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: nafcillin / clindamycin attending: chief complaint: sustained vt refractory to icd major surgical or invasive procedure: -redo median sternotomy and epicardial ventricular tachycardia ablation using the cryocath device -right ventricular biopsy -elective intubation for surgery -central venous line placement for surgery history of present illness: 48 yom, who is an ep patient with arrhythmogenic right ventricular cardiomyopathy (arvc), hx of svc syndrome, bilateral subclavian stenosis, hx of endocarditis and multiple icd complications, admitted after sustained vt refractory to icd firing for elective external ablation and pacemaker placement, whose post-operative course has been complicated by vt responsive to bb. . he was diagnosed with vt at the age 17 and was managed on quinidine until the age of 33; during this interval he was very active - ran a marathon and -dived - and only had rare episodes of vt, which would spontaneously resolve with cessation of physical activity. at the age of 33, an icd was implanted; however, his course since then has been complicated by multiple infections and line dislodgements, requiring replacement of multiple icds. . 4 weeks prior to this hospitalization, his icd fired while he was carrying a wood duck house in the ; it fired 5 times and he returned to sinus. 5 days later, his icd fired again, this time after he was startled by a moose while hunting. however, this time, he sustained vt. he called his wife, who found him in the and took him to the local ed. . at the local ed, his vt was refractory to medications and he was finally dc cardioverted and transferred to for further management. during this hospitalization, the patient was scheduled for an epicardial ablation, but during the procedure, the ep team was not able to perform the ablation because the icd lead was stenosed to lv and not functioning. the icd lead could not be removed in ep lab. the patient was discharged home on lifevest and scheduled to return for elective thoracic surgery for epicardial ablation and replacement of icd on right side in weeks. . he underwent the procedure monday . during the procedure, dr. mapped the epicardium and dr. ablated areas of the inferior aspect of the right ventricle with a cryo/cath in several different locations; a biopsy of the area was also taken. right sided icd was placed. . post-operatively he did well intitially, but then had an episode of sustained vt on pod2 with persistent icd firing. his bb was started and uptitrated and he has since remained in sinus. . . cardiac review of systems: (+) per hpi. has noticed increased diffuse ue edema and skin tightness, improving le edema, and facial edema. (-) denies chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . other review of systems: (+) per hpi (-) denies any exertional buttock or calf pain; prior history of stroke, tia, deep venous thrombosis, pulmonary embolism; bleeding at the time of surgery, hemoptysis, black or red stools. . also denies fevers, chills, myalgias, joint pains; cough, wheezes; diarrhea, or recent change in bowel habits; dysuria or change in voiding habits; rashes or skin breakdown; numbness/tingling in extremities; feelings of depression or anxiety. all of the other review of systems were negative. . past medical history: cardiac risk factors: (-)diabetes, (-)dyslipidemia, (-)hypertension, (-) smoking, (-) fh early mi or sudden cardiac death . cardiac history: -right ventricular icd -arrhythmogenic right ventricular cardiomyopathy -exertional syncope due to vt at the age of 16, treated chronically with quinidine -inducible vt by ep study on -dual chamber icd implant (left pectoral) on , with a pacesetter atrial lead and a cpi ventricular lead. -new right-sided icd in , at an outside hospital following lead fracture. -endocarditis involving the right-sided icd in . -hemi-sternotomy and lead extraction on . -implant of a 6949 rv lead on , following venoplasty of an occluded right axillary subclavian vein. -right ventricular 6949 lead extraction on , due to high impedance and lead recall with implant of a st. right ventricular dual coil defibrillation lead following right subclavian venoplasty. . coronary artery bypass grafts: none . percutaneous coronary interventions: none . pacing / icd: as above social history: -smoking/tobacco: none -etoh: none -illicits: none -lives at/with: wife, 15yo son, also has 2 children from previous marriage; works as a real-estate manager. loves to hunt duck and big game. also loves gather wood (no axe swinging) for his woodstove. family history: -mother 72 and