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: patient recorded as having no known allergies to drugs attending: chief complaint: "chest fluttering" at osh, transfer for management of atrial flutter major surgical or invasive procedure: transvenous electrophysiology study/catheter ablation history of present illness: 48 yo m with hx of arrhythmia with 'shocked rhythm,' presumably svt, in , presented to pm with "chest fluttering," was found to have hemodynamically stable wide complex tachycardia thought to be ventricular tachycardia, and transferred to for management of atrial flutter. pt attended celtics game on , drank a bottle of wine, beer, and grain alcohol/stayed up all night, then felt "not his usual self/hungover" on , but denies chest fluttering or symptoms then. pt reports that in am hours on , had intermittent "chest fluttering" without chest pain but with some "discomfort." he lied on the couch, hoping that the symptoms would abate. with persistence of symptoms, he decided to seek medical care. has had symptoms like this in past requiring medical care, notably in and , and he reports transient sensations of heart fluttering up to several times a week at baseline, never associated with pain. on arrival to , ekg showed wide complex tachycardia with systolic blood pressure of 120/107, hr 240, rr 28. the rhythm then broke to 'sinus tach with pvcs' with hr 190s. he was given 5mg iv lopressor, and after 1 min, he reverted to wct in the 240s. he was then given 150mg amio bolus, following which he was seen to be in 'atrial flutter with 2:1 block' with continuation of amio gtt (1 mg/min x 1hr-->0.5 mg/min). cxr, cbc, lytes were all within normal limits, ces neg. in ed upon transfer, pt remained on amiodorone gtt, in atrial flutter with 2:1 block with rate ~150, with sbp of 128/112, with o2 saturations 97% on 2l. ekg showed lateral st-depressions of 1-2mm, undetermined if new, thought to be strain in setting of tachycardia. he was given 5mg of iv lopressor with no response, then given iv diltiazem with decrease in rate to 140. pt transitioned to diltiazem gtt and transferred to ccu. . on ros, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, 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, syncope or presyncope. . past medical history: 1. psoriasis - followed by derm clinic - 20yr hx 2. arrhythmia - - 'was given meds that stopped heart, which didnt work, then was cardioverted.' pt had no episodes until ~ when heart rate was "fast again," which slowed with medications. pt denies taking heart rate controlling medications for longer than 1-wk between and current. has taken aspirin for years for 'sleep.' 3. r knee 'surgery' . cardiac risk factors - none identifiable cardiac history - as above, hx of arrhythmia percutaneous coronary intervention - none identifiable pacemaker/icd - none social history: lives with wife, two children. works as project manager for audio-visual company. absence of current tobacco use, reports glasses of wine per night with dinner, last drank 1 bottle of wine three days prior to admit. . family history: no family history of premature coronary artery disease or sudden death. physical exam: vs: t 98 bp 140/100 hr 135 rr 20 97%ra, 99% 2l gen: wdwn middle aged male with mild anxiety. oriented x3. mood, affect appropriate. dry mucus membranes. bl hand tremor, no asterixis. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp not appreciated l or r in upright position, ej identifiable on l in upright position 1cm from clavicle. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3, tachycardic. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. sign (-) for splenomegaly. liver edge not percussed below right costal margin. ext: no c/c/e. no femoral bruits. skin: multiple psoriatic skin lesions on abdomen and bl les. pulses: femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: 03:25am glucose-104 urea n-10 creat-0.8 sodium-143 potassium-3.6 chloride-106 total co2-21* anion gap-20 03:25am estgfr-using this 03:25am ctropnt-<0.01 03:25am calcium-8.7 03:25am wbc-9.6 rbc-5.49 hgb-16.7 hct-46.5 mcv-85 mch-30.4 mchc-35.9* rdw-13.6 03:25am neuts-77.4* lymphs-16.1* monos-5.0 eos-0.7 basos-0.9 03:25am pt-11.4 ptt-21.5* inr(pt)-0.9 03:25am pt-11.4 ptt-21.5* inr(pt)-0.9 . cxr - no pulmonary edema, no cardiac enlargement . 06:40am blood wbc-5.4 rbc-5.05 hgb-15.0 hct-42.9 mcv-85 mch-29.8 mchc-35.0 rdw-13.6 plt ct-224 06:40am blood pt-13.4 ptt-25.9 inr(pt)-1.2* 06:40am blood glucose-96 urean-12 creat-1.0 na-139 k-4.1 cl-103 hco3-27 angap-13 06:40am blood calcium-9.0 phos-3.7 mg-2.2 . 