventricular systolic function is normal (lvef>55%). there is no pericardial effusion. . cxr (pa + lat) : prelim read - proper placement of both pacemaker leads . ct abdomen/pelvis - prelim read - no evidence of retroperitoneal or other abdominal bleed brief hospital course: this is a 77 y.o. male with history of htn and hyperlipidemia with h/o two episodes of syncope, admitted to ccu for acute hypotension and bradycardia during ep study and pacemaker placement. . # hypotension: ddx included acute blood loss during procedure, however, no site of bleeding was clinically identified despite hct drop of 6 points (44.0 -->38.1) post procedure. repeat hematocrit at 2 pm was 41.8. ct scan of abdomen and pelvis was obtained to ensure that there was no retroperitoneal bleed, and there was not. no groin hematoma either. no pericardial effusion or tanmponade. hypotension was likely a result of a prolonged vasovagal phenomenon due to manipulation of a well innervated deltopectoral fat pad during procedure. atropine and dopamine were initally instituted and resolved the initial episode but nesynephrine was required to avoid unde tachycardia. the neosynephrine drip was weaned over 2-3 hours with close monitoring on telemetry, and no further events occured with sbps in 120s. serial hcts were monitored and stabilized. . # s/p pacemaker placement: pt tolerated pain well post-procedure, in fact felt that symptoms were overall improved. stable and proper placement of leads was confirmed by re-interrogation of the pacemaker in the am and by pa + lat cxr. due to penicillin allergy, as prophylaxis vancomycin (in hospital) and clindamycin (to take at home) was given for 2 days. his pacemaker was programmed to include a "rate drop response" to provide rapid pacing (above the lower rate limit) in the event of sudden cardiac deceleration such as during a vasovagal episode. a brief (20 second) asymptomatic svt (avnrt vs atrial tachycardia) was noted on telemetry. if a recurrent or more sustained problem is documented by his pacemaker, or should it become associated with symptoms, dr. indicated that this could be ablated at a later date. dual av nodal pathways (a pre-requisite for avnrt) were documented at eps, but no sustained arrhythmias, supraventricular or ventricular were induced. . # history of hypertension: held antihypertensives while in the hospital and instructed to cont. to hold until told to resume by physician. . # hyperlipidemia: most recent ldl in system (): 82. pt was continued on atorvastatin in the hospital. . on the day of discharge, mr. was displaying normal vital signs, with no further drops in bp or hct, was tolerating po, ambulating and was able to perform activities of daily living. medications on admission: cymbalta 60 mg p.o. daily lisinopril 10 mg p.o. daily lipitor 20 mg p.o. daily protonix 40 mg p.o. daily oxybutynin 5 mg p.o. daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 2. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*20 tablet(s)* refills:*0* 6. clindamycin hcl 300 mg capsule sig: one (1) capsule po four times a day for 4 doses: take first dose at 5pm today (). disp:*4 capsule(s)* refills:*0* 7. oxybutynin chloride 5 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary diagnosis: vasovagal hypotension . secondary diagnoses: bifascifular block syncope hypertension hyperlipidemia gastro-esophageal reflux disease discharge condition: good, hemodynamically stable discharge instructions: you were admitted for a pacemaker placement. after the procedure your blood pressure was low and you were observed in the coronary care unit with improvement in your blood pressure, likely due to a a vasovagal event, a type of exaggerated reflex. please do not take your blood pressure medications until follow up with your pcp . early next week (monday or tuesday). you will need to follow up in the device clinic in the next 7-10 days (already scheduled), as well as with dr. in weeks. . please do not lift anything with your left arm. . please return to the hospital if you experience chest pain, shortness of breath, dizziness/lightheadedness, worsening pain, swelling, redness around the pacemaker sight, fevers/chills, or any other concerning symptoms. followup instructions: please call dr. to make a follow up appointment as soon as possible. . please follow up with dr. according to the following appointment in the building . provider: . phone: date/time: 10:40 . provider: clinic phone: date/time: 3:00 . provider: , m.d. phone: date/time: 8:45 md, procedure: catheter based invasive electrophysiologic testing initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: other iatrogenic hypotension esophageal reflux other and unspecified hyperlipidemia other specified cardiac dysrhythmias other bilateral bundle branch block 

Answer: The patient is high likely exposed to