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: coreg / lopressor attending: chief complaint: dyspnea and hypoxia major surgical or invasive procedure: catheterization for pfo closure history of present illness: 88 yo f with known asd, chf (ef 35%), paroxysmal a-fib, s/p ddd pacemaker/icd and multiple admission for hypoxia, presented from nh with episodes of hypoxia/hypotension (sbp of 80s). patient with 18 month history of intermittent hypoxia which was last evaluated here in with echo showed possible asd and pfts showed restrictive lung pattern. she was discharged on o2 supplement at 4l nc. since her echo showed 35% ef, her hypoxia was thought to be multifactorial. she was also evaluated at 4 weeks ago for similar episode and discharged to nh on 6 l non-rebreather. patient also reports l rib pain. in ed, ekg showed left bundle without new st/t changes. however, trop was elevated at 0.12, which was new compared to last admission. her chest ct was negative for pe or pneumonia. abg: 7.45/39/61. patient was given prednisone for possible reactive airway disease and levofloxacin for possible uti given positive urinalysis. she was also given 1.2l of fluid for resuscitation with (bp up to 90s). however, she still has intermittent hypoxic episodes that spontaneously resolve. she remained afebrile with normal lactate level of 1.2. past medical history: 1. chf (ef 30%, 1+ mr, 1+ tr, significant pulmonary regurgitation, multifocal ak/hk on tte ) 2. ddd pacemaker and icd placement for sick sinus syndrome and nsvt 3. paroxysmal atrial fibrillation 4. pre-syncope 5. pneumonia 5. hypothyroidism 6. hyperparathyroidism 7. gerd 8. l3 fracture and cauda equina syndrome s/p l2/l3 laminectomy c/b residual severe lbp 9. osteopenia 10. obstructive sleep apnea 11. urinary retention 12. dysphagia 13. depression social history: the patient normally lives at home with husband, who has alzheimer??????s dementia. she has a full-time male aide for her husabnd, and "a woman" who comes into the home a few times a week. she has been at an extended care facility in the recent months due to intermittent hypoxia and hypotension. she's never smoked cigarettes, and denies any alcohol use. the patient has 3 married daughters, one of whom is an anesthesiologist at this hospital. family history: no known history of coronary artery disease, otherwise non-contributory. physical exam: vitals: 96.5, 95/49. 64. 17. 95%4lnc gen: cachectic but comfortable heent: no jvp cv: rrr lungs: ctab abd: soft, nt ext: no edema neur: a&a and able to answer questions appropriately pertinent results: echo: left atrium: dilated la. right atrium/interatrial septum: dilated ra. a catheter or pacing wire is seen in the ra and/or rv. aneurysmal interatrial septum. rght-to-left shunt across the interatrial septum at rest. left ventricle: mildly dilated lv cavity. moderate global lv hypokinesis. moderately depressed lvef. right ventricle: normal rv chamber size. aortic valve: mildly thickened aortic valve leaflets. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild (1+) mr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor parasternal views. conclusions: 1. the left atrium is dilated. the right atrium is dilated. the interatrial septum is aneurysmal. a right-to-left shunt across the interatrial septum is seen at rest. 2. the left ventricular cavity is mildly dilated. there is moderate global left ventricular hypokinesis. overall left ventricular systolic function is moderately depressed. 3. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. cath : comments: 1. venous access via the rfa using a 8f short sheath. 2. initial hemodynamics demonstrated a mean ra pressure of 6 mm hg, rv pressure 37/5 mm hg. 3. successful closure of the pfo with a 35 mm amplatzer pfo occluded device. post procedure bubble study with cough was positive, but the o2 saturation remained >95% in the sitting position. final diagnosis: 1. pfo with symptomatic orthodeoxia. 2. successful closure of the pfo. : hct 30.1, inr 2.1 brief hospital course: she remained stable on the floor during the first 2 days and finished 48 hrs of iv heparin drip for nstemi with trop trended downwards. however, on the scheduled day of discharge, she had a prolonged episode of hypoxia with o2 sat down to 70s% while on nrb in the morning. however, she remained relatively asymptomatic (normal mental status, normotensive, speaking full sentences, no tachycardia, tachypnea, chest pressure or dyspnea) despite the severe hypoxia until she was given a slntg for trial of vasodilator for presumed pulmonary hypertension when her o2 sat went down to 50s% with development of chest pain and dyspnea. she quickly improved, however, with some ivf. she had remained stable since the early afternoon until the next morning when she had another similar episode of hypoxia. she was seen by dr. and noted to