well -father died of esophageal cancer at 58. -four siblings, who are alive and in good health. . no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission pe: . vs: t=96.4...bp= 90/60, hr 60s...o2 sat= 98% ra general: wdwn 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 cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. pacer pocket is without erythema or warmth. lungs: cta bl abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: radial 2+ dp 2+ left: radial 2+ dp 2+ discharge pe: vitals: 98.2 78 108/63 78 18 97 ra . discharge pe: . general: wdwn in nad. alert & oriented x3. mood, affect appropriate. no central or peripheral cyanosis; no jaundice, no palor. heent: ncat. sclera anicteric. perrl, eomi. neck: supple; no jvd. r ij in place. cardiac: pmi non-displaced. rr, normal s1, s2; no s3, s4. no m/r/g. no thrills, lifts. chest: well healing sternotomy wound cdi. lungs: bronchial breath sounds half-way up r lung fields posteriorly, asymmetric compared to left. otherwise, no adventitial sounds. respirations unlabored, no accessory muscle use. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. groin: no femoral bruits. extremities: no cyanosis, clubbing, or edema. mildly tense ue skin and bilateral hand + edema. skin: no stasis dermatitis, ulcers, scars. pulses: right: dp 2+ left: dp 2+ neuro: cn2-12 intact; moving 4 extremities spontaneously pertinent results: admission labs: 11:07pm type-art po2-173* pco2-38 ph-7.31* total co2-20* base xs--6 11:07pm o2 sat-98 09:48pm type-art po2-148* pco2-35 ph-7.34* total co2-20* base xs--5 09:48pm glucose-147* 09:48pm o2 sat-98 08:43pm wbc-10.7 rbc-4.01* hgb-11.7* hct-34.5* mcv-86 mch-29.2 mchc-33.9 rdw-13.8 08:43pm plt count-185 08:43pm pt-16.6* ptt-29.5 inr(pt)-1.5* 08:26pm type-art po2-152* pco2-57* ph-7.21* total co2-24 base xs--5 08:26pm glucose-128* na+-139 k+-3.5 08:26pm freeca-1.07* 05:28pm type-art po2-175* pco2-46* ph-7.30* total co2-24 base xs--3 intubated-intubated vent-controlled 05:28pm glucose-112* lactate-0.7 na+-140 k+-3.2* cl--109 05:28pm hgb-11.8* calchct-35 05:28pm freeca-1.05* 01:52pm type-art po2-458* pco2-32* ph-7.49* total co2-25 base xs-2 intubated-intubated 01:52pm glucose-93 lactate-1.0 na+-138 k+-3.8 cl--106 01:52pm hgb-12.9* calchct-39 01:52pm hgb-12.9* calchct-39 01:52pm freeca-1.08* 10:25am pt-14.4* inr(pt)-1.2* . ekg: : sinus rhythm. diffuse st-t wave changes may be due to ischemia. compared to the previous tracing of qrs change is not quite as wide so full criteria for right bundle-branch block are not quite met and the rate has increased. . stress: : this 44 year old man s/p aicd ' with a history of right ventricular dysplasia was referred to the lab for arrhythmia evaluation. the patient exercised for 13 minutes of protocol and stopped for fatigue. the estimate peak mets are 15.1 which represents an excellent physical working capacity for his age. no arm, neck, back or chest disocmfort was reported by the patient throughout the study. there were no st segment changes during exercise or in recovery. the rhythm was sinus with several isolated vpbs. appropriate hemodynamic response to exercise on beta blocker therapy. . impression: no anginal type symptoms, ischemic ekg changes or significant exercise induced ectopy. nuclear report sent separately. . nuclear: 1. normal myocardial perfusion. 2. mild left ventricular enlargement. 3. lvef 53%. . cardiac cath: no recent . echocardiogram: . tte: 1. the left atrium is mildly dilated. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. overall left ventricular systolic function is low normal (lvef 50-55%). 3. the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. 4. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. there is no aortic valve stenosis. no aortic regurgitation is seen. 6. the mitral valve appears structurally normal with trivial mitral regurgitation. 7. there is a very small pericardial effusion. drs. and were notified in person of the results. after lead extraction, there was no increase in the size of the pericardial effusion. . tte: the right atrial pressure is indeterminate. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). **the right ventricular cavity is dilated with severe global free wall hypokinesis.** no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is a small circumferential pericardial effusion without echocardiographic signs of tamponade. . compared with the prior study (images reviewed), the pericardial effusion now appears more circumferential, but likely similar in absolute volume of fluid. . . imaging: . ct-coronary: impression: 1. mild nonobstructive noncalcified plaque within lad, lcx, and rca, causing up to 30% luminal narrowing. 