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: benzodiazepines / buspar / xanax attending: chief complaint: infected pacemaker major surgical or invasive procedure: pacemaker lead removal pacemaker replacement emergent cardioversion from ventricular tachycardia history of present illness: is a 75 year old gentleman with pmh of htn, hld, afib, chf with ef of 15%, s/p icd after 3 separate cardiac arrests. patient underwent an biv upgrade at after being transferred from , s/p vf arrest at that time. the patient says that the site of the pacer never healed after surgery he had in . he reports that he recently visited his cardiologist in , dr. , it was decided that he need to undergo surgical repair. the patient has not had any pain at the site of the infection. he feels the reddness is stable. he denies fevers or chills. he reports that he can visualize the pacer lead and that it has been that way for quite some time. he has been on keflex tid for at least 1 month. pt discontinued his coumadin 2 days previously as instructed by his cardiologist. he is being admitted today for iv antibiotics in preparation for lead/pocket revision in or 1 on monday at 2pm. . ros: 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. he denies recent fevers, chills or rigors. 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: cardiac risk factors: + diabetes, - dyslipidemia, - hypertension cardiac history: cabg: none percutaneous coronary intervention: none pacemaker/icd: icd in place since ; icd updgraded . other past history: chronic systolic heart failure: cardiomyopathy. he had a witnessed ventricular fibrillation arrest atrial fibrillation - on coumadin hypertension hypothyroidism depression coronary artery disease - pt reports three heart attacks (, -while mountainbiking, - while waiting for a cab) no pci/cabg right eye cataract surgery anemia - pt recently had work up of his anemia, thought to be r/t to multiple recent hospitalizations mgus social history: patient is a psychotherapist who specializes in addiction counseling. he lives in an . -tobacco history: denies -etoh: denies -illicit drugs: denies family history: no family history of early mi, otherwise non-contributory. physical exam: vs - t 96.0 bp 115/53 p 60 rr 18 o2sat 98% ra gen: wdwn male in 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 8 cm. cv: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. no femoral bruits. skin: 10 cm area of erythema and scaling on the left chest over the pacer site. there is a 1-2cm opening in the skin where the pacerwire is visualize. there is no purulent drainage. pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: 06:48pm wbc-4.3 rbc-3.36* hgb-11.1* hct-30.4* mcv-90 mch-33.1* mchc-36.6* rdw-14.9 06:48pm neuts-65.7 lymphs-22.5 monos-6.0 eos-5.4* basos-0.4 06:48pm plt count-179 06:48pm glucose-95 urea n-21* creat-1.5* sodium-138 potassium-4.2 chloride-97 total co2-34* anion gap-11 06:48pm calcium-9.4 phosphate-3.2 magnesium-2.7* 06:48pm tsh-5.7* 06:48pm digoxin-2.2* 05:05pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg . cxr findings: in comparison with the study of , there is little change. again there is substantial enlargement of the cardiac silhouette in a patient with pacemaker device in place. no evidence of vascular congestion or pleural effusion. the nipple ring has been removed. ekg : v paced hr 60with no significant change compared with prior dated . ekg: ventricular paced rhythm with intermittent atrial pacing. . 2d-echocardiogram performed on demonstrated: 1. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is severe global left ventricular hypokinesis (lvef = 20 %). overall left ventricular systolic function is severely depressed. 3. the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. 4. the ascending aorta is moderately dilated. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. severe (4+) aortic regurgitation is seen. 6. mild (1+) mitral regurgitation is seen. 7. there is no pericardial effusion after extraction of the leads. . ett performed on demonstrated: impression: no anginal type symptoms with an uninterpretable ekg. possible drop in blood pressure with exercise. frequent ectopy. nuclear report: 1. no reversible perfusion defects at the level of exercise achieved. 2. severe, global hypokinesis of the left ventricle. 3. further increase in left ventricle cavity size compared to the prior study. 4. ef 17%. . cxr - the three pacemaker leads terminate in right atrium, right ventricle, and left ventricular epicardial vein. the lungs are essentially clear. there is no pneumothorax or appreciable pleural effusion. brief hospital course: mr is a 75 yo male with a history of severe chf, afib, htn, hld, cad who presented with concern for an infected pacemaker, s/p ccu stay for hypotension. . # pacemaker pocket infection: likely chronic cellulitis of pacemaker pocket since 7/. blood cultures persistently negative, wound swab gram stain/culture non-revealing. pt was started on vancomycin for a 10-day course (day 1: ). previous l-sided icd removed and new right-sided biv-icd placed on . at the time of placement of new pacer on the right, a pocket hematoma of the left pacer site was evacuated and a drain placed. . # hypotension: pt w history of htn, however, became hypotensive into 70s post-icd lead removal on likely poor forward flow from chf, hypovolemia from being npo, opiates during procedures, and loss of biventricular synchrony after icd extraction. echo did not show pericardial effusion or tamponade. initially required phenylephrine gtt in the peri-procedure hours, which was transitioned to dopamine gtt which was then weaned. his carvedilol, lisinopril, furosemide, spironolactone were held in setting of hypotension, but restarted once symptoms resolved in the ccu. . # pump: