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: respiratory distress major surgical or invasive procedure: transesophageal echocardiogram cardiac catherization 1. mitral valve replacement with a 31-mm st. epic tissue valve, model number e-. 2. his aortic valve replacement with a 21 mm cup, pericardial tissue valve, model number 3300 tfx. and left thoracenteses history of present illness: this patient is a 61 year old female who is transferred from outside hospital for dyspnea with known syndrome and known mr. history is very limited due to her acuity and is mostly from ems and outside hospital. the patient presented with acute onset dyspnea, tachycardia, and was very tachypneic. upon arrival to the er she was intubated and admitted tothe micu. an echo was done this morning revealing 4+ mitral regurg w/ flail leaflet. she is presently acidotic in cardiogenic shock, intubated, sedated on levophed and neo. cardiac surgery was consulted for emergent mvr. past medical history: bicuspid aortic valve aortic stenosis mitral regurgitation s/p emergent aortic valve replacement and mitral valve replacement this admission pmh: diverticulitis, syndrome, hypothyroid past surgical history: s/p sigmoid colectomy w/ pouch at . cervical laminectomy social history: lives with husband family history: non-contributory. physical exam: pulse:102 st resp: ac 100%, peep 20, vt 350 x rate 34 o2 sat: 94% b/p a-line 95/73 height: weight: general: skin: dry intact heent: pupils pinpoint- sedated. s/p cervical laminectomy . native dentition without obvious deformity. neck: supple full rom chest: lungs crackles bilat heart: tacycardic murmur v/vi sem abdomen: obese, hypoactive, soft extremities: cool, 4+ pitting edema all extremities neuro: intubated and sedated pulses: doppler pulses lower extremities. unable to appreciate varicosities d/t edema radial a-line left carotid bruit : on vent right: left: pertinent results: inr 1.9 pt 20.5 mg 2.2 creat 0.9 04:30am blood wbc-18.4* rbc-3.13* hgb-9.6* hct-30.6* mcv-98 mch-30.7 mchc-31.4 rdw-20.8* plt ct-177 03:04am blood wbc-24.7* rbc-3.21* hgb-10.1* hct-30.8* mcv-96 mch-31.4 mchc-32.8 rdw-21.0* plt ct-139* 01:52am blood wbc-27.5* rbc-3.24* hgb-10.0* hct-31.1* mcv-96 mch-30.8 mchc-32.0 rdw-20.2* plt ct-120* 04:30am blood pt-25.8* inr(pt)-2.5* 03:04am blood pt-26.1* ptt-30.2 inr(pt)-2.5* 01:52am blood pt-32.9* ptt-36.0* inr(pt)-3.3* 02:53am blood pt-33.3* ptt-33.6 inr(pt)-3.4* 02:53am blood pt-33.3* ptt-33.6 inr(pt)-3.4* 04:22am blood pt-22.7* ptt-57.5* inr(pt)-2.1* 12:18am blood pt-21.8* ptt-63.5* inr(pt)-2.0* 04:30am blood glucose-182* urean-36* creat-1.0 na-133 k-4.2 cl-94* hco3-28 angap-15 03:04am blood glucose-138* urean-32* creat-0.9 na-137 k-4.8 cl-100 hco3-33* angap-9 01:52am blood glucose-158* urean-26* creat-0.8 na-139 k-4.0 cl-102 hco3-30 angap-11 preop echo left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. at least moderate (2+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: small, hyperdynamic left ventricle. dilated and hypokinetic right ventricle. mitral valve prolapse with at least moderate mitral regurgitation. moderate aortic stenosis. compared with the report of the prior study (images unavailable for review) of , severity of mitral regurgitation has probably worsened and right ventricle is now hypocontractile. this study might be significantly underestimating the severity of eccentric mitral regurgitation and if there is clinical concern for acute severe mitral regurgitation, a transesophageal study is recommended. chest ct 1. no evidence of pulmonary embolism or aortic dissection. 2. cardiomegaly with marked left atrial enlargement. bilateral diffuse ground glass opacity and interlobular and intralobular septal thickening suggests severe pulmonary edema. more consolidative areas within the lower lobes bilaterally may be due to pneumonia or atelectasis. 3. small to moderate sized bilateral pleural effusions, left larger than right. cardiac cath final diagnosis: 1. anomolous coronary arteries with no hemodynamically significant 2. severely elevated left- and right-sided filling pressures. 3. successful placement of intra-aortic balloon pump. intra-op echo prebypass no atrial septal defect is seen by 2d or color doppler. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). with severe global rv free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve is bicuspid. the aortic valve leaflets are severely thickened/deformed. significant aortic stenosis is present (not quantified). unable to calculate gradients and due to poor doppler alignment in the deep transgastric views. no aortic regurgitation is seen. the mitral valve leaflets are myxomatous. there is partial mitral leaflet flail. torn mitral chordae are present. severe (4+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). moderate tricuspid regurgitation is seen. dr. was notified in person of the results on at 1500 hours. post bypass patient is in sinus rhythm and receiving an infusion of norepinephrine, epinephrine and milrinone. rv function is slightly improved. lvef= 35%. the inferior and inferoseptal walls are hypokinetic. bioprosthetic valve seen on the aortic position. valve appears well seated and the leaflets move well. trace central aortic insufficiency present. there is a strut seen in the lvot. there is a bioprosthetic valve seen in the mitral position. this valve appears well seated and the leaflets move well. aorta appears intact post decannulation. intraaortic balloon pump tip seems to be in good position. echo the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. 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 aorta is mildly dilated. a bioprosthetic aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. no aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the transmitral gradient is normal for this prosthesis. there is severe mitral annular calcification. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the mitral and aortic prostheses are new and are with normal gradients chest ct, abdomen, pelvis impression: 1. no evidence of fluid collections or abscess. 