2. borderline mediastinal and hilar lymph nodes, that might be consistent with the diagnosis of sarcoisdosis. no evidence of pulmonary sarcoidosis. no definite evidence of abnormal myocardial perfusion/thickening to suggest cardiac sarcoidosis. 3. partially visualized left upper lobe pulmonary nodule, stable since at least . 4. retained cardiac pacer wire within proximal left brachiocephalic vein, unchanged since . 5. small hiatal hernia. . pa-l cxr : the patient was extubated in the meantime interval. the appearance of the pacemaker with its leads transversing the chest is unchanged. the right internal jugular line tip is not seen, but most likely does not extend beyond the superior/mid svc. . there is interval removal of the mediastinal drains and chest tube. there is no evidence of left pneumothorax. there is minimal apical right pneumothorax, new compared to prior study. bibasilar consolidations have slightly progressed in the interim, most likely consistent with interval progression of atelectasis. . pathology : right ventricular outflow tract, myocardial biopsy (a): -cardiac muscle with degenerative features and replacement by fibrofatty scar tissue (see note). right ventricular wall scar, myocardial biopsy (b): - cardiac muscle with degenerative features and replacement by fibrofatty scar tissue (see note). - areas with inflammatory infiltrate composed of neutrophils and occasional eosinophils. tissue on pacing lead (c): -acellular scar tissue. . note: (a-b): the histologic findings are consistent with arrhythmogenic right ventricular cardiomyopathy (arvc). . discharge labs: . 07:00am blood wbc-5.4 rbc-3.23* hgb-9.7* hct-28.3* mcv-88 mch-30.1 mchc-34.4 rdw-14.2 plt ct-214 07:00am blood plt ct-214 07:00am blood pt-17.0* ptt-28.7 inr(pt)-1.5* 07:00am blood 07:00am blood glucose-91 urean-16 creat-0.9 na-140 k-3.8 cl-103 hco3-26 angap-15 07:00am blood calcium-8.4 phos-4.0 mg-1.6 brief hospital course: 48 yom, who is an ep patient with arrhythmogenic right ventricular cardiomyopathy (arvc), hx of svc syndrome, bilateral subclavian stenosis, hx of endocarditis and multiple icd complications, admitted after sustained vt refractory to icd firing for elective external ablation and pacemaker placement, whose post-operative course was complicated by vt responsive to bb. . active issues: . # sustained vt in the setting of a history of paroxysmal vt: underlying etiology found to be arvc by pathology this admission. underwent elective epicardial ablation performed in tandem by drs. and as well as placement of a new pacemaker by dr. . he tolerated the redo sternotomy well but did have an episode of post-operative sustained vt refractory to icd firing as detailed below. he was discharged on quinidine 648 q8, toprol xl 100 daily, and warfarin. . # post-operative sustained vt: post-operatively had an episode of sustained vt refractory to icd firing thought to be due to post-operative catecholamines. he was re-started on a bb and did not have any further episodes; he was discharged on bb as detailed above. . # post-op edema in the setting of known svc syndrome: post-operatively had minimal edema that resolved with gentle lasix diuresis. when transferred to , had worsening ue edema bilaterally and subjective facial edema. his symptoms were thought to be secondary to mechanical obstruction caused by the patient's history of multiple pacer wires; given that his symptoms was thought to be hardware related, further diuresis was held. **the patient's ue edema will need close follow-up after discharge.** . # icd post-op management, history of endocarditis: discharged on a course of levofloxacin 500 q24 day 1 = , course = 7 days. . # anemia: hct on discharge was approximately 25 from 35 on admission. iron studies suggested iron deficiency anemia. **hct and response to fe supplementation started on discharge will need to be followed.** . # elective intubation for surgery: electively intubated and durably extubated without complications. . inactive/chronic issues: none . transitional issues: as above in **. medications on admission: cardiac meds -quinidine 648 mg tid -atenolol 100 mg daily -coumadin 2.5 mg daily . other meds . allergies/adr's: -nafcillin -clindamycin discharge medications: 1. quinidine gluconate 324 mg tablet sustained release sig: two (2) tablet sustained release po three times a day. 2. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 3. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 4. aspirin 81 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. disp:*4 tablet(s)* refills:*0* 6. