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 / paxil attending: chief complaint: hypotension major surgical or invasive procedure: pacemaker placement history of present illness: briefly, 59 year old female with cad s/p pci stent x 2 in and diastolic chf, mechanical valve replacement and paroxysmal atrial tachycardia admitted on for ep ablation. she was admitted to the service for heparin bridge and coumadin held in anticipation of procedure. she got the ep procedure today and her atrial tachycardia was ablated. after the procedure, she developed junctional bradycardia to the 50's. she was reportedly given atropine without effect. she maintained her bp's in the 80's to 90's. then her bradycardia evolved to a accelerated junctional escape to 80's. the cardiology fellow on call did a bedside echo that did not show tamponade. she is transferred to the ccu for closer monitoring. . currently, she feels tired but does not have any specific complaints. +lh, denies cp, sob, palpiations. past medical history: rheumatic fever at age 10. coronary artery disease status post pci and stents x2 in . history of diastolic dysfunction with congestive heart failure. history of mechanical mitral valve replacement in . history of paroxysmal atrial fibrillation s/p cardioversion in . history of anxiety and depression. . cardiac risk factors: dyslipidemia, hypertension . cardiac history: . percutaneous coronary intervention, in anatomy as follows: right dominant system with single vessel coronary artery disease. the lmca had a 20% stenosis. the lad had mild diffuse disease. the lcx had minimal luminal irregularities. the rca had a total occlusion in the previously placed mid-vessel stent. social history: lives alone in . close to son. alcohol or drugs. smokes ppd. has smoked for 40 years. family history: mother with diabetes and coronary artery disease. physical exam: vs - 95.1, 82, 98/46, 22, 100%2lnc gen: lethargic but arousable and carries short conversation appropriately heent: ncat. sclera anicteric. perrl, eomi. neck: supple, neck veins pulsatile to ears but likely from tr cv: rr, s1, s2. ii/vi systolic murmur. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. soft faint crackles at right base, no wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: pt 1+, cannot palpate dp pulse left: pt 1+, cannot palpate dp pulse pertinent results: 04:55pm blood wbc-8.1 rbc-4.23 hgb-12.7 hct-36.8 mcv-87 mch-30.0 mchc-34.5 rdw-14.7 plt ct-193 05:47am blood wbc-8.5 rbc-3.64* hgb-10.9* hct-31.8* mcv-87 mch-30.0 mchc-34.5 rdw-14.6 plt ct-113* 04:55pm blood pt-28.1* ptt-150* inr(pt)-2.8* 05:47am blood pt-17.0* ptt-56.5* inr(pt)-1.5* 04:55pm blood glucose-140* urean-10 creat-0.8 na-137 k-3.5 cl-101 hco3-25 angap-15 05:47am blood glucose-99 urean-15 creat-0.8 na-140 k-3.2* cl-109* hco3-23 angap-11 04:55pm blood calcium-9.7 phos-2.8 mg-2.0 05:47am blood calcium-7.6* phos-2.0* mg-1.9 09:45am blood wbc-6.4 rbc-3.54* hgb-11.0* hct-31.3* mcv-88 mch-30.9 mchc-35.0 rdw-14.9 plt ct-97* 07:45am blood pt-19.1* ptt-59.5* inr(pt)-1.8* 09:45am blood glucose-141* urean-8 creat-0.8 na-140 k-3.6 cl-104 hco3-25 angap-15 09:45am blood calcium-9.0 phos-2.9 mg-1.9 . cardiology report ecg study date of 3:28:56 pm ecg : atrial tachycardia modest nonspecific st-t wave changes suggested, but atrial waveforms makes assessment difficult since previous tracing of , ventricular ectopy absent intervals axes rate pr qrs qt/qtc p qrs t 74 172 78 396/420 65 71 33 . ecg study date of 9:04:38 am atrial tachycardia. modest nonspecific st-t wave changes suggested, but atrial waveforms makes assessment difficult. since previous tracing of , no significant change . ecg study date of 12:17:10 pm sinus bradycardia. a-v conduction delay. compared to the previous tracing of the rate has slowed. otherwise, no diagnostic interim change. . ecg study date of 11:51:38 pm junctional bradycardia with retrograde conduction as recorded previously on . no diagnostic interim change. . ecg study date of 7:20:44 am junctional bradycardia with retrograde conduction and occasional ventricular ectopy. otherwise, no diagnostic interim change . ecg study date of 9:16:46 am junctional bradycardia with retrograde conduction and occasional ventricular ectopy. compared to the previous tracing of no diagnostic interim change. . ecg study date of 8:31:10 am junctional bradycardia with marked q-t interval prolongation. compared to the previous tracing of no diagnostic interval change. . echo : the right atrium is dilated. the left ventricle is not well seen. overall left ventricular systolic function cannot be reliably assessed. the aortic valve is not well seen. the mitral valve leaflets are not well seen. a mitral valve prosthesis is present. there is no pericardial effusion. impression: limited study due to poor echo windows and focused views. there is no pericardial effusion. the right atrium appears dilated. the right ventricle may also be dilated. overall left ventricular systolic function is not well visualized but is probably normal. compared with the prior study (images reviewed) of , the limited findings on the current study appear similar. . chest (portable ap) 10:49 pm addendum: partially imaged sclerotic focus in proximal left humerus is noted with apparent chondroid matrix. in the absence of localized symptoms, this is most likely an enchondroma and less likely a bone infarct. however, if there are symptoms in this region, dedicated humeral radiographs would be recommended for initial further assessment as