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: sulfa (sulfonamides) / penicillins attending: chief complaint: second degree atrioventricular block atrial perforation major surgical or invasive procedure: pacemaker insertion pericardiocentesis pulmonary artery catheter insertion femoral venous central line history of present illness: 89yo f w pmh htn and osteoporosis presents to ccu with atrial perforation and tamponade secondary to pacemaker lead placement. pt presented to her pcp's office for preoperative evaluation for cataract surgery and found to be bradycardic to high 30's with 2nd degree heart block. pt was sent to emergency for further evaluation and sent for stat ep consultation and pacemaker was placed. rv lead was placed without difficulty. cephalic vein required dilation to pass ra lead. ra lead required multiple attempts to capture, once captured lead was screwed into place and pt became hypotensive to sbp 50's. given fluids and dopamine was started, emergent echo showed moderate pericardial effusion. pa catheter introduced and pericardiocentesis revealed equilibration of pa and pericaridial pressures. pericardial catheter drained 300ml of blood with stabilization of systemic blood pressures. patient was weaned from dopamine and transferred to the ccu for further monitoring. . ros: per dr. (pmd). slight doe, no palpitations, no dizziness or lh, no ha, n/v, denied cp, sob. past medical history: htn osteoporosis shoulder arthritis . psurghx: none social history: widowed, lives alone, but actively cares for her mentally disable daughter who also lives alone nearby. retired from substitue teaching about 1 year ago. son in the area is hcp. etoh, tobacco, or illicits. physical exam: t 95.1, bp 123/65, hr 70, r15, 100% on 100% fio2 gen: critically ill elderly female, intubated and sedated. heent: mmm, perrl, no exudates neck: no cervical lad, unable to assess for carotid bruit on vent chest: l pectoralis bandage cdi, no hematoma, coarse transmitted upperairway sounds, breath sounds heard bilaterally in all lung fields heart: normal s1 and s2, high pitched crescendo-decrescendo sem loudest at rusb, no rubs or gallops. pericardial catheter lateral to xiphoid process draining small amounts of blood. abd: soft, nd, bs+, non-pulsatile, no masses, no hsm. extrem: warm, well-perfused, 2+ dp, pt pulses, no cce. pertinent results: 01:00pm plt count-204 01:00pm wbc-6.5 rbc-3.90* hgb-12.8 hct-36.6 mcv-94 mch-33.0* mchc-35.1* rdw-14.0 01:00pm t4-7.4 01:00pm tsh-4.7* 01:00pm ctropnt-<0.01 01:00pm glucose-92 urea n-31* creat-1.3* sodium-139 potassium-4.2 chloride-101 total co2-25 anion gap-17 07:32pm type-art temp-34.3 rates-12/0 tidal vol-450 peep-0 o2-100 po2-206* pco2-33* ph-7.36 total co2-19* base xs--5 aado2-503 req o2-81 -assist/con intubated-intubated lyme serology (final ): no antibody to b. burgdorferi detected by eia. reference range: no antibody detected. negative results do not rule out b. burgdorferi infection. patients in early stages of infection or on antibiotic therapy may not produce detectable levels of antibody. patients with clinical history and/or symptoms suggestive of lyme disease should be retested in weeks. 05:45am blood glucose-97 urean-21* creat-1.2* na-136 k-3.6 cl-104 hco3-23 angap-13 data: hct 34.2 from 36 in ed, wbc 9.5, plts 237, na 131, k 4.5, cl 101, hco3 25 bun 31, creat 1.3, abg 7.36/33/220/19 on 100% fio2 . ekg's: 1) (from pmd's office) sinus rhythm with 2:1 av block at rate 40 bpm. normal axis. no st segment changes, no lvh. 2) old ekg ()- nsr 55, normal intervals, no q-waves, no st changes. 3) ekg on admit to ccu- a-v paced at 70 bpm. . . cxr: 1)ap-portable- in ed- no acute cardiopulm process, new cardiomegaly. 2)ap-portable- in ccu- left-sided pacemaker with leads in the right atrium and right ventricle. a pericardial drain is seen entering from the left, terminating around the area of the mid left main stem bronchus. impression: no definite pneumothorax is seen on this supine view. there is fullness of the hila, which may be due to vascular fullness. blunting of the right costophrenic angle is identified, which probably represents scarring on this supine view. there is atelectasis of the left costophrenic angle. again no definite evidence of pneumothorax on this view; if pneumothorax is clinically suspected, a right-side decubitus film may be obtained. 