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: penicillins / motrin / naprosyn attending: chief complaint: substernal chest pain major surgical or invasive procedure: none history of present illness: 79 f with cabg x1(lima->lad)/mvr (tissue) (pod 12) with an uncomplicated course, permanent pacer, pafib, was being transferred to rehab, when in the ambulance she had crushing sscp with associated sob and diaphoresis that lasted for 2 min. she was brought back to the ed, and received asa, o2, sat up and became cp-free and sob-free. ekg according to ed report showed no acute st changes, and is a-paced with lbbb. first set of cardiac enzymes showed ck 49, mb not done, trop 0.04. cxr showed possibly mildly worse bilateral pleural effusions. patient was given lasix 20 iv x1. admitted for romi. . she has no records of cardiac cath, but her cardiac catheterization before cabg revealed a 60% in-stent stenosis in the proximal lad stent and a patent rca stent. the lcx was noted to have only a 50% lesion. left ventriculography confirmed 4+ mr and lvef 60%. her only echo is a tee on taken pre-bypass, shows ef 50-55%, 3+ mr, 2+ tr, dilated and post-bypass shows improved tr, av paced. . after coming to floor, patient had 8/10 l cp, sharp, as well as sob and she felt anxious. cp is reproducible on palpation over costochondral joints and deep inspiration. patient felt better upon sitting up and tylenol. did not take nitro. has very little pain over area of cabg scar. past medical history: cabg x1(lima->lad) mvr (porcine) permanent pacer for bradycardia paroxysmal afib chf hypertension copd pulmonary hypertension hypothyroidism dm2 history of gib and peptic ulcer disease coronary stents(lad & rca) in anemia social history: married, lives alone. she does not smoke or drink alcohol. family history: denies history of premature coronary artery disease physical exam: vs: no temp taken / 138/70 / 86 / 20 / 98% ra gen: elderly female in no acute distress, pleasant heent: jvd flat, no lad, no carotid bruits. no thyromegaly, op clear, anicteric sclerae lungs: bibasilar rales chest: s/p thoracotomy. wounds c/d/i heart: 1/6 sem llsb, no r/g abd: soft, +bs, nd nt extr: + peripheral edema, 2+ dp bilaterally neuro: motor pertinent results: studies: ekg : atrial pacing at 70 borderline first degree a-v block intraventricular conduction defect poor r wave progression - probable normal variant lateral t wave changes are nonspecific low qrs voltages in limb leads since previous tracing of , atrial pacing is new . tee : pre bypass: 1. the left atrium is moderately dilated. no spontaneous echo contrast is seen in the body of the left atrium. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no thrombus is seen in the left atrial appendage. no spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size is normal. right ventricular systolic function is normal. 3. there are simple atheroma in the aortic root. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. 4. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. 5. the mitral valve leaflets are moderately thickened. no mass or vegetation is seen on the mitral valve. there is moderate thickening of the mitral valve chordae. moderate to severe (3+) mitral regurgitation is seen. the mitral regurgitation vena contracta is >=0.7cm. 6. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. there is flow reversal in the hepatic vein. small left sided pleural effusion. post bypass: pt. is av paced, on phenylephrine and epinephrine drip. preserved biventricular systolic function mv - well seated bioprosthetic valve with trace of paravavular leak. normal aortic contour post decanulation. mild tr, improved from pre bypass. . tte : the left atrium is dilated. the right atrium is moderately dilated. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the mitral valve has been replaced. . cxr : permanent pacemaker remains in standard position. cardiac silhouette is enlarged but stable in size. there is no evidence of chf. moderate bilateral pleural effusions are present with adjacent basilar opacities, which probably reflect atelectasis, although underlying infection is not fully excluded. direct comparison is somewhat limited by differences in technique, but effusions and basilar opacities may be slightly worse compared to the previous study. . cxr : stable bilateral effusions and bibasilar atelectasis, with no evidence for worsening fluid status or new consolidation. . . labs pt-22.6* inr(pt)-2.2* wbc-14.2* rbc-3.42* hgb-10.5* hct-32.1* mcv-94 mch-30.8 mchc-32.8 rdw-16.1* glucose-119* urea n-19 creat-0.8 sodium-134 potassium-4.2 chloride-95* total co2-28 anion gap-15 wbc: 14.2 -> 14.6 -> 11.1 -> 10.2 -> 9.7 -> 9.6 inr: 2.2 -> 2.8 -> 3.2 -> 3.4 -> 2.0 -> 1.6 brief hospital course: ms. is a 79-year-old woman with a history of cad s/p stents to lad and rca and cabg x1 (lima -> lad) on with porcine mv replacement on the same date, a history of symptomatic bradycardia s/p permanent pacemaker, and history of chf who presented with chest pain. her brief hospital course by problem is as follows: . 1. chest pain. as this was reproducible with palpation, it was attributed to her recent surgery. acs and post-cabg pericarditis were also considered; she was ruled out by cardiac enzymes and an echocardiogram showed no pericardial effusion. she was treated with tylenol and oxycodone, although she declined the oxycodone. she is allergic to nsaids. her surgeons evaluated her in the ed and felt there were no further surgical issues. . 