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: aphasia and right hemiplegia. major surgical or invasive procedure: administration of intravenous t-pa. history of present illness: mrs. is a 70-year-old woman (per initial report, later found to be 87) with a history of atrial fibrillation, presently subtherapeutic on coumadin (inr 1.4) arriving via ems with aphasia and right hemiplegia in afib with rvr. per ed team (in discussion with ems) she was at home and last seen normal at 1800 and then developed sudden onset aphasia and right-sided weakness. patient was supposed to go to but reportedly showed up here by accident. no further history was known at time of arrival and family unavailable despite numerous attempts to contact (as they were en route to hospital). later, her daughter, arrived who provided additional history; she was actually last seen normal around 5:30 pm when she left the house. when she returned around 9:30 pm she called her name and she did not respond and was not moving the right side of her body. ros unobtainable. past medical history: - atrial fibrillation - colostomy, unclear reason (has had for years per daughter) social history: lives independently and does all adls. family history: unknown. physical exam: on admission: vs; bp 151/100 p 150 rr 14 gen; lying in bed, nad heent; nc/at, nonrebreather in place cv; tachycardic, regular rate pulm; cta anteriorly abd; soft, nt, nd extr; 1+ edema at ankles neuro; ms; eyes open, does not speak or follow any commands. cn; perrl 3mm-->2mm, eyes deviated to the left and do not cross midline. does not appear to blink to threat on the right. face obscured by nonrebreather but appears to have r nlf flattening. motor; spontaneously moves rue and rle antigravity. flacid paralysis of lue and lle. sensory; withdrawl to noxious in rue and rle, no grimace or withdrawl to noxious in lue and lle pertinent results: 05:20am blood wbc-6.5 rbc-4.01* hgb-12.3 hct-36.1 mcv-90 mch-30.6 mchc-33.9 rdw-13.7 plt ct-171 02:49am blood wbc-6.8 rbc-3.96* hgb-12.3 hct-35.5* mcv-90 mch-31.0 mchc-34.6 rdw-13.7 plt ct-160 01:23am blood wbc-5.9 rbc-4.13* hgb-12.7 hct-37.9 mcv-92 mch-30.7 mchc-33.4 rdw-14.1 plt ct-181 02:10am blood wbc-11.1*# rbc-4.48 hgb-13.7 hct-40.9 mcv-91 mch-30.6 mchc-33.5 rdw-14.1 plt ct-198 10:00pm blood wbc-6.0 rbc-4.82 hgb-14.6 hct-44.1 mcv-92 mch-30.3 mchc-33.1 rdw-14.2 plt ct-205 10:00pm blood neuts-67.6 lymphs-23.7 monos-5.5 eos-1.8 baso-1.5 05:25am blood pt-19.3* ptt-29.4 inr(pt)-1.7* 05:20am blood pt-17.3* inr(pt)-1.5* 02:49am blood pt-15.7* ptt-31.1 inr(pt)-1.4* 01:23am blood pt-14.9* ptt-23.4 inr(pt)-1.3* 02:10am blood pt-16.8* ptt-24.8 inr(pt)-1.5* 10:00pm blood pt-16.1* ptt-25.4 inr(pt)-1.4* 05:20am blood glucose-102* urean-23* creat-0.9 na-139 k-3.8 cl-100 hco3-31 angap-12 02:49am blood glucose-99 urean-13 creat-0.9 na-138 k-4.8 cl-105 hco3-26 angap-12 01:23am blood glucose-130* urean-16 creat-0.9 na-139 k-4.3 cl-106 hco3-27 angap-10 02:10am blood glucose-146* urean-32* creat-0.9 na-138 k-5.0 cl-101 hco3-27 angap-15 10:00pm blood glucose-123* urean-33* creat-1.0 na-140 k-4.7 cl-98 hco3-26 angap-21* 01:23am blood ck(cpk)-68 02:10am blood ck(cpk)-157 01:23am blood ck-mb-2 ctropnt-<0.01 02:10am blood ck-mb-3 ctropnt-<0.01 10:00pm blood ctropnt-<0.01 05:20am blood calcium-8.4 phos-2.9 mg-2.0 02:49am blood calcium-8.8 phos-3.2 mg-2.3 01:23am blood calcium-8.6 phos-2.7# mg-2.2 cholest-179 01:23am blood triglyc-130 hdl-49 chol/hd-3.7 ldlcalc-104 01:23am blood %hba1c-6.0* eag-126* 11:13am blood digoxin-0.3* 10:00pm blood digoxin-0.4* 09:17pm urine color-straw appear-clear sp -1.009 09:17pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.5 leuks-neg 10:30pm urine color-straw appear-clear sp -1.011 10:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg ekg : atrial fibrillation with a rapid ventricular response. inferolateral st-t wave changes may be due to myocardial ischemia. clinical correlation is suggested. no previous tracing available for comparison. read by: , intervals axes rate pr qrs qt/qtc p qrs t 154 0 80 276/440 0 46 -31 nchct : findings: there is subtle obscuration of -white matter differentiation in the left parieto-occipital region. there is no acute