3) ? r hilar fullness larger from previous- will require ct with contrast, no-angio, follow-up. ct chest, indication: pacemaker insertion complicated by right atrial perforation and tamponade. right hilar fullness on previous chest x-ray. comparison: chest radiograph, which described right hilar fullness. no prior chest cts. multidetector ct of the chest was performed following intravenous administration of 65 cc of optiray. images were presented for display in the axial plane at 5 mm and 1 mm collimation. there is no right hilar mass. the observed hilar fullness on the prior chest radiograph was likely due to a combination of prominent pulmonary vasculature and patient rotation. the heart is mildly enlarged. a small pericardial effusion is present with relatively high attenuation values of 60. small-to-moderate bilateral dependent pleural effusions with simple fluid attenuation are present with adjacent basilar atelectasis. a pericardial drain is present, coursing from an inferoposterior approach inferiorly to an anteromedial approach superiorly with the tip terminating anterior to the ascending aorta and main pulmonary artery in the superoanterior pericardial space. coronary artery calcifications are present. a permanent pacemaker is present with leads in the right atrium and right ventricle. in the imaged portion of the upper abdomen, the left adrenal gland is mildly enlarged, but maintains a normal adrenal shape. diffuse vascular calcifications are present in the abdominal aorta extending into the proximal renal arteries. the remaining imaged portion of the upper abdomen is unremarkable on this examination that was not specifically tailored for evaluating the abdominal organs. one additional finding is dependent sludge within the gallbladder. endotracheal tube is present, terminating several centimeters above the carina. with the exception of basilar atelectasis adjacent to pleural effusions, the lungs are well expanded and grossly clear except for scattered areas of discoid atelectasis or linear scarring. coronal reformation images: these images confirm the presence of bilateral pleural effusions and a small pericardial effusion. note is also made of soft tissue stranding within the mediastinal fat and small mediastinal lymph nodes. degenerative changes are present within the spine. finally, calcification of the aortic valve is also noted. impression: 1. no right hilar mass. observed finding on recent chest radiograph was due to prominent pulmonary vasculature accentuated by patient rotation. 2. small high attenuation pericardial effusion, likely due to hemopericardium related to provided history of right atrial perforation following pacemaker insertion. 3. small-to-moderate dependent bilateral pleural effusions with adjacent atelectasis. ct head w/o contrast 8:18 am findings: there is no intracranial hemorrhage. there is no midline shift, mass effect, or hydrocephalus. the -white matter differentiation is preserved. there are areas of periventricular white matter hypodensity, most consistent with chronic microvascular ischemic changes. there are no fractures. incidental note is made of air-fluid levels around the visualized paranasal sinuses which would be consistent with the patient's recent intubation. impression: no intracranial hemorrhage or mass effect. echocardiogram: conclusions: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are three severely thickened/calcified aortic valve leaflets. there is moderate aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: no pericardial effusion. preserved biventricular systolic function. moderate aortic stenosis. moderate mitral regurgitation. moderate tricuspid regurgitation. mild pulmonary hypertension. compared with the prior study (images reviewed) of , more significant tricuspid regurgitation is identified. the other findings appear similar. brief hospital course: 89yo f with new 2:1 av block s/p pacemaker insertion complicated by atrial perforation and tamponade. pt was intubated and sedated for 24hours with minimal output from her pericardial drain. she was extubated on hospital day #2, pericardial drain and central lines were removed. following extubation the pt had a period of marked short term memory impairment and difficulty with naming common objects. a head ct scan obtained was negative for any acute process. the patient's mental status improved over the next few days, but marked short term memory deficit persisted. the patient developed atrial fibrillation and underwent two separate attempts at dc cardioversion, but reverted to afib within 24hours. she was started on full dose aspirin therapy, but not anticoagulated due to her recent atrial perforation. repeat echocardiogram revealed resolution of the pericardial effusion. she is scheduled to follow up with electrophysiology for her pacemaker and new onset atrial fibrillation in one week. the patient was seen by pt and ot prior to discharge and recommended home pt. she was also given an appointment to see dr. in behavioral neurology for evaluation of her likely underlying dementia. 