2. dyspnea. she had pleural effusions on cxr and significant peripheral edema, so this was treated as congestive heart failure. her inr had been therapeutic, so pe was considered unlikely. she was diuresed 1l - 1.5l daily with good effect on her respiratory status; an ace inhibitor was also started. she also responded to albuterol nebs, suggesting an element of copd. she was satting well on room air at discharge. . 3. cad s/p cabg/mvr. she continued to have an uncomplicated post-op course. her surgical wound was healing well, with no signs of infection during her hospitalization. she was treated with aspirin and atorvastatin; her metoprolol was increased to 125 tid given her persistently elevated bp and hr on 100 tid. she was also started on an ace inhibitor. . 4. paroxysmal atrial fibrillation. her previous medication regimen was continued: she was well rate controlled with metoprolol and digoxin, and rhythm controlled with dofetilide. her coumadin was held for one day after a supratherapeutic inr, but was otherwise continued on her previous dose. . 5. permanent pacer for bradycardia. the pacer reprogrammed to increase the sensed av delay from 210 to 220 in an effort to minimize pseudofusion on ecg. . 6. hypothyroidism. she was continued on levoxyl per her home regimen. . 7. dm2. she was continued on glyburide per her home regimen and covered with a humalog sliding scale. . 8. history of gib and peptic ulcer disease. ranitidine per her home regimen. . 9. anemia. her hematocrit was stable at her baseline. transfusion threshold was treated as 30 given her recent cabg, but she did not meet this threshold. . 10. code: full . 11. dispo: she was discharged to rehab with instructions to follow up with her new pcp (dr. ) and new cardiologist (dr. ) after returning home. medications on admission: 1. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 2. potassium chloride 20 meq packet sig: one (1) packet po q12h (every 12 hours). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 6. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 8. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 9. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 10. dofetilide 125 mcg capsule sig: three (3) capsule po q12h (every 12 hours). 11. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 12. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 13. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 14. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 15. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: 2 tablets today only ( 5mg dose); then daily dosing per rehab pcp . allergies: pcn motrin naprosyn discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. dofetilide 125 mcg capsule sig: three (3) capsule po q12h (every 12 hours). 7. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 9. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 10. acetaminophen 325 mg tablet sig: two (2) tablet po qid (4 times a day): take routinely while awake. 11. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 12. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 13. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day): apply to affected area. 14. warfarin 2.5 mg tablet sig: one (1) tablet po daily (daily). 15. albuterol sulfate 0.083 % solution sig: one (1) inh inhalation q6h (every 6 hours) as needed for sob. 16. ipratropium bromide 0.02 % solution sig: one (1) inh inhalation q6h (every 6 hours) as needed for sob. 17. furosemide 20 mg tablet sig: one (1) tablet po twice a day. 18. metoprolol tartrate 50 mg tablet sig: 2.5 tablets po tid (3 times a day). 19. potassium chloride 20 meq packet sig: one (1) packet po daily (daily). 20. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 21. outpatient lab work check chem-7 on admission to rehab facility and at least qod discharge disposition: extended care facility: hospital discharge diagnosis: primary: 1. congestive heart failure, systolic, decompensated 2. coronary artery disease status post coronary artery bypass surgery. secondary: 1. paroxysmal atrial fibrillation 2. hypothyroidism 3. diabetes mellitus, type 2 discharge condition: good condition, surgical pain controlled, vital signs stable. discharge instructions: you have been evaluated for chest pain. you were found not to have had a heart attack. most likely, this pain is simply related to your surgery. you were also short of , and it was determined that you had some excess fluid. you were given iv lasix to help diurese. you will be discharged with a slightly higher dose of oral lasix. please take all medications as directed and keep all follow-up appointments. . if you develop different chest pain, increased shortness of , increase in your weight by more than 3 pounds, increasing leg edema. followup instructions: follow-up with your pcp 2 weeks of returning home. md, procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of mitral valve with tissue graft transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases other complications due to other cardiac device, implant, and graft fitting and adjustment of cardiac pacemaker 

Answer: The patient is high likely exposed to