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: history of present illness: this 87 year old woman has a known history of aortic stenosis with a recent echocardiogram revealing an estimated valve area of 0.4 cm squared and fairly well preserved left ventricular function. she was admitted for cardiac catheterization pre-aortic valve replacement. the patient reports generalized fatigue and weakness. she has occasional complaints of chest pressure. she denies claudication, orthopnea or edema. past medical history: significant for gastroesophageal reflux disease, hypertension, status post shingles, carotid artery disease status post right carotid endarterectomy, aortic stenosis, congestive heart failure, scleroderma and crest syndrome. past surgical history: she is status post appendectomy, status post hysterectomy, status post carotid endarterectomies as previously noted. allergies: the patient states no known drug allergies. medications on admission: aspirin, prilosec, cartia, trental, lasix and iron supplements. laboratory data: laboratory values on admission to the hospital are unremarkable with the exception of a creatinine of 1.4. physical examination: physical examination on admission to the hospital reveals she is alert and oriented. her chest was clear to auscultation. her heart was with regular rate and rhythm. abdomen was benign. she had no peripheral edema. the patient was taken to the cardiac catheterization laboratory which revealed nonobstructive flow in her coronary arteries. hospital course: the patient was taken to the operating room on where she underwent an aortic valve replacement with #19 carbomedics valve in the aorta position. postoperatively the patient was on intravenous propofol drip and intravenous nitroglycerin. she was transported from the operating room to the cardiothoracic intensive care unit in stable condition. the patient remained hemodynamically stable in the cardiac surgery recovery unit for approximately the first 48 hours postoperatively requiring some intravenous fluids for hypotension and required arteriovenous pacing for heartblock. on postoperative day #2 the patient became more wakeful. it was noted that she had evidence of some left-sided neglect. neurology consult was obtained. computerized tomography scan of her head was ordered at that time which was unremarkable. it was the recommendation of the neurology service to keep her anticoagulated and to repeat carotid studies at some point if symptoms had recurred. over the next few days in the intensive care unit the patient did require some nitroprusside as well as some intravenous milrinone for low cardiac index and elevated supraventricular rhythm. the patient also evidenced some low urinary output and was placed on low dose dopamine intravenous drip. an electrophysiology consult was obtained on postoperative day #7 due to continued need for pacing. a renal medicine consult was obtained on postoperative day #4 as well due to continued low urinary output. it was their recommendation to hold diuretics at that time to continue to maximize her cardiac output and to obtain a renal ultrasound to rule out obstruction. the patient remained in the intensive care unit on milrinone for the next few days. over the course of the next few days the patient woke up and became much more interactive from a neurologic standpoint. while she still evidenced some left leg weakness she was moving all extremities at this point in time. the patient remained dependent on pacemaker due to continued third degree heartblock. feeding tube was placed on postoperative day #5 since the patient's mental status precluded her from eating appropriately. she had been weaned from mechanical ventilator and extubated briefly but failed extubation requiring reintubation for respiratory failure on postoperative day #5. on postoperative day #6 the patient's pulmonary catheter was discontinued. she was more stable from the hemodynamic standpoint and her renal function had begun to improve. the patient was subsequently started on low dose intravenous heparin drip because of her mechanical valve and inability to start coumadin because of an anticipated need for permanent pacemaker. the patient was reintubated after being extubated for approximately 48 hours due to her respiratory failure. the patient remained arteriovenous paced via her epicardiac wires over the next few days. electrophysiology service thought that her other medical issues precluded her from having permanent pacemaker at that time. on , the plastic/hand surgery consultation was obtained due to mottled right hand. the right radial arterial line was immediately discontinued when the mottling was noted without improvement. warm compresses were initiated. anticoagulation was begin continued at the recommendation of the plastic surgery consult. on the morning of , there was increased mottling in the right hand and the patient was taken to the interventional radiology department where she has arteriogram which revealed no flow to the right hand as well as microvascular circulation which was shut down. total parenteral alimentation was injected through the catheter with what appeared to be minimal improvement initially, however, circulation to the hand did improve by the next morning. she had a palpable right radial pulse and the condition of the hand was significantly improved. the patient