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: sob/doe major surgical or invasive procedure: pericardiocentesis history of present illness: 64 m with history of htn, hl, cad, mi s/p des presents with worsening fatigue, cp, and doe x 1 month. the shortness of breath has worsened over the last few weeks, getting symptomatic now when walking up stairs. he also experiences some associated chest tightness and has an intermittent cough productive of white sputum. otherwise denies fevers, chills, nausea, vomiting. ros also positive for 20 lb weight loss over the last few months. . in the ed, initial vs: 98.6 76 117/65 16 100%. initial concern was for pe. d-dimer was in the 4000s, so cta was obtained which was negative for pe, but found moderate pericardial effusion. cardiology evaluated the patient using bedside echo which showed that there was no signs of right atrial or ventricular diastolic collapse. chronicity of this effusion is slightly unclear and so decision was made to admit patient to cardiology service for further monitoring. morphine was not helpful in relieving patient's chest discomfort, however toradol was. vitals prior to transfer to the floor were: 98.9 82 135/85 18 95% ra. . currently, patient feels much better, still having very light chest discomfort but otherwise is resting comfortably, not having any difficulties with breathing past medical history: 1. cad as above acute mi in sp stents (unknown where as no report available) 2. hyperlipidemia 3. hypertension 4. mild cva in no deficits 5. cholecystectomy social history: the patient has a h/o smoking 1ppd x 30 yrs, for 6 weeks cut back to 5 cig/day. drinks 2 glasses of red wine per day (5x/week). an administrator, married with one child family history: father with htn and heart disease died at 72 mother 74 died of cancer sister mi, htn, dm 64 physical exam: admission exam: pulsus: 8mmhg vs: t 97-99 bp 90-116/40-60 hr 88-100 rr 18 o2 sat 96% ra gen: nad, comforatble heent: eomi, ncat neck: supple, thyroid non-tender, jvp 6cm above the ra cv: irreg irreg, normal s1/s2, no s3/s4, no murmurs or rubs pulm: ctab, no incrased wob abd: ntnd, nabs ext: wwp, no c/c/e neuro: a/ox3, cn ii-xii intact. non focal. . discharge exam: pulsus: 8mmhg vs: t 98 bp 120-130/60-70 hr 70s rr 18 o2 sat 96% ra gen: nad, comforatble heent: eomi, ncat neck: supple, thyroid non-tender, jvp 6cm above the ra cv: rrr, normal s1/s2, no s3/s4, no murmurs, gallops or rubs pulm: ctab, no incrased wob abd: ntnd, nabs ext: wwp, no c/c/e neuro: a/ox3, cn ii-xii intact. non focal. pertinent results: admission labs: 03:38pm blood wbc-8.4 rbc-4.51* hgb-10.6* hct-33.8* mcv-75* mch-23.4* mchc-31.3 rdw-15.2 plt ct-345 03:38pm blood glucose-93 urean-17 creat-1.0 na-136 k-3.9 cl-101 hco3-24 angap-15 03:38pm blood ctropnt-<0.01 07:04am blood ck-mb-1 ctropnt-<0.01 06:31pm blood d-dimer-4205* . discharge labs: 07:25am blood wbc-6.1 rbc-4.17* hgb-9.8* hct-31.3* mcv-75* mch-23.5* mchc-31.3 rdw-15.0 plt ct-416 07:00am blood glucose-97 urean-13 creat-1.0 na-138 k-4.3 cl-101 hco3-28 angap-13 07:00am blood ld(ldh)-177 07:04am blood ld(ldh)-179 ck(cpk)-49 07:04am blood ck-mb-1 ctropnt-<0.01 03:38pm blood ctropnt-<0.01 07:00am blood albumin-3.3* calcium-8.6 phos-2.7 mg-2.0 07:00am blood rheufac-18* 02:41pm blood -negative 05:35am blood dsdna-negative 01:23pm other body fluid wbc-* rbc-0 hct,fl-14.5* polys-76* lymphs-21* monos-3* 01:23pm other body fluid totprot-4.8 glucose-78 ld(ldh)-842 amylase-42 albumin-2.8 05:35am blood sm antibody-neg 05:35am blood anti-histone antibody-neg . cxr (): the lungs are clear bilaterally with no areas of focal consolidation. small nodular densities overlying the left fifth rib are again noted most consistent with bone islands as seen on the prior chest radiographs with obliques. there are no areas of focal consolidation to suggest pneumonia. there is no pleural effusion or pneumothorax. there is mild cardiomegaly. the mediastinal silhouette is unchanged. impression: mild cardiomegaly, which is new since study. no evidence of pneumonia. . cta (): 1. moderate-sized pericardial effusion with faint enhancement of the pericardium. pericarditis cannot be excluded. 2. no pulmonary embolism. 3. moderate centrilobular emphysema. multiple small pulmonary nodules measuring up to 3 mm. followup chest ct in 12 months is recommended. . tte (): overall left ventricular systolic function is normal (lvef>55%). with rv normal free wall contractility. no mitral regurgitation is seen. there is a moderate sized pericardial effusion posteriorly (1.9cm) and small anterior effusion (0.9cm). no right atrial diastolic collapse is seen. no right ventricular diastolic collapse is seen. . tte (): overall left ventricular systolic function is normal (lvef>55%). after pericardiocentesis there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. impression: successful pericardiocentesis. trivial residual pericardial effusion without echocardiographic signs of tamponade. . tte (): overall left ventricular systolic function is normal (lvef>55%). there is a very small anterior pericardial effusion. there is a larger focal pericardial vs. pleurial effusion posteriorly. there are no echocardiographic signs of tamponade. impression: small residual pericardial effusion. there is an echolucent space near the left atrium that is probably a small pleural effusion. no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of the findings are similar. . tte (): the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. the effusion is echo dense, consistent with blood, inflammation or other cellular elements. impression: very small partiall echo filled pericardial effusion with abnormal septal motion. no hemodynamic compromise, but the abnormal septal motion raises the possibility of early constriction. pulmonary artery hypertension. compared with the prior study (images reviewed) of , the findings