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: transfer for pericardiocentesis major surgical or invasive procedure: pericardiocentesis with drain placement, s/p drain removal history of present illness: this is a 56 yo female with a history of hypertension, hyperlipidemia, new onset afib (~1wk ago) who presented to with a 1.5 week history of epigastric pain diagnosed with viral pericarditis and transferred here for pericardiocentesis. the pt had viral illness that started about two weeks pta with ha, nausea and epigastric discomfort x 3 days. the ha and nausea resolved but the epigastric pain continued and worsened. she went to hospital about five days after her symptoms started and was dx with afib and subsequently started on a bb and coumadin. she then presented to her pcp for check of her inr after discharge from with increasing epigastric/rib pain in addition to doe, orthopnea and pnd. she was sent to . a ct was ordered for the workup of her epigastric discomfort and found a pericardial effusion. an echo obtained on showed a large pericardial effusion (1.5-2cm anteriorly; no posterior accumulation). a subsequent echo obtained showed an expanding pericardial effusion (3.0 - 3.2cm anteriorly and 2.4 - 2.6cm posteriorly)with no echocardiographic evidence of tamponade. the patient was transferred to for placement of pericardial drain and rhc. the patient had no h/o rheumatologic diseases, cancer, or tuberculosis. no h/o arthritis, myalgias, or joint pains. she is up to date on pap screening and has had a colonoscopy within the last year. her last was a few yrs ago. . the patient was taken to cath lab and had rhc, pcwp 30-->25, ra 25-->17, pp25-->6 fem artery pr: 152/75/105, pa: 45/25/35, rv: 44/13. pericardiocentesis performed with difficulty fibrotic pericardium. hemodynamics consistent with tamponade. sbp prior to drainage 70. 470 cc bloody fluid removed. . note: pt had neg stress test 2 mo ago at osh for luq pain. past medical history: htn hypercholesterolemia possible tia in past new onset afib (1wk pta) social history: no tobacco, occ etoh, no drugs. pt lives at home with husband and is a decorative painter. family history: grandmother ra, aunt with breast ca, cad father with first mi late 40s, died at 83. physical exam: t 97.5 hr 90 bp 136/71 rr 18 po2 99% gen: nad heent: clear op, mmm, neck: supple; no cervical lad, jvp ~10cm cv: rrr. nl s1, s2. + pericardial friction rub. no m/g lungs: ctab no c/w/r abd: soft, nt, nd. nl bs. no hsm ext: no le edema. 1+ dp/pt pulses bl skin: no lesions neuro: a&ox3, cn ii-xii, 5/5 strength b/l, sensation intact b/l. pertinent results: 03:00pm hgb-13.0 calchct-39 o2 sat-98 03:00pm type-art po2-106* pco2-42 ph-7.42 total co2-28 base xs-2 intubated-not intuba 03:30pm other body fluid wbc-3339* hct-22* polys-15* lymphs-84* monos-0 mesotheli-1* 03:30pm other body fluid tot prot-5.9 glucose-142 ld(ldh)-209 amylase-27 albumin-3.5 09:15pm pt-14.8* ptt-25.4 inr(pt)-1.3* 09:15pm plt smr-unable to 09:15pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 09:15pm neuts-90* bands-0 lymphs-5* monos-5 eos-0 basos-0 atyps-0 metas-0 myelos-0 09:15pm wbc-10.2 rbc-3.66* hgb-11.4* hct-33.5* mcv-92 mch-31.2 mchc-34.1 rdw-12.8 09:15pm calcium-8.8 phosphate-3.8 magnesium-2.1 09:15pm estgfr-using this 09:15pm glucose-149* urea n-13 creat-0.9 sodium-141 potassium-3.9 chloride-107 total co2-25 anion gap-13 . ccath: comments: 1. right heart catheterization revealed hemodynamics consistent with cardiac tamponade with ra mean equal to mean pcpw of 25mmhg. initial pericardial pressure was also 25mmhg an tracked with the ra presure recording. cardiac index was normal at 3.5l/min/m2. 2. pericardiocentesis was performed via the subxyphoid approach. there was difficulty advancing the catheter due to markedly fibrotic pericardium. 475cc of bloody fluid was removed. at end of procedure, pcpw reamined elevated at 25mmhg. mean ra fell to 17mmhg and pericardial pressure fell to 5mmhg. 3. the patient transiently became hypotensive to sbp 70s during the procedure. she was briefly administered dopamine and atropine. he bp normalized with removal of pericardial fluid. final diagnosis: 1. pericardial tamponade. 2. successul pericardiocentesis of 475cc of fluid. . tte: conclusions: the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a small pericardial effusion (layering mainly posteriorly). there are no echocardiographic signs of tamponade. there at least mild mitral regurgitation. tte: conclusions: left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size is normal. right ventricular systolic function is borderline normal. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , no major change. . tte: conclusions: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). the right ventricular cavity is mildly dilated. there is mild global right ventricular free wall hypokinesis. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , no major change is evident. brief hospital course: this is a 56 yo female with a history of htn, hyperlipidemia, new onset afib (~1wk ago)who was supratherapuetic on coumadin dx with viral pericarditis now s/p pericardiocentesis and pericardial drain placement and removal. the following issues were addressed during her hospitalization: . 1. cardiovascular: a. pericarditis: this patient was transferred to with a pericardial effusion and tamponade physiology seen on right heart cath. her effusion was likely secondary to a viral pericarditis given her recent gi illness. myocarditis also cannot be ruled out. other etiologies of her effusion were considered such as rheumatologic causes and specific viral etiologies. labs drawn in were negative for hep b, hep c, cmv, hiv, , rf. the patient's ebv labs showed infection at some point in the past. upon arrival at , the patient was taken to the cath lab and a pericardiocentesis, drain placement, and rhc were performed. 