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: history of present illness: this is an 81 year old woman with hypertrophic cardiomyopathy and aortic stenosis, hypertension, hyperlipidemia and an av pacemaker, who was admitted for elective septal ablation. she has had progressive worsening of her mixed outflow gradient plus valvular aortic stenosis and mitral regurgitation over the past few years with a peak aortic gradient of 105, a mean of 48, on transthoracic echocardiogram on , and left ventricular outflow gradient of 74 by catheterization on . she is fully functional and walks approximately one mile per day and uses a stationary bike, swims about 20 minutes per day and she denies any shortness of breath, chest pain, nausea or vomiting associated with exercise, however, she complains of mild increasing fatigue with exercise over the last few months. she denies any claudication, edema, paroxysmal nocturnal dyspnea, orthopnea, or lightheadedness. her cardiac history includes a catheterization in which showed no significant coronary artery disease outside of a 50% lesion at the origin of d1 and mild narrowing of the left circumflex at its origin. a repeat catheterization in , showed a peak to peak left ventricular outflow gradient of 53 at rest and 70 with valsalva maneuver. again, no significant coronary disease, with mild valvular stenosis. transthoracic echocardiogram on , showed an ejection fraction of 65% along with moderate to severe aortic stenosis, one plus aortic regurgitation, four plus mitral regurgitation and three plus tricuspid regurgitation with a gradient across the aortic valve of 48. catheterization on , showed severe resting left ventricular outflow tract gradient of 74; the gradient increased to 166 with dobutamine. the gradient decreased to 42 with inderal. aortic valve stenosis itself was mild with a peak gradient of 28, a mean of 23. based on increasing left ventricular outflow gradient, an elective alcohol septal ablation was performed on . post-procedure, the left ventricular outflow gradient at rest and with provocation decreased markedlyto 20 with an aortic valve gradient unchanged at 25 mmhg, compared with pre- procedure. there were no complications of the procedure and the patient was transferred to cardiac care unit for close hemodynamic monitoring and post myocardial infarction precautions. past medical history: 1. hypertrophic obstructive cardiomyopathy with septal ablation, and mild valvular aortic stenosis. 2. pmr. 3. osteoarthritis. 4. history of rheumatic fever as a child. 5. ddd pacemaker placed in secondary to tachy/brady syndrome. 6. chronic intermittant vertigo with left inner ear injury. 7. gastrointestinal bleed in , secondary to nsaid use. past surgical history: 1. back surgery. 2. tonsillectomy. 3. benign breast biopsy times two. 4. dilatation and curettage times two. 5. hysterectomy. 6. bladder suspension. social history: no history of smoking; no alcohol use. she is a widow and lives alone, fully functional. has enlisted the assistance of a visiting nurse in the past, none currently. family history: significant for a brother who developed coronary artery disease in his fifties. allergies: vancomycin which causes itching and a rash; cephalosporins which cause gi upset; clindamycin which causes a rash as well as lip swelling and penicillin which causes swelling. medications outpatient: 1. verapamil sr 180 q. day. 2. cozaar 50 twice a day. 3. lipitor 10 q. h.s. 4. hydrochlorothiazide 12.5 q. day. 5. prednisone 5 q. day. 6. protonix 40 q. day. 7. premarin 0.3 mg q. day. 8. iron 325 three times a day. 9. folate 1 mg q. day. 10. vitamin e 400 units q. day. 11. fosamax. physical examination: her physical examination on admission to the cardiac care unit was temperature 96.9 f.; blood pressure 135/70; heart rate 70 which was ventricular paced; respiratory rate 17; oxygen saturation was 99% on two liters nasal cannula. on examination, in general, she was in no apparent distress. she is somnolent but answers questions appropriately. heent showed an oropharynx which was clear. her mucous membranes were slightly dry. her jugular venous pressure was not elevated. her neck is supple and there is no thyromegaly. on chest examination, her lungs were clear to auscultation anteriorly (the patient was laying flat due to femoral catheter in place). cardiovascular: she had a regular rate, normal s1, s2. she had a iii/vi harsh holosystolic murmur best heard at the left sternal border which