03:25am blood alt-62* ast-50* alkphos-73 04:20am blood alt-45* ast-25 ld(ldh)-150 alkphos-66 totbili-1.0 03:25am blood triglyc-114 hdl-64 chol/hd-3.5 ldlcalc-134* ldlmeas-131* 03:25am blood asa-neg ethanol-15* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg brief hospital course: # cad/ischemia the patient had no identifiable cad history and no clinical history to suggest stable or unstable cad. he has had negative set of cardiac enzymes at osh, and a negative troponin upon admission. . # pump - the patient had no hx to suggest compromised pump function or congestive heart failure prior to this event. no evidence of fluid overload on exam and was saturating well on room air. the patient was given normal saline as he was felt to be dry on exam. a tte showed normal ejection fraction of 55% with no wmas. thus no further intervention needed. . # rhythm/rate - the patient was transferred from osh for wct with conversion to atrial flutter with rate of 130-150. amiodorone was started at osh for wct, then continued on gtt after conversion to atrial flutter as treatment for atrial arrhythmia. iv diltiazem was started in the ed. amiodarone was stopped on the first hospital day to allow for ep evaluation, but pt reverted to nsr prior to procedure. review of osh ekg and results of ep study were though to be more consistent with an initial arrhythmia of a-flutter with 1:1 conduction, rather than vt. ep study showed multiple inducible foci of af and aflutter, and ablation of aflutter focus was performed. patient was anticoagulated on coumadin with a target inr of for 3 months. electrolytes were repleted as need for k of 4, mg of 2. a tsh was normal. pt was given follow up for his coumadin management on discharge with a lovenox bridge and follow up with cardiology. . # valves - no apparent hx of valvular dysfunction, physical exam not suggestive of valvular dysfunction. tte with trivial mr. . # etoh - pt reported daily etoh intake, glasses of wine per day, with recent binge two days prior to presentation. no spider angiomatas or hepatomegaly as clinical signs of liver disease, but pt does have hand tremor bilaterally. concern for withdrawal. ciwa scale implemented and ativan tapered. stox with etoh of 15 on admission. lfts initially mildly elevated, but normalized on day 2. social work was consulted. pt was tapered off ativan needs and no further intervention needed. . # thrombophlebitis: on , patient was noted to have inflammation of left forearm in association with an infiltrated iv. an ultrasound demonstrated a basilic vein clot, but no dvt. given 1 day iv cephalzolin, sent home for 7 day course of cephalexin. . # anion gap - ag 16, in setting of etoh in serum, normalized day 2. . . # prophylaxis - initiate ppi with indication being 1. icu, 2. relative hypotension to gastric mucosa. once stabilized, stress ulcer prophylaxis not indicated as outpt. . medications on admission: 1. clobetasol ointment (as per derm note) 2. dovonex cream (as per derm note) 3. aspirin 81mg discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 2. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 3. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. enoxaparin 60 mg/0.6 ml syringe sig: one (1) syringe subcutaneous (2 times a day). disp:*60 syringe* refills:*2* 5. cephalexin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 6 days. disp:*24 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: atrial flutter discharge condition: stable. discharge instructions: you were admitted to the for atrial flutter, a rapid arrhythmia. you were initially treated with medications (amiodarone and diltiazem) to control your heart rate and rhythm. you had an electrophysiology study that showed that your arrhytmia was inducible, and likely to occur again, so an electrocautery was used to eliminate the area of your atrium causing the arrhtymia. you were started on lovenox and coumadin to reduce your risk of having a stroke associated with atrial arrhythmia and your procedure. you were found to have a clot in your left arm that possibly could be infected, and you were started on an antibiotic. . you were started on new medications, including: keflex: antibiotic for infection of l arm vein, take for 7 days warfarin (coumadin): blood thinner to prevent stroke, take each day until your cardiologist (dr. tells you to stop. you will need to have weekly follow-up with your pcp to ensure proper dosing. lovenox: blood thinner, take until you are told to stop by a doctor atenolol: a beta blocker, to help control your heart rate. . you will need to have your inr, a measure of blood thinning, checked weekly by your pcp. call dr. office on monday after 8:30 am to schedule an appointment within one week to have your inr checked. the number to call is (. followup instructions: please call your primary care doctor, dr. on monday after 8:30 am to schedule an appointment within one week to have your inr checked. the number to call is (. . you have an appointment with dr. on at 3 pm in the , , . the office phone number is (. procedure: diagnostic ultrasound of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach diagnoses: atrial flutter other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of upper extremities, unspecified 

Answer: The patient is high likely exposed to