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: icd firing, vt storm major surgical or invasive procedure: electrophysiology study and ablation history of present illness: the patient is a 67 year old female with idiopathic dilated cardiomyopathy (? viral myocarditis 10 years ago) with lvef of 20% s/p biv icd, and recurrent multifocal ventricular tachycardia s/p l vats for sympathectomy and excision of the left stellate ganglion on in setting of recurrent vt who presents from home with multiple icd shocks. since returning home, she has felt well. she has noted intermittent palpitations since yesterday. . the patient has had a long course of admissions since for recurrent multifocal ventricular tachycardia and icd firings. she was found to have multiple inducible vts arising from the septum, lateral wall and apex during ep study in , with the septal origin of vt precluded ablation. she was started on mexilitine but continued to have frequent sustained vt. anterior septal ablation was attempted, but she experienced recurrent vt. she was readmitted and had successful stellate ganglion block and was started on qunidine. about one week later, she had recurrent palpitations and was re-admitted for repeat stellate ganglion block twice. during her most recent admission, she was taken to the operating room with thoracic surgery on and had a left-sided video-assisted thoracoscopic surgery (vats) procedure with sympathectomy without issue and was in sinus rhythm afterwards. she was discharged on metoprolol but not any anti-arrhythmics. the patient had been feeling very well until yesterday, when she began to note some palpitations. she was having dinner with her family and felt palpitations and experienced one shock, followed in succession by approximately 3 more shocks. her husband called dr. and he advised admission to the ccu. . in the ccu, she has no complaints. interrogation of her icd reveals 20 episodes of vt since , mostly with rate in 110-130s range. . on review of systems, she 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. she denies recent fevers, chills or rigors. she 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. cardiac risk factors: none. 2. cardiac history: idiopathic dilated cardiomyopathy (?viral myocarditis), ef 20-25%%. -cabg: none. -percutaneous coronary interventions: -pacing/icd: icd and biv device 3. other past medical history: - osteoarthritis - h/o gout - stellate ganglion block x2 -left-sided video-assisted thoracoscopic surgery (vats) procedure with sympathectomy () social history: tobacco history: denies. -etoh: rare -illicit drugs: denies. the patient lives with her husband. family history: negative for premature atherosclerotic cardiovascular disease and sudden death. there is no diabetes or hypertension in the family history. son: viral induced dm1 father- mi mother- died at 93 physical exam: admission exam vs: afebrile 92/46 76 18 97%ra general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp at clavicle. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. icd pacer pocket scar noted on left anterior wall. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, or xanthomas. healing scars in left axilla c/w vats scars pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge exam: unchanged, except with slight pericardial rub on exam and minimally tender site of pericardial drain without erythema or hematoma. pertinent results: admission lab results 09:03pm blood wbc-8.9 rbc-3.80* hgb-11.8* hct-34.8* mcv-92 mch-30.9 mchc-33.7 rdw-13.7 plt ct-263 09:03pm blood pt-10.7 ptt-28.3 inr(pt)-1.0 09:03pm blood glucose-139* urean-35* creat-1.7* na-142 k-3.7 cl-103 hco3-28 angap-15 09:03pm blood alt-28 ast-28 ld(ldh)-213 ck(cpk)-40 alkphos-72 totbili-0.4 09:03pm blood ck-mb-3 ctropnt-0.05* probnp-6045* 09:03pm blood albumin-3.8 calcium-9.2 phos-3.4 mg-2.2 discharge lab results 05:46am blood wbc-6.1 rbc-3.22* hgb-10.2* hct-30.9* mcv-96 mch-31.6 mchc-33.0 rdw-13.5 plt ct-181 05:46am blood pt-11.9 ptt-25.5 inr(pt)-1.1 05:46am blood glucose-85 urean-23* creat-1.3* na-137 k-3.6 cl-101 hco3-32 angap-8 05:46am blood calcium-8.5 phos-3.8 mg-1.9 imaging: left pectoral aicd device is seen with its leads terminating into the right atrium, right ventricle and coronary sinus. mildly enlarged heart size is stable. there are no lung opacities of concern. there is no pleural effusion. mediastinal and hilar contours are normal. impression: no acute process in the chest. cxr: as compared to the previous radiograph, the patient has received a pericardial drain. the size of the cardiac silhouette has minimally increased. there is mild retrocardiac atelectasis, but no evidence of substantial pleural effusions. no pulmonary edema. no hilar or mediastinal abnormalities. echo:focused study for pericardial effusion. the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is severe global left ventricular hypokinesis (lvef = 20 %). right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a small pericardial effusion. no right atrial diastolic collapse is seen. slight right ventricular invagination during mid-diastole. no mv/tv respiratory variation. impression: mild right ventricular invagination during mid-diastole (best seen on subcostal views) in presence of small circumferential pericardial effusion. severely depressed left ventricular systolic function. mild right ventricular hypokinesis. compared with the prior study (images reviewed) of , the pericardial effusion is new. echo: focused study: overall left ventricular systolic function is severely depressed (lvef= 25 %). right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , right ventricular invagination is not seen. there is slightly more mitral regurgitation. echo: focused study: there is severe global left ventricular hypokinesis (lvef = 25 %). right ventricular chamber size and free wall motion are normal. mild to moderate (+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. impression: stable, trivial pericardial effusion without echocardiographic signs of tamponade. compared with the prior study (images reviewed) of the findings are similar. brief hospital