chronic systolic congestive heart failure with lvef 15%. s/p new right-sided biv-icd placement on . ace-i/bbl held for hypotension on transfer to ccu. once stable, pt restarted on carvedilol, lisinopril, digoxin, furosemide and spironolactone. . # coronaries: pt with history of multiple previous mis, but no history of cabg or pci. pt had episodes of substernal pressurelike 5/10 chest pain in the setting of anemia and hypertension. these were thought to be demand ischemia and not from an acute coronary event. he was continued on his aspirin 81mg, atorvastatin 10mg. outpatient risk stratification should be considered. . # rhythm: patient had a history of atrial fibrillation. was v-paced on admission. in the setting of dopamine drip for hypotension, he had an episode of ventricular tachycardia with sbp falling to the 50s. he was shocked at 200j once and returned to sinus rhythm with prolonged pr. coumadin was held, and he was anticoagulated with heparin gtt because of procedures. transitioned to coumadin after new biv-icd placed. digoxin continued. . # anemia: chronic of unclear etiology. hct 30s on admission; normocytic. the hct dropped with admission. . # hyponatremia - unclear etiology. initial na of 139, trended down to high 120s. he was apparently euvolemic. the differential included siadh, hypothyroidism, hypocortisolism. random cortisol was 18.1, so he was unlikely to have adrenal insuffiency. tsh was slightly elevated but free t4 was normal. sodium trended up with free water restriction. . # hypothyroidism: tsh slightly elevated at 7.2. free t4 was normal. continued on levothyroxine 25 mcg po qday. . # depression: stable, continued on sertraline. . # acute renal failure likely - creatinine was elevated to 1.5 on admisssion. urine lytes not consistent with prerenal. urine output monitored. . pt will have cardiology and pcp follow up care. medications on admission: amiodarone 200mg po qday atorvastatin 10 mg po qhs carvedilol 12.5 mg po bid digoxin 125 mcg po qday furosemide 120mg po qday (at noon) levothyroxine 25 mg po qday lisinopril 10 mg po qday spironolactone 25 mg qday (at noon) warfarin 3 mg po qhs - stopped taking 2 days pta ascorbate calcium 500mg po qday aspirin 81 mg po qday calcium- cholecalciferol 500mg-200unit po qday mvi discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po hs (at bedtime). 2. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 3. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 6. spironolactone 25 mg tablet sig: one (1) tablet po noon (at noon). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. 11. keflex 250 mg capsule sig: one (1) capsule po three times a day for 7 days. disp:*21 capsule(s)* refills:*0* 12. outpatient lab work please have your inr checked on thursday . please have your bun & creatinine checked on thursday . please have results faxed to your pcp 13. lasix 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 16. senna 8.6 mg capsule sig: two (2) capsule po once a day. disp:*60 capsule(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: infected pacemaker hyponatremia ventricular tachycardia secondary diagnoses: chronic systolic heart failure atrial fibrillation hypertension hypothyroidism depression coronary artery disease anemia discharge condition: stable discharge instructions: you were admitted with an infection in your pacemaker. you were treated with intravenous antibiotics. you underwent removal and replacement of that pacemaker. you also had ventricular tachycardia for which your heart was shocked. you had a low blood count after the surgery and were given a transfusion. please take your medications as prescribed. we recommend that you take keflex 1 tab twice a day for 7 days. we recommend that you restart your coumadin at a dose of 3mg. we decreased your dose of lasix to 80mg by mouth daily. you will need to follow up with your doctor in the next few weeks to possibly readjust this dosage. we stopped your lisinopril due to problems with your renal function. please have your kidney function checked with your inr and ask your pcp if it is okay to restart that medication. we recommend that you take iron for your anemia. iron can be constipating so you should also take stool softeners which are over the counter. please keep your follow up appointments. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: none followup instructions: we recommend that you follow up with your cardiologist, dr. in months. please call to make an appointment with dr. . you have an appointment for a pacemaker check. provider: clinic phone: date/time: 11:30am please contact your primary care doctor, dr. , to have your inr level checked 3 days. your primary care doctor will adjust your coumadin dose accordingly. your primary care doctor will need to assess your fluid status and adjust your lasix dosing as needed. procedure: other electric countershock of heart other incision with drainage of skin and subcutaneous tissue removal of lead(s) [electrode] without replacement implantation of cardiac resynchronization defibrillator, total system [crt-d] revision or relocation of cardiac device pocket diagnoses: other primary cardiomyopathies other iatrogenic hypotension anemia, unspecified cellulitis and abscess of trunk congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism atrial fibrillation hematoma complicating a procedure paroxysmal ventricular tachycardia other specified forms of chronic ischemic heart disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of anticoagulants acute on chronic systolic heart failure disruption of external operation (surgical) wound personal history of sudden cardiac arrest infection and inflammatory reaction due to cardiac device, implant, and graft monoclonal paraproteinemia 

Answer: The patient is high likely exposed to