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: zyban attending: chief complaint: atrial fibrillation with rapid ventricular response major surgical or invasive procedure: cardioversion history of present illness: is a 71 year-old woman with h/o hyperthyroidism, dm, htn, and dyslipidemia who was found by her pcp to have hr of 150 in atrial flutter. she had gone to her pcp for routine visit and was asymptomatic. she was noted to have a resting hr of 160. ecg showed narrow-complex tachycardia at depressions in lateral leads. her bp was 132/90 mmhg. she was sent to the er to romi. she denied any chest pain, palpitaitons, diziness, lightheadedness, shortness of breath or any symptoms. . in the er vs were t 97.5 f, bp 140/92 mmhg, hr 160 bpm, rr 18, spo2 100% ra. during her stay in the er her min sbp was 100. patient did not respond to metoprolol 5mg iv x2 and then labetalol 10 mg iv x1; however her bp was always stable. then, sedated her with propofol and tried cardioversion unsucessfully. she dropped her blood pressure after propofol and received 1.2 l of ns. she had nausea and vomiting. then, cardiology was consulted and patient received iv dilt and was started on dilt drip. patient had sob and did not respond to ipratropium bromide nebs. she was also given methylprednisolone for possible bronchospasm. bipap was started at 8/5. lasix was not given. . on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. diabetes mellitus type 2 - uncontrolled; last a1c 7.4 ( ). followed at clinic. 2. disease & thyroid nodules - tft's wnl: free t4 1.2 and tsh 0.35 (). initially treated with ptu; recurred then low-dose i-131 and had pafib, did not respond to ptu, then methimazole & stopped 1 y ago. 3. hypertension - on enalapril. well-controlled sbp 100-130 mmhg. 4. active smoking 5. hypercholesterolemia - ldl 96, hdl 43, chol 178, tg 197 on 6. osteoarthrosis 7. paroxismal atrial fibrillation associated with as above. she was sucessfully cardioverted and her anticoagulation was stopped. social history: she lives in , ma with her husband. she has 3 sons and 3 daughters. she currently smokes pack per day and has history of 25 pack-year. she drinks 4-5 drinks/year. denies any illegal substance use. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. son with dm1 and mi in his 30s. motherr with stroke in 30s. no history of cancer. physical exam: vital signs - temp 97.8 f, bp 100/60 mmhg, hr 120 bpm, rr 16 x', o2-sat 100% ra general - well-appearing woman in nad, oriented x3, comfortable, mood, affect appropriate. heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck - supple, no thyromegaly, jvp >7cm (difficult to assess given bipap mask), no carotid bruits lungs - bibasilary crackles, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. sem rusb no radiation. no thrills, lifts. no s3 or s4. abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding. abd aorta not enlarged by palpation. no abdominial bruits. extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps), no c/c/e. no femoral bruits. skin - no rashes or lesions. no stasis dermatitis, ulcers, scars, or xanthomas. lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, cerebellar exam intact, steady gait 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-11.5 hgb-13.9 hct-40.3 plt ct-256 pt-11.2 ptt-21.9 inr(pt)-0.9 glucose-163 urean-26 creat-1.2 na-140 k-4.7 cl-105 hco3-24 ck(cpk)-87 ctropnt-<0.01 t4-6.3 t3-111 free t4-1.4 tsh-0.057 echo : the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cxr : the heart is mildly enlarged and there is pulmonary vascular redistribution with small right pleural effusion and small areas of subsegmental atelectasis seen best on the lateral films. discharge labs: wbc-11.2* rbc-3.75* hgb-12.1 hct-35.5* mcv-95 mch-32.3* mchc-34.1 rdw-14.2 plt ct-229 pt-30.8* ptt-32.2 inr(pt)-3.1* glucose-160* urean-29* creat-1.1 na-140 k-4.3 cl-106 hco3-26 angap-12 calcium-9.9 phos-4.1 mg-2.1 tsh-0.057* d-dimer-427 t4-6.3 t3-111 free t4-1.4 brief hospital course: # rhythm - patient with afib with rvr in the setting of subclinical hyperthyroidism. she was asymptomatic at presentation and continued to deny palpitations. in the ed, she failed to convert to sinus rhythm after iv metoprolol. she was sucessfully converted to sinus rhythm after cardioversion, but promptly returned to afib with rvr. she was also in and out of aflutter. in the ccu, she was continued on a diltiazem drip and given metoprolol 100 mg qid. she was also started on a heparin drip for anticoagulation with a bridge to coumadin. she was also started on methimazole as the thought was that her persistent atrial fibrillation was likely due to her being clinically hyperthyroid due to her history of grave's disease. cardioversion was deferred until we could determine if controlling her hyperthyroidism would restore her to sinus rhythm. on the day prior to discharge diltiazem xl 120mg was added as her hr continued to sustain in the 120's at rest. at discharge, her heart rates were approximately ******. she did not convert to sinus rhythm during her admission. she was started on warfarin for chronic anticoagulation. after 1 month of anticoagulation, may be beneficial to consider cardioversion in this patient if she remains in atrial fibrillation. inr monitoring was arranged with the clinic prior to discharge. # hyperthyroidism - she has a history of disease, s/p treatment for hyperthyroidism multiple times. patient with low tsh level, but normal levels of t4, free t4, and t3. she was started on methimazole 10 mg daily for low of clinical hyperthyroidism, as it was felt this was likely contributing to her atrial fibrillation. she will need to repeat thyroid studies in approximately 2 weeks from discharge. follow up with endocrinology was arranged on discharge