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: codeine / shellfish derived attending: chief complaint: bradycardia and hypotension following pvi major surgical or invasive procedure: pulmonary vein isolation (pvi) atrial fibrillation ablation direct current cardioversion (dcv) -ventricular pacemaker placement history of present illness: ms. is a 68yof with a h/o myxomatous mitral valve s/p core valve in c/b postoperative paroxysmal atrial fibrillation. she was managed on amiodarone until . at that time event monitoring demonstrated accelerated junctional rhythm with apbs and atrial couplets, and amiodarone was discontinued. she was then asymptomatic until when she began to experience episodes of palpitations. of hearts monitor revealed frequent apbs and vpbs, short runs of atrial tachycardia and bigeminy. she was started on propafenone and metoprolol, but subsequently reverted to afib. she underwent successful dccv on , but on she presented to osh ed for palpitations and was found to again be in atrial fibrillation on . she was again cardioverted and her propafenone was increased to 225mg tid. stress echo was done on which was notable for a junctional rhythm that occurred during peak exercise. echo imaging was negative for ischemia and showed preserved ef. she was admitted today for elective pvi. . post ablation pt underwent dcv with 200 joules. she cardioverted to sinus rhythm but was bradycardic with hr 30s and hypotensive (sbp 80s). temp wire inserted and pacer set at 90, and she was started on dopamine gtt. she was transferred to the ccu for further management. on arrival, vitals were t 96.6, hr 81, bp 110/48. she was still intubated on arrival but quickly extubated and then breathing comfortably with o2 sats 100% on 2l nc. she noted mild chest discomfort, but denied palpitations, sob. past medical history: mr/mvp s/p minimally invasive mitral valve repair (38 mm annuloplasty band) on paroxysmal atrial fibrillation - post mvr atrial tachycardia and frequent pvcs htn hyperlipidemia gerd diverticulosis osteopenia schatzki's ring h/o hearing loss - conductive loss, has a hearing aid s/p l ear surgery s/p trigger finger release r hand social history: married and lives in with husband. retired. smoked. occas etoh, none recently. family history: father died age brother with connective tissue disease and 2 valve replacements avr/asc aorta. numerous family members with cholecystectomies. physical exam: admission physical exam: general: nad. drowsy, but oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. mmm. neck: supple, no jvd. cardiac: rr, normal s1, s2. ii/vi holosystolic murmur at llsb. no s3 or s4. lungs: decreased air movement bilat. no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. l femoral temp wire in place. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge physical exam: general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. mmm. neck: supple, no jvd. cardiac: rr, normal s1, s2. ii/vi holosystolic murmur at llsb. no s3 or s4. lungs: no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. palpable superficial cord on right arm. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs: wbc 4.7 hgb 11.9 hct 34.2 plts 252 inr 3.0 pertinent studies: renal ultrasound (): 1. polypoid urothelial lesion seen within the lumen of the urinary bladder suggestive of a urothelial tumor vs. intraluminal clot. a cystoscopy is recommended. note is made that the bladder is moderately distended despite a foley catheter in place. 2. normal appearance of the kidneys. discharge labs: pt-27.8* inr(pt)-2.7* wbc-3.7* rbc-3.06* hgb-9.2* hct-26.6* mcv-87 mch-30.0 mchc-34.5 rdw-13.6 plt ct-192 brief hospital course: 68yof with h/o paroxysmal atrial fibrillation after percutaneous mvr in now s/p pvi today c/b sinus bradycardia with hr to 20s-30s. # sinus bradycardia/tachycardia: s/p pvi, successfully cardioverted to sinus rhythm but bradycardic to 20s-30s. initially with temporary atrial pacing and dopamine drip. however, in am on hd1, patient reverted back into atrial tachycardia to 150s. patient was given 5mg iv metoprolol and loaded with digoxin with no effect. she was cardioverted but returned to tachycardic rhythm within an hour. she was started on an esmolol drip with rate control to the 100s. on hd2, patient had a dual chamber pacer palced in the right atria and ventricle. they were unable to place a lead in the lv, however, the device may be upgraded at a later date. rate was controlled at 80 following the procedure. she was loaded with amiodarone for rhythm control. metoprolol was held initially as pressures were low but was started on hd4 at home dose. heart rate and blood pressure remained stable after this, and she was transferred to the floors where she remained hemodynamically stable. she was discharged on amiodorone taper and metoprolol. # hypotension: patient required a dopamine drip to maintain blood pressures following initial procedure. after pacemaker was placed, dopamine drip was held, but patient's pressures continued to be low. this resolved with placement of permanent pacemaker and blood pressure remained stable after she was transitioned to the floors, tolerating the addition of metoprolol and her home valsartan. # hematuria: the patient was noted to have gross hematuria in the setting of foly placement with an elevated inr. urine studies showed 182 