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: aspirin attending: chief complaint: hypotension/ atrial fibrillation with rvr. major surgical or invasive procedure: none history of present illness: yo female with pmh chf, paf, polycythemia , siadh who presented to ed with decreased po intake. pt was recently discharged from on after being hospitalized for hyponatremia, altered ms, and chf. per caregiver, pt was well until 2 d prior to admission(day of d/c) when pt "just looked much worse." more confused and significantly decreased po intake. per caregiver, no , fevers, increased leg swelling, or notable increased sob. . in ed, cxr showed increased large bilateral pleural effusion. head ct was negative for acute process. pt with hr up to 150s on telemetry in rapid a fib and sbp dropped to 80s. pt given 750 cc ns in ed in boluses for hypotension with no improvement in hr. pt then given 10 mg iv diltiazem for rapid a fib with decreased hr. the patient was then transferred to the unit for futher management. the patient was diuresed 1l with 10 mg iv lasix with improved respiratory function clinically. diltiazem was discontinued and rate control was done via titrating metoprolol with good effect. pending stability, patient was tranferred to floor. past medical history: 1. polycythemia 2. paroxysmal atrial fibrillation 3. macular degeneration 4. chf (echo : w/ lvef >55%, mod pulmonary htn, rv strain, 3+ tr, 2+ mr, small pericardial effusion) 5. osteoporosis 6. hypothyroidism 7. siadh in response to traumatic pain. 8. pelvic fractures, not surgically treat 9. t11 spinal comprssion. 10. chronic hyponatremia (baseline 125-135) social history: sh: pt splits her time between and . she has a roughly 50 pack-year smoking history, quit over 20 years ago. she does not use etoh, and has never used illicits. she has an in-home caregiver. children live in and . family history: m heart problems f heart problems physical exam: physical exam on discharge: pt deceased in hospital. no spontaneous respirations. pulseless. no cardiac beats. pertinent results: 04:20pm pt-14.4* ptt-31.0 inr(pt)-1.4 02:45pm glucose-100 urea n-12 creat-0.6 sodium-125* potassium-4.7 chloride-91* total co2-25 anion gap-14 02:45pm ck(cpk)-16* 02:45pm ck-mb-2 ctropnt-<0.01 02:45pm probnp-6850* 02:45pm wbc-15.1* rbc-4.17* hgb-8.7* hct-31.3* mcv-75* mch-20.9* mchc-27.9* rdw-19.5* 02:45pm neuts-87* bands-0 lymphs-3* monos-2 eos-1 basos-3* atyps-0 metas-2* myelos-1* promyelo-1* blasts-0 nuc rbcs-1* other-0 02:45pm hypochrom-3+ anisocyt-2+ poikilocy-3+ macrocyt-normal microcyt-2+ polychrom-normal ovalocyt-2+ teardrop-1+ fragment-occasional 02:45pm plt count-384 02:45pm urine color-straw appear-clear sp -1.006 02:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:32pm lactate-1.3 02:00pm urine hours-random creat-22 sodium-61 potassium-32 chloride-85 02:00pm urine osmolal-262 studies during admission: 1. ed head ct: benign 2. ed cxr :there are large bilateral pleural effusions with associated atelectasis and obscuration of the lung bases. heart size cannot be assessed. no overt vascular congestion at this time. the visualized lungs show no focal consolidations. since single frontal radiograph eight days ago (), the pleural effusions have increased slightly in size with otherwise little change. large increasing bilateral pleural effusions without overt chf at this time. 3. micu cxr : again noted is a small to moderate-sized left pleural effusion, which is not significantly changed since the previous exam. opacity at the right base is slightly improved since the prior exam. again demonstrated are increased interstitial changes bilaterally, most likely related to chronic chf. the cardiac silhouette is enlarged. there is aortic atherosclerosis. the upper and mid lung fields are clear of focal consolidation. findings consistent with elevated pulmonary venous pressures and pleural effusions, the right pleural effusion has slightly improved since the prior exam. 4. cta on suspicion of pe: negative upper and lower extremity us for dvt: negative 3. ekg results : atrial fibrillation with a rapid ventricular response and ventricular premature beats. poor r wave progresion, probable normal variant. inferolateral t wave changes are non-specific. repolarization changes may be due in part, to rate/rhythm. low qrs voltage in the limb leads. compared to the previous tracing of no significant change 5. echo the left and right atrium are markedly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small circumferential pericardial effusion without evidence for tamponade physiology. compared with the prior study (tape reviewed) of , the findings are similar. brief hospital course: f with pmh diastolic chf, paf, , siadh who returns 2 days post discharge for failure to thrive/ hypotension/ afib with rvr at rehab. systems based description: pulmonary: consulted pulmonary about pulmonary htn. phtn was thought to be secondary