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: pericardial effusion major surgical or invasive procedure: vagus nerve stimulator generator replacement pericardiocentesis with pericardial drain history of present illness: please see original neurology admission note and micu transfer note for details. . briefly, 47 y/o man with long standing history of epilepsy s/p right temporal lobectomy (at age 19) and vns placement (7 years ago), h/o etoh and cocaine abuse who was having increased seizure frequency in the setting of vns malfunction. he was admitted on for elective replacement of the vagus nerve stimulator generator. the procedure went without complication. overnight he developed af with rvr to the 180s with hypotension to the 80s. ciwa was 17 with last drink approximately 72 hours prior. patient was also noted to be with a ciwa of 17 and is thought that last etoh drink was 72 hours ago. he received 2mg iv ativan with somnolence and apenea afterwards. he was subsequently transferred to the micu. . his micu course was notable for an echocardiogram which showed a large pericardial effusion on . he was seen by the cardiology fellow and subsequently underwent pericardial window. 450cc of bloody pericardial fluid was drained. patient developed svt in the cath lab and was treated with 9 mg iv metoprolol. he was transferred to ccu postprocedurally for monitoring. . on arrival, patient complained of spinal back pain from lying on the operating table. he also reports that his lungs feel "collapsed" but denied shortness of breath. . review of systems was otherwise negative. past medical history: - epilepsy and nonelectrographic seizures (petite mal with rare secondary generalization) - s/p right temporal lobectomy - s/p vns placement - mood disorder and likely borderline personality organization - multiple suicide attempts in past (largely overdose) - dm due to medication, now apparently resolved - cervical strain - rosacea - esophagus - polysubstance abuse: etoh, mj, cocaine/crack binges with resultant unsafe sexual practices - h/o atrial fibrillation (not on medication) social history: unemployed, lives alone. smokes 1pk/day, occasional etoh and omr records indicate some history of crack cocaine use. family history: states has fh of diabetes and 'cancer in everyone' but no fh of cad, htn, sudden death or cardiac dysrhythmias physical exam: on transfer to ccu: vs: hr:90 bp:128/82 o2sat:93% 2l(nc) gen: agitated, in fetal position, not tachypneic heent: perrl. mm dry. neck: neck supple. left neck dressing with dried blood. no active bleeding or discharge. mild tenderness on palpation. pulm: moving air appropriately, diffuse crackles. left upper chest (vns) site c/d/i. card: soft heart sound, rrr, s1/s2 present, no m/g/r, with pericardial window draining frank blood abd: +bs, soft, nt/nd ext: wwp, no edema, 2+pd bilaterally skin: warm back: tenderness to palpation along the spine neuro: aox3, agitated, but agreeable. on discharge: vs: 96.6 118/62 (94-130/64-90) 64 16 97% ra tele: hr in 160s yesterday afternoon, otherwise 60s, sinus this morning, short runs of svt to 130s <30 seconds gen: aox3, nad heent: perrla, mmm neck: neck supple pulm: ctab card: rrr, normal s1/s2, no m/g/r abd: soft, nontender, nondistended ext: wwp no edema. l calf ttp, no swelling or cords noted. pertinent results: admission labs: . 07:11pm blood wbc-9.3# rbc-4.12* hgb-13.3* hct-40.2 mcv-98 mch-32.3* mchc-33.1 rdw-14.2 plt ct-189 07:11pm blood glucose-115* urean-25* creat-1.1 na-138 k-4.4 cl-102 hco3-27 angap-13 07:11pm blood calcium-9.0 phos-4.7* mg-2.2 06:27am blood t4-4.7 06:27am blood tsh-5.8* cardiac biomarkers . 05:55am blood ck-mb-2 ctropnt-<0.01 06:27am blood ck-mb-2 ctropnt-<0.01 . micro: . -urine cx : neg -pericardial fluid culture : ngtd, but pending as of transfer to micu -pericardial fluid cytology: pnd studies: . echo : . left atrium: normal la size. right atrium/interatrial septum: increased ivc diameter (>2.1cm) with 35-50% decrease during respiration (estimated ra pressure (10-15mmhg). left ventricle: normal lv wall thickness. normal lv cavity size. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. depressed lvef. no resting lvot gradient. no vsd. right ventricle: borderline normal rv systolic function. aortic valve: no as. mitral valve: no ms. mr. tricuspid valve: indeterminate pa systolic pressure. pericardium: moderate to large pericardial effusion. no ra diastolic collapse. no rv diastolic collapse. general comments: suboptimal image quality - poor echo windows. the rhythm appears to be atrial flutter. echocardiographic patient. poor image quality.the estimated right atrial pressure is 10-15mmhg with ivc dilation (2.5 cm). left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. lv systolic function appears mildly depressed. there is no ventricular septal defect. rv with borderline normal free wall function. there is no aortic valve stenosis. