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: iodine attending: chief complaint: decreased exercise tolerance major surgical or invasive procedure: aortic valve replacement with a mechanical st. size 23-mm valve history of present illness: 55 year old male with progressive intolerance for activity over the previous 12-18 months. he was found to have a murmur on exam with his pcp. revealed severe ai. he was referred for tee which confirmed severe ai and showed flail right coronary cusp. he is referred for surgical evaluation. past medical history: colon ca s/p anastomotic reconstruction followed by chemotherapy/radiation port-a-cath discontinued in erectile dysfunction fecal stress incontinence chronic right sided sinus pressure decreased auditory acuity tonsillectomy colon resection as above social history: mr. lives in with his wife. one daughter lives at home with him. his occupation is teaching video data networks. he has never smoked or used illicit drugs and drinks two beers per week. family history: his father had an unknown cancer diagnosed at age 70. physical exam: pulse: 76 resp: 14 o2 sat: 97%ra b/p right: left: 180/71 height: 5'" weight: 195lb general: nad, wgwn, appears stated age skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur grade _3/6 diastolic_ abdomen: soft non-distended non-tender +bs extremities: warm , well-perfused edema none varicosities: none neuro: grossly intact pulses: femoral right: 2+ left:2+ dp right: 2+ left:2+ pt : 2+ left:2+ radial right: 2+ left:2+ pertinent results: echocardiography report left atrium: dilated la. mild spontaneous contrast in the body of the la. no mass/thrombus in the laa. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. mild symmetric lvh. moderately dilated lv cavity. normal regional lv systolic function. moderately depressed lvef. right ventricle: normal rv systolic function. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no masses or vegetations on aortic valve. no aortic valve abscess. no as. severe (4+) ar. eccentric ar jet directed toward the anterior mitral leaflet. mitral valve: mildly thickened mitral valve leaflets. physiologic mr tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) pr. pericardium: trivial/physiologic pericardial effusion. conclusions pre-bypass: the left atrium is dilated. mild spontaneous contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately to severely dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is globally, moderately depressed (lvef= 30-35 %). the right ventricle displays normal free wall contractility. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. there is no aortic valve stenosis. there is severe prolapse of right coronary cusp and also some prolapse of one of the other leaflets. severe (4+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is a trivial/physiologic pericardial effusion. dr. was notified in person of the results in the operating room at the time of the study. post-bypass: the patient is receiving epinephrine by infusion. the patient was av paced. there is normal right ventricular systolic function. the left ventricle displasia new septal dyskinesis that may be secondary to pacemaking vs. new intraventricular conduction delay vs. ischemia. the rest of the left ventricular segments display improved function relative to the pre-bypass exam. overall ejection fraction is likely marginally improved to the 35-40% range. there is a bileaflet prosthesis in the aortic position. it appears well seated and displays normal leaflet motion. at a cardiac output of 6.5 liters/minute, the maximum gradient across the valve was 28 mmhg woith a mean gradient of 13 mmhg and an effective area of about 1.9 cm2. there is trace aortic regurgitation as consistent with this prosthesis. the thoracic aorta is intact after decannulation. no other significant changes from the pre-bypass findings. pa and lateral chest compared to : left lower lobe atelectasis nearly resolved. small residual pleural effusions and stable normal-appearing postoperative cardiomediastinal silhouette, heart size increased since the last preoperative study on . no pulmonary edema. no pneumothorax. ekg normal sinus rhythm. left bundle-branch block with secondary st-t wave abnormalities. compared to the previous tracing of the left bundle-branch block is new. intervals axes rate pr qrs qt/qtc p qrs t 87 158 138 416/463 70 -52 107 admission labs: 08:05am hgb-13.4* calchct-40 11:11am hgb-10.4* calchct-31 11:57am fibrinoge-174 11:57am pt-14.9* ptt-28.4 inr(pt)-1.3* 11:57am plt count-176 12:01pm glucose-183* lactate-2.3* na+-136 k+-5.1 cl--107 01:12pm urea n-19 creat-1.2 sodium-142 potassium-4.0 chloride-110* total co2-23 anion gap-13 discharge labs: 06:00am blood wbc-5.4 rbc-3.97* hgb-11.8* hct-34.3* mcv-86 mch-29.6 mchc-34.3 rdw-13.6 plt ct-193 05:32am blood pt-29.2* inr(pt)-2.8* 