radiated to the apex. her abdomen was soft, nontender, nondistended. she had normoactive bowel sounds. on extremity examination, her right groin site was without oozing, hematoma or bruits. she had two plus dorsalis pedis and posterior pulses bilaterally. her skin was warm and dry. on neurological examination she was alert and oriented times three. her cranial nerves ii through xii were intact and she demonstrated understanding of her present condition. laboratory values: her white blood cell count was 7.8, hemoglobin 10.8, hematocrit 30, and platelets were 222. her sodium was 127, potassium 3.2, chloride 92, bicarbonate 28, bun 17, creatinine 0.6 and glucose of 150. ekg done pre-procedure showed ventricular paced with a rate of 70 beats per minute and a left bundle branch block morphology. post-procedure, the ekg showed again ventricular pacing with a rate at 76 beats per minute and left bundle branch block. impression: this is an 81 year old with hypertrophic obstructive cardiomyopathy and aortic stenosis with progressive worsening of exercise tolerance and a rise in her left ventricular outflow tract gradient. she is admitted to cardiac care unit status post elective alcohol ablation with good results. hospital course: 1. cardiovascular: the patient without any significant coronary artery disease. following alcohol induced septal ablation of lv outflow gradient, the patient was transferred to cardiac care unit in stable condition. she was started on aspirin and lipitor as well as heparin at 650 units per hour heparin was continued for 24 hours. surveillance cardiac enzymes showed a peak cpk of 2240 on , at 04:00 p.m., a few hours after the procedure. the peak index was 19.2. cardiac enzymes trended downward for the remainder of the hospital course. she was restarted on her outpatient anti-hypertensives which included cozaar, verapamil and hydrochlorothiazide. hydrochlorothiazide was later held due to the patient's hyponatremia. her ddd pacemaker was capturing well with a heart rate of 70. 2. fluids, electrolytes and nutrition: on presentation, the patient was hyponatremic and hyperkalemic, which was partly at baseline, but additionally attributed to a large amount of intravenous fluids received in the catheterization laboratory. she was switched to normal saline with supplementation of potassium and her electrolytes normalized. hydrochlorothiazide was held due to electrolyte abnormalities but will be restarted upon discharge. 3. gastrointestinal: the patient with complaints of black stool times one but denied any bright red blood per rectum. given her history of gi bleed in the past, stools were ordered for guaiac. however, at the time of dictation, no stools were available for guaiac. hematocrits remained stable at 33.0 throughout hospital course which was at patient's baseline. disposition: the patient was out of bed and ambulating by hospital day number two without any difficulties. a fasting lipid panel was run on the day of discharge which showed a triglyceride of 93, hdl 63, ldl 64, for which the patient will follow-up with primary care physician. condition at discharge: improved, stable. discharge diagnoses: 1. hypertrophic cardiomyopathy status post alcohol ablation, and stable mild valvular aortic stenosis. 2. polymyalgia rheumatica. 3. osteoarthritis. 4. ddd pacemaker. 5. hypertension. 6. hyperlipidemia. 7. anemia. 8. history of gastrointestinal bleed. discharge medications: 1. aspirin 325 mg q. day. 2. losartan 50 twice a day. 3. verapamil sr 180 q. day. 4. lipitor 20 q. day. 5. hydrochlorothiazide 12.5 q. day. 6. prednisone 5 mg q. day. 7. folate 1 mg q. day. 8. protonix 40 q. day. 9. premarin 0.3 mg q. day. the patient had current medications at home, and therefore is not discharged with any prescriptions. discharge instructions: 1. a follow-up appointment to be scheduled by the patient with dr. for follow-up in two weeks. 2. she will also continue regular followup with her primary care physician at . , m.d. dictated by: medquist36 d: 14:46 t: 09:45 job#: procedure: left heart cardiac catheterization excision or destruction of other lesion or tissue of heart, endovascular approach injection or infusion of other therapeutic or prophylactic substance diagnoses: hyperpotassemia anemia, unspecified polymyalgia rheumatica pure hypercholesterolemia unspecified essential hypertension hyposmolality and/or hyponatremia aortic valve disorders cardiac pacemaker in situ 

Answer: The patient is high likely exposed to