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: chest pain radiating to back major surgical or invasive procedure: emergency repair of acute type a aortic dissection with ascending aortic and hemiarch replacement with a size 26 gelweave graft. aortic valve resuspension. history of present illness: yo f biba from home c/o chest pain radiating to back. in ed,pt acutely decompensated, becoming tachycardic, hypotensive,unresponsive. she was intubated. hemodynamics improved on dopamine. echo reveals pericardial effusion with tamponade, cxr reportedly reveals widened mediastinum. cardiac surgery is called for emergent evaluation. she does have a h/o asc. aortic aneurysm of 4.2cm past medical history: - diastolic chf, last echo with (lvef>55%) - mitral regurgitation - hypertension - hypercholesterolemia - cva w/ right sided dysarthria and facial droop - gerd - restrictive lung disease unknown etiology - hx of gi bleeding - morbid obesity - obstructive sleep apnea - right multinodular goiter, hx thyroid cyst removal - osteoarthritis in the knee and dip joints bilaterally - djd of spine - chronic venous insufficiency - pancreatic cyst (refused workup) - renal cyst (refused workup) - lower extremity edema - schatzki's ring social history: her husband died in , which was very hard on her. she now lives alone but goes to russian "second home" adult day care. she worked as a nurse for 50 years in . no tobacco for 40 years. denies alcohol, illicit drug history. has son and daughter-in-law in who have come up to visit while she is in the hospital. has a great grandson in who is a doctor. was a part-time interpreter at and now works at hospital. children want her to move to soon, but she wants to stay here. family history: her parents were both killed at baba yar in at a young age, so she is not aware of any health problems they may have had. physical exam: pulse: 141 resp: o2 sat: 97% b/p right: 128/68 left: height: weight: general: obese, intubated 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 + obese extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right: left: dp right: left: pt : left: radial right: left: carotid bruit right: left: pertinent results: echocardiography report germsnovskaya, (complete) done at 1:39:30 pm final referring physician information , division of cardiothoracic , , - department of cardiac s , 2a , status: inpatient dob: age (years): f hgt (in): 66 bp (mm hg): 105/88 wgt (lb): 227 hr (bpm): 69 bsa (m2): 2.11 m2 indication: aortic dissection. icd-9 codes: 441.00 test information date/time: at 13:39 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 #: 2010aw001-0:00 machine: aw2 echocardiographic measurements results measurements normal range aorta - annulus: 2.7 cm <= 3.0 cm aorta - sinus level: *3.8 cm <= 3.6 cm aorta - sinotubular ridge: *3.1 cm <= 3.0 cm aorta - ascending: *4.2 cm <= 3.4 cm aorta - arch: *3.5 cm <= 3.0 cm aorta - descending thoracic: *3.9 cm <= 2.5 cm findings left atrium: normal la and ra cavity sizes. no spontaneous echo contrast or thrombus in the body of the laa. left ventricle: normal lv wall thickness, cavity size, and global systolic function (lvef>55%). right ventricle: rv not well seen. aorta: mildly dilated aortic sinus. moderately dilated ascending aorta. mildly dilated aortic arch. moderately dilated descending aorta ascending aortic intimal flap/dissection.. aortic arch intimal flap/dissection. descending aorta intimal flap/aortic dissection. thickened aortic wall c/w intramural hematoma. aortic valve: normal aortic valve leaflets (3). no as. trace ar. mitral valve: normal mitral valve leaflets with trivial mr. tricuspid valve: tricuspid valve not well visualized. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: small pericardial effusion. 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. no tee related complications. conclusions pre-bypass: the left atrium and right atrium are normal in cavity size. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). the aortic root is mildly dilated at the sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. the descending thoracic aorta is moderately dilated. a mobile density is seen in the ascending aorta consistent with an intimal flap/aortic dissection. a mobile density is seen in the aortic arch consistent with an intimal flap/aortic dissection. a mobile density is seen in the descending aorta consistent with an intimal flap/aortic dissection. the aortic wall is thickened consistent with an intramural hematoma. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a small pericardial effusion. post-bypass: the patient is receiving no inotropic support post-cpb. there is an ascending aorta tube graft seen distal to the sinotubular junction without any changes to the aortic valve. biventricular systolic function is preserved and all other findings are consistent with pre-cpb findings. all findings were communicated to the surgeon intraoperatively. preliminary report developed by a cardiology fellow. not reviewed/approved by the attending echo physician. certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 10:44 complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:45 7.8 3.67* 10.5* 33.1* 90 28.6 31.7 14.8 348 chemistry renal & glucose glucose urean creat na k cl hco3 angap 04:45 117*1 34* 0.9 142 4.3 104 33* 9 , f 91 radiology report chest (pa & lat) study date of 6:03 pm , csurg fa6a 6:03 pm chest (pa & lat) clip # reason: eval for effusion medical condition: year old woman s/p aortic dissection repair reason for this examination: eval for effusion wet read: aglc fri 1:10 am slightly wider apperance to mediastinum may again be in part due to differences in pt rotation. else no change in moderate lt, small rt pleural effusion and bibasilar atelectasis. final report chest history: status post aortic dissection. re-evaluation of effusion. comparison: . compared to the prior study the diameter of the mediastinum has increased slightly from 130 mm to 137 mm. this may be due to differences in technique. the right ij line has been removed. there are bilateral pleural effusions, left greater than right, which are stable. the visualized lungs are stable as well. impression: slight increase in the size of the diameter of the mediastinum. this may be positional. otherwise stable pleural effusions. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 10:58 am brief hospital course: this -year-old russian speaking patient with sudden onset chest pain radiating to the back presented to the emergency room where ct angiogram demonstrated a type a acute dissection involving the ascending aorta without involvement of the arch or the descending. she has a known history of ascending aortic aneurysm. she was hemodynamically stable and was taken emergently to the operating room for surgery with dr.. she underwent repair of acute type a aortic dissection with ascending aortic and hemiarch replacement with a size 26 gelweave graft/aortic valve resuspension. please see operative report for further details. she tolerated the procedure well and was transferred to the cvicu for further invasive monitoring. hemodynamic support with inotropes/pressors were initially required. she was grossly volume overloaded and a lasix drip was initiated. over the next few days she slowly improved and drips were weaned off. she was extubated on and remained in the cvicu for altered mental status-confusion, hiflo oxygen for hypoxemia, and decompression of gastric dilitation. beta-blocker/statin/aspirin and diuresis continued. she continued to improve and on pod# 10 ms. was transferred to the step unit for further monitoring. physical therapy was consulted for evaluation of strength and mobility. on pod# 14 dr. cleared her for discharge to for rehabilitation. she will be seen by dr. in follow up on @ 1:30pm. all appointments were advised. medications on admission: unknown discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). capsule(s) 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 9. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day) for 4 days: decrease dose to 400 mg po daily after dose completed, then after 7 days decrease to 200 mg po daily. 10. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 13. furosemide 40 mg tablet sig: one (1) tablet po daily (daily) for 10 days. 14. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily) for 10 days. discharge disposition: extended care facility: - discharge diagnosis: type a acute dissection involving the ascending aorta without involvement of the arch of the descending. she has a known history of ascending aortic aneurysm. htn, hypercholesterolemia, gerd, bronchomalacia, ascending thoracic aortic aneurysm 4.2cm, obesity discharge condition: alert and oriented x3, nonfocal. ambulating with steady gait. incisional pain managed with tylenol only incisions: sternal - healing well, no erythema or drainage discharge instructions: 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. 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, until follow up with surgeon. 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 of sternal wound. **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. # your appointment was arranged for @ 1:30 pm. please call to schedule appointments with your primary care/cardiologist in weeks: pcp: ., m. # in weeks cardiologist: as referred by dr. in weeks *please call cardiac surgery office with any questions or concerns (). answering service will contact on call person during off hours.** md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery resection of vessel with replacement, thoracic vessels open heart valvuloplasty of aortic valve without replacement diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified acute on chronic diastolic heart failure aortic valve disorders paralytic ileus obesity, unspecified dissection of aorta, thoracic stricture and stenosis of esophagus oliguria and anuria other late effects of cerebrovascular disease, facial weakness cardiac tamponade late effects of cerebrovascular disease, dysarthria 

Answer: The patient is high likely exposed to