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: pre-syncope major surgical or invasive procedure: 1.pacemaker placement 2. surgical evacuation of hematoma at pacemaker site history of present illness: the patient is a -year-old male with a past medical history of atrial fibrillation, hypertension and has a mechanical aortic valve which was placed approximately 30 years ago for a "leaky" aortic valve per patient. the patient is on home coumadin therapy for his atrial fibrillation and valve. he presented to the emergency room complaining of multiple presyncopal episodes. the patient describes these episodes as sudden occurences of lightheadedness while sitting at the table. he would then set his head down on the table and within seconds the symptoms would resolve. these episodes occur at rest and never happen when the patient is walking or up and about and more active. he denies palpitations, chest pain, shortness of breath, and he has no associated nausea or vomiting. these episodes have occurred x in the past week. no related orthopnea, pnd, or edema. . pt was recently admitted to the cardiology service for similar episodes. it was felt that his episodes were due to bradycardia secondary to severe htn up to sbp 220s. the patient was started on lisinopril, amlodipine and hctz. upon discharge, hr ranged in 70s, sbp in 130s. of note, the patient has been inadvertently taking his prescribed dose of amlodipine prescribed over the past week. . in the ed, initial vital signs were: temp 97.1 f, pulse rate 48, bp 180/72 and rr 18, oxygen saturation 100% ra. his hr ranged from 40-60 in slow atrial fibrillation. on telemetry, he reportedly had occasional pauses of up to 3-5 seconds, but he remained asymptomatic during these pauses. . on the floor the patient promptly triggered for marked nursing concern and persistent hr < 40. patient had multiple second pasuses on telemetry with narrow junctional escape beats. cardiology was consulted who recommended deferring temporary pacing wire given elevated inr and history of mechanical valve. patient was transferred to ccu for closer observation and monitoring overnight. on arrival to ccu patient denied chest pain, sob, pnd, orthopnea, le swelling, syncope or other complaints. past medical history: 1. cardiac risk factors:: hypertension 2. cardiac history: no interventions in past. 3. other past medical history: - atrial fibrillation, on coumadin, no beta-blocker - htn - aortic valve replacement 30 years ago on coumadin - chronic kidney disease, baseline cr 1.5-1.8 - emphysema by cxr - no o2 requirement, no medical therapy. social history: patient lives in with his wife in his own home. 45 pack year smoking history. quit 30 years ago. family history: non contributory physical exam: vitals: t 97.8, bp 147/78, hr 59, rr 18, o2 sat: 98% on ra gen: well appearing, nad. heent: ncat.sclera anicteric. no pallor or cyanosis. neck: supple. no , no jvd. cardiac: no rubs/gallops, systolic murmur with audible mechanical click lungs: breathing comfortably at rest, no crackles or wheezes. abdomen: soft, nt, nd. no masses. no rebound or guarding. extremities: warm, well perfused. no edema. good distal pulses. neuro: a+ox3. cn 2-12 intact and symmetric. grossly non focal. able to move all extremities. pulses: dopplerable le pulses, femoral 1+ b/l, radial 2+ b/l carotids: audible mechanical murmur, no bruits. . at time of discharge: pt's exam is unchanged except for extensive erythema and edema of left arm secondary to tracking of blood associated with pace maker insertion. he has a palpable, but small hematoma surrounding his pacer site which is bandaged. pertinent results: : ekg: atrial fibrillation with bradycardia hr 40-50bpm, left axis, no hypertrophy, mildly peaked t-waves, no acute st-t changes . telemetry : bradycardia with junctional escape, frequent pauses of seconds duration . tte / echo : (no priors for comparison) the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. a mechanical aortic valve prosthesis is present. the discs appear to move, but the transaortic gradient is higher than expected for this type of prosthesis (unless very small prosthesis - details unknown). . mild (1+) aortic regurgitation is seen. the mitral valve leaflets and supporting structures are thickened. no mitral stenosis. moderate (2+) mitral regurgitation is seen. there is borderline pulmonary artery systolic pressure. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. well seated aortic valve prosthesis with slightly increased gradient. increased pcwp. moderate mitral regurgitation. borderline pulmonary artery systolic hypertension. cxr post-pacemaker placement: single-chamber pacemaker lead ending in the right ventricle. the rest of the study is grossly unchanged compared to the previous scan. 05:40pm blood wbc-4.9 rbc-3.22* hgb-10.8* hct-32.3* mcv-100* mch-33.5* mchc-33.5 rdw-13.9 plt ct-140* 05:55am blood wbc-4.9 rbc-2.79* hgb-9.9* hct-27.5* mcv-99* mch-35.6* mchc-36.0* rdw-13.8 plt ct-117* 01:25pm blood wbc-4.7 rbc-2.64* hgb-8.8* hct-25.7* mcv-98 mch-33.2* mchc-34.1 rdw-17.6* plt ct-253 05:50am blood wbc-5.7 rbc-2.74* hgb-9.1* hct-26.8* mcv-98 mch-33.0* mchc-33.7 rdw-17.2* plt ct-240 12:46am blood pt-23.1* ptt-35.7* inr(pt)-2.2* 07:00am blood pt-15.2* ptt-29.7 inr(pt)-1.3* 05:50am blood pt-23.6* inr(pt)-2.3* 05:40pm blood glucose-87 urean-40* creat-1.8* na-138 k-4.9 cl-103 hco3-28 angap-12 05:50am blood glucose-86 urean-39* creat-1.6* na-142 