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: protamine sulfate / gluten / milk / wheat flour attending: chief complaint: shortness of breath, atrial fibrillation s/p mvr ( 25 mosaic procine), maze, ligation of left atrial appendage major surgical or invasive procedure: re-do sternotomy, evacuation of pericardial and pleural effusions mvr (25 mosaic, porcine), maze, ligation of left atrial appendage history of present illness: 85 year old female s/p mvr (25 mosaic porcine),maze, ligation of left atrial appendage . readmitted from rehab with shortness of breath, atrial fibrillation. past medical history: paroxysmal atrial fibrillation rheumatic heart disease moderate-to-severe mitral stenosis hypertension hypothyroidism glaucoma osteoporosis social history: she currently lives alone but has a daughter retired denies etoh denies family history: non contributory physical exam: admit history and physical vs: 99.2, 94/55, 66, 18, 96% on 2 liters neuro: alert and oriented x3, non-focal resp: lings cta bilat,-decreased at the bases, no rhonchi or wheezing. cardiac rrr s1, s2, no murmur gi: soft, tender bilat lower quadrants, non-distended, +bs extrem: upper extremities: warm, pulses +2, no edema. lower extremities: cool, pulses +1, +1 edema. skin: sternal incision- healing, no erythema, no drainage, stable pertinent results: : wbc 7.9 *hgb 11.4* hct 35.0* plt 319 echocardiography report , portable tte (complete) done at 4:37:43 pm final referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 85 f hgt (in): 64 bp (mm hg): / wgt (lb): 119 hr (bpm): 66 bsa (m2): 1.57 m2 indication: h/o cardiac surgery. pericardial effusion. icd-9 codes: 423.3, v42.2 test information date/time: at 16:37 interpret md: , md test type: portable tte (complete) son: doppler: full doppler and color doppler test location: / 6 contrast: none tech quality: adequate tape #: 2009w0-0:00 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: 3.8 cm <= 4.0 cm left atrium - four chamber length: *5.5 cm <= 5.2 cm left atrium - peak pulm vein s: 0.4 m/s left atrium - peak pulm vein d: 1.0 m/s right atrium - four chamber length: *5.2 cm <= 5.0 cm left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 3.3 cm <= 5.6 cm left ventricle - systolic dimension: 1.9 cm left ventricle - fractional shortening: 0.42 >= 0.29 left ventricle - ejection fraction: 65% to 75% >= 55% aorta - sinus level: 3.4 cm <= 3.6 cm aorta - ascending: *3.5 cm <= 3.4 cm aorta - arch: 2.8 cm <= 3.0 cm aortic valve - peak velocity: 1.1 m/sec <= 2.0 m/sec mitral valve - mean gradient: 2 mm hg mitral valve - pressure half time: 91 ms mitral valve - mva (p t): 2.4 cm2 mitral valve - e wave: 1.4 m/sec mitral valve - a wave: 0.9 m/sec mitral valve - e/a ratio: 1.56 mitral valve - e wave deceleration time: *270 ms 140-250 ms tr gradient (+ ra = pasp): *29 mm hg <= 25 mm hg pericardium - effusion size: 2.2 cm findings left pleural effusion this study was compared to the prior study of . left atrium: elongated la. right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: mild symmetric lvh. small lv cavity. normal regional lv systolic function. overall normal lvef (>55%). no resting lvot gradient. no vsd. right ventricle: borderline normal rv systolic function. aorta: normal aortic diameter at the sinus level. mildly dilated ascending aorta. normal aortic arch diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: bioprosthetic mitral valve prosthesis (mvr). mvr well seated, with normal leaflet/disc motion and transvalvular gradients. no mr. tricuspid valve: moderate to severe tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: no ps. pericardium: large pericardial effusion. effusion circumferential. stranding is visualized within the pericardial space c/w organization. no echocardiographic signs of tamponade. no rv diastolic collapse. conclusions the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. with borderline normal free wall function. the ascending aorta is mildly dilated. 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. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a large pericardial effusion. the effusion appears circumferential. stranding is visualized within the pericardial space c/w organization. no right ventricular diastolic collapse is seen, however there are indirect signs of elevated intrapericardial pressure (rv free wall diastolic flattening) compared with the prior study (images reviewed) of , the large pericardial effuison is new. impression: large circumfirential pericardial effusion with early organization. no overt tamponade. electronically signed by , md, interpreting physician 17:04 brief hospital course: pt was admitted to intially to the cardiac surgical floor then had an echo which revealed pericardial effusion and was transferred to the cardiac icu to monitor for tamponade. of note, ms. was c-diff positive at rehab abd was being treated with flagyl. her urine was also positive for gram neg rods and was treated with cipro. ms. aggressive diuresis. on hd #2 ms. was taken to the or with dr. for pericardial window for drainage of pericardial effusion and bilat pleural effsuions (left 1 liter and right 500cc). she was treated with periop vanco. she was readmitted to the icu post operatively intubated and on neosynephrine. she weaned from the vent and pressors and was extubated. she was seen by electrophysiology and her dofetilide was maintained and very low dose coumadin was recommended when stable. she was transferred from the icu to the floor. bilateral chest tubes remained in place to suction for drainge. when chest tubes were placed to water seal, she developed pneumothoracies and was placed back to suction. chest tubes were later removed and ms. cxr showed stable bilateral 20% pneumothoracies. she was evaluated by physical therapy and reab was recommended. on pod#8 she was discharged to rehab. she will need her inr checked daily and recieve only low dose coumadin- 1mg daily. she will also need her renal and liver function monitored closely while on dofetilide. she will have close follow up with dr. - appointment is scheduled. medications on admission: coumadin held since , asa, levoxyl 75/d, effexor xr 75/d, vanco po for cdiff discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 6. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 7. venlafaxine 75 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po daily (daily). 8. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 9. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 10. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 12. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 14. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed. 15. lasix 40 mg tablet sig: one (1) tablet po once a day for 10 days. 16. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours) for 10 days. 17. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 1 months. 18. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 19. coumadin 1 mg tablet sig: one (1) tablet po once a day. 20. dofetilide 250 mcg capsule sig: one (1) capsule po q12h (every 12 hours). discharge disposition: extended care facility: tba discharge diagnosis: pericardial and pleural effusion after mvr (25 mosaic, porcine), maze, left atrial appendage ligation discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month, and while taking narcotics no lifting more than 10 pounds for 10 weeks please call with any questions or concerns daily inr checks- very low coumadin for afib. close monitoring of liver function and renal tests while on dofetilide. followup instructions: make the following appointments: dr. (primary care)upon dischrage from rehab you have the following appointments: dr. phone: date/time: 11:40 dr. , md phone: date/time: 1:00 dr. phone: date/time: 10:00 md procedure: insertion of intercostal catheter for drainage pericardiotomy removal of thoracotomy tube or pleural cavity drain diagnoses: unspecified pleural effusion unspecified acquired hypothyroidism atrial fibrillation unspecified disease of pericardium iatrogenic pneumothorax osteoporosis, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other respiratory complications heart valve replaced by transplant rheumatic heart disease, unspecified functional disturbances following cardiac surgery 

Answer: The patient is high likely exposed to