2. new right pectoral hematoma. 3. bilateral moderate-sized pleural effusions with adjacent compressive atelectasis. 4. small pericardial effusion. 5. small amount of ascites. brief hospital course: 61 year old female with a history of syndrome and aortic stenosis with bicuspid aortic valve who presents with respiratory failure and cardiogenic shock. emergent cardiac surgery evaluation was requested. echo revealed severe mr and severe as with a bicuspid aortic valve. cath did not reveal any significant coronary disease. she was taken to the operating room on where she underwent aortic valve replacement with 21mm tissue valve and mitral valve replacement with 31mm st. porcine tissue valve. post-operatively was transferred to the cvicu for further invasive monitoring in critical condition. she left the or with an intra-aortic balloon pump and on titrated levophed, milrinone and epinephrine. post-operatively, she developed rapid atrial fibrillation with hemodynamic instability and was electrically cardioverted. she remained in atrial fibrillation, and rate control was achieved with amiodarone. iabp was discontinued and eventually the patient was weaned from inotropic and vasopressor support. a lasix drip was initiated to aggressively diurese her excessive volume overload. thrombocytopenia developed and hit was negative. platelets would eventually trend up to normal levels. given the patient's complicated hospital course, and question of vegetation on the mitral valve, id was consulted for antibiotic recommendations and leukocytosis. additionally, the patient developed a rash, and was tested for spotted fever- which would ultimately return negative. she was eventually weaned from the ventilator and extubated on pod 6. due to right upper extremity swelling a right upper extremity ultrasound was performed and negative for thrombus.left thoracentesis done on . dobhoff placed for tube feeds for increased nutritional needs and poor intake. she continued to progress and was transferred to the step down unit.on pod#17 a 700cc left pleural effusion was evacuated via repeat thoracentesis. on pod#18 she was cleared by dr. for discharge to rehab. all follow up appointments were advised. target inr is 1.8-2.2 for postop afib ( per dr. due to chest hematoma). blood draws should be mon-wed-fri ( next draw ) . coumadin dose today is 1 mg, inr today 1.9.please recheck bun / creat for iv lasix dosing. please re-check lfts to dtermine eligibility for statin therapy. medications on admission: unknown discharge medications: 1. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm: 1 mg today, then 0.5 mg fri and sat;then further daily dosing by provider; target inr 1.8-2.2 for postop a fib . 2. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 weeks. 6. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. metolazone 5 mg tablet sig: one (1) tablet po daily (daily): 30 minutes prior to iv lasix. 9. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for to affected area. 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po bid (2 times a day): hold for k+ > 4.5 with iv lasix. 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 12. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 13. cefepime 2 gram recon soln sig: one (1) recon soln injection q12h (every 12 hours): last dose pm . 14. vancomycin 500 mg recon soln sig: 1.5 recon solns intravenous q12h (every 12 hours): 750 mg iv; last dose pm . 15. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: one (1) 500 mg piggyback intravenous q8h (every 8 hours): last dose pm . 16. furosemide 10 mg/ml solution sig: forty (40) mg injection (2 times a day): 40 mg iv; please recheck creat ;baseline creat 1.5. 17. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: iv prn line flush and daily for picc; flush with 10 ml ns. 18. insulin fixed dose and sliding scale ( see attached) discharge disposition: extended care facility: - discharge diagnosis: bicuspid aortic valve aortic stenosis s/p mitral valve replacement with a 31-mm st. epic tissue valve, model number e-. 2. his aortic valve replacement with a 21 mm cup, pericardial tissue valve, model number 3300 tfx mitral regurgitation s/p emergent aortic valve replacement and mitral valve replacement this admission pmh: diverticulitis, syndrome, hypothyroid past surgical history: s/p sigmoid colectomy w/ pouch at . cervical laminectomy discharge condition: alert and oriented x3 nonfocal does not ambulate-using for lifts incisional pain managed with tramadol and tylenol incisions: sternal - healing well, no erythema or drainage edema : 2+ ble discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 until follow up with surgeon no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: provider: , md phone: date/time: 1:30 please call to schedule appointments primary care dr. , in weeks cardiologist dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours target inr for this pt is 1.8-2.2 per dr. for postop a fib blood draws mon-wed-fri please please check bun/creatinine tomorrow ( baseline creat 1.5) re-check lfts for possible statin therapy in future procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances thoracentesis open and other replacement of aortic valve with tissue graft implant of pulsation balloon open and other replacement of mitral valve with tissue graft injection or infusion of oxazolidinone class of antibiotics diagnoses: thrombocytopenia, unspecified mitral valve disorders congestive heart failure, unspecified toxic encephalopathy acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation hemorrhage complicating a procedure acute respiratory failure cardiogenic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation rash and other nonspecific skin eruption nontraumatic hematoma of soft tissue congenital insufficiency of aortic valve critical illness myopathy attention to colostomy gonadal dysgenesis rupture of chordae tendineae other aneurysm of heart 

Answer: The patient is high likely exposed to