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: patient recorded as having no known allergies to drugs attending: chief complaint: weakness and dizzines major surgical or invasive procedure: implantation of dual chamber st. pacemaker history of present illness: ms. is a 87 yo f with pmh of cad s/p mi approximately 25 years ago, htn and dm who presents to the ed with complaint of weakness and dizziness. states she has been having intermittent chest pain for some time and has used nitroglycerin which is somewhat helpful to her. her worst episode of chest pain was about 2 weeks ago, with radiation to her left shoulder and some associated nausea. she is unsure how long this may have lasted for, but did contact her pcp at that time who referred her 'for some tests' which she did not complete. she now states her most recent chest pain / pressure was ealier in the day, but has been resolved for several hours. she intermittently feels short of breath, but not currently. she also states that her chest pain is not associated with the weakness, but that the chest pain is a chronic problem. the weakness is new. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . in the ed, initial vitals were 98.3, 137/62, 40, 14 and 97/ra. patient was noted to be comfortable and in no acute distress. phsyical notable dry mm, jvp = 10cm with slow, regular heart rate. labs notable for mild anemia, hct 35.9 with low mcv. ekg concerning for new avb (second vs third degree). . pcp upon arrival to ccu, states she does not home access to records but believes patient was recently complaining of nausea and abdominal symptoms. she was planning to get an endoscopy. she is unsure if the patient recently saw her nurse practioner about other complaints. . of note, review of available records indicates patient was admitted to in for bradycardia and nausea. she was on atenolol 25mg on admission and discharged on atenolol 25mg daily. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension, prior mi 2. cardiac history: -cabg: negative -percutaneous coronary interventions: negative -pacing/icd: negative 3. other past medical history: gastric cancer s/p partial gastrectomy, gastritis social history: (per omr) -tobacco history: never -etoh: none -illicit drugs: never family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t= 98.4 bp= 111/51 hr= 40 rr= 16 o2 sat= 98/2l general: wdwn female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 7 cm. 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: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: pertinent admission results: ck 31, tropt <0.01 negative ua, negative urine eos. cr 1.0, bun 27, tsh 1.9, wbc 7.3, inr 1.0, pt 12.1 . echo : normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the ascending aorta is moderately dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild-moderate mitral regurgitation. mild pulmonary artery systolic hypertension. . cxr : findings: in comparison with study of , the pacemaker leads again are in the general area of the apex of the right ventricle and the right atrium. cardiac silhouette is within normal limits, and tortuosity of the aorta persists. specifically, no evidence of pneumothorax or acute focal pneumonia. brief hospital course: 87 yo f with pmh of cad, htn, hyperlipidemia and bradycardia, p/w weakness and found to have bradycardia with hr 20-30s. brief hospital course by problem: . # bradycardia: patient was found to be in complete heart block, but was asymptomatic except for a vague history of nausea that did not appear linked to her heart block. of note, she was communicating clearly with an interpreter, was not short of breath, did not have chest pain and cardiac enzymes were negative. her av node dysfuction is most likely age-related as she has not had any recent changes to her medications. the patient was monitored overnight in the cardiac care unit without needing any intervention. her bradycardia slowly improved to a hr in the low 50s. a dual chamber st. pacemaker was placed . she had a period of hypotension to sbp in the 60s during the procedure, but there were no signs of perforation and an echocardiogram showed no tamponade. her pressures improved with fluids. after the procedure she was in sinus rhythm with occasional paced beats. . # coronaries: she has a history of a prior mi while in ~25 years prior. cardiac enzymes were negative and there were no ischemic changes on ecg. patient is on atenolol as an outpatient but not an ace inhibitor, statin or aspirin. she was started on aspirin 81mg po qdaily and should start an ace inhibitor and statin as an outpatient. . # orthostatic hypotension: the morning of the patient had a significant drop in blood pressure while standing up. she appeared slightly hypovolemic on exam after being npo prior to pacer placement. she was given a 500cc iv fluid bolus but again had dizziness and orthostatic hypotension. she had no pulsus paradoxus, jvd or distant heart sounds. she was given her home dose of prn meclizine and maintenance fluids. by , orthostasis was gone and physical therapy cleared her to go home with services. . # pump: her echo showed a normal ef, normal wall motion, mild-moderate mitral regurg and mild pulmonary hypertension. . # elevated cr: patient had a creatinine of 1.0 on admission up from baseline of 0.8. she also repurted dysuria that had been treated with three days of amoxicillin but had not resolved. she was started on ceftriaxone 1gm q24hrs. her creatinine improved to baseline with fluids. a urine analysis was negative so the ceftriaxone was discontinued. . # htn: atenolol was held on admission but restarted at 25mg qdaily after ppm placement. given her history of diabetes and cad, an ace inhibitor could be considered after discharge. . # microcytic anemia: had a stable anemia during her admission which is concerning given her history of gastritis and partial gastrectomy. she denied any dark coloured stools. she did not have a bowel movement while in hospital, but should be encouraged to guaiac several stools as an outpatient. . # gastritis: denies any current pain, continued on home ranitidine. . prophylaxis: received dvt prophylaxis with heparin sc, pain was managed with tylenol prn and she was continued on her home docusate. . code: patient wished to be full code. . comm: with son, medications on admission: meclizine 12.5 mg po q8h prn docusate 100mg po bid calcium carbonate 600mg po daily vitamin d po daily ranitidine 150 mg po bid ampicillin 250 mg q6h for 3 days (prescribed , dr. tramodol 50 mg po q6h prn pain (dispensed ) atenolol 25 mg po bid magnesium oxide 400 mg po daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. calcium 600 + d(3) 600-400 mg-unit tablet sig: one (1) tablet po once a day. 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. atenolol 25 mg tablet sig: one (1) tablet po once a day. 6. magnesium oxide 400 mg tablet sig: one (1) tablet po once a day. 7. tramadol 50 mg tablet sig: one (1) tablet po three times a day as needed for pain. 8. meclizine 12.5 mg tablet sig: one (1) tablet po twice a day as needed for dizziness. 9. cephalexin 500 mg capsule sig: one (1) capsule po every eight (8) hours for 2 days. disp:*6 capsule(s)* refills:*0* discharge disposition: home with service facility: family & services discharge diagnosis: complete heart block coronary artery disease diabetes mellitus type 2 discharge condition: stable. afebrile discharge instructions: you had a very slow heart rate and required a pacemaker. you did not have a heart attack. you will need to avoid lifting more than 5 pounds with your left arm for 6 weeks. do not lift your arm over your head for 6 weeks. you may not shower for 1 week, you can take a bath and wash your hair but do not get the pacemaker dressing wet. you will be seen in the device clinic in 1 week and will get the dressing removed at that time. . medication changes: 1. cephalexin for 2 days: to prevent the pacer site from becoming infected 2. decrease your atenolol to 25 mg daily 3. start a baby aspirin daily. . please call dr. if you notice any swelling, increasing tenderness or bleeding at the pacer site. please also call for fevers, chills, chest pain, trouble breathing, vomiting, urinary urgency or pain. . dr. will see you for the pacemaker and your heart problems. followup instructions: cardiology: device clinic phone: date/time: 10:00. clinical center, . , . . device clinic phone: date/time: 1:00. clinical center, . and provider: , md phone: date/time: 01:20p clinical center, . , . primary care: provider: , md phone: date/time: monday at 11:15am. 110 steet, , ma. procedure: initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other specified cardiac dysrhythmias atrioventricular block, complete old myocardial infarction iron deficiency anemia, unspecified personal history of malignant neoplasm of stomach 

Answer: The patient is high likely exposed to