rbcs and 182 white cells. the patient underwent a renal us which showed polypoid mass in the bladder concerning for a mass but which could also present a blood clot. urology was contact and recommended outpatient f/u with repeat u/a in 6 months and possible cystoscopy. # hld: continued home gemfibrozil. # gerd: continued home pantoprazole. # transitional issues: - f/u with urology for bladder mass medications on admission: betamethasone dipropionate -0.05 % ointment - epinephrine - 0.3 mg/0.3 ml estradiol - 2 mg ring - per vagina q 3 months gemfibrozil - 600 mg tablet - 1 tablet(s) by mouth twice a day metoprolol succinate - (prescribed by other provider) - 25 mg tablet extended release 24 hr - 1.5 tablet(s) by mouth daily increased from 12.5 when she went into afib pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day propafenone - 225 mg tablet - 1 tablet(s) by mouth three times a day valsartan - 160 mg tablet - 1 tablet(s) by mouth daily warfarin - 2 mg tablet - 1- 3 tablet(s) by mouth at bedtime. as directed by anticoag to maintain inr aspirin - (otc) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day biotin - (prescribed by other provider) - dosage uncertain cholecalciferol (vitamin d3) - (otc) - 1,000 unit capsule - 1 capsule(s) by mouth once a day docusate calcium discharge medications: 1. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 2. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. docusate calcium 240 mg capsule sig: one (1) capsule po prn (as needed) as needed for constipation. 7. amiodarone 200 mg tablet sig: as directed tablet po as directed: take 2 pills 3 times/day for one week (), then take 2 pills 1 time/day until you are seen in cardiology clinic with dr. . disp:*100 tablet(s)* refills:*0* 8. biotin oral 9. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 10. betamethasone dipropionate 0.05 % cream topical 11. epipen intramuscular 12. estring 2 mg ring sig: one (1) per vagina vaginal q3 months. 13. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*5 tablet(s)* refills:*0* 14. cephalexin 250 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 3 days: stop after taking your doses on . disp:*2 capsule(s)* refills:*0* 15. outpatient lab work inr check at center clinic discharge disposition: home discharge diagnosis: primary diagnosis: atrial fibrillation hypotension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , as you know, you were admitted to for surgical ablation of your atrial fibrillation and cardioversion (shock) of your heart into normal rhythm. after the procedure, your heart rate and blood pressure became very low, requiring you to be treated in the icu. your heart rate then became rapid again, so you had a pacemaker placed. your heart rate and blood pressure have now improved. while you were in the icu, you had blood in your urine, and ultrasound imaging showed a mass in your bladder. this was most likely a blood clot from trauma caused by your urinary catheter. however, we would like you to follow up with a urologist in weeks for a cystoscopy (bladder study using a tiny camera inserted into the urethra) and full exam to be sure that it is not a tumor. we made the following changes to your medications: 1.) added amiodarone 400mg three times/day for one week (), then 400mg once daily until you are seen in cardiology clinic (dr. 2.) decreased valsartan to 80mg daily 3.) added cephalexin 250 mg three times/day for 3 days (start=, last day=) 4.) stopped propafenone 5.) please check your inr at clinic on tuesday . please start 2.5mg coumadin on and again on and have inr checked on . please attend the following doctor's appointments listed below to follow up on the conditions for which you were hospitalized. it was a pleasure taking care of you! followup instructions: please continue to go to the center clinic as directed. make sure to go on tuesday to have your inr checked. already scheduled appointments: department: cardiac services when: friday at 11:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage department: when: wednesday at 10:50 am with: dr. address: , location: post clinic building: sc clinical ctr campus: east best parking: garage this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. ***we are working on a follow up appointment in cardiology with dr. within 1 month. the office will contact you at home with an appointment. if you have not heard within 2 business days or have any questions please call . department: surgical specialties (urology) when: tuesday at 8:45 am with: , md building: campus: east best parking: garage md procedure: other electric countershock of heart other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle insertion of temporary transvenous pacemaker system cardiac mapping artificial pacemaker rate check diagnoses: other iatrogenic hypotension anemia, unspecified esophageal reflux congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation atrial flutter other and unspecified hyperlipidemia heart valve replaced by other means unspecified hearing loss other left bundle branch block unspecified accident gross hematuria sinoatrial node dysfunction phlebitis and thrombophlebitis of superficial veins of upper extremities lumbago other symptoms referable to back disorder of bone and cartilage, unspecified unspecified disorder of bladder 

Answer: The patient is high likely exposed to