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: atrial fibrillation, failed medical therapy major surgical or invasive procedure: s/p bilateral mini thoracotomy with pulmonary vein isolation using atricure synergy system with resection of left atrial appendage. 2. electrophysiology study performed by dr. history of present illness: this 50 year old male with a history of atrial fibrillation was diagnosed in with congestive heart failure and cardiomyopathy. symptoms are disabling for him and he has had recurrent episodes despite initial sinus rhythm. his ejection fraction has ultimately improved to 50%, but he failed flecainide/dronedarone therapy and subsequently multaq. he is currently on flecanide and toprol xl and has had one episode of fibrillation since , which lasted less than 12 hours. he is thus referred for evaluation for mini-maze procedure. past medical history: paroxysmalatrial fibrillation hypertension cardiomyopathy social history: race: caucasian last dental exam: regular dental care lives with: wife and 2 children occupation: auto insurance appraiser, limo driver tobacco: quit 25yrs. ago etoh: 4/week family history: family history:non-contributory physical exam: admission physical exam pulse: 58 sr resp: 16 o2 sat: 98%ra b/p right: 112/77 left: height: 6'3" weight: 225lb general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema -no varicosities -minor neuro: grossly intact x pulses: femoral right: 2+ left:2+ dp right: 2+ left:2+ pt : 2+ left:2+ radial right: 2+ left:2+ carotid bruit right: left: pertinent results: 04:50am blood wbc-13.7* rbc-4.64 hgb-14.3 hct-41.4 mcv-89 mch-30.8 mchc-34.5 rdw-13.0 plt ct-172 10:40pm blood wbc-6.3 rbc-4.68 hgb-14.7 hct-40.3 mcv-86 mch-31.4 mchc-36.5* rdw-13.2 plt ct-176 04:50am blood pt-13.0 inr(pt)-1.1 10:40pm blood pt-13.5* ptt-29.8 inr(pt)-1.2* 04:50am blood glucose-115* urean-12 creat-0.8 na-138 k-3.7 cl-104 hco3-25 angap-13 10:40pm blood glucose-137* urean-18 creat-1.0 na-142 k-3.5 cl-106 hco3-26 angap-14 10:40pm blood alt-18 ast-24 ld(ldh)-146 alkphos-76 amylase-33 totbili-0.4 echocardiography report , (complete) done at 12:35:47 pm final referring physician information , c. , status: inpatient dob: age (years): 50 m hgt (in): 72 bp (mm hg): 105/67 wgt (lb): 220 hr (bpm): 78 bsa (m2): 2.22 m2 indication: atrial fibrillation. hypertension. shortness of breath. hx of cardiomyopathy of unknown origin. intraoperative tee for bilateral mini maze procedure and left atrial appendage ligation. icd-9 codes: 425.4, 427.31, 786.05 test information date/time: at 12:35 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2010aw1-: machine: ie33 echocardiographic measurements results measurements normal range left atrium - four chamber length: *6.2 cm <= 5.2 cm left ventricle - septal wall thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *5.8 cm <= 5.6 cm left ventricle - systolic dimension: 3.9 cm left ventricle - fractional shortening: 0.33 >= 0.29 left ventricle - ejection fraction: 60% >= 55% aorta - annulus: 2.6 cm <= 3.0 cm aorta - sinus level: 3.3 cm <= 3.6 cm aorta - sinotubular ridge: 2.8 cm <= 3.0 cm aorta - ascending: 2.8 cm <= 3.4 cm aorta - descending thoracic: 2.3 cm <= 2.5 cm aortic valve - peak velocity: 1.3 m/sec <= 2.0 m/sec aortic valve - peak gradient: 6 mm hg < 20 mm hg aortic valve - mean gradient: 4 mm hg aortic valve - lvot diam: 2.4 cm mitral valve - e wave: 0.8 m/sec mitral valve - a wave: 0.4 m/sec mitral valve - e/a ratio: 2.00 findings left atrium: marked la enlargement. no spontaneous echo contrast in the body of the la. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: bidirectional shunt across the interatrial septum at rest. small secundum asd. left ventricle: normal lv wall thickness. mildly dilated lv cavity. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending, transverse and descending thoracic aorta with no atherosclerotic plaque. normal diameter of aorta at the sinus, ascending and arch levels. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: trivial mr. tricuspid valve: physiologic tr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions the left atrium is markedly dilated. no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. there is a 0.5 cm mass that resembles a clot in the left atrium at the junction of the left atrial appendage and the coumadin ridge. 3d examination revealed this to be a fold of tissue arising from the wall of the atrium. ejection velocities in the left atrial appendage was greater than 40 cm/sec. 3d examination performed by dr and confirmed as native tissue and not clot. a small secundum atrial septal defect is present. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque . the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. trivial mitral regurgitation is seen. dr. was notified in person of the results. post procedure the left atrial appendage has been ligated. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 16:12 ?????? caregroup is. all rights reserved. brief hospital course: on mr. preoperative testing including cardiac mri and cardiac cath. during catheterization, prior to sheath insertion, mr. had an asystolic episode for 20 seconds treated with atropine. please refer to catheterization report for further details. on he was taken to the operating room and bilateral thoracotomies for mini-maze procedures with ligation of the left atrial appendage by dr.. please refer to the operative report for further surgical details. he tolerated the procedure well and was transferred to the cvicu intubated in critical but stable condition. he awoke neurologically intact and was weaned to extubation without difficulty. all lines and drains were discontinued in a timely fashion. his preop flecainide was resumed along with beta-blocker and aspirin. diuresis was initiated. he was transferred to the step down unit on pod#1 for further monitoring.physical therapy was consulted for evaluation of strength and mobility. transient postoperative atrial fibrillation was treated with diltiazem and increasing beta- blocker.his rhythm converted to normal sinus. anti coagulation with coumadin was resumed. inr goal 2-2.5. follow up coumadin dosing to be resumed by his cardiologist, dr. . on pod#3 his rhythm again went into atrial flutter/fibrillation with a rate 130s. beta-blocker iv and orally was given with minimal response. iv diltiazem given with immediate rate control in 70-80s. oral diltiazem was initiated. he continued to progress and his fib/flutter rate remained controlled. on he was cardioverted to sinus rhythm and diltiazem was changed to a long acting formulation. his coumadin will be dosed on discharge by dr. in , who has done so before. by post-operative day seven he was ready for discharge to home. all follow-up appointments were advised. medications on admission: coumadin 5mg three days per week, 7.5mg four days per week-last dose 8/25 lisinopril 10 mg daily fish oil flecanide 100 mg po bid toprol xl 100 mg po daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. metoprolol tartrate 100 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 3. flecainide 150 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 4 weeks. disp:*50 tablet(s)* refills:*0* 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day for 4 weeks. disp:*56 tablet(s)* refills:*0* 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 7. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever/pain. 9. indomethacin 25 mg capsule sig: one (1) capsule po tid (3 times a day): with meals. disp:*90 capsule(s)* refills:*2* 10. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day as needed for afib. disp:*30 capsule, sustained release(s)* refills:*0* 12. outpatient lab work please draw a inr/pt on and then prn phone results to dr. at . inr goal 2-2.5 for afib. 13. coumadin 5 mg tablet sig: one (1) tablet po once a day: 5mg daily three times per week, 7.5mg four days per week as directed by dr. at . inr goal 2-2.5 for afib. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna, discharge diagnosis: medically refractory paroxysmal atrial fibrillation. s/p bilateral mini thoracotomy with pulmonary vein isolation using atricure synergy system with resection of left atrial appendage. 2. electrophysiology study performed by dr. hypertension cardiomyopathy acute systolic congestive heart failure discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. #, appointment arranged for at 1:30 pm cardiologist:dr. (appointment arranged for at 11:15 am please call to schedule appointments with your primary care: dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication: maze/laa ligation/ afib goal inr: 2-2.5 first draw: results to: dr. procedure: coronary arteriography using two catheters left heart cardiac catheterization other electric countershock of heart other electric countershock of heart catheter based invasive electrophysiologic testing insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: other primary cardiomyopathies congestive heart failure, unspecified unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation atrial flutter cardiac arrest peripheral vascular complications, not elsewhere classified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 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 systolic heart failure syncope and collapse pre-operative cardiovascular examination 

Answer: The patient is high likely exposed to