k-4.5 cl-109* hco3-26 angap-12 05:55am blood ck-mb-notdone ctropnt-0.02* 05:40pm blood vitb12-791 folate-greater th 05:10pm blood triglyc-54 hdl-50 chol/hd-2.7 ldlcalc-73 05:55am blood tsh-2.5 05:40pm blood digoxin-<0.2* brief hospital course: in summary, mr. is a -year-old male with pmh atrial fibrillation, htn, and s/p avr on coumadin who presented with pre-syncope, bradycardia and prolonged pauses on telemetry/ekg and was referred to the ep team at . ultimately, after evaluation it was felt that mr. would benefit from a pacemaker. he underwent surgery on and had a local complication of a left anterior subclavian and anterior shoulder region small hematoma after his procedure with some additional ecchymotic tracking down his left arm. he was given a pressure dressing and warm compresses for comfort after the procedure. throughout this time he had a slight dip in his hct levels from 29-30 range to 25-26 range but was hemodynamically stable and did not require transfusion. discharge delayed by hematoma and by subtherapeutic inr. pt has a inr goal of 2.5 to 3.0 given his atrial fibrillation, advanced age, hypertension, and mechanical valve. . # rhythm: pt persistently in atrial fibrillation. ventricular rate maintained in the 60-70 range by pacer. pt not orthostatic or lightheaded. will need to maintain inr of 2.5 to 3.0 given atrial-fib and valve. inr will be followed by pcp who followed inr prior to this admission. - pt will f/u with dr. at . . # cad: no known cad, no e/o active ischemia by ekg and no prior infarcts on ecg. - ruled out mi, 2 sets cardiac enzymes negative . #presyncope: likely to bradycardia. no syncope or falls. - negative w/u for other causes with u/a, ucx, cxr, echo, b12, tsh level . # htn: adequately controlled at the time of discharge in the sbp range of 110 to 135 . # s/p aortic valve replacement: inr goal 2.5-3 as above . # chronic renal failure: cr at baseline of 1.5-1.8 during hospitalization . # follow-up: pt has appt's with cardiology and pcp. family is actively involved in his healthcare and is aware of these appts and the need for close follow-up of inr. medications on admission: hctz 25 mg amlodipine 10 mg dialy lisinopril 40 mg daily warfarin 2.5 mg daily lanoxin 0.125 mg daily discharge medications: 1. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 3. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 4. bacitracin-polymyxin b 500-10,000 unit/g ointment sig: one (1) appl ophthalmic q6h (every 6 hours): continue until you see your opthamologist. disp:*1 tube* refills:*2* 5. warfarin 2.5 mg tablet sig: one (1) tablet po once a day. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q12h (every 12 hours) as needed for pain. 7. cephalexin 500 mg capsule sig: one (1) capsule po q12h (every 12 hours): stop taking after . disp:*8 capsule(s)* refills:*0* 8. erythromycin 5 mg/g ointment sig: one (1) ophthalmic qhs (once a day (at bedtime)). 9. outpatient lab work please check inr, hct on and call results to dr. office.( discharge disposition: home with service facility: discharge diagnosis: atrial fibrillation and bradycardia requiring pacemaker placement mechanical avr hypertension infected left tear duct discharge condition: the patient was stable at time of discharge with no complaints of left pacemaker site pain, no chest pains, dizziness or palpitations. hematoma site improved. inr 2.5 hct 26.5 bun 33 and cr 1.5 discharge instructions: you had a very low heart rate and required a pacemaker. please don't move your left arm over your head or tuck in your shirt for the next 6 weeks. no lifting more than 5 pounds for 6 weeks. keep the bandage dry, no showers until after you see the clinic physicians at for a follow-up pacemaker appointment on . you can also follow-up with dr. for ongoing pacemaker management. you may take a bath as long as the pacer dressing stays dry. you had some bleeding around the pacer site and into your left arm and needed some fluid and blood to keep your blood pressure up. . new medicines: you can . please stop these medicines: you can stop taking your previous lanoxin medication. followup instructions: cardiology: , md phone: date/time: 3:30pm on , please call the office if this time is not possible, but you must see dr. at some point next week. ep follow-up appointment : please return to the of the clinic building at on at 10am for a follow-up appointment to check your pacemaker and hematoma. . primary care: , md phone: ( date/time: pt's family will call for an appt. please continue to follow your inr level with your coumadin therapy with a goal inr of 2.5-3.5. . opthamology: provider: , md phone: date/time: 2:30pm at the clinic procedure: transfusion of packed cells initial insertion of single-chamber device, rate responsive initial insertion of transvenous lead [electrode] into ventricle revision or relocation of cardiac device pocket diagnoses: anemia in chronic kidney disease acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation heart valve replaced by other means chronic kidney disease, stage iii (moderate) other emphysema long-term (current) use of anticoagulants other complications due to other cardiac device, implant, and graft surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation anticoagulants causing adverse effects in therapeutic use sinoatrial node dysfunction dehydration syncope and collapse dacryocystitis, unspecified 

Answer: The patient is high likely exposed to