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: dyspnea on exertion major surgical or invasive procedure: aortic valve replacement (25mm st. porcine valve) history of present illness: mr. is a 77-year-old male with worsening symptoms of heart failure and chest tightness and dyspnea on exertion related to critical symptomatic aortic stenosis with a bicuspid aortic valve. past medical history: aortic stenosis hypertension hyperlipidemia heart failure arthritis sleep apnea abdominal aortic aneurysm skin cancer s/p removal s/p cholecystectomy s/p back surgery social history: quit smoking 30 years ago after 25 pack year history. rare alcohol use. lives alone. family history: non-contributory physical exam: physical examination in the office (preop ) revealed a pulse of 74 and regular, respirations of 18, and blood pressure of 160/80. in general, he was a well-developed and well-nourished elderly gentleman in no acute distress. his skin was unremarkable. his oropharynx was benign. neck was supple with full range of motion. there was no jvd. lungs were clear to auscultation bilaterally. heart had a regular rate and rhythm, normal s1 and s2 with a iii/vi systolic ejection murmur. abdomen was soft, nontender, and nondistended. extremities were warm and well perfused with 1+edema bilaterally. his greater saphenous veins did not display varicosities. neurologically, he was alert and oriented x3. cranial nerves ii through xii were grossly intact. he had 5/5 strength and no focal deficits were appreciated. his distal pulses were 2+and no carotid or femoral bruits were appreciated. pertinent results: 05:35am blood wbc-6.1 rbc-3.39* hgb-10.6* hct-31.4* mcv-93 mch-31.4 mchc-33.9 rdw-14.1 plt ct-159 11:45am blood wbc-10.7# rbc-3.96* hgb-12.2* hct-35.1* mcv-89 mch-30.7 mchc-34.7 rdw-13.5 plt ct-141* 05:30am blood pt-21.6* inr(pt)-2.1* 11:45am blood pt-15.4* ptt-37.9* inr(pt)-1.4* 05:35am blood glucose-109* urean-41* creat-1.1 na-141 k-4.3 cl-104 hco3-29 angap-12 12:31am blood glucose-113* urean-26* creat-1.1 na-138 k-4.7 cl-110* hco3-23 angap-10 06:08am blood alt-20 ast-50* ld(ldh)-253* alkphos-64 amylase-34 totbili-1.0 echocardiography report , portable tte (complete) done at 3:33:42 pm final referring physician information , cardiology , 4 , status: inpatient dob: age (years): 77 m hgt (in): 71 bp (mm hg): 150/75 wgt (lb): 209 hr (bpm): 86 bsa (m2): 2.15 m2 indication: abnormal ecg. aortic valve disease. s/p catherization. icd-9 codes: 425.4, 427.89, 424.1, 424.0, 424.2 test information date/time: at 15:33 interpret md: , md test type: portable tte (complete) son: doppler: full doppler and color doppler test location: west echo lab contrast: none tech quality: adequate tape #: 2009w006-0:0 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: 3.3 cm <= 4.0 cm left atrium - four chamber length: 4.9 cm <= 5.2 cm right atrium - four chamber length: *5.7 cm <= 5.0 cm left ventricle - septal wall thickness: *2.3 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.6 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.2 cm <= 5.6 cm left ventricle - systolic dimension: 2.4 cm left ventricle - fractional shortening: 0.54 >= 0.29 left ventricle - ejection fraction: >= 75% >= 55% left ventricle - stroke volume: 83 ml/beat left ventricle - cardiac output: 7.15 l/min left ventricle - cardiac index: 3.33 >= 2.0 l/min/m2 left ventricle - lateral peak e': *0.03 m/s > 0.08 m/s left ventricle - septal peak e': *0.02 m/s > 0.08 m/s left ventricle - ratio e/e': *24 < 15 aorta - sinus level: *4.4 cm <= 3.6 cm aorta - ascending: *4.3 cm <= 3.4 cm aortic valve - peak velocity: *4.4 m/sec <= 2.0 m/sec aortic valve - peak gradient: *76 mm hg < 20 mm hg aortic valve - mean gradient: 29 mm hg aortic valve - lvot pk vel: 1.16 m/sec aortic valve - lvot vti: 24 aortic valve - lvot diam: 2.1 cm aortic valve - valve area: *1.0 cm2 >= 3.0 cm2 mitral valve - e wave: 0.6 m/sec mitral valve - a wave: 0.8 m/sec mitral valve - e/a ratio: 0.75 mitral valve - e wave deceleration time: *136 ms 140-250 ms tr gradient (+ ra = pasp): *24 to 27 mm hg <= 25 mm hg findings left atrium: normal la size. right atrium/interatrial septum: mildly dilated ra. left ventricle: severe symmetric lvh. normal lv cavity size. normal regional lv systolic function. hyperdynamic lvef >75%. estimated cardiac index is normal (>=2.5l/min/m2). tdi e/e' >15, suggesting pcwp>18mmhg. no resting or valsalva inducible lvot gradient. apical intracavitary gradient. right ventricle: normal rv chamber size and free wall motion. aorta: moderately dilated aortic sinus. moderately dilated ascending aorta. aortic valve: moderately thickened aortic valve leaflets. moderate-severe as (area 0.8-1.0cm2). trace ar. mitral valve: normal mitral valve leaflets. trivial mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. borderline pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not visualized. no ps. physiologic pr. pericardium: no pericardial effusion. conclusions the left atrium is normal in size. there is severe symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no left ventricular outflow obstruction at rest or with valsalva. an apical intracavitary gradient is identified. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the aortic valve leaflets are moderately thickened. there is moderate to severe aortic valve stenosis (area 1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: severe left ventricular hypertrophy with hyperdynamic systolic function. moderate to severe aortic stenosis. moderately dilated ascending aorta and aortic root. electronically signed by , md, interpreting physician 18:07 ?????? caregroup is. all rights reserved. brief hospital course: admitted and went to surgery for aortic valve replacement (#25mm st. porcine valve). see operative report for further details. he was transferred to the cvicu for hemodynamic monitoring. in first twenty four hours he was weaned from sedation, awoke neurologically intact and was extubated without complications. on postoperative day one he went into atrial fibrillation that was treated with amiodarone and lopressor. overnight day 1 into day 2 he had pauses > 10 seconds and amiodarone was discontinued. he had no further prolonged pauses off amiodarone but remained in atrial fibrillation. he was started on coumadin for anticoagulation. sleep consult was called due history of sleep apnea and he was placed on auto cpap as tolerated. general surgery consulted for abdominal distention and distended loops in bowel evident on kub. he received bowels medications with flatus, bowel movements, and over few days the abdomen improved. his diet was progressed and he has been tolerating regular diet. ep consulted for rapid atrial fibrillation with rate not controlled with beta blockers, and diltiazem drip was started. his medications were adjusted to toprol xl in am and cardizem cd in pm with heart rate 70-100 atrial fibrillation. he was discharged home with his family and vna services. medications on admission: aspirin 325mg daily, lisinopril 10mg daily, zocor 40mg daily, lasix 20mg daily, norvasc 10mg daily, inderal 40mg daily discharge medications: 1. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 5. psyllium packet sig: one (1) packet po daily (daily). disp:*30 packet(s)* refills:*0* 6. metoprolol succinate 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). disp:*60 tablet sustained release 24 hr(s)* refills:*0* 7. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). disp:*30 capsule, sustained release(s)* refills:*0* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily) for 10 days. disp:*10 tablet(s)* refills:*0* 9. potassium chloride 10 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 10 days. disp:*10 tab sust.rel. particle/crystal(s)* refills:*0* 10. simvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 11. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: please take 2.5mg tablet - then have blood drawn and further dosing by dr . disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: aortic stenosis s/p aortic valve replacement atrial fibrillation acute on chronic diastolic heart failure hypertension hyperlipidemia arthritis obstructive sleep apnea abdominal aortic aneurysm skin cancer s/p removal s/p cholecystectomy s/p back surgery 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 no lifting more than 10 pounds for 10 weeks please call with any questions or concerns please get refitted for bipap mask and wear at night time, follow up with sleep clinic followup instructions: please call to schedule appointments dr. in 4 weeks () dr. in weeks dr. in weeks () sleep clinic in weeks () pt/inr for coumadin dosing: goal inr 2.0-2.5 for atrial fibrillation first draw with results to dr office phone # fax procedure: extracorporeal circulation auxiliary to open heart surgery intraoperative cardiac pacemaker non-invasive mechanical ventilation open and other replacement of aortic valve diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders other and unspecified hyperlipidemia personal history of other malignant neoplasm of skin paralytic ileus surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation abdominal aneurysm without mention of rupture congenital insufficiency of aortic valve arthropathy, unspecified, site unspecified 

Answer: The patient is high likely exposed to