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: bradycardia major surgical or invasive procedure: placement of sensia sesr01 (serial numer nwr232733) () history of present illness: f of htn, slow af (not on coumadin) that presents from nursing home for bradycardia down in the 20s. pt was feeling unwell and they called ems, there she was found to have pulse down to the 20s, sbp in the 90s, she was alert. according to the pt's son, she was also seen at for bradycardia recently, but no interventions were performed. at the nsh she received 0.5mg of atropine and 250ml of iv fluids-> hr increased to 40s, and bp in 120s/50s. she was brought in. her current medications include amlodipine and lisinopril but no nodal agents and she is not on digoxin. . upon arrival to the ed 97.2 40 123/48 18 100% 2l nc. cardiology was consulted that recommended admission to the cariology floor for potential pacemaker. labs notable for cr 1.7 up from 1.0. k 5.4. no leukocytosis. trop 0.02. she was given ns 500cc, kayexelate 30ml. vitals prior to transfer were stable with sbp in the 90s and hr in the 40s. . upon arrival to the floor, the pt is alert but not oriented. she has no complaints and denies lightheadedness, fevers or chills, nausea, vomitting. her son states that this is the most energetic he has seen her months. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, +hypertension 2. cardiac history: none 3. other past medical history: # constipation per omr notes; pt denies # spinal stenosis - last mri here, : severe stenosis l3/l4, l4/l5 # hiatal hernia # callus 5th metatarsal head - debridement hx # atrial fibrillation - rate controlled, not on anticoagulation due to family's decison and concern for falls. # s/p breast excision of density, non-malignant # depresion # ? cva per bench mark alf information. # anemia-iron deficiency # venous stasis social history: pt worked for 30 yrs as exec-director of a synagogue in ct. pt lives at , an facility. she receives all meds and meals there, and feels safe there. she uses a walker at baseline. she denies smoking, alcohol, or drug use. her son, , is her health proxy: , cp: . family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. daughter s/p cva. physical exam: physical examination: vs: 96.8 143/60 55 18 100%ra general: alert, interactive, appropriate, no acute distress. heent: dry mm. sclera anicteric. perrl, eomi. mmm. neck: supple. jvp flat. cardiac: rrr, no m/r/g. no thrills, lifts. no s3 or s4. lungs: ctab, no crackles, wheezes, rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ 2+ dp 2+ pt 2+ pertinent results: admission labs: 08:50pm blood wbc-7.1 rbc-3.51* hgb-10.4*# hct-32.1*# mcv-92# mch-29.6 mchc-32.4 rdw-16.4* plt ct-207 06:20am blood wbc-7.2 hct-30* plt ct-171 08:50pm blood neuts-76.5* lymphs-16.4* monos-4.2 eos-2.1 baso-0.9 08:50pm blood plt ct-207 06:20am blood plt ct-171 09:35am blood pt-13.1 ptt-23.7 inr(pt)-1.1 08:50pm blood glucose-96 urean-36* creat-1.7* na-138 k-5.4* cl-104 hco3-24 angap-15 06:20am blood glucose-82 urean-28* creat-1.3* na-139 k-4.4 cl-107 hco3-23 angap-13 08:50pm blood ctropnt-0.02* 06:20am blood ctropnt-<0.01 08:50pm blood tsh-1.7 08:50pm blood digoxin-<0.2* labs on discharge: 07:30am blood wbc-6.3 rbc-3.41* hgb-10.3* hct-30.9* mcv-91 mch-30.3 mchc-33.5 rdw-16.0* plt ct-182 06:08am blood pt-13.6* ptt-29.1 inr(pt)-1.2* 07:30am blood glucose-81 urean-17 creat-0.8 na-143 k-3.9 cl-107 hco3-26 angap-14 06:08am blood calcium-8.4 phos-3.6 mg-2.0 08:50pm blood tsh-1.7 08:50pm blood digoxin-<0.2* microbiology: 4:12 am urine source: cvs. **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. blood cultures x 2 pending blood culture pending 10:16 am urine site: catheter **final report ** urine culture (final ): enterococcus sp.. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- 128 r tetracycline---------- =>16 r vancomycin------------ 1 s imaging: chest (portable ap) study date of 9:00 pm findings: portable ap view of the chest is obtained. low lung volumes significantly limit the evaluation, thought allowing for this, there is no focal consolidation, effusion, or signs of chf. cardiomediastinal silhouette appears grossly stable, though visualization is quite limited given the low lung volumes. lung apices are clear. bony structures are intact. impression: limited study without definite signs of chf or pneumonia. - ecg study date of 9:05:34 pm regular supraventricular rhythm. diminutive p waves. p-r interval prolongation. st-t wave abnormalities. since the previous tracing of the rate is slower. q-t interval is longer. st-t wave abnormalities are more prominent. - ecg study date of 8:28:18 am sinus bradycardia with frequent atrial premature beats. left ventricular hypertrophy. significant st-t wave changes in leads ii, iii, avf and v2-v6. compared to the previous tracing of no diagnostic interval change. - chest (portable ap) study date of 5:45 pm findings: in comparison with the study of , there has been placement of a new left-sided pacemaker with the single lead extending to the region of the apex of the right ventricle. no evidence of pneumothorax or other acute abnormality. - chest (pa & lat) study date of 9:20 am findings: in comparison with study of , there is no interval change or evidence of pneumothorax. single-channel pacemaker device remains in place and there is no evidence of acute focal pneumonia or vascular congestion. brief hospital course: f nsh resident who