06:00am blood glucose-105* urean-18 creat-0.9 na-140 k-3.8 cl-107 hco3-28 angap-9 03:45pm blood alt-14 ast-23 ld(ldh)-350* alkphos-44 totbili-0.5 06:00am blood calcium-8.3* phos-3.2 mg-2.0 brief hospital course: 55-year-old patient with progressive intolerance for activity over the previous several months was found to have a cardiac murmur. a subsequent investigation showed severe aortic valve regurgitation with some dilatation of the left ventricle with an ejection fraction about 35%. a`coronary angiogram had non obstructive coronary artery disease. the patient was admitted for elective aortic valve replacement on . he was taken to the operating room and had aortic valve replacement with a mechanical st. size 23-mm valve, his bypass time was 145 minutes with a crossclamp of 132 minutes. please see operative report for further details. he tolerated the procedure well and was transferred to the cvicu intubated and sedated in stable condition. he weaned off pressor support, awoke neurologically intact and was extubated without incident. anticoagulation was initiated with coumadin for his mechanical valve. beta-blocker and diuresis were initiated. all tubes, lines and drains were discontinued per cardiac surgery protocol. on pod1 he was transferred to the step down unit for further monitoring. physical therapy was consulted for evaluation of strength and mobility. an ace-i was started for hypertension management. he continued with issues with hypertension so he was transitioned to hctz and lasix was stopped, additionally he was taken off lopressor and placed on carvedilol for chronic sytolic heart failure and hypertension with good response. the remainder of his hospital stay was uneventful, he continued to progress and was cleared for discharge to home on pod 6 his inr is to be followed by dr. medications on admission: zyrtec 10 mg once a day aspirin 325 mg once a day discharge medications: 1. outpatient lab work labs: pt/inr for coumadin ?????? indication :mechanical avr goal inr 2.5-3 first draw results to phone primary care dr., j. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nares . 4. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 5. outpatient lab work lft in 1 month - results to pcp statin 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 7. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 8. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). disp:*qs qs* refills:*1* 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 11. outpatient lab work lft 1 month result to pcp statin 12. lisinopril 20 mg tablet sig: one (1) tablet po twice a day: start am. disp:*60 tablet(s)* refills:*1* 13. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. disp:*30 tablet, er particles/crystals(s)* refills:*1* 14. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*1* 15. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*1* 16. warfarin 2 mg tablet sig: goal inr 2.5-3 tablets po once a day: dose to be adjusted based on inr . disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: aortic insufficiency s/p avr hypertension chronic systolic heart failure colon ca s/p anastomotic reconstruction followed by chemotherapy/radiation erectile dysfunction fecal stress incontinence chronic right sided sinus pressure decreased auditory acuity tonsillectomy colon resection discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with tramadol/tylenol incisions: sternal - healing well, no erythema or drainage discharge instructions: please 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 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 and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive 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** followup instructions: labs: pt/inr ?????? indication :mechanical avr goal inr 2.5-3 first draw - results to phone primary care dr. please check pt/inr monday and wednesday and friday for first two weeks then decrease as directed by pcp you are scheduled for the following appointments surgeon: dr on at 1:30 wound check - on at 10:30 cardiac surgery office . cardiologist: dr on 4:00 please call to schedule appointments with your primary care 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: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve cardiopulmonary resuscitation, not otherwise specified diagnoses: other iatrogenic hypotension congestive heart failure, unspecified unspecified essential hypertension intestinal bypass or anastomosis status aortic valve disorders chronic systolic heart failure long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine syncope and collapse dizziness and giddiness other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use sympatholytics [antiadrenergics] causing adverse effects in therapeutic use other disease of nasal cavity and sinuses 

Answer: The patient is high likely exposed to