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: ciprofloxacin / zometa / keflex / tetracycline / erythromycin / iodine containing agents classifier attending: chief complaint: icd firing x 2 major surgical or invasive procedure: none history of present illness: 64 yo f with h/o non-ischemic cardiomyopathy s/p biv-icd, ef 5-15%, paroxysmal atrial fibrillation s/p ablation, severe asthma, and reported episodes of v-fib vs. torsadesd de pointes when she gets sick who presents after experiencing icd shocks at an osh. in , the patient experienced a syncopal episode secondary to torsades and was shocked, upon which she had the generator to her icd changed. she was admitted to for fatigue and dizziness. while admitted, patient experienced a fall, during which she was shocked by her icd for presumable torsades. a head ct and tee were reportedly performed, both of which were unremarkable. ? electrolytes deranged at osh, got shocked twice at for torsades. on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he 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: - pacing/icd: aicd and biv pacer - nonischemic idiopathic cardiomyopathy, ef 5-15%, s/p aicd and biventricular pacer - paroxysmal atrial fibrillation status post ablation - severe asthma - old compression fractures of t8 and t10 - venous stasis disease - anxiety - depression - restless legs syndrome - recent septic bursitis of right knee social history: used to work as a jeweler. lives with son. - tobacco history: remote, 1 pack per week, quit 42 years ago. - etoh: approx. 1-2 drinks 4 times a week - illicit drugs: none family history: father had "heart problems" and died at 69. brother had some form of arrhythmia. no other cardiac history. son has a1-at. physical exam: physical examination on admission: vs: t=98.4 bp=121/70 hr=82 rr=17 o2 sat= 95% on 3l general: 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 with jvp of *** cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: aaox3, cnii-xii intact, 5/5 strength biceps, triceps, wrist, knee/hip flexors/extensors, 2+ reflexes biceps, brachioradialis, patellar, ankle. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ physical examination on dc: general: 68 yo f in mild distress, holding her lower back heent: mucous membs moist, no lymphadenopathy, jvp non elevated sitting at side of bed. chest: ctabl no wheezes, faint crackles left base cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. ext: wwp, no edema. feet warm. neuro: sensation intact to lt, pain, temperature, vibration, proprioception. cerebellar fxn intact, gait wnl. skin: no rash psych: alert, oriented, feels positive about progress with workup. pertinent results: labs on admit: 08:30pm blood wbc-6.6 rbc-3.78* hgb-12.3 hct-34.2* mcv-91 mch-32.5* mchc-35.9* rdw-14.8 plt ct-180 08:30pm blood neuts-74.9* lymphs-17.0* monos-3.8 eos-2.5 baso-1.8 08:30pm blood pt-45.6* ptt-44.3* inr(pt)-4.5* 08:30pm blood glucose-165* urean-15 creat-1.0 na-137 k-4.4 cl-100 hco3-28 angap-13 08:30pm blood calcium-8.7 phos-2.7 mg-2.0 11:30am blood digoxin-1.0 labs on dc: 06:45am blood wbc-7.4 rbc-3.74* hgb-11.9* hct-34.7* mcv-93 mch-31.9 mchc-34.4 rdw-14.8 plt ct-276 06:45am blood pt-16.8* inr(pt)-1.6* 06:45am blood urean-20 creat-0.9 na-140 k-4.0 cl-99 hco3-32 angap-13 ecg : sinus rhythm with atrial sensing and ventricular paced rhythm. possible left atrial abnormality. compared to the previous tracing of no significant change. cxr : severe cardiomegaly is stable. transvenous pacer leads are in stable, standard position. there is no pneumothorax. there are persistent low lung volumes. there are no enlarging pleural effusions. mild pulmonary edema is stable. cath : comments: 1) right heart catheterization was initially attempted via percutaneous access of the right antecubital vein. after introduction of a 5 french introducing sheath in the right antecubital vein, a 5 french pa catheter was advanced proximally, but encountered resistance in the upper mediastinum and could not be advanced toward the heart even with 0.025" guidewire support and infusion of 200 mcg iv nitroglycerin to alleviate potential venous spasm. the right femoral vein was therefore used for percutaneous access, and the 5 french pa catheter was introduced via the femoral vein uneventfully. 2) resting hemodynamics revealed moderate pulmonary hypertension with a mean pa pressure of 40 mmhg. left-sided filling pressures were moderately-elevated with a mean pcwp of 22 mmhg. the computed pvr was 379 dynes-sec/cm5 (4.5 ). the cardiac index was mildly reduced at 2.08 l/min/m2. final diagnosis: 1. moderate pulmonary arterial hypertension most likely due to elevated left-sided filling pressures. brief hospital course: hospital course: this is a 68f with with a pmh significant for non-ischemic and ischemic cardiomyopathy (lvef 5-10%) s/p aicd and biventricular pacer, paroxysmal atrial fibrillation s/p ablation, transferred from osh with vent tachycardia and likely chf exacerbation here for further management. # ventricular tachycardia/torsades: the patient had 2 recent episodes of ventricular tachycardi. tranfserred here after an appropriate shock for vt. per ep interrogation, icd interrogation : vf: 2 events, at 19:31, rate 273 bpm, shocked 35j with successful cardioversion, preceeding rhythm atrial tach at 22:40, rate 286 bpm, polymorphic, successfulcardioversion with 35j, preceeding rhythm atrial tach (cl ~500). review of telemetry recordings from , ecgs, and interrogation of icd performed showed that qt interval was normal, initiation of polymorphic vt/vf occured by an early-coupled vpd, not "short-long-short" sequence of vpf. arrhythmias are due to worsening chf, possibly precipitated by worsening chf. above discussed extensively with patient. ppm chages included a amplitude decreased from 3.5 