1) cardiac: left ventricular function- tamponade physiology secondary to hemopericardium resolved s/p pericardial drain placement. hyperdynamic lv fx ef > 75%, murmur suggestive of as with suboptimal echo evaluation. moderate as on repeat echo evaluation with severe calcification of aortic and tricuspid leaflets. resolution of pericardial effusion. preserved lvef >55%. we re-started her hydrochlorothiazide, added lisinopril to reach goal sbp < 130. . rhythm- presented with 2:1 av block likely related to intrinsic disease of the conduction pathway, fibrosis, sclerosis secondary to lev's disease. at time of presentation the patient was symptomatic only with exertion. no known ischemic disease. she was given a ddi pacemaker in the ep lab with the complication described above. new onset afib with rvr in ep lab, dc cardioversion to sinus, reverted to afib < 24hrs later. started amiodarone- baseline lft's and tft's were within normal limits. the patient will need pft's scheduled as an outpatient should amiodarone therapy continue. a second trial of dc cardioversion for new onset afib maintain sinus rhythm for 24hours. she is scheduled to follow up with electrophysiology in one week for determination if long term anticoagulation is warranted. . valves- the patient was moderate to severe aortic stenosis by echocardiogram. severe valvular calcification. her valvular disease should be followed closely as an outpatient should she become symptomatic. . 2) pulmonary- ct chest was obtained to evaluate r hilar fullness found on x-ray film. ct chest was unremarkable- full findings above. pt developed a mild cough productive of clear sputum (prior to initiation of ace inhibitor), repeated cxr evaluations revealed small bilateral pleural effusions. these were likely transudative and she was gently diuresed with a single dose of lasix. she did not develop signs of symptoms consistent with pneumonia. . 3) heme- she was transfused 2units of red blood cells on admission to the ccu for low hematocrit and peri-procedure blood loss. her hematocrit was stable thereafter until dishcarge. . 4) renal- serum creatinine on admission 1.3, flucated 1.1-1.3 during admission. likely age related reduction in gfr in absence of other known renal disease. calculated creatinine clearance was 33.4. . 5) pt was intubated and sedated. there was however a brief period of hypotension in the ep lab to sbp 50's related to tamponade physiology. as patient's mental status improved following extubation her underlying short term memory deficit persisted. she has short term memory deficits at baseline per son and pcp. was started on aspirin 325mg daily. she was schedulred to see dr. in behavioral neurology friday at 8:30am, rm 253. for eval of dementia, may need carotid doppler studies at discretion of dr. . the patient was advised to avoid driving until evaluated by dr. and was agreeable. . 6) endocrine- elevated tsh, normal t4. ? subclinical hypothyroid- consider anti tpo antibodies for further work-up as outpatient. . pcp: . () contact: (home), (cell) medications on admission: hydrochlorothiazide 25mg po daily alendronate discharge medications: 1. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 3. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. amiodarone 400 mg tablet sig: one (1) tablet po once a day for 2 months. disp:*60 tablet(s)* refills:*0* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary: 2:1 av block pericardial tamponade atrial fibrillation . secondary: hypertension discharge condition: good discharge instructions: you were found to have a conduction abnormality within your heart requiring a pacemaker to be placed. during placement of the pacemaker you developed bleeding around your heart and required a drain to be placed. after removal of the drain your heart developed an irregular rhythm called atrial fibrillation. you received a shock to get your heart out of atrial fibrillation, but you returned to atrial fibrillation one day later. . it is important that you take all of your medications as prescribed. we have added several new medications for your heart. amiodarone is for your heart rhythm, aspirin to prevent blood clots, lisinopril for your blood pressure, in addition to continuing your hydrochlorothiazide and fosamax as you were before being admitted to the hospital. . call dr. or 911 if you should experience any chest pain or pressure, dizziness, racing heart beat or palpitations, profuse sweating, nausea or vomiting, worsening cough or shortness of breath. high fevers or shaking chills. followup instructions: you have the following appointments: . you have an appointment with dr. of behavioral neurology on friday, at 8:30am, at the building, , . . clinic (cardiology clinic') phone: date/time: 11:30 . provider: . , electrophysiology lab phone: date/time: 3:00 . cardiology will setup pulmonary function tests at your followup appointment since you will be on amiodarone for the atrial fibrillation. procedure: venous catheterization, not elsewhere classified pericardiocentesis initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle pulmonary artery wedge monitoring transfusion of packed cells infusion of vasopressor agent diagnoses: unspecified pleural effusion unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified osteoporosis, unspecified mitral valve insufficiency and aortic valve stenosis diseases of tricuspid valve hemopericardium other second degree atrioventricular block 

Answer: The patient is high likely exposed to