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 s/p aflutter ablation and pacemaker insertion major surgical or invasive procedure: atrial flutter ablation permanent pacemaker insertion history of present illness: the patient is a 76m w/ a h/o cad s/p cabg approximately 19 years ago, atrial flutter since on coumadin and atenolol, who presented for elective aflutter ablation +/- pacemaker after increased doe. he had increased sob after walking up two flights of stairs and noted his heart rate (resting in the 70s) had been rising to 150s with minimal amounts of exercise. . after the ablation, he was noted to be in sinus node arrest, necessitating the need for a pacemaker. during pacemaker insertion, he became hypotensive to sbp 60s-70s. dopamine was started and his sbp returned to 90s-100s. tte was negative for pericardial effusion. ct abdomen was preliminarily negative for rp bleed. the patient denies lightheadedness, presyncope/syncope, palpitations, chest pain, or shortness of breath during the procedure. he was transferred to the ccu on low-dose dopamine (2.5cc/hr) in comfortable and stable condition for further monitoring. . past medical history: cardiac risk factors: (-) diabetes, (+) dyslipidemia, (+) hypertension . cardiac history: cabg , lima to lad, svg to d1, svg to om1, svg to pda . percutaneous coronary intervention: n/a . pacemaker/icd , , ddd . other past history: cad s/p nstemi cabg as above atrial flutter as above htn remote bleeding stomach ulcer obesity lower back pain, particularly with bed rest chronic prostatitis with occasional urinary urgency social history: social history is significant for the absence of current tobacco use although he has a 20 pack-year history (quit in ). there is no history of alcohol abuse. he is a practicing ophthalmologist. he is married and has a daughter. family history: family history is significant for his father with mi at age 55, mother with mi at age 84. no family history of sudden death. physical exam: blood pressure was 100/59 mmhg while supine. pulse was 80 beats/min and regular, respiratory rate was 11 breaths/min. generally the patient was well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. . there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jvp of ~6 cm. the carotid waveform was normal. there was no thyromegaly. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. . palpation of the heart revealed the pmi to be located in the 5th intercostal space, mid clavicular line. there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. there were no rubs, murmurs, clicks or gallops. . the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing or edema. there were no abdominal, femoral or carotid bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: 02:45pm wbc-13.9* rbc-4.10* hgb-13.0* hct-37.3* mcv-91 mch-31.7 mchc-34.8 rdw-13.7 02:45pm glucose-150* urea n-23* creat-1.0 sodium-143 potassium-4.1 chloride-114* total co2-25 anion gap-8 ct abdomen on : impression: 1. no evidence for retroperitoneal hematoma. 2. small bilateral pleural effusions and lower lobe atelectasis. 3. simple-appearing cysts in the right kidney. echocardiogram on :interpretation: findings: right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. left ventricle: mild symmetric lvh. normal lv cavity size. overall normal lvef (>55%). pericardium: trivial/physiologic pericardial effusion. no echocardiographic signs of tamponade. conclusions: there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior report (images unavailable for review) of , probably no major change. electronically signed by , md on 16:51. brief hospital course: ## hypotension: patient initially admitted to ccu due to hypotension that occurred in the setting of pacemaker insertion. echocardiogram was negative for tamponade. there was no rp bleed on abdominal ct. patient was successfully weaned off of pressors within a few hours of arriving to ccu. hematocrit was stable. likely vasovagal. . ## rhythm - patient received a.flutter ablation and then had pacemaker inserted for bradycardia post-procedure. he tolerated this well and was started on anticoagulation. he will need to follow-up his anticoagulation as he normally does as outpatient and also follow-up with device clinic. . ## cad - no symptoms during this admission. continued aspirin, lipitor, restarted low-dose beta blocker and lisinopril. . ## remote history of gi bleed, but hematocrits stable and stools guaiac negative during this admission. ppi was continued. medications on admission: atenolol 100mg qam lisinopril 40mg qam aspirin 81mg daily protonix 20mg daily lipitor 20mg qhs coumadin 2.5mg daily, last dose discharge medications: 1. pantoprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. atenolol 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnoses: atrial flutter ablation permanent pacemaker insertion secondary diagnoses: coronary artery disease discharge condition: vital signs stable discharge instructions: you were admitted for ablation of atrial flutter heart rhythm. you received a pacemaker after this procedure. you had an episode of low-blood pressure that resolved on its own and was likely due to slow heart rhythm. you were also started on warfarin, a blood thinner, after the pacemaker was placed. please follow-up with clinic for your pacemaker and with your primary care physician for management of your warfarin, as detailed below. if you notice any palpitations, episodes of passing out, chest pain, shortness of breath, or any other concerning symptoms, please call 911 or report to the emergency room. followup instructions: please call the pacemaker and device clinic at on monday to schedule an appointment within 7 days for follow-up on your pacemaker. please call your primary cardiologist, dr. , at ( on monday to schedule follow-up monitoring of inr, since you have been started on coumadin. procedure: catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle infusion of vasopressor agent diagnoses: unspecified essential hypertension cardiac complications, not elsewhere classified aortocoronary bypass status atrial flutter long-term (current) use of anticoagulants sinoatrial node dysfunction 

Answer: The patient is high likely exposed to