course: 67yo female with incessant vt s/p multiple anti-arrythmics, ablations and sympathectomy on with recurrent vt today, now s/p attempted endocardial ablation complicated by carotid sinus perforation, epicardial ablation, hemodynamically stable. . acute care: # coronary sinus perforation: during the patient's endocardial vt ablation procedure, the coronary sinus was inadvertently perforated. given this complication, pericardial drain was placed and the patient was kept in the ccu for monitoring. patient remained stable, and a small pericardial effusion was noted at the time of removal of the drain (24hrs after placement). echo on the morning of discharge showed trivial effusion without no signs of tamponade, unchanged from the day prior. aspirin was held, and subcutaneous heparin was deferred given bleeding risk. . # recurrent ventricular tachycardia: the patient has had multiple attempts at ablation, and multiple trials of anti-arrhythmic medications. additionally, patient is s/p sympathectomy. she has ongoing vt and the foci seems likely left septal, thought to be a triggered rhythm. given complications during endocardial ablation, she was only able to undergo epicardial ablation. she was monitored in the ccu and continued to have occasional asymptomatic non-sustained vt overnight. during this admission, metoprolol was held. sotalol 80mg and mexiletine 150mg tid were started. k+ and mg were repleted appropriately. pain was managed with iv morphine initially, tranistioned to a lidocaine patch, and at discharge patient elected to only use tylenol for pain management. given persistent vt, patient will need further ablation within the next week and consideration of possible heart transplant. . # dilated cardiomyopathy: chronic, lvef 20%. ny class iii per outpatient notes which has worsened recently from ii. on chf regimen including metoprolol, spironolactone, and torsemide at home. currently appears euvolemic without signs of overload on physical exam. she has baseline dyspnea which is unchanged. during her admission her regimen was altered; including discontinuation of metoprolol, initiation of sotalol 80mg , increasing aldactone to 50mg from 25mg daily, and continuing torsemide at 20mg daily. she will have f/u labs drawn at the end of the week to monitor potassium, and will schedule an appointment with dr. after the holiday. . chronic care: # osteoarthritis: continued tylenol up to 2grams daily. . # gout: continued allopurinol. . # anxiety: continued alprazolam. . issues to address at follow up: - monitoring of potassium given increase in aldactone (to be drawn on and faxed to dr. . - elevation in tsh to 4.7 - patient will need repeat ablation within the next week or two given intermittent vt. - patient should be on an acei or . it was unclear as to why she is not on one, though could be due to her recent . pcp could not be reached for clarification given the holiday. this should be follow up as an outpatient by her pcp and cardiologist. medications on admission: -allopurinol 100mg daily -aspirin 81mg daily -spironolactone 25mg daily -metoprolol succinate 50mg -alprazolam 0.25-0.5mg prn anxiety -torsemide 20mg daily -magnesium oxide 400mg daily -midodrine 5mg tid -colase prn -acetaminophen prn -senna prn -oxycodone prn discharge medications: 1. allopurinol 100 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. alprazolam 0.25 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for anxiety. 4. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). 5. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 6. senna oral 7. acetaminophen oral 8. midodrine 5 mg tablet sig: one (1) tablet po three times a day. 9. sotalol 80 mg tablet sig: 0.5 tablet po twice a day. 10. spironolactone 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. mexiletine 150 mg capsule sig: one (1) capsule po three times a day. 12. outpatient lab work please draw a basic metabolic panel on and fax results to dr. , fax #. 13. colace 100 mg capsule sig: one (1) capsule po once a day as needed for constipation. discharge disposition: home discharge diagnosis: primary diagnosis: ventricular tachycardia secondary diagnosis: dilated cardiomyopathy, chronic systolic heart failure, anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to for firing of your icd. you underwent an electrophysiology procedure called a ventricular tachycardia ablation. you were started on two anti-arrhythmia medications after, sotalol and mexiletine, which you will continue to take after you leave the hospital. this procedure was complicated by some bleeding into the pericardial space. for the bleeding, a temporary drain was placed and then removed 24hrs later. follow up scans of your heart do not show any significant re-accumulation of fluid. weigh yourself every morning, md if weight goes up more than 3 lbs. please note the following changes to your medications: - start sotalol (dr. has called this into your pharmacy for you) - start mexiletine - increase spironolactone from 25mg to 50mg once daily - stop taking metoprolol - stop taking supplemental potassium continue all of your other medications as prescribed. please be sure to follow up with your physicians. you will need to come back for a blood draw at the end of the week (on ). followup instructions: dr. office will contact you to make an appointment. if you do not hear from them within one week, please call their office to schedule yourself an appointment, (. md procedure: pericardiocentesis excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping diagnoses: other primary cardiomyopathies mitral valve disorders congestive heart failure, unspecified gout, unspecified accidental puncture or laceration during a procedure, not elsewhere classified paroxysmal ventricular tachycardia hemorrhage complicating a procedure anxiety state, unspecified chronic systolic heart failure osteoarthrosis, unspecified whether generalized or localized, site unspecified accidental cut, puncture, perforation or hemorrhage during other specified medical care accidents occurring in residential institution 

Answer: The patient is high likely exposed to