470 cc of bloody fluid was drained initially. a pericardial drain was left in place for 24hrs and then was pulled once the drainage had slowed. repeat echos confirmed that there was no reaccumulation of the fluid after the drain was pulled. it is likely that pericarditis induced the atrial fibrillation. the bloody effusion is thought to be due to bleeding into the pericardium induced by her supratherapuetic inr 3.1 from her coumadin. the patient's pleuritic chest pain was treated with ibuprofen and then indomethacin in addition to oxycodone prn. it was recommended that the patient have a cardiac mr to assess for myocarditis/scar and resolution of pericardial fibrosis in the future. she will also need a repeat echo in weeks along with f/u with a cardiologist in . the patient was advised to get a referral to one of the cardiologists in and to make an appoinment for the week after discharge. after discharge the dr. called to report atypical lymphocytes in the pericardial fluid. although these could be reactive lymphoctyes, this warrents follow up. the pcp . was informed. . b. coronaries: this patient has no h/o of cad. during this admission she has no signs of ischemia on ekg. cardiac enzymes were neg at . she was continued on metoprolol but this was held for two days due to hypotension. she was also kept on lipitor 40 qd. . c. pump: the patient had evidence of tamponade on rhc. her ef was estimated a 55%, which may be consistent with some degree of mycoarditis. she did become hypotensive to sbp high 80s-90s. she was given a fluid bolus and encouraged to take po liquids. her sbp subsequently improved. . d. rhythm: the patient was admitted in nsr with a recent h/o of new onset afib, likely secondary to pericarditis. she remained in nsr until the day of discharge. therefore, she was started on lopressor 25 for rate control. anticoagulation was not continued due to her recent bloody effusion. she was advised to make an appointment with a cardiologist in next week for follow up for her effusion and atrial fibrillation. . 2. hypotension: the patient had an episode of hypotension with sbp in the high 80s-90s. she is known to be hypertensive at baseline. her hypotension is most likely secondary to hypovolemia. a repeat echo was negative for reaccumulation of fluid, thereby ruling out tamponade physiology. she was given a fluid bolus and her metoprolol was discontinued for 24 hrs. she was encouraged to increase her po intake of fluids. she was restarted on metoprolol 25 on the day of discharge given her afib returned with rvr to 120s. she was advised to discontinue her antihypertensive medications and to follow up with her pcp upon discharge. . 3. arf: the patient's cr increased transiently to 1.3 at the same time that she became hypotensive. this was thought to be secondary to po intake. her arf resolved s/p a fluid bolus. upon discharge her cr was 0.9. . 4. htn: the patient's hctz/triamcinolone was held during this admission for hypotension. she was continued on lopressor 25 . . 5. hyperlipidemia: she was continued on lipitor 40 qd. . medications on admission: meds on admission from hosp: prednisone 60 mgqd morphine sulfate (last dose 12/28 at 6pm) protonix lopressor lipitor coumadin . meds at home: lopressor 75 lipitor 40 qd traimpterene/hctz 37.5/25 qd coumadin 5mg qd discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain for 6 doses. disp:*6 tablet(s)* refills:*0* 2. atorvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. indomethacin 25 mg capsule sig: two (2) capsule po tid (3 times a day) as needed for pain for 7 days. disp:*21 capsule(s)* refills:*0* 4. aspirin 325 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 5. discontinued medications we are holding your triamterene/hctz since your blood pressures have been on the low side. please discuss restarting these medications with your primary doctor. 6. lopressor 50 mg tablet sig: 0.5 tablet po twice a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: viral pericarditis complicated by pericardial effusion and tamponade. secondary: hypertension transient a.fib likely secondary to pericardial irritation discharge condition: good - mild pleuritic chest pain, ambulating, stable heart rate and blood pressure. discharge instructions: please take all of your medications as directed. we are holding diuretic since your blood pressure has been on the low side. please discuss restarting these with your primary care physician when you seen her next week. please ensure that you follow up with your primary care doctor within one week following discharge. you will also need to be seen by a cardiologist. please call dr. office to schedule an appointment with him or another physician. is very important that you have a repeat echocardiogram performed in one weeks time to ensure that no other fluid is reaccumulating around your heart. please contact your or proceed to the nearest emergency room with any shortness of breath, worsening chest pain or any other complaints whatsoever. followup instructions: pcp: , . . cardiology: , p. procedure: pericardiocentesis right heart cardiac catheterization diagnoses: other iatrogenic hypotension unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation other and unspecified hyperlipidemia diarrhea hypovolemia acute idiopathic pericarditis 

Answer: The patient is high likely exposed to