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a moderate to large sized pericardial effusion (greatest anteriorly and best seen in the subcostal view). no right atrial diastolic collapse is seen. no right ventricular diastolic collapse is seen (mild rv compression in the subcostal view is suggestive of elevated intrapericardial pressure). . cardiac cath : comments: under fluoroscopic guidance, 450 cc of bloody pericardial fluid was obtained through subxiphoid approach. intrapericardial origin of fluid was confirmed with contrast injection and intrapericardial pressure measurement. initial pericardial pressure was elevated at 21 mm hg and dropped to 3 mm hg after remorval of fluid. pericaridal drain was sutured in place for 24 hours. final diagnosis: 1. successful urgent pericardiocentesis through subxiphoid approach for impending pericardial temponade . echo impression: small amount of echodense pericardial material/fluid is seen. no evidence of tamponade. probable regional lv systolic dysfunction. moderately dilated and hypokinetic right ventricle. compared with the prior studies (images reviewed) of and , the appearance of the pericardium is similar to that of the post-tap echo yesterday. the basal to mid inferior/inferolateral hypokinesis was probably present in but image quality is poor on all studies. the right ventricle appears dilated on studies from yesterday and today - it was probably normal in . . leni's bilateral lower extremity ultrasound: grayscale, color, and doppler images of the bilateral common femoral, superficial and deep femoral, and popliteal veins were obtained. there is non-occlusive thrombus in the mid left popliteal vein and left peroneal veins, as well as the right posterior tibial vein. the bilateral common femoral, superficial femoral, and right popliteal veins demonstrated normal compressibility and wall-to-wall color flow. impression: non-occlusive thrombus in left popliteal, left peroneal, and right posterior tibial veins. . ct torso (prelim) 1. pulmonary embolism involving right lower posterior basal segmental and subsegmental branches, and subsegmental branch of left lower anterior basal pulmonary artery. 2. bilateral moderate-sized pleural effusions with adjacent atelectasis. 3. evidence of right heart strain, manifest as reflux of iv contrast into the ivc and hepatic veins. 4. mediastinal and right hilar adenopathy with right hilar soft tissue causing some narrowing of the airways and vessels, concerning for malignancy. bronchial wall thickening noted, particularly along right middle and right lower bronchi. 5. perifissural consolidation in posteromedial right middle , represent atelectasis or infection; however, underlying tumor or extension of right hilar mass not excluded. 6. 11 mm spiculated nodule in the right upper is suspicious for malignancy. 7. predominantly paraseptal emphysema in the right upper with largest bulla measuring 3.5 x 5.9 cm. 8. tiny pericardial fluid and possible pericardial thickening. 9. no evidence of malignancy in the abdomen and pelvis. 10. intraabdominal findings include aortic and iliac artery calcifications, colonic diverticulosis, and tiny bubble of gas within the urinary bladder, which could be due to recent catheterization (correlate clinically). 11. no bony destruction concerning for malignancy. 12. evidence of right femoral head avascular necrosis, without significant collapse. . ct head no evidence of an acute intracranial process. postoperative changes of right temporal lobectomy. . pathology, pericardial effusion: positive for malignant cells, consistent with metastatic adenocarcinoma. \ repeat echo, : lv systolic function appears depressed. the right ventricular cavity is borderline dilated with mild global free wall hypokinesis. there is a small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. there are no echocardiographic signs of tamponade. brief hospital course: 47 yo m with history of epilepsy admitted for elective vagal nerve stimulator replacement, transferred to micu for management of tachycardia, hypotension, and hypoxia, found to have pericardial effusion, now s/p pericardiocentiesis with drain in place, transferred to ccu for post-operative monitoring, with frequent agitation, now found to have bilateral pes . # pericardial effusion: in the micu, pt noted to be tachycardic with hypotension, and found to have pericardial effusion. he underwent pericardiocentesis with drain placement with drainage of bloody fluid. hct stable despite profuse bloody drainage. etiology is likely malignancy given that ct torso showing rul lung spiculated nodule. effusion cytology and micro showed cells c/w metastatic lung adenocarcinoma. drain was eventually pulled without complication and without any further hemodynamic instability. pulsus checked for several days after drain pulled and resolved effusion on echo, was ~8 mmhg on discharge. . # pe/dvt: pt noted to have enlarged rv on repeat echo , so cta was obtained for concern of pes which confirmed b/l subsegmental pes. lenis also positive for b/l dvts. he was started on heparin ggt in house and transitioned to an anticoagulation regimen of coumadin, with a lovenox bridge. he will f/u with his pcp on after discharge. . # agitation: patient with history of etoh, marijuana, cocaine/crack binges. he was significantly agitated throughout admission which was initially thought to be secondary to etoh withdrawal. he was maintained on a valium ciwa and klonipin 1mg tid. however, agitation persisted despite being well out of the acute withdrawal window. he had several code purples called for him and was often violent towards nurses. of note, pt would be lucid and engaging often during the day with decompensation at night. psych was consulted who felt that this was less likely to be withdrawal and instead a behavioral issue/delerium, likely in setting of supratherapeutic valproate level. they recommended haldol for his agitation which was continued 5mg prn along with 10mg qhs standing, these were discontinued on discharge, takes no psych meds at home and delirium apparently cleared. evaluated by psychiatry prior to discharge, appeared to understand importance of f/u. he was started on mvi, thiamine, folate. . # afib with rvr: patient oscillates between hr of 70s ?????? 