intracranial hemorrhage. the ventricles and sulci are prominent, consistent with age-related involutional changes. periventricular and subcortical white matter hypodensities are consistent with small vessel ischemic disease. more focal hypodensities in the right corona radiata and right occipital lobe likely represent chronic lacunes. there is no shift of normally midline structures. dense calcifications are noted in the bilateral cavernous and supraclinoid portions of the internal carotid arteries, as well as the left vertebral artery. the paranasal sinuses and mastoid air cells are clear. note is made of bilateral lens prostheses. impression: 1. subtle hypodensity in left mca territory, corresponding to infarct seen on subsequent cta/ctp. 2. chronic involutional changes. cta head and neck/ct perfusion : findings: ct perfusion: there is area of increased transit time and slightly decreased cerebral blood flow and volume identified in the left frontal watershed and left parietal watershed regions as well as in the deep watershed region of the left cerebral hemisphere. these findings indicate areas of watershed ischemia with likely evolving infarcts. ct angiography neck: the ct angiography of the neck demonstrates tortuous arteries without evidence of high-grade stenosis or occlusion in the neck. vascular calcifications are seen at the aorta. linear opacities are seen at the right lung apex, otherwise less prominent at the left lung apex. this could be related to patient's congestive heart failure, but clinical correlation recommended. ct angiography head: ct angiography of the head demonstrates tortuous intracranial arteries, but no evidence of vascular occlusion is identified. impression: 1. findings indicative of watershed ischemia with probable evolving infarcts in the left cerebral hemisphere. mri can help for further assessment. 2. ct angiography of the neck demonstrates tortuous arterial structures with calcification without stenosis or occlusion. 3. ct angiography of the head demonstrates tortuous intracranial arteries without evidence of stenosis or occlusion. mri brain : findings: there are small areas of restricted diffusion in the left posterior temporal watershed region. there are no other acute infarcts identified. mild-to-moderate changes of small vessel disease are seen in the subcortical white matter and the periventricular white matter. there is no midline shift or hydrocephalus. moderate brain atrophy is seen. impression: small areas of restricted diffusion in the left posterior temporal lobe indicate areas of evolving infarcts in the left posterior watershed distribution. no other infarcts are seen. moderate brain atrophy and small vessel disease. the infarcts demonstrated are much less extensive than the perfusion abnormality seen on the previous ct perfusion study. nchct : findings: the small acute infarcts in the left posterior temporal cortex, left parietal white matter, and possibly in the left parietal cortex, which were seen on the prior mri, are barely detectable on this ct. foci of low density in the periventricular, deep and subcortical white matter of the cerebral hemispheres, including the left temporal and parietal lobes, do not demonstrate any progression since , and they appeared consistent with chronic microvascular infarcts on the mri. there is no acute intracranial hemorrhage, edema or mass effect. the ventricles and sulci are prominent due to age-related involutional changes. there is fluid in the sphenoid sinuses. impression: 1. the small acute infarcts in the left temporal and parietal lobes are barely detectable by ct. 2. unchanged supratentorial white matter hypodensities, likely chronic microvascular infarcts. 3. fluid in the sphenoid sinuses, possibly related to prolonged supine positioning. please correlate with symptoms. ekg : atrial fibrillation. diffuse st-t wave abnormalities. the qtc interval appears prolonged but it is difficult to measure. cannot exclude ischemia. clinical correlation is suggested. since the previous tracing of the ventricular rate is slower and further st-t wave abnormalities are now present. read by: , w. intervals axes rate pr qrs qt/qtc p qrs t 91 0 86 398/452 0 48 -141 tte : the left atrium is moderately dilated. no thrombus/mass is seen in the body of the left atrium. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: time code stroke called: 2156 time neurology at bedside for evaluation: 2159 upon arrival to the emergency room, code stroke was called: time (and date) the patient was last known well: 1800 nih stroke scale score: 22 t-: yes time t-pa was given: 10:40 i was present during the ct scanning and reviewed the images instantly within 20 minutes of their completion. nih stroke scale score was 22 1a. level of consciousness: 0 1b. loc question: 2 1c. loc commands: 2 2. best gaze: 1 3. visual fields: 2 4. facial palsy: 1 5a. motor arm, left: 0 5b. motor arm, right: 4 6a. motor leg, left: 0 6b. motor leg, right: 4 7. limb ataxia: unable to assess 8. sensory: 2 9. language: 3 10. dysarthria: unable to assess 11. extinction and neglect: 1 given the absemce of hemorrhage or other contraindications, t-pa was given in the emergency room under the direction and supervision of neurology. as per protocol, she was then transferred to the neuroicu for close monitoring. on examination after arriving in the neuroicu, she continued to demonstrate a mild upper motor neuron pattern of weakness, most evident in the hand, along with aphasia, most notable for anomia and difficulty repeating. this was, however, a marked improvement from her admission examination. while in the icu she continued to demonstrate atrial fibrillation with a rapid ventricular rate. diltiazem drip was initiated then weaned with increased dosing of metoprolol and initiation of digoxin. coumadin was restarted and aspirin started, with the intent of continuing this until her inr was above 2.0, at which point, aspirin can be discontinued. the etiology of her stroke was felt to be cardioembolic given her af and subtherapeutic inr. her tte was negative for thrombus, atheroma, or pfo, and ef was normal. while on the floor, she had some intermittent, self-limited episodes of rapid heart rate, which were responsive to bolus doses of iv metoprolol. fasting lipid panel was normal, and hgba1c is 6.0. inr on day of discharge was 1.7. on day of discharge, pt's language is fluent, but she cannot repeat, and she has an anomia for low-frequency words. her cn are normal. strength shows some cortical slowness to right sided ue movements, but generally preserved strength. she can bear weight, but had difficulty walking independently. medications on admission: -coumadin -others unknown discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily): please discontinue once inr > 2.0 . 2. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 3. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm: please check inr daily with goal . . 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain or fever. 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 8. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 9. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 10. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 12. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 13. insulin regular human 100 unit/ml solution sig: 2-10 units injection qac and qhs: per sliding scale. discharge disposition: extended care facility: - discharge diagnosis: acute stroke discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted with an acute stroke that affected your language and strength. you were given a medicine in the emergency room to break up the blood clot in your brain, and after this, your symptoms improved markedly, though not completely. as you have atrial fibrillation, it will be important for you to continue on coumadin and have your inr monitored regularly, with a followup instructions: provider: . & sidorov phone: date/time: 4:00 md, procedure: diagnostic ultrasound of heart injection or infusion of thrombolytic agent diagnoses: atrial fibrillation long-term (current) use of anticoagulants cerebral embolism with cerebral infarction aphasia attention to colostomy difficulty in walking other musculoskeletal symptoms referable to limbs flaccid hemiplegia and hemiparesis affecting unspecified side other symbolic dysfunction 

Answer: The patient is high likely exposed to