are similar (pa hypertension is now identified). . tte (): overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the septal "bounce" is not as apparent on the current study. the other findings are similar. . pericardial fluid cytology (): rare atypical cells, cannot exclude reactive mesothelial cells. . pericardial fluid cell block (): rare atypical cells, cannot exclude reactive mesothelial cells. brief hospital course: priamry reason for admission: 64 m with h/o htn, hl, cad, mi s/p des presents with pericardial effusion of unknown etiology. . active problems: . # pericardial effusion: in the ed bedside tte was negative for tamponade physiology. on the morning of hd #1, the pts bp was downtrending 120->110->90s and his hr was uptrending 80s->100s. at this point the pt was bolused 500cc ns and repeat tte showed moderate pericardial effusion with brief ra diastolic collapse. given the pt's deteriorating vs, elective pericardiocentesis was performed and 270 cc of serosanguinous pericardial fluid was removed. the patient tolerated the procedure well. repeat echo after drain placement showed no significant reaccumulation of pericardial fluid. the patient's drain was pulled on and serial echos were obtained that showed small residual echodense effusion with mild restrictive physiology. clinically, the patient stated he felt much better immediately post-procedure and continued to improve throughout his course. he was started on colchicine and ibuprofen for anti inflammatory effects with symptomatic improvement. the patient's hydralazine was held due to concern for hydralazine induced sle that could account for effusion; after d/c his anti-histone ab returned negative. at the time of d/c, he was able to ambulate without sx and felt near his baseline. transitonal issues: the cause of his effusion is unclear at this time and ongoing outpatient workup should be conducted to r/o malignancy or other treatable cause. all autoimmune ab labs were negatuve. his effusion was clearly exudative based on lytes criteria (see results). . # atrial fibrilation: on admission pt was noted to be in a-fib. he has no known h/o a-fib, and it was felt his abnormal rhythm was periacrdial effusion. after pericardiocentesis, he remained in nsr for the remainder of his course. . # hypertension: while in the ccu, his antihypertensive medications were initially held except for his carvedilol because of hypotension. however, on transfer from the ccu back to the floor, the patient was restarted on amlodipine (dose increased to 10 mg) and lisinopril 20 mg daily. of note, his hydralazine was discontinued, as there was some concern about hydralazine induced sle that could account for this effusion; anti-histone ab returned negative. . chronic problems: . # weight loss - patient reports 20lb weight loss over last few months. has been evaluated by gi as outpatient because of guaiac positive stool. gi workup has thus far been unrevealing with negative egd/. transitional issues: pt should have ongoing outpatient workup for malignancy given weight loss and exudative pericardial effusion of unknown etiology . # htn - we continued his amlodipine, carvedilol and lisinporil and d/c'ed his hydralazine. . # hl - per patient, he was told by his pcp to stop taking simvastatin, unclear why . transitional issues: lung nodules seen on chest ct. on tte, there was possible areas calcfications in liver; will likely need outpatient ruq u/s to further evaluate. f/u with pcp and cardiologist. medications on admission: amlodipine 5mg daily carvedilol 50 mg clopidogrel 75 mg daily ecotrin 81 mg daily hydralazine 50 mg tid lisinopril 20 mg daily omeprazole 20 mg daily discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 5. carvedilol 12.5 mg tablet sig: four (4) tablet po bid (2 times a day). 6. ibuprofen 600 mg tablet sig: one (1) tablet po every eight (8) hours for 7 days. 7. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 8. chantix starting month pak 0.5(11)-1(3x14) mg tablets, dose pack sig: 1-2 tablets, dose packs po twice a day: as directed on box. disp:*1 dose pack(s)* refills:*0* 9. colchicine 0.6 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: priamry: cardiac tamponade secondary: cad s/p mi with des () hl htn anemia h/o cva () discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you at the . you were admitted because you were having shortness of breath and chest pain due to fluid around your heart. we performed a pericardiocentesis to remove the fluid. at this time, it is unclear what caused your pericardial effusion. results of the tests performed during your hospitalizaion will be sent to your primary care doctor and cardiologist; it will be important to follow up with your physicians to definitively diagnose the cause of this problem. during this hospitalization, the following changes were made to your medications: started ibuprofin 600mg by mouth 3 times a day x7 days started colchicine 0.6 mg twice a day, continue until you see your cardiologist stopped hydralazine 50mg by mouth three times a day you have been given a prescription for chantix to help you stop smoking. you have tolerated this medication well in the past. you will need to get the continuation pack from your pcp. thank you for allowing us to participate in your care. followup instructions: department: medical group when: monday at 1:30 pm with: dr. building: (, ma) campus: off campus best parking: on street parking name: , address: ,ste 7c, , phone: appt: at 4pm procedure: pericardiocentesis diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder unspecified essential hypertension atrial fibrillation other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia unspecified disease of pericardium loss of weight old myocardial infarction other emphysema iron deficiency anemia, unspecified cardiac tamponade 

Answer: The patient is high likely exposed to