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: chest pain, hypotension major surgical or invasive procedure: none history of present illness: mrs. is an 81f with hx of as (valve area 1.0-1.2 cm2), ar, htn, dvt x3, dyslipidemia, copd, pmr, mild pulmonary htn, initially admitted to for chest pain and new atrial fibrillation, now transferred to ccu for hypotension. . see nightfloat admission note for full details of initial presentation. briefly, the patient developed substernal chest pain that awoke her from sleep about 24 hours ago. the pain has an aching quality and is non-exertional and non-pleuritic. she has not previously had this type of chest pain, so she presented to the er for further evaluation. . in the ed, the patient had bradycardia at 44bpm. her hr initially ranged 42-44 and she was asymptomatic at that time. she then went into atrial fibrillation with hr in the 90's with associated decrease in bp of 80's-90's. she was given multiple 250cc boluses for a total of 1.75l in the ed to maintain her bp between 80's-100's systolic. she remained asymptomatic throughout. cta was negative for a pe. cxr was negative. she had a positive ua and was given cipro iv x1 and lovenox in the ed. ce's were neg x1. overnight she continued to have intermittent episodes of hypotension with sbp's in the 80's, so her antibiotic coverage was broadened to unasyn, and planned to be transferred to the ccu for a tee and cardioversion once a bed became available. prior to transfer to the ccu her blood pressure again dropped to the 80's systolic and she required another 250cc bolus. . on arrival to the ccu her initial vs were: 75, 99/37, 24, 95% on ra, she is well appearing and denies shortness of breath, lightheadedness, nausea, palpitations, or other symptoms. she does report continued mild chest pain that has improved throughout her stay. she says that she is not excited about her upcoming procedures but is willing to undergo the tee and cardioversion. she says that she has never been in a.fib before. shortly after arrival to the ccu she spontaneously converted to nsr with ectopy. . on review of systems, she denies any prior history of stroke, afib, fevers, cough, dysuria, polyuria or increased frequency, diarrhea. all of the other review of systems were negative. past medical history: 1. cardiac risk factors: (+)dyslipidemia, (+)hypertension 2. cardiac history: - aortic stenosis - moderate with peak gradient 73mmhg, mean 39mmhg 1.1 cm2 (). - mild aortic regurgitation. 3. other past medical history: 1. copd 2. polymyalgia rheumatica/seronegative rheumatoid arthritis 3. 3 dvts in the context of plane rides 4. large ventral hernia social history: currently smoking 1 pack per day since college in , stopped for 5 or 6 years at one time but restarted when he daughter got divorced 20 years ago, no history of drug or alcohol abuse. patient is married and is a former biochemist. the patient's weekly exercise regimen consists of walking briskly. patient usually tries to adhere to a sensible diet and manages adls well. family history: mother died of a ruptured aaa at age 70. father died of leukemia. there is no family history of premature coronary artery disease, unexplained heart failure, or sudden death. physical exam: admission physical: vs: 75, 99/37, 24, 95% on ra general: alert, interactive, appropriate, comfortable, nad. heent: pupils equal and round, eomi, mmm. neck: supple, jvd ~10cm cardiac: irregularly irregular, iii/vi late peaking systolic murmer at rusb without audible s2, gii holosystolic murmer at lsb, ii/vi diastolic murmer at rusb radiating to lsb. lungs: ctab but poor air movement, no wheezes, rhonchi. abdomen: soft, ntnd, large ventral hernia. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ left: dp 2+ . discharge physical: pertinent results: admission labs (): blood wbc-10.5 rbc-4.10* hgb-12.3 hct-37.4 mcv-91 mch-30.0 mchc-32.8 rdw-12.7 plt ct-202 neuts-76.3* lymphs-16.7* monos-5.8 eos-0.5 baso-0.7 pt-12.9 ptt-35.6* inr(pt)-1.1 glucose-159* urean-34* creat-1.3* na-135 k-4.3 cl-99 hco3-27 angap-13 alt-7 ast-19 ld(ldh)-209 ck(cpk)-50 alkphos-73 totbili-0.7 calcium-9.0 phos-3.3 mg-2.2 tsh-0.28 lactate-1.4 . cardiac markers: 06:45pm blood ctropnt-<0.01 02:45am blood ctropnt-<0.01 09:05am blood ck-mb-2 ctropnt-<0.01 . discharge labs: wbc-6.8 rbc-3.16* hgb-9.8* hct-28.5* mcv-90 mch-31.1 mchc-34.4 rdw-12.6 plt ct-194 pt-16.1* inr(pt)-1.4* glucose-99 urean-27* creat-1.4* na-139 k-3.8 cl-104 hco3-28 angap-11 calcium-8.5 phos-3.6 mg-1.9 . studies: cxr : impression: interval slight enlargement of the cardiac silhouette likely indicating cardiomegaly, although pericardial effusion remains within the differential diagnosis. no acute pulmonary process. . cta : impression: 1. no acute pulmonary embolism or aortic pathology. 