170s with frequent episodes of rvr on tele, asymptomatic. based on old records, has a history of afib with rvr, a flutter, was treated with diltiazem and flecainide, and was supposed to be on metoprolol. increased metoprolol to 75 mg po qid standing which has controlled rate well, though still with frequent episodes of rapid ventricular response that respond to iv lopressor 5 mg x 1. because of continued episodes of rvr (likely in the setting of pericardial effusion and multiple pes) pt started on diltiazem drip, weaned off and started on diltiazem er 120 mg daily, and metoprolol changed to 200 mg of metoprolol succinate on discharge. hr in the 60s with these changes, with short bursts of svt to 130s prior to discharge. would consider uptitrating rate control as an outpatient. . #. h/o epilepsy and seizure activity: vns placed and was re-activated about 1 week after placement. he was continued home aeds. depakote er 1250/1500/1500 and oxcarbazepine 600 mg which was often given iv due to inability to take pos from agitation. depakote level was found to be elevated in setting of delirium, however unclear if this was true trough. was discharged on home meds and advised to f/u with his outpatient neurologist for management of his depakote. . # foley self-d/c: pt pulled own foley overnight . of note there was blood around the uerethral meatus after he pulled it. urine output was monitored and foley ended up being replaced on given that he was put back into 4pt restraints. foley dc'ed and was able to void on his own with no hematuria for remaineder of admission. medications on admission: - clonazepam 1 mg qid - divalproex 250 mg sustained release qam - depakote er 500 mg tab- tabs qam, 3 tabs in the afternoon and 3 tabs qpm - omeprazole 20 mg delayed release daily - oxcarbazepine 600 mg - asa 81 mg daily (not taking as prescribed) discharge medications: 1. lovenox 100 mg/ml syringe sig: one (1) subcutaneous twice a day for 10 days. disp:*20 syringe* refills:*0* 2. oxcarbazepine 600 mg tablet sig: one (1) tablet po bid (2 times a day). 3. clonazepam 1 mg tablet sig: one (1) tablet po four times a day. 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 6. diltiazem hcl 120 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*2* 7. divalproex 250 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qam: use in addition to the depakote 500 mg strength tabs for total dose of 1250/1500/1500 mg . 8. divalproex 500 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po qafternoon (). 9. divalproex 500 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po qhs (once a day (at bedtime)). 10. divalproex 500 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po qam: take in addition to 250 mg dose for a total 1250 mg every morning. 11. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 12. metoprolol succinate 200 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* 13. aspirin 81 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: seizure disorder atrial fibrillation lung adenocarcinoma, pericardial effusion deep vein thrombosis, pulmonary embolism discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were seen in the hospital to have your vagal nerve stimulator replaced, which has been turned on again, for your seizures. you were also found to have a very fast heart rate from your atrial fibrillation (irregular heart rate) and for this we started diltiazem and metoprolol, which slow your heart rate. in addition, you were found to have a pericardial effusion (fluid around your heart) which is likely due to spreading of lung cancer, which was discovered on a ct scan. you were seen by the oncologists here who recommended that you go to clinic for follow up to discuss further workup and treatment. you were also found to have a pulmonary embolism and deep vein thrombosis (blood clots in your lung and legs) for which you were started a blood thinner. you will be taking a blood thinner called coumadin to prevent more clots from forming and to treat the ones you already have, and you should take this medication every day. you will be taking lovenox, another blood thinner which works immediately, temporarily until your blood level of coumadin reaches the therapeutic range. changes to your medications: start diltiazem 120 mg every day start taking metoprolol 200 mg daily start taking warfarin 5 mg daily start taking lovenox shots twice a day until you are told to stop by your doctor followup instructions: in addition to the appointments below, the oncologists are trying to schedule you an appointment in clinic. the phone number to call with questions is . department: when: friday at 4:00 pm with: mark , licsw building: sc clinical ctr campus: east best parking: garage department: when: friday at 3:00 pm with: mark , licsw building: sc clinical ctr campus: east best parking: garage department: when: thursday at 4:50 pm with: , md building: campus: east best parking: garage procedure: pericardiocentesis implantation or replacement of peripheral neurostimulator lead(s) insertion or replacement of other neurostimulator pulse generator diagnoses: atrial fibrillation secondary malignant neoplasm of other specified sites atrial flutter malignant neoplasm of upper lobe, bronchus or lung unspecified accident acute venous embolism and thrombosis of deep vessels of proximal lower extremity injury to bladder and urethra, without mention of open wound into cavity drug-induced delirium other pulmonary embolism and infarction generalized nonconvulsive epilepsy, with intractable epilepsy alcohol withdrawal mechanical complication of nervous system device, implant, and graft acute venous embolism and thrombosis of deep vessels of distal lower extremity other and unspecified anticonvulsants causing adverse effects in therapeutic use unspecified episodic mood disorder borderline personality disorder physical restraints status 

Answer: The patient is high likely exposed to