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: ketek pak / augmentin / lisinopril / cozaar / norpace attending: chief complaint: palpitations/fatigue major surgical or invasive procedure: atrial flutter ablation history of present illness: mrs. is a 73 year old woman with a history of asd repair in , hypertension, hyperlipidemia, atrial flutter (on coumadin) who was admitted for an atrial flutter ablation and developed complications of an rp bleed with hypotension, now improved. she had been diagnosed with atrial flutter since and since then has had intermittent palpitations. lately she developed worsening fatigue secondary to the a flutter as well as the medications for a flutter and therefore elected to undergo an ablation. . in the ep lab, she underwent a successful ablation and seemed to tolerate the procedure well. after the procedure, the patient developed acute hypotension. ekg revealed inferior st elevations and so she went to the cath lab which revealed an incidental 80% d1 lesion as well as a total obstruction of a very small distal lcx - no intervention was done. her st elevations resolved on their own, however, a hct showed a drop to 24 from 37 preprocedure. ct abdomen/pelvis revealed a retroperitoneal bleed, so she was urgently admitted to the ccu. the massive transfusion protocol was activated and she received 4 units of prbcs, and 4 units of ffp. her hct corrected to 32.8 and inr to 1.8. she was also given lasix 20mg iv for mild chf, which responded well. vascular was consulted who recommended correcting the coagulopathy, and holding pressure until inr was 1.5 or less. . on the floor, she noted some recurrent wheezing, dry mouth, and groin pain where we are holding pressure. . 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, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: - hypertriglyceridemia - hypertension 2. cardiac history: - atrial flutter/fibrillation s/p dccv () 3. other past medical history: - subclinical hypothyroidism - allergic rhinitis - osteopenia - s/p asd repair () social history: born and raised in . married with 2 kids. no grandchildren. retired secretary. smoked 2 packs per day from age 20-40. no etoh. goes to the gym and does yoga, spinning, muscle conditioning, and aerobics. family history: mother and father both with some type of ca when elderly. no significant cardiac history. physical exam: physical examination on admission: vs: 97 82/50 73 21 99%ra general: agitated elderly woman in moderate distress heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with normal jvp cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. 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. abd aorta not enlarged by palpation. no abdominial bruits. extremities: cool extremities. no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ left: dp 1+ pertinent results: labs on admission: 07:35am blood wbc-6.4 rbc-4.35 hgb-13.9 hct-40.9 mcv-94 mch-32.0 mchc-34.0 rdw-12.6 plt ct-178 07:35am blood neuts-69.5 lymphs-22.2 monos-5.8 eos-1.7 baso-0.7 07:35am blood pt-28.0* inr(pt)-2.7* 07:35am blood plt ct-178 07:35am blood glucose-102* urean-10 creat-0.6 na-141 k-4.5 cl-105 hco3-28 angap-13 06:30pm blood calcium-7.4* phos-5.3*# mg-1.6 cardiac enzymes: 02:45pm blood ck-mb-3 ctropnt-0.51* 06:30pm blood ck-mb-6 ctropnt-0.86* 02:24am blood ck-mb-30* mb indx-9.6* ctropnt-1.17* 10:54am blood ck-mb-47* mb indx-8.8* ctropnt-1.69* 03:59pm blood ck-mb-37* mb indx-7.0* ctropnt-1.60* micro: 4:52 pm urine source: cvs. **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. imaging: tte: no atrial septal defect is seen by 2d or color doppler. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. impression: low-normal lv systolic function. the inferior wall motion is probably normal. the right ventricle appears mildly dilated/hypokinetic. no asd/pfo seen but cannot exclude on basis of this study. ct abd/pelvis: mpression: 1. large hematoma extending along the left pelvic sidewall into the preperitoneal and subperitoneal space surrounding the bladder 2. small amount of ascites 3. cholelithiasis without cholecystitis. tte: the left atrium is elongated. the right atrium is moderately dilated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with focal hypokinesis of the apical inferior and apical lateral segments. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. 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. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: mild focal lv systolic dysfunction (consistent with known pda occlusion). normal size and function of right ventricle. no significant valvular abnormality seen. cxr: impression: 1) increase in vascular congestion with lower lung volumes and new right basilar atelectasis. no pleural effusion is seen. 2) no pulmonary edema. renal us: renal ultrasound: the right kidney measures 10.4 cm and the left kidney measures 10.9 cm. there is no hydronephrosis, mass or stone. the parenchymal echogenicity is symmetric bilaterally. in the upper pole of the right kidney, there is a 9 x 8 x 7 mm anechoic avascular cyst. this study was performed with a decompressed urinary bladder. in the suprapubic region at the midline, there is a 10 cm fluid collection with some solid components presumed to be the retroperitoneal hemorrhage. impression: no evidence of hydronephrosis. brief hospital course: 73 year old woman with a history of asd repair in , hypertension, hyperlipidemia, atrial flutter (on coumadin) who was admitted for an atrial flutter ablation and developed complications of an rp bleed with hypotension and stemi secondary to pda ablation. . active diagnoses: . # st elevation mi: patient was