presents with bradycardia in the setting of intravascular depletion and calcium channel blocker use. . # sick sinus syndrome/af: pt in slow af with occasional pauses up to 3-5 seconds, thus occasionally with a hr in the 30s. here her sbp has been in the 150-160s, while at her care facility she had sbp in 90s. hr improved with atropine, and it appears her sbp has improved with fluids after she received close to 600cc ns. pt was comfortable and hemodyanamically stable. ep was consulted and felt a permanent pacemaker was warranted. per ep recs pt was transferred to ccu for iv isoproterenol infusion while awaiting for pacemaker implant on monday given that placement of a temporary pacemaker was not feasible or safe w/pt's baseline dementia. in the icu, isoproterenol was kept on hold in case of bradycardia, but the patient did not require any medical intervention for her heart rate. she was stable and went for uncomplicated placement of a single-chamber permanent pacemaker through the left subclavian. she will have a device clinic appt in 1 week and f/u with , md in about 1 month. she is not on coumadin because of falls and is on full dose asa for stroke prophylaxis. . # coronaries: no known cad. pt without chest pain and no complaints of chest pain when examine. trop 0.02 and <0.01. aspirin continued . # pump: last tte from showed pt had ef of 60-65%. pt apepars clinically dry by further evidence of rise in bun/cr. was given gentle fluids and encouraged to take pos and cr improved. . # hyperkalemia: k 5.4 in setting of intravascular depletion. pt received kayexelate in ed. no peaked t waves. k was 4.4 on repeat. . # chronic constipation: stable. continued bowel regimen colace, polyethylene glycol, bisacodyl; also added senna. . # anemia: hct 32.1 up from mid twenties in . likely further evidence of intravascular depletion. was relatively stable at 30 after iv fluids. . # hx of hypertension: pt initially had borderline sbps in setting of bradycardia. amlodipine, lisinpril were held. pressures improved and lisinopril was restarted at 20 mg daily, can be titrated up to home dose of 40 mg as bp tolerates. amlodipine was not restarted and can be considered if bp is still high with full dose of linsinopril. # uti: pt had positive urine culture and started empirically on ciprofloxacin. the urine culture grew enterococcus, sensitive to ampicillin. rehab was contact and advised to start ampicillin 250 mg po q8h for 7 days to adequately treat. a repeat urine culture should be checked after the antibiotics are finished. . full code confirmed . comm: medications on admission: meds per pharmacy ( pharmacy) aspirin ec 325mg daily lisinopril 40mg dailyy omeprazole 20mg daily cyanocobalamin 100mcg po 1.5 amlodipine 5mg daily ferrous gluconate 325mg po tylenol 650mg tid . bowel regimen docusate sodium 100mg polyethylene glycol 3350 17 gram/dose po daily bisacodyl 10 mg po daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: 1.5 tablets po daily (daily). 3. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po daily (daily). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 9. ciprofloxacin 500 mg tablet sig: 0.5 tablet po q12h (every 12 hours) for 4 doses. 10. cephalexin 500 mg capsule sig: one (1) capsule po three times a day for 1 days. 11. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: for the aged - discharge diagnosis: sick sinus syndrome s/p pacemaker placement hypertension urinary tract infection atrial fibrillation dementia discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had a slow heart rate called sick sinus syndrome and required a pacemaker to keep your heart rate up. it is functioning well now and you will need to return in 1 week to check the wound area. in the meantime, do not get the dressing wet for 72 hours, no lifting your left arm over your chest or lifting more than 5 pounds for 6 weeks. the dressing can come off in 72 hours and then you can shower. no baths or pools until after the device clinic checkup. you have been started on antibiotics for one more day to prevent an infection at the wound site. you also have a urinary tract infection that we are treating with ciprofloxacin. you will need to take this for 7 days. we have restarted some of your antihypertensive medicines. . we made the following changes to your medicines: 1. start taking ciprofloxacin for your urinary tract infection 2. start taking cephalexin for one day to prevent an infection at the pacer site 3. decrease the lisinopril to 20 mg daily 4. stop taking the amlodipine because your blood pressure is lower, may be restarted in the future. followup instructions: we are working on a follow up appointment in cardiology with dr. within 1 month. the office will contact you at home with an appointment. if you have not heard within 2 business days or have any questions please call . . device clinic: tuesday at 1pm. clinical center, , , , . . please make an appt with your primary care doctor after you get out of rehabilitation procedure: initial insertion of single-chamber device, rate responsive initial insertion of transvenous lead [electrode] into ventricle diagnoses: hyperpotassemia urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere constipation, unspecified iron deficiency anemia, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] sinoatrial node dysfunction dehydration other specified retention of urine 

Answer: The patient is high likely exposed to