v-->1.5 v, rv amplitude decreased from 3.5 v--> 2.5 v, lv amplitude increased from 2.25 v to 2.75 v and av delay increased from 200 ms. we continued dig 0.125 and monitored her on tele, and didnt have any events during her hopsital course. # systolic congestive heart failure: non-ischemia cardiomyopathy with (lvef 5-15%). transferred from osh for further management and concerns for potential worsening of chf and to assess if she is a candidate for lvad or heart transplant. we initially held many of her home medication due to hypotension. rhc showed mild to moderate pulmonary hypertension, pa 58/29 and pcwp 25. echos were performed to optimize his biv settings. the echocardiographic assessment showed no improvement in mitral valve flow by altering the v-v interval, but there was significant improvement when we increased the av delay. we also increased the beta-blocker dose in an effort to optimize ventricular filling. we changeded the pt from lasix to torsemide, reduced the valsartan dose and increased the metoprolol dose to 75. followup was set up with dr . # paroxysmal atrial fibrillation s/p ablation; was dced on 2.5mg qd of warfarin # anxiety: we continued home sertraline, trazodone. psych was consulted who suggested adding ativan while in house, and continuing home meds. # restless legs: we continued requip # back pain: stable. we continued oxycodone 2.5 ;prn and gabapentin 200 and 300 qhs;prn # copd: stable. we continued singulair, advair and replaced claritin w/ fexofenadine # gerd: stable. we continued protonix 40mg qd. transitonal issues: lasix was switched torsemdiode, valsartan was decreased and metop xl increased. f/up with dr who can then make appropriate changes to these meds after assessing repsonse. medications on admission: home medications: advair 500/50 ferrous sulfate daily (dose not listed) multiviatmin daily lasix 80 mg po bid aspirin 81 mg daily zoloft 100 mg daily magnesium oxide 400 mg daily aldactone 25 mg daily diovan 40 mg daily claritin 10 mg daily protonix 40 mg daily digoxin 0.125 mg daily gabepentin 300 mg tid singulair 10 mg qpm requip 0.25 mg qpm trazodone 25 mg prn for anxiety/sleep metoprolol succinate 12.5 mg whs warfarin (dose not listed) oxycodone 2.5 mg prn transfer medications: digoxin 0.25mg daily coumadin mag ox 400mg lasix 40mg iv bid kcl 20meq q8 asa 81 valsartan spironolactone 25mg singular 10mg oxycodone 5mg po q3h prn trazodone 25mg advair 50/500 1 puff requip 0.25mg at hour of sleep for restless legs loratadine 10mg po daily pantoprazole 40mg po daily sertraline 100mg po daily diet: fluid restriction of 1500ml, low salt. discharge medications: 1. outpatient lab work please check inr on monday with results to clinic at 2. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 3. multivitamin tablet sig: one (1) tablet po once a day. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 6. montelukast 10 mg tablet sig: one (1) tablet po hs (at bedtime). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. ropinirole 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 9. ferrous sulfate oral 10. sertraline 100 mg tablet sig: one (1) tablet po once a day. 11. magnesium oxide 400 mg tablet sig: one (1) tablet po once a day. 12. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for epigastric burning. 13. valsartan 40 mg tablet sig: 0.5 tablet po daily (daily). 14. torsemide 20 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*2* 15. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia. 16. metoprolol succinate 50 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po daily (daily). disp:*45 tablet extended release 24 hr(s)* refills:*2* 17. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 18. oxycodone 5 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for pain. 19. gabapentin 300 mg capsule sig: one (1) capsule po three times a day as needed for neuropathic pain. 20. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 21. claritin 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: acute on chronic systolic congestive heart failure ventricular tachycardia atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had an episode of ventricular tachycardia and received some shocks from your icd. you were transferred to for an evaluation of your congestive heart failure. we have adjusted your pacemaker to improve the pumping function of your heart and have adjusted some of your medicines. there have been no further episodes of irregular heart rhythms while you were here. you will start seeing dr. and advanced heart failure clinic here at . weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. please also call if you think you are dehydrated and dizzy. continue with home telemonitoring as before. . we made the following changes to your medicines: 1. stop taking spironolactone for now, dr. or dr. will restart this medicine later 2. decrease the valsartan to 20 mg daily instead of 40 mg 3. stop taking lasix, take torsemide instead to remove extra fluid. 4. increase the metoprolol to 75 mg daily to slow your heart rate. followup instructions: name: , h. address: 131 ornac , ste#800 jcb bldg, , phone: appt: at 11am department: cardiac services when: monday at 10:00 am with: dr. building: sc clinical ctr campus: east best parking: garage procedure: pulmonary artery wedge monitoring right heart cardiac catheterization diagnoses: other primary cardiomyopathies esophageal reflux congestive heart failure, unspecified atrial fibrillation other chronic pulmonary heart diseases paroxysmal ventricular tachycardia automatic implantable cardiac defibrillator in situ chronic obstructive asthma, unspecified acute on chronic systolic heart failure restless legs syndrome (rls) adjustment disorder with mixed anxiety and depressed mood 

Answer: The patient is high likely exposed to