2. 8-mm right thyroid nodule. if clinically indicated, recommend non-emergent thyroid ultrasound to further characterize. . tte : conclusions the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the degree of as calculated is now severe. . micro: time taken not noted log-in date/time: 7:12 am urine site: not specified 2005f. urine culture (preliminary): escherichia coli. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s brief hospital course: hospital course: pt is a 81f with hx of as (valve area 1.0-1.2 cm2), ar, htn, dvt x3, dyslipidemia, copd, pmr, mild pulmonary htn who presented with chest pain, now with new onset of atrial fibrillation with hypotension when her rates increase to the 90's. she briefly converted spontaneously to sr, but returned to atrial fibrillation and was started on amiodarone initially with bolus therapy . active issues: # atrial fibrillation: the patient was admitted from to the ccu for tee cardioversion for hypotension in setting of atrial fibrillation. the patient flipped into sinus on admission to the ccu floor and was normotensive. she was loaded with iv amiodarone. given persistent heart rates in the 50s with brief bradycardic epsiodes to 30s and frequent ectopy the patient was monitored overnight in the ccu. she remained in sinus overnight, with heart rates stable in the 50-60s with normal blood pressures. the following morning she flipped back into atrial fibrillation and stayed normotensive. the onset of af was thought to possibly be secondary to her uti, and in the setting of predisposition to afib given her valvular abnormalities likely causing possible dilation of her cardiac , although her la was 3.9cm on her most recent echo. she is asymptomatic with the afib and may have been in paroxysmal afib prior to this admission. she was started on amiodarone with improvement in her heart rate however with significant ectopy w/ ventricular trigeminy that improved overnight. tsh normal. chads2 score 2. she reverted back into af, but remained hd stable. tte demonstrated worsened as with valve area 0.8-1. her hr into 120s with ambulation, though asymptomatic, and started on low dose metoprolol which was later stopped due to bradycardic episodes. pt also spontanous converted out of af on and stayed in sinus rhythm until discharge. ep was consulted, and recommended tee/, pt refused this intervention and was managed on amiodarone. she was continued on heparin gtt, and started on coumadin. at time she left the hospital her inr was not yet therapeutic and pt was placed on lovenox as an outpt to bridge to theraputic inr . # as: as above, tte demonstrated now severe as, with valve area 0.8-1cm. symptoms of cp on admission possibly related to as, though may have also been demand in setting of af. pt refused cardiac surgery consult in inpt setting although agreed to see ct surgery service in clinic. . # urinary tract infection: urinary tract infection on admission to ed, she was started on ciprofloxacin and changed to iv unasyn on the floor. she was changed back to ciprofloxacin. ucx grew e. coli pan-sensitive, and she completed a 3 day course for uncomplicated uti. . # coronaries: no evidence of active ischemia. her cardiac enzymes were cycled and negative. her ecg's initially showed af but after spontaneous conversion to sinus showed sinus bradycardia with atrial premature beats. q-t interval prolongation. low amplitude t waves. . # pump: patient had ef 55% and as with valve area 1.0-1.2 which she has been tolerating well prior to this admission. she appeared mildly volume overloaded to euvolemic with mildly elevated jvp, difficult to assess volume status by lung exam given significant copd and poor air movement, no le edema. tte yesterday with ef 55% again. at time of discharge pt was relatively euvolemic. . #. hypertension: home anti-hypertensives were initially held in setting of low bp's (atenolol, hctz, lisinopril). low dose metoprolol 12.5mg was started on for rate control but then stopped as above due to bradycardia. acei was no restarted in the hospital due to slightly elevated cr. pt will need f/u of cr as outpt and addition of ace-i when normalizes. . inactive issues: #. dyslipidemia: continued home pravastatin. . #. copd: stable. on no home