communicated by phone to dr. by phone on . there is no evidence of pneumothorax or pleural effusion. cardiomediastinal contours are unchanged, and lungs and pleural surfaces remain clear. . chest (portable ap) 7:22 am impression: ap chest compared to and : the lungs are clear. patient has had median sternotomy. heart is overall top normal in size but both atria and possibly the right ventricle are markedly dilated though unchanged since at least . . chest (portable ap) 7:52 am chest: a dual-chamber pacemaker is present with leads in satisfactory position. there is no evidence of a pneumothorax. the lung fields are clear. the cardiac size is within normal limits. previous cabg noted. impression: no pneumothorax, pacemaker lines in good position. . brief hospital course: assessment and plan : patient is a 59 year old female with cad s/p stenting x2, and mechanical mitral valve replacement rheumatic fever and known paroxysmal atrial flutter admitted for elective atrial tachycardia ablation complicated by post-procedural junctional bradycardia and hypotension, s/p pacer placement. # rhythm: the patient was admitted s/p atrial tachycardia ablation. post-procedure, she had bradycardia and hypotension. she had a junctional rhythm in the 40's. initially, she received no ionotropes and was monitored on telemetry. the following day, her sinus node had not yet recovered; she remained bradycardiac and hypotensive and she was then started on dopamine. beta blockers, lasix, spironolactone and losartan were held. the dopamine was weaned as her blood pressure improved. coumadin was held for pacemaker placement and she was maintained on heparin. she had a mild groin bleed the day after ablation which resolved with pressure. as she continued to have junctional bradycardia, weakness and occasional dizziness, it was decided to place a pacemaker. she underwent pacemaker placement without complication. beta blockers, lasix, spironolactone and losartan were restarted. coumadin was restarted and she was maintained on heparin bridge. her inr goal is 2.5 to 3.5. she was discharged when her coumadin was above 2.0 with instructions to continue her outpatient coumadin clinic. #. cad - history of 3 vessel disease requiring stenting of the left main and the rca. she was continued on statin and metoprolol as above. #. pump - last ef>55%, history of diastolic dysfunction with chronic congestive heart failure. lasix, valsartan, spironolactone, metoprolol as above. #. valves - mechanical mitral valve replacement in rheumatic fever and 3+ tricuspid regurgitation. target inr 2.5-3.5 for mechanical valve. 3+ tr on recent echo. she received heparin and coumadin as above. #. htn - she is to continue on lasix, valsartan, spironolactone and metoprolol as above. metoprolol was decreased from 37.5mg to 25mg . medications on admission: warfarin 5 mg daily - held losartan 50 mg daily metoprolol tartrate 37.5 mg p.o. b.i.d. pravastatin 80 mg daily folic acid 1 mg daily lasix 20 mg daily lorazepam .5-1 mg q8h p.r.n. docusate sodium 100mg spironolactone 25mg daily discharge medications: 1. outpatient work please check inr and fax results to dr. office. phone number: 2. warfarin 5 mg tablet sig: one (1) tablet po once a day. 3. losartan 50 mg tablet sig: one (1) tablet po daily (daily). 4. pravastatin 80 mg tablet sig: one (1) tablet po once a day. 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 7. lorazepam 0.5 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: junctional bradycardia chronic diastolic congestive heart failure anticoagulation for mechanical valve discharge condition: good, afebrile, ambulating discharge instructions: you were admitted to the hospital to undergo an ablative procedure by the electrophysiology department, in an attempt to eliminate your atrial fibrillation. this procedure was complicated by a resulting slow heart rate, and low blood pressure. you were admitted to the ccu for closer monitoring. you received a pacemaker in order to maintain an adequate heart rate and blood pressure. . please continue to take your medications as prescribed. your metoprolol was decreased from 37.5mg twice a day to 25mg twice a day. please discuss titrating your metoprolol dose with your primary care provider. other medications remained the same. . your inr was 2.1 on discharge. your goal is 2.5 to 3.5. please have your inr checked with your pcp on wednesday . . please follow up as described below. . please call your doctor or return to the hospital if you experience chest pain, shortness of breath, fever over 102, or any other concerning symptom. followup instructions: please have your inr checked on wednesday and fax results to your pcp office for follow up. . provider: clinic phone: date/time: 2:30 . you will need to follow up with your pcp on at 10am. . please follow up with your cardiologist , on at 10am. . please follow up with your cardiologist (electrophysiology for your pacemaker) ( on at 9:20am. . provider: phone: date/time: 3:10 procedure: 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 cardiac mapping diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atrial fibrillation atrial flutter percutaneous transluminal coronary angioplasty status heart valve replaced by other means hemorrhage complicating a procedure other specified cardiac dysrhythmias other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation diseases of tricuspid valve chronic diastolic heart failure paroxysmal supraventricular tachycardia 

Answer: The patient is high likely exposed to