was taken to the operating room in for right palmar fasciotomy by the plastic surgery service. the patient's hand continued to improve over the next few days. the patient remained in the intensive care unit because of continued need for ventilatory support. she had another trial of extubation on , which she failed by respiratory arrest and required emergent reintubation. for this reason, she underwent a tracheostomy on for continued need for ventilatory support. it was attempted to place a percutaneous gastrostomy feeding tube but this was not possible because esophagoscopy could not be successfully accomplished due to likely esophageal strictures. over the next few days the patient stabilized from the hemodynamic standpoint and on the patient was taken to the electrophysiology laboratory. she underwent placement of a permanent esophagogastroduodenoscopy pacemaker. the patient tolerated that procedure well. the patient remained in the intensive care unit for continued need for ventilatory support. she continued to be fed through a nasogastric dobbhoff tube and placement in a rehabilitation facility screening was in initiated. over the next few days the patient remains hemodynamically stable in the intensive care unit. she is appropriately arteriovenous pacing, remained on a heparin drip for anticoagulation due to her mechanical aortic valve and coumadin was initiated. over the next few days, the patient has remained stable in the intensive care unit, was assessed again by the speech therapist for possible oral feedings, however, on the patient still evidenced clinical signs and symptoms of aspiration with a bedside evaluation. it was the recommendation of the speech therapist to continue tube feedings for nutritional support and not attempt oral feeds again and re-evaluate her in one to two weeks. for this reason, the patient was sent to the interventional radiology department where she underwent a gastroesophageal/jejunostomy feeding tube placement which was done by the interventional radiology service. the patient tolerated this procedure well. this was done on . the patient was continued on her tube feeds and tolerating it well. the patient has remained stable with short period of trach mask trials, tolerating two to four hours per day. she continues to tolerate her tube feeding through the new tube without any difficulty. she is ready to be discharged today to the rehabilitation facility to continue with cardiac rehabilitation, increasing strength and mobility, ventilator weaning and continued speech therapy for possible weaning from her feeding tube as well. the patient's condition today is as follows - she is afebrile. heartrate is 74. she is paced. her blood pressure is 100/64. her respiratory rate is 20. she is on cpap with aid of pressor support on a ventilator at 40% and has been off the ventilator for two hours today on a trach collar so far. the patient neurologically is alert and oriented and follows commands. her lungs are clear to auscultation bilaterally. her coronary examination is regular rate and rhythm. her abdomen is soft, nontender, nondistended. the patient's most recent laboratory values are from which reveal a white blood cell count of 9.1, hematocrit 29.4, platelet count 167. pt is 22.0, inr 3.2. sodium 138, potassium 4.0, chloride 102, carbon dioxide 29, bun 46, creatinine 0.9, glucose 90. the patient had received 1 mg of coumadin on , and on . she received no coumadin on . she is to receive no coumadin on . her inr target is 1.5 to 2.0. she will need to have prothrombin time/inr checked daily and if she falls below 2 be begun perhaps on 0.5 to 1 mg of coumadin at that time. discharge medications: 1. captopril 6.25 mg per gastrostomy tube t.i.d. 2. hydrochlorothiazide 12.5 mg gastrostomy tube q.d. 3. colace 100 mg gastrostomy tube b.i.d. 4. combivent metered dose inhaler 2 puffs via trach q. 6 hours 5. multivitamin one tablet q.d. 6. prevacid liquid 15 mg q.d. 7. vitamin c 500 mg via gastrostomy tube b.i.d. 8. zinc sulfate 220 mg per gastrostomy tube q.d. 9. lopressor 50 mg per gastrostomy tube b.i.d. 10. mycostatin powder to skin folds b.i.d. and prn 11. coumadin to be held today and pro-time/inr followed until it falls below 2 at which point she should be dosed with 0.5 to 1 mg to use a goal inr of 1.5 to 2.0 the patient is being tube fed through her interventional radiology placed jejunostomy feeding tube with full strength ultracal at 45 cc/hr which is her goal and she has been tolerating this well. condition on discharge: stable. discharge diagnosis: 1. severe aortic stenosis, status post aortic valve replacement 2. respiratory failure status post tracheostomy 3. third degree heartblock status post permanent pacemaker , m.d. dictated by: medquist36 procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters enteral infusion of concentrated nutritional substances initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle open and other replacement of aortic valve temporary tracheostomy percutaneous [endoscopic] gastrojejunostomy fasciotomy of hand diagnoses: acute kidney failure, unspecified unspecified protein-calorie malnutrition cardiac complications, not elsewhere classified aortic valve disorders atrioventricular block, complete cardiac arrest stricture of artery iatrogenic cerebrovascular infarction or hemorrhage 

Answer: The patient is high likely exposed to