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain for 21 days. disp:*63 tablet(s)* refills:*0* 7. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain for 14 days. disp:*42 tablet(s)* refills:*0* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 14 days. disp:*28 capsule(s)* refills:*2* 9. ferrous sulfate 325 mg (65 mg iron) capsule, sustained release sig: one (1) capsule, sustained release po once a day. disp:*30 capsule, sustained release(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: -arrhythmogenic right ventricular cardiomyopathy (the source of your ventricular tachycardia) . secondary: -none discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it has been a privilege to take care of you at the (). . you were hospitalized to undergo heart surgery in which your chest was opened and electrically overactive regions of your heart were precisely mapped and strategically destroyed; the purpose of this procedure was to stop your heart from recurrently going into a potentially dangerous fast rhythm known as ventricular tachycardia. at the same time of this operation, a new implantable cardioverter defibrillator (icd) was placed into your right chest to protect you from the potential dangers of ventricular tachycardia if they were to recur at some point in the future despite the aforementioned surgery. both procedures were performed successfully and you have made a very good recovery. . you had an episode of ventricular tachycardia after the surgery, but this was likely due to a combination of you not being on your regular beta-blocker at the time as well as being in a post-operative state in which your heart was easily excitable because of stress hormones normally released in the body in response to surgery. it is reassuring that you have not had any further episodes of ventricular tachycardia since your beta-blocker has been restarted, which suggests that the surgery was successful. . as you know, the care that you received in the hospital is not the end of your treatment. it is very important that you continue the following heart regimen after you are discharged: # start: levofloxacin 500 mg daily for 4 days, then stop. # start: toprol xl 100 mg daily # stop: atenolol 100 mg daily # continue: quinidine 648 mg three times daily # continue: coumadin 2.5 mg daily # start: aspirin 81 mg daily # refrain: from physical exertion or adrenaline-inducing activities, such as hunting, if at all possible # refrain: from activities that could dislodge your icd leads, such axe-swinging . it is also very important that you continue your post-operative recovery regimen from thoracic surgery after leaving the hospital. # start: incentive spirometer. **your goal should be to fill the entire spirometer four times per hour. it will be painful at first, but the pain gets better the more you use the spirometer and with increased activity as well as time.** # start: ibuprofen 600 mg every 8 hours as needed for pain. **for the first week after hospitalization, it will help prevent pain by taking this every 8 hours even if you don't have pain.** # start: percocet tabs every 8 hours as needed for breakthrough pain # start: colace to prevent constipation that can be caused by percocet; you may stop this medication after you stop taking percocet # stop temporarily: heavy lifting more than lbs for 1 month # stop temporarily: driving until you can lift lbs without pain . we have also started you on a medication for your low blood count, which is the result of your surgery as well as iron deficiency. # start: iron supplement 325 mg daily. take this medication until your primary care physician instructs you to stop taking it. . otherwise, continue taking your other medications as previously prescribed and attend all of the follow-up appointments detailed below. followup instructions: since it is the weekend, no physician offices are open. your follow-up appointments with the following physicians will be scheduled after your discharge and the physicians' offices will contact you shortly with dates and times. . # dr. # dr. # dr. procedure: venous catheterization, not elsewhere classified excision or destruction of other lesion or tissue of heart, open approach cardiac mapping biopsy of heart replacement of automatic cardioverter/defibrillator lead(s) only diagnoses: other primary cardiomyopathies acute posthemorrhagic anemia paroxysmal ventricular tachycardia compression of vein mechanical complication of automatic implantable cardiac defibrillator long-term (current) use of anticoagulants stricture of artery adhesive pericarditis 

Answer: The patient is high likely exposed to