to longstanding mr. viagra was was contraindicated because of low blood pressure. no therapeutic options were available to treat phtn. cardiology: cardiology suggested rate control with diltiazem as monotherapy as long as possible. other suggested potentially adding amiodarone to regimen. pulmonary was comforatable with this suggestion. advised light diuresis to address edema with caustion about reflex tachycardia with more aggresive diuresis. advised low salt diet for chf and continued fluid restriction to address hyponatremia. heart rate was not adquately controled with diltiazem on friday the patient and her family elected to have an atrial sinus ablation with a pacemaker placement. pallative care: the pacemaker did not signficantly improve the patient's hemodynamic state. the patient and family elected to have measures only on . the patient had previously been dnr/dni. all medications (antidepressants, cardiac, diuretics) were discontinued. the patient was started on po morphine which progressed to concentrated morphine and then a morphine drip on . morphine was given only to make the patient comfortable and was held for respiratory depression. the patient expired on on saturday evening due to advanced congestive heart failure (specificaly pulmonary congestion). the family consented to an autospy. problems proceeding measures only descision desciaion: 1.chf: pt grossly total body overloaded, but with recent decreased po intake and dry mm, ? intravascularly dry. - patient came in with new b/l pulmonary infiltrates - diuresed with lasix 10iv in icu and was net approx 1l on transfer to floor today . (gingerly given relative hypotension in ) - cycle enzymes to r/o ischemia as etiology of chf exacerbation. - resp status improved significantly after diuresis. to no diuresis. light diuresis, 5mg iv lasix discharge with 20 mg po lasix qd. . 2. rhythm disturbance: pt having bursts of rvr up to 140s in ed. - rate controlled initially with diltiazem in ed and micu, then switched to metoprolol titrated up to 25 tid on before micu discharge. - it was felt that fluid overload in lungs was probably rapid rate and poor filling and backup of fluid. - 5 am, pt had an episode of rapid refractory afib, metoprolol was d/c'd and diltiazem restarted iv then po 45 mg qid. dose increased to 75 mg qid on b/c of hr in 140's with good effect. - diltiazem increased to 100 mg qid with good effect. - diltiazem determined a poor long term remedy to refractory afib. ablation and pacing was suggested and consented by the patient and family. placemant was performed without complication. . 3. hypotension: bp baseline has ranged from sbp 80s to 100s. - monitor bp closely. - bp 100s/50s on transfer to floor . 6. hyponatremia, attributed to siadh, na 125-135: at baseline - fluid restriction for hyponatremia 750 ml was continued throughout stay. - patient was last discharged with na of 125. now with 130. hypertonic saline was never used for fear of chf exaserbation. . 7. polycythemia : - follow hct closely. holding heparin sq and asa per heme onc recs from previous admission. .during hospital course wbc increaed to 30. plts increased from to 400s. -pt is currently untreated for polycythemia and blood count will continue to rise. hematology/oncology: was not consulted this admission but on last admission advised holding anticoagulants (coumadin) b/c of bleeding risk secondary to polycythemia . 8. uti: noted on with ua positive for wbc, bacteria and yeast. cipro 250 qd was started and should be continued for 14 days. 9. fen: low sodium diet. boost plus tid (not counted in fluid total). . 10. ppx: , stockings. ppi. . 11. code: dnr/dni. . medications on admission: 1. alendronate 70 mg po q wednesday 2. metoprolol tartrate 12.5mg qid 3. pantoprazole 40 mg tablet qd 4. oxycodone 5 mg tablet po q6h prn 5. escitalopram 10 mg tablet qd 6. calcium carbonate 500 mg qd 7. levothyroxine 175 mcg qd 8. ipratropium bromide q4-6h prn 9. docusate sodium 100 mg 10. magnesium hydroxide 400 po q6h prn 11. senna 8.6 mg 12. multivitamin qd 13. furosemide 40 mg qod discharge medications: none discharge disposition: extended care discharge diagnosis: rapid atrial fibrillation with hypotension, congestive heart failure. discharge condition: expired. discharge instructions: none. followup instructions: none. procedure: excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of transvenous lead [electrode] into ventricle initial insertion of single-chamber device, not specified as rate responsive diagnoses: mitral valve disorders urinary tract infection, site not specified unspecified acquired hypothyroidism atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases pulmonary collapse constipation, unspecified acute respiratory failure hypotension, unspecified other disorders of neurohypophysis aftercare for healing traumatic fracture of other bone polycythemia vera 

Answer: The patient is high likely exposed to