have orthodeoxia. bedside echo showed functional tricuspid stenosis in the sitting position, which causes increased right to left shunt via the known pfo due to the increased right side pressure. she was instructed to lying flat to minimize the right to left shunt to avoid severe hypoxia. she was evaluated by cardiac surgery and interventional cardiology for pfo repair. because the patient was deemed a poor surgical candidate due to incrased risks from comorbidities, she was referred for percutaneous closure of the pfo. the device, however, had been recalled by the manufaturer, and would not be available for two weeks. the patient remained in the hospital given her poor functional status, and the device arrived early. she was anticoagulated with heparin pending hte procedure, and coumadin was restarted thereafter. successful procedure was performed and pt was able to sit up without desaturating thereafter. she tolerated the procedure well with a small hematoma ensuing. current condition by problem: 1) pfo: now s/p procedure. light activity tolerated in terms of o2 sats, patient able to sit up. limitation is primarily deconditioning. 2) afib: continue coumadin, beta-blocker, amiodarone. note: pt has icd, dd pacer. 3) cardiomyopahty: asymptomatic, continue bb, ace-i, asa, statin 4) + ua: asymptomatic, but + ua, no fever/elevated wbc, cx contaminated. bactrim x 7 day course. 5) hypothyroid: continue levothyroxine 6) hyperparathyroid: calcitonin 7) vaginal itching: treat minor yeast infxn, imidazole cream x 7 days 8) anemia: stools guaiac negative, pt transfused one unit . anemia likley phlebotomy, chronic disease and poor nutrition. pt also had small, stbale hematoma s/p cath. 9) depression/anxiety: continue ativan (prn) and paxil, social work following. 8) fen: low sodium plus shakes 9) ppx: bowel regimen 10) code: dnr/dni, has icd medications on admission: amio, pantoprazole, levothyroxine, calcitonin, metoprolol, lipitor, bowel meds, lisinopril discharge medications: 1. amiodarone hcl 200 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. levothyroxine sodium 75 mcg tablet sig: one (1) tablet po daily (daily). 4. calcitonin (salmon) 200 unit/actuation aerosol, spray sig: one (1) nasal daily (daily). 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for sbp<95, hr<55. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): hold for sbp<100. 10. zolpidem tartrate 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 12. paroxetine hcl 10 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 13. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 14. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 15. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed. 16. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). 17. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily) for 3 days. 18. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 4 days. 19. clotrimazole-betamethasone 1-0.05 % cream sig: one (1) appl topical hs (at bedtime) for 5 days. 20. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: non-st elevation myocardial infarction hypoxia due to right to left shunt via known patent foramen ovale functional tricuspid stenosis chf (ef 30%, 1+ mr, 1+ tr, significant pulmonary regurgitation, multifocal ak/hk on tte ) ddd pacemaker and icd placement for sick sinus syndrome and nsvt paroxysmal atrial fibrillation hypothyroidism hyperparathyroidism gastoesophageal reflux disease hx of l3 fracture and cauda equina syndrome s/p l2/l3 laminectomy c/b residual low back pain osteopenia obstructive sleep apnea urinary retention dysphagia depression urinary tract infection yeast infection discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet please have inr rechecked in 2 days and then biweekly until stable in target range of 2 to 3. coumadin dose should be adjusted accordingly. please repeat a chest ct in 3 months to reevaluate the pulmonary nodules seen on this admission. please have inr rechecked in 2 days and then biweekly until stable in target range of 2 to 3. coumadin dose should be adjusted accordingly. followup instructions: 1) please follow up with your primary care physician 1 to 2 weeks. , d. 2) follow-up with dr. in weeks: ( procedure: diagnostic ultrasound of heart arteriography of pulmonary arteries transfusion of packed cells repair of atrial septal defect with prosthesis, closed technique diagnoses: other primary cardiomyopathies subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation dysthymic disorder hypotension, unspecified ostium secundum type atrial septal defect unspecified sleep apnea unspecified disorder of kidney and ureter automatic implantable cardiac defibrillator in situ cardiac pacemaker in situ chronic obstructive asthma, unspecified candidiasis of vulva and vagina aneurysm of heart (wall) 

Answer: The patient is high likely exposed to