medications. . #. polymyalgia rheumatica/seronegative rheumatoid arthritis: stable continued hydroxychloroquine. . #. smoking cessation: continued home bupropion. tobacco cessation discussed with patient at bedside yesterday. she endorsed desire to quit and belief that she would succeed. offered nicotine patch/nicorette gum at time of d/c for assistance w/ continued cessation. . # thyroid nodule: noticed 8mm thyroid nodule on cta. need further workup as outpatient. . transitional care: 1. code: full 2. medical management: 3. follow-up: ***as above, thyroid nodule noted on cta, may need further workup as outpatient medications on admission: home medications: atenolol - 25 mg daily bupropion sr- 150 mg twice a day hydrochlorothiazide - 25 mg daily hydroxychloroquine - 200 mg twice a day lisinopril - 20 mg once a day pravastatin - 20 mg once a day aspirin - 81 mg once a day calcium carbonate - 600 mg (1,500 mg) twice a day ergocalciferol (vitamin d2)- 1,000 unit daily centrum silver - 1 tablet daily omega-3 fatty acids -1,000 mg once a day . medications on transfer: aspirin 81mg daily acetaminophen 325-650mg q6h prn:pain ampicillin-sulbactam 3g q8h bupropion sr 150mg calcium carbonate 1500mg docusate sodium 100mg enoxaparin 30mg sc q24h fish oil 1000mg daily hydroxychloroquine sulfate 200mg multivitamin 1 tablet daily pravastatin 20mg daily senna 1 tablet :prn constipation vitamin d 1000 units daily discharge medications: 1. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). 2. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 3. pravastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. calcium 600 600 mg (1,500 mg) tablet sig: one (1) tablet po twice a day. 6. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 7. centrum silver tablet sig: one (1) tablet po once a day. 8. omega-3 fatty acids 1,000 mg capsule sig: one (1) capsule po once a day. 9. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 10. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily) for 2 weeks. disp:*30 tablet(s)* refills:*0* 11. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous daily (daily). disp:*5 syringes* refills:*2* 12. outpatient lab work please check chem-7 and inr on friday with results to dr. at discharge disposition: home with service facility: homecare discharge diagnosis: atrial fibrillation and rapid ventricular response urinary tract infection aortic stenosis hypertension dyslipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had an irregular heart rhythm called atrial fibrillation and needed to be started on a new medicine, amiodarone. this medicine eventually converted you back into a regular rhythm. as atrial fibrillation increases your risk of a stroke, we started you on coumadin to decrease the risk. you will need to take this medicine every day and use lovenox injections once a day until your inr is > 2.0. dr. will tell you how much coumadin to take every day and when it is ok to stop using the lovenox. you had a urinary tract infection that was treated with 3 days of an antibiotic. you had some chest pain but did not have a heart attack. you also had a 8 mm thyroid nodule that was found. this nodule is probably not serious but you will need an ultrasound that dr. can arrange to further evaluate the nodule. there is no sign that your thyroid function is affected. . we made the following changes to your medicines: 1. stop taking atenolol, lisinopril and hydrochlorothiazide 2. start taking coumadin (warfarin) to prevent blood clots and strokes 3. start taking lovenox injections once daily until your inr is more than 2.0 3. start taking amiodarone to keep your heart rhythm regular. you will take two tablets daily for 2 weeks, then decrease to one tablet daily. followup instructions: department: cardiac services when: friday at 2:00 pm with: , md building: campus: east best parking: garage department: gerontology when: monday at 11:30 am with: , rnc building: lm campus: west best parking: garage department: radiology when: wednesday at 1:30 pm building: ra (/ complex) campus: east best parking: main garage department: cardiac services when: friday at 10:40 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage procedure: diagnostic ultrasound of heart diagnoses: polymyalgia rheumatica tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia long-term (current) use of anticoagulants rheumatoid arthritis personal history of venous thrombosis and embolism other fluid overload nontoxic uninodular goiter 

Answer: The patient is high likely exposed to