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: dyazide attending: chief complaint: pericardial effusion major surgical or invasive procedure: pericardiocentesis, right heart cardiac catheterization history of present illness: 84 yo w with hx of paroxysmal af on coumadin, ppm for sinus node dysfunction, htn, prior aaa s/p repair, aortic root dilation (5.4 cm)& mild ai with recent admission to osh for influenza, found to be in af with rvr, d/c with plans for future cv on , which was d/c as pt was in sinus rhythm. patient then represented to osh with fever and diarrhea on , was started on levaquin & flagyl, and underwent abdominal ct that showed pericardial and pleural effusions. per report, she appeared volume overloaded and received iv lasix 20. an echo was performed that revealed a 2cm circumferential pericardial effusion. given her tachycardia and hypotension she was given 5 of iv vitamin k for reversal of supratherapuetic inr in anticipitation of tap, and transferred here for further management. . on arrival to the ccu the patient was tachypneic, having difficulty speaking more than words at a time, tachycardic to 110-120s, with low-normal blood pressures. her pulsus was 20. echo findings were concerning for tamponade. she was ordered 4u of ffp to reverse her inr and taken to the cath lab for emergent pericardiocentesis. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, hemoptysis, black stools or red stools. she 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, paroxysmal nocturnal dyspnea, orthopnea, ankle edema. + dyspnea on exertion, + history of palpitations and syncope/presyncope. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, +hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: ppm 1 year ago 3. other past medical history: - paroxysmal atrial fibrillation - sinus node dysfunction s/p pacemaker implant 1 year ago - aortic root dilation (5.4 cm) - mild aortic insufficiency - hypertension - aaa s/p repair in - osteoporosis - recent traumatic rib fracture (r-side t10-t11) - excision of benign thyroid tumor - carpal tunnel repair - cataract surgery - left total knee replacement 15 yrs ago social history: -widowed, retired, prior college professor -currently resides at lifecare center of -tobacco history: none, never -etoh: one glass of wine nightly -illicit drugs: none, never family history: mother had angina, otherwise non-contributory. physical exam: vs: 97.4, 115, 115/81, 23, 97% on 2l nc general: elderly woman in moderate respiratory distress heent: ncat, sclera aniceteric, eomi, no xanthalesma neck: supple with jvp at angle of mandible, dynamic neck veins cardiac: tachycardic, irregular rhythm, unable to auscultate murmurs lungs: inspiratory rales to mid-field bilaterally (l>r) abdomen: soft, distended, non-tender, tympanic extremities: no edema, + varicosities pulses: radial 2+, dp 1+ pertinent results: -wbc-9.2 rbc-3.60* hgb-11.0* hct-32.4* mcv-90 mch-30.6 mchc-34.0 rdw-14.2 plt ct-549*# -neuts-80.8* lymphs-12.6* monos-5.6 eos-0.7 baso-0.4 -pt-34.6* ptt-36.8* inr(pt)-3.5* -glucose-120* urean-24* creat-0.5 na-131* k-4.8 cl-99 hco3-23 angap-14 -alt-26 ast-34 ld(ldh)-284* alkphos-106* totbili-0.5 -totprot-5.6* albumin-3.1* globuln-2.5 calcium-7.9* phos-2.4* mg-2.1 iron-28* -caltibc-267 ferritn-520* trf-205 -%hba1c-6.2* eag-131* brief hospital course: medicine course: # ascending aortic aneurysm with penetrating ulcer: confirmed on cta. patient was evaluated by cardiac surgery and taken for repair on . prior to surgery we obtained a cta coronaries, which was negative for hemodynamically significant disease. her blood pressure was kept under strict control (sbp<120). . # constrictive pericarditis/exudative pericardial effusion: on admission the patient had a 2 cm circumferential effusion with tamponade physiology seen on echo. she underwent an emergent pericardiocentesis with removal of 420 cc of fluid, determined to be exudative in nature, likely post-viral in etiology given her recent history of influenza. gram stain and cultures were negative for growth. cytology was negative. right heart catheterization revealed elevated pressures consistent with a constrictive pattern, thought to be secondary to pericarditis. repeat echocardiogram revealed very small effusion and the drain was removed. . # af with rvr: the patient has a history of paroxysmal afib and is s/p ppm for underlying node dysfunction. she presented in atrial fibrillation with rapid ventricular response in the 120s, which she did not tolerate. electrophysiology was consulted. the patient underwent tee, which was negative for clots. we then attempted electrical cardioversion twice, both which failed at keeping her in sinus rhythm. her antiarrhythmic regimen was switched from sotalol to amiodarone, and an additional attempt at electrical cardioversion was successful. she was kept on an amiodarone gtt, and a heparin gtt for anticoagluation, until her cardiac surgery. . # acute