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: tramadol attending: chief complaint: syncope major surgical or invasive procedure: pacemaker placement pericardial drain placement history of present illness: pt is an 81 yo woman with pmh htn, early alzheimer's, bradycardia, who presents w/ syncope. per pt and pt's husband, pt was sitting at kitchen table eating lunch this afternoon when her husband noticed she suddenly looked pale and then passed out, falling off her chair and hitting her head on the floor. she had loc for approximately 20 seconds and then awoke, no confusion/post-ictal state. pt otherwise denies any pre-syncope including lh/dizziness, palpitations, diaphoresis, also denies any cp/pressure, sob, f/c. with this event, pt's husband called ems. per report, on ems arrival, pt was felt to be in junctional rythym at 40bpm (looking at strip, looks sinus w/ p waves before qrs, just wavy baseline) and pt was administered atropine 0.5mg iv x 1 and brought to hospital. . at osh, per report pt was bradycardic to 30's and 40's, bp stable, pt asymptomatic. pt had head ct at osh that per report showed "2 punctate hemorrhages, one frontal and one parietal" and was therefore transferred to for neurosurg evaluation. . upon arrival at , hr 40's-50's, bp stable, pt asymptomatic. labs wnl except for elevated ca at 10.5. ct head negative for bleed, and therefore neurosurg consult was cancelled. ct c spine negative for acute fracture. pt admitted for syncope w/u. currently pt feels well, denies any sxs. past medical history: -htn -bradycardia (per pt's husband, baseline hr in 40's) -early alzheimer's dementia (per husband, they call it the " problem". pt does not know about diagnosis of alzheimers) -h/o arm and leg pain -> per pt, pcp attributes this to arthritis -s/p appy -s/p cholecystectomy social history: married, lives with husband. past tobacco 20 pack year history, quit in , rare etoh, no drug use. family history: nc physical exam: vitals - t 97.3, bp 150/44, hr 48, rr 16, o2 97% ra gen - awake, alert, lying in bed, nad, pleasant heent - perrl, eomi, mmm neck - l sided faint carotid bruit cvs - bradycardic, regular, grade ii/vi sem lungs - cta b/l abd - soft, nt/nd ext - no le edema b/l pertinent results: 07:30pm pt-12.4 ptt-24.6 inr(pt)-1.1 07:30pm plt count-177 07:30pm neuts-65.5 lymphs-28.8 monos-4.4 eos-0.5 basos-0.8 07:30pm wbc-7.7 rbc-4.26 hgb-12.6 hct-38.1 mcv-89 mch-29.5 mchc-33.0 rdw-13.3 07:30pm calcium-10.5* phosphate-2.8 magnesium-2.1 07:30pm ck-mb-2 ctropnt-<0.01 07:30pm ck(cpk)-51 07:30pm estgfr-using this 07:30pm glucose-101 urea n-28* creat-0.7 sodium-140 potassium-4.1 chloride-104 total co2-23 anion gap-17 11:43pm urine gr hold-hold 11:43pm urine hours-random 11:43pm urine hours-random tot prot-40 . ct c-spine : degenerative changes with osteophyte formation on the left side of uncovertebral joint, with left neural foraminal narrowing at 3/4. grade i anterolisthesis at c3/4. no fracture. . ct head : findings: there is no acute intracranial hemorrhage. there is no mass effect. no shift of normally midline structure is noted. ventricles are not dilated, and -white differentiations are preserved. calcification along the choroid plexus, pineal gland and mid posterior fossa is noted. there is subcutaneous hematoma in the left frontal area. impression: no acute intracranial hemorrhage. no mass effect. left subcutaneous hematoma. . echo conclusions: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate +] tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . echo conclusions: left ventricular systolic function is hyperdynamic (ef>75%). there is a large pericardial effusion. the effusion is echo dense, consistent with blood. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. compared with the prior study (images reviewed) of at 10am, the pericardial effusion and tamponade are new. images were obtained after pericardiocentesis with significant reduction of pericardial fluid (0.8 cm residual interiorly) and improved rv diastolic expansion. . xr l-spine impression: no compression fracture is seen. there is grade i spondylolisthesis at l4/5. blunting of both costophrenic sulci is noted, also seen on a plain film of the chest performed on the same day. . xr of bilat hips impression: no evidence of an acute bony injury. . cxr findings: ap and lateral chest views obtained with the patient in sitting upright position are analyzed in direct comparison with preceding portable chest examinations obtained nine hours earlier during the same date and a first portable chest examination dated . the patient is now extubated, and there is no evidence of pneumothorax. the previously described permanent pacer remains in left anterior axillary position connected to two intracavitary electrodes. one of these terminates in a position compatible with the anterior superior wall of the right atrium possibly in the right atrial appendage. the second right ventricular lead terminates overlying the apical area of the right ventricle. there is no evidence of pulmonary vascular congestion or new acute