as well. # respiratory failure - patient presented to the ccu on bipap with acute pulmonary edema after being given intravenous fluids in the ed while in afib with rvr. she was diuresed with lasix and rate-controlled as above. her respiratory status improved with diuresis and her o2 sats were excellent on room air at discharge. # pump - no signs of chf. patient had tte to rule out structural heart disease as the cause of afib. echo showed normal wall motion, moderate mr, and mild pulmonary hypertension. # cad - she has no known cad and no evidence that her atrial fibrillation is related to ischemia. # leukocytosis - patient with an increased in white blood cell count to 20.7 (from 11.5 on admission). she had negative urinalysis, blood cultures, and a chest xray that was not suggestive of infection. she also remained afebrile. it was felt that her leukocytosis was most likely due to the administration of iv solumedrol in the ed. # dm2 - patient managed on sliding scale insulin while hospitalized. metformin was added back at her home dose for better blood sugar control and she was restarted on her home dose of glyburide prior to discharge. # hypertension - patient without hypertension during her treatment with metoprolol and diltiazem for rate control of afib. she was added back on half her home dose of enalapril. hctz was held during this admission and on discharge to allow blood pressure room for heart rate control. # smoking - patient wore a nicotine patch and social work was consulted to discuss smoking cessation. # dyslipidemia - continued home-dose statin. patient was full code during this admission. family contact was daughter (home: , cell: ) medications on admission: albuterol 90 mcg hfa aerosol inhaler 1-2 puffs(s) by mouth every four (4) to six (6) hours as needed for cough/wheezing budesonide 32 mcg spray, non-aerosol 2 sprays(s) each nostril once a day enalapril maleate 10 mg tablet 1 (one) tablet(s) by mouth twice a day glyburide 5 mg tablet one tablet(s) by mouth twice a day hydrochlorothiazide 25 mg tablet 1 tablet(s) by mouth once a day metformin 500 mg tablet sustained release 24 hr 2 (two) tablet(s) by mouth twice a day metoprolol tartrate 50 mg tablet 1 (one) tablet(s) by mouth twice a day simvastatin 40 mg tablet 0.5 tablet(s) by mouth at bedtime use tablet nr calcium carbonate-vitamin d3 (not taking) flaxseed oil dosage uncertain (not taking) multivitamin dosage uncertain (not taking) nicotine 7 mg/24 hour patch 24 hr use daily once a day discharge medications: 1. outpatient lab work please check a pt/inr on thursday and call results to the anti coagulation lab at ( 2. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: 0.5 tablet po at bedtime. 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 6. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 7. rhinocort aqua 32 mcg/actuation spray, non-aerosol sig: sprays nasal twice a day. 8. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 9. metformin 500 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po bid (2 times a day). 10. enalapril maleate 5 mg tablet sig: one (1) tablet po bid (2 times a day). 11. glipizide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 12. warfarin 2 mg tablet sig: 1.5 tablets po once a day. disp:*150 tablet(s)* refills:*2* 13. methimazole 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. outpatient lab work please check tft's, cbc on and call results to dr. at 15. metoprolol succinate 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po bid (2 times a day). disp:*120 tablet sustained release 24 hr(s)* refills:*2* 16. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*2* discharge disposition: home discharge diagnosis: hyperthyroidism atrial fibrillation with rapid ventricular response diabetes mellitus tobacco abuse discharge condition: stable discharge instructions: you were found to have atrial fibrillation, a very common heart arrhythmia. your heart rate was very fast and we started you on 2 new medicines to slow the rate down. we believe the rhythm as in part caused by a hyperactive thyroid and we started you on methimazole to decrease the amount of thyroid hormone that is released. if you have any fevers you should call your doctor and have blood drawn for a cbc with differential because the methimazole can cause you to lose your white blood cells which protect you from infection. because you have atrial fibrillation, you will need to be on coumadin to prevent blood clots and strokes. you will need to check a coumadin level (inr) frequently until we know how much coumadin you need to take. your goal inr is 2.0-3.0. please see the teaching sheet about how to take coumadin and what medicines can interact with coumadin. new medicines: 1. methimazole: a medicine to decrease the amount of thyroid hormone 2. metoprolol succinate: to lower your heart rate 3. diltiazem: to lower your heart rate 4. warfarin (coumadin): a blood thinner that will help to prevent a stroke. . please call dr. if you notice palpitations, dizziness, dark or bloody stools, bleeding that wont stop, vomiting of blood. please call dr. for fatigue, dizziness, skin or appetite changes, fevers or other signs of infection. followup instructions: needs follow-up of tft's in weeks (started on methimazole for subclinical hypothyroidism) primary care: provider: , medical unit phone: date/time: tuesday at 2 pm date/time: 12:00 endocrine: provider: , m.d. phone: date/time: monday at 1 pm. office may call you with an earlier appt. date/time: 10:00 cardiology: dr. phone: date/time: at 10:30 am. this appt is with , np procedure: atrial cardioversion diagnoses: tobacco use disorder unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm acute respiratory failure 

Answer: The patient is high likely exposed to