found to have posterior ste on ekg. at cath, she was found to have tight distal pda lesion likely secondary to ablation. patient was asymptomatic despite persistent st elevations. tte showed mild focal lv systolic dysfunction (consistent with known pda occlusion), normal size and function of right ventricle, and no significant valvular abnormality. patient was eventually restarted metoprolol succinate 50mg daily, atorvastatin 80, asa 81 mg po daily, coumadin 2mg daily. she was not started on an acei or as patient is allergic. # atrial flutter: now resolved s/p ablation. she was restarted on metoprolol when her blood pressure could tolerate it, and was started on amiodarone 200mg po bid x2 weeks, then 200mg po daily x1-2 months. # rp bleed: the patient was found to be hypotensive after her aflutter ablation, secondary to acute blood loss from retroperitoneal bleed as confirmed by ct abdomen/pelvis. this bleeding resolved with aggressive blood transfusions and ffp. hct stabilized 12 hours after bleed at a hct of 30, and there was no evidence of persistent bleeding. patient did experience abd and back pain, likely secondary to irritation from bleeding. pain from irritation from bleeding was controlled with oxycodone as needed and a lidocaine patch. her anticoagulation was reversed at the time of rp bleed, but coumadin was eventually restarted, initially at half home dose (2mg) and then titrated to meet inr goal . # dyspnea/wheezing: after the multiple transfusions, the patient developed wheezing on exam and dyspnea that worsened on lying flat. most likely etiology of dyspnea is secondary to pulmonary edema due to aggressive volume resuscitation during rp bleed. patient was diuresed a total of ~2l during length of hospital stay. upon discharge, she was breathing comfortably and her oxygen saturation was well-maintained on room air. # leukocytosis: mild up to 12, has been up to 13 before, most likely secondary to stress. differential showed no bandemia. patient remained afebrile, with no cough, dysuria or other focal symptoms. urine and blood cultures showed no growth. leukocytosis eventually resolved. . chronic diagnoses: . # hld: patient was continued on atorvastatin 80. # subclinical hypothyroidism: last t4 was normal and pt without sx of hypothyroidism. medications on admission: metoprolol succinate - (prescribed by other provider) - 100 mg tablet extended release 24 hr - 2.5 (two and a half) tablet(s) by mouth once a day warfarin - (prescribed by other provider: . - 2 mg tablet - 2 (two) tablet(s) by mouth once a day/afternoon medications - otc calcium carbonate - (prescribed by other provider; otc) - dosage uncertain cholecalciferol (vitamin d3) - (prescribed by other provider) - 1,000 unit capsule - 1 (one) capsule(s) by mouth once a day multivitamin - (prescribed by other provider; otc) - tablet - 1 tablet(s) by mouth daily discharge medications: 1. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 2. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: two (2) tablet, chewable po once a day. 3. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 4. warfarin 2 mg tablet sig: 1.5 tablets po once daily at 4 pm. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 10. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). disp:*30 adhesive patch, medicated(s)* refills:*0* 12. oxycodone 5 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 13. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: 1. atrial flutter ablation 2. retroperitoneal bleed 3. myocardial infarction secondary to rf catheter ablation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted to the hospital for a procedure called atrial flutter ablation. you developed a complication, and had bleeding into the back (retroperitoneal bleed). during this event, you had a small heart attack. this was managed with maximal medical therapy. you received blood products for your bleeding, and stabilized. medication changes: - start amiodarone to control your heart rate - decrease warfarin to 3mg daily - decrease metoprolol succinate to 100 mg daily - start lipitor (atorvastatin) to help prevent heart attacks and help the current heart attack heal - start amiodarone to help prevent further episodes of unstable rhythm - start aspirin to help prevent heart attacks and help the current heart attack heal - start lidocaine patches for pain control - start oxycodone as needed for pain control - start senna as needed for constipation - start colace for bowel control - start tylenol as needed for pain please seek medical attention for worsening symptoms. followup instructions: unfortunately we were unable to make a post-discharge appointment for you with your primary care provider. call dr. at to follow up, we would ideally like you seen within 1 week. if you encounter problems making a quick appointment call . department: cardiac services when: thursday at 1:40 pm with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 10:40 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: thursday at 2:20 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: coronary arteriography using two catheters excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping diagnoses: pure hypercholesterolemia unspecified essential hypertension cardiac complications, not elsewhere classified atrial flutter hemorrhage complicating a procedure cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of anticoagulants acute myocardial infarction of inferolateral wall, initial episode of care accidents occurring in other specified places hemorrhage, unspecified acute edema of lung, unspecified 

Answer: The patient is high likely exposed to