parenchymal infiltrates, however, there exists mild blunting of the left lateral pleural sinus, continuing into the posterior sinus, as seen on the lateral view. patient's inability to elevate the arms detracts from the image quality of the heart on the lateral view and thus conclusive findings concerning pleural effusion related displacement of the epicardial fat line cannot be made. comparison with the next previous studies does not indicate a significant change in heart size as possible on portable examinations. comparison of the right ventricular electrode position suggests that the termination point was slightly further advanced on the previous studies than it is now. impression: satisfactory followup findings following extubation and pericardial drain removal, status post tamponade. . echo conclusions: 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 aortic valve leaflets are mildly thickened. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the large pericardial effusion is no longer present. . echo conclusions: the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). there is no pericardial effusion. compared with the prior study (images reviewed) of , there is no significant change. brief hospital course: 81 f w/ pmh htn, bradycardia, p/w syncope, found to have sick sinus syndrome, s/p pacemaker placment c/b tamponade from rv perforation s/p pericardial drain and intubation for airway protection. . # rv perforation: s/p pericardial drain. the day after drain placement the patient's drain had minimal output and repeat echocardiogram showed trivial pericardial effusion. the drain was pulled prior to transfer. . # s/p dual chamber icd: for sick sinus syndrome - cefazolin iv x 3 days, started , will have 2 days of cephalexin as outpatient to complete a 5-day course - ep followed - will have an appt on monday with dr. and for device clinic. . # respiratory failure: intubated for airway protection during drain placement. extubated the day after intubation without difficulty. - satting in high 90s on ra on discharge . # hip pain: her husband was concerned that she was having l lower rib and hip pain from her fall. multiple xrs did not sho hip/rib/spinal fractures. she did not have any pain on discharge . # anemia: normocytic, ? acd - iron studies/folate/b12 as outpatient . # hypercalcemia: resolved. most likely secondary to dehydration +/- increased calcium intake. other possibilities include hyperparathyroidism, multiple myeloma, paraneoplastic syndrome, sarcoid, all unlikely. - pth, spep, and upep all wnl . # htn: restarted metoprolol on discharge, may need addition of lisinopril as outpatient. . # dementia: continue aricept . medications on admission: -aricept 10mg qhs -hctz 25mg daily -caltrate + vitd 600mg daily -fosomax 70mg q friday -prilosec 20mg prior to fosamax dose -asa 81mg daily -genteel eye drops prn -multivit daily discharge medications: 1. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 2. hexavitamin tablet sig: one (1) cap po daily (daily). 3. prilosec otc 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 4. fosamax 70 mg tablet sig: one (1) tablet po once a day: every friday. 5. caltrate -25 mg-unit-mg tablet sig: one (1) tablet po twice a day. 6. vitamin d 400 unit tablet sig: one (1) tablet po once a day. 7. aspirin 81 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. amiodarone 200 mg tablet sig: two (2) tablet po twice a day for 30 days: 400 mg 2x/day through , then 400 mg 1x/day through then 200 mg po daily through then stop. disp:*100 tablet(s)* refills:*0* 10. cephalexin 500 mg tablet sig: one (1) tablet po twice a day for 2 days. disp:*4 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: sick sinus syndrome hypertension atrial fibrillation discharge condition: hemodynamically stable. ambulatory with assist. discharge instructions: you were admitted after an episode of syncope. you were found to have a slow heart rate and a pacemaker was placed. . please keep your pacer site dry. . please seek medical medical attention if you spike a fever > 101, or have chest pain, shortness of breath or any other concerning symptoms. followup instructions: you have an appointment with dr. on at 9:40 am . tel. (. you have an appointment in device clinic the same day () at 8:30 am. tel. (, also , . . please make a follow-up appointment with dr. (your primary care doctor) within the next 2 weeks. - you will need pulmonary function testing and an eye exam as you have been started on amiodarone that can cause vision and lung problems. . please make a follow-up appointment with dr. within the next 2-3 weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube pericardiocentesis initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle diagnoses: anemia, unspecified unspecified essential hypertension atrial fibrillation accidental puncture or laceration during a procedure, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance sinoatrial node dysfunction dehydration syncope and collapse acute pericarditis, unspecified 

Answer: The patient is high likely exposed to