diastolic chf: tte confirmed preserved ef of 60% and revealed signs of rv volume overload and elevated ra pressure. pcw on rhc was 17. cxr had evidence of pulmonary edema and bilateral effusions, and the patient was experiencing significant dyspnea. she was diuresed with iv lasix boluses to meet net negative 1 l daily. her dyspnea and oxygen requirement improved. . # gout and pseudogout: the patient complained of acute right knee and ankle pain with limited range of motion. the areas were warm and tender to palpate over the joint space. clinical picture was consistent with an inflammatory arthropathy; however, given her upcoming surgery with graft placement we elected to consult rheumatology to tap the effusion and rule out infection. she was given a one time dose of prednisone. her pain was controlled with tylenol, tramadol, and morphine. . # mild hyponatremia: likely hypervolemic hyponatremia from chf, or increased adh secondary to pain/stress. . # anemia of chronic inflammation: hematocrit remained stable. . # osteoporosis: patient was continued on vitamin d and calcium supplementation. . # hypoalbuminemia: nutrition was consulted and recommended mealtime ensure supplements. . . . . . . . . . ................................................................ surgical course: dental clearance was obtained preoperatively. the patient was brought to the operating room on where the patient underwent replacement of ascending hemi arch aorta with a 32-mm gelweave graft under hypothermic circulatory arrest. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring on epinephrine and levophed drips. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. amiodarone and coumadin were initiated for atrial fibrillation. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. she did complain of abdominal pain. general surgery was consulted and ct did not reveal obstruction. she had several subsequent bowel movements, and diet was advanced. she developed a left forearm phlebitis and was treated with keflex. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod 7, the patient was ambulating with assistance, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to of rehab in good condition with appropriate follow up instructions. medications on admission: -sotalol 120 mg -coumadin 3 mg daily -tylenol/vicodin prn -colace 100 daily -calcium carbonate -vit d 1000u daily -kcl 20 daily discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ranitidine hcl 150 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. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever/pain. 6. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): 400mg x 1 week, then 400mg daily x 1 week, then 200mg daily until further instructed. 7. warfarin 1 mg tablet sig: one (1) tablet po daily (daily) as needed for afib: md to dose daily for goal inr 2-2.5, dx: afib. 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 10. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal once a day as needed for constipation. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. magnesium hydroxide 400 mg/5 ml suspension sig: sixty (60) ml po hs (at bedtime) as needed for constipation. 14. furosemide 40 mg tablet sig: one (1) tablet po once a day for 2 weeks. disp:*14 tablet(s)* refills:*0* 15. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day for 2 weeks. tablet, er particles/crystals(s) discharge disposition: extended care facility: senior healthcare - discharge diagnosis: ascending aortic dissection s/p repair this admission pmh: atrial fibrillation sinus node dysfunction s/p ppm hypertension aortic root dilation aortic insufficiency osteoporosis recent traumatic rib fracture (r-side t10-t11) discharge condition: alert and oriented x 2, nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage edema: + le discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: you are scheduled for the following appointments: surgeon dr. , md phone: date/time: 1:15 cardiologist dr. phone: date/time: 9:20 please call to schedule the following: primary care dr. , a in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart other electric countershock of heart other electric countershock of heart pericardiocentesis resection of vessel with replacement, thoracic vessels pulmonary artery wedge monitoring arthrocentesis right heart cardiac catheterization diagnoses: anemia, unspecified congestive heart failure, unspecified unspecified essential hypertension hyposmolality and/or hyponatremia atrial fibrillation mitral valve insufficiency and aortic valve insufficiency osteoporosis, unspecified long-term (current) use of anticoagulants paralytic ileus cardiac pacemaker in situ acute diastolic heart failure other and unspecified coagulation defects knee joint replacement dissection of aorta, thoracic diseases of tricuspid valve constrictive pericarditis acute gouty arthropathy cardiac tamponade 

Answer: The patient is high likely exposed to