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: vancomycin / penicillins / gentamicin / clindamycin / cefotaxime attending: chief complaint: chest pain major surgical or invasive procedure: redo sternotomy. single vessel coronary artery bypass grafting utilizing free left internal mammary artery to left anterior descending artery. aortic valve replacement utilizing a 19mm st. mechanical valve. egd and colonoscopy capsule study history of present illness: this is a 73 year old female with rheumatic heart disease and history of coronary artery disease. she underwent closed mitral commisurotomy in . she subsequently underwent single vessel coronary artery bypass grafting and mechanical mitral valve replacement in . since that time, she has undergone pci of the right coronary artery with placement of des in for recurrent angina. recently in , she presented to outside hospital with chest pain and ruled in for a small nstemi. echocardiogram at that time was notable for aortic stenosis. while on integrillin and heparin, she developed melena followed by a 17 unit gi bleed. once her bleeding issues resolved, she underwent cardiac catheterization. left ventriculograhpy showed an lvef of 50% without mitral regurgitation through the mechanical mvr. coronary angiography showed total occlusion of lad, 60% lesion in the distal circumflex and patent stents in the rca. the vein graft to the lad was known to be occluded. right and left heart catheterization demonstrated critical aortic stenosis with of 0.5cm2 and mean gradient of 37mmhg. the mean pa pressure was 30mmhg and cardiac output was 3.2l/min very consistent with congestive heart failure. based on the above results, she was transferred to the for cardiac surgical intervention. past medical history: congestive heart failure, aortic stenosis, atrial fibrillation, coronary artery disease with recent history of myocardial infarction - s/p pci/stenting to rca in , hypertension, hypercholesterolemia, chronic obstructive lung disease, interstitial lung disease, obesity, history of rheumatic heart disease - s/p mitral valve commisurotomy in , s/p mitral valve replacement(bjork shiley) and single vessel coronary artery bypass grafting(vein graft to left anterior descending) in , history of gi bleed(secondary to av malformations) - s/p cautery, cerebrovascular disease - history of cva in , chronic renal insufficiency, type ii diabetes mellitus, history of gout, history of gastritis/gerd, history of pulmonary embolus, recent deep vein thrombosis - s/p ivc filter in , anemia social history: lives with husband. denies use of tobacco, etoh, or illicit drugs. family history: non-contributory. physical exam: admission vitals: t 98.1, bp 118/80, hr 66 af, rr , sat 98% on 2l nc general: obese female in no acute distress heent: oropharynx benign, perrl, sclera anicteric neck: supple, no jvd, bilateral carotid bruits(versus transmitted murmur) heart: irregular rate, normal s1s2, 3/6 systolic murmur lungs: clear bilaterally abdomen: obese, soft, nontender, normoactive bowel sounds ext: warm, no edema, bilateral varicosities pulses: 1+ distally neuro: alert and oriented, nonfocal discharge vitals 98.7, 86 af 88/50, 18 2l nc neuro alert and oriented nonfocal pulmonary lungs clear bilaterally cardiac irregular sternal incision: healing no drainage no erythema, sternum stable abdomen soft nontender, nondistended, + bowel sounds ext warm, no edema pertinent results: 05:28am blood wbc-15.6* rbc-2.88* hgb-8.8* hct-25.1* mcv-87 mch-30.4 mchc-34.9 rdw-17.2* plt ct-246 01:12am blood wbc-21.9* rbc-3.26* hgb-10.0* hct-28.4* mcv-87 mch-30.6 mchc-35.2* rdw-16.2* plt ct-155 10:40pm blood wbc-10.2 rbc-3.77* hgb-11.6* hct-33.0* mcv-88 mch-30.8 mchc-35.2* rdw-17.6* plt ct-150 05:28am blood plt ct-246 05:28am blood pt-25.0* ptt-80.6* inr(pt)-2.5* 08:17pm blood pt-22.4* ptt-72.5* inr(pt)-2.2* 06:29am blood pt-17.6* ptt-60.2* inr(pt)-1.6* 10:40pm blood pt-13.3* ptt-47.9* inr(pt)-1.2* 10:40pm blood plt ct-150 05:28am blood glucose-107* urean-30* creat-0.8 na-135 k-3.9 cl-97 hco3-31 angap-11 10:40pm blood glucose-92 urean-10 creat-0.9 na-135 k-4.7 cl-101 hco3-26 angap-13 10:40pm blood alt-22 ast-23 ld(ldh)-244 alkphos-102 totbili-0.6 09:22pm blood calcium-8.5 phos-4.4 mg-1.9 10:40pm blood calcium-8.9 phos-3.7 mg-2.0 chest (pa & lat) 11:02 am chest (pa & lat) reason: evaluate left lower lobe opacity medical condition: 73 year old woman s/p redo sternotomy/avr/cabgx1 reason for this examination: evaluate left lower lobe opacity reason for examination: followup of a patient after sternotomy, aortic valve replacement and cabg. portable ap chest radiograph compared to . the pulmonary edema has been improved being now mild. the bilateral pleural effusions and left lower lobe retrocardiac atelectasis are unchanged. the replaced aortic valve is in unchanged position. impression: improvement in pulmonary edema, now being of mild degree. otherwise unchanged. atrial fibrillation with a controlled ventricular response. slight t wave inversions in leads i, avl and v4-v6 suggest possible anterolateral ischemia. compared to the previous tracing of the anterolateral t wave inversions are new. clinical correlation is suggested. read by: , intervals axes rate pr qrs qt/qtc p qrs t 80 0 98 390/425.71 0 85 128 conclusions: pre-bypass: the left atrium is dilated. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. mild spontaneous echo contrast is present in the left atrial appendage. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. no left ventricular aneurysm is seen. overall left ventricular systolic function is moderately depressed. there is mild global right ventricular free wall hypokinesis. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is moderate aortic valve stenosis (area 0.8-1.19cm2) mild to moderate (+) aortic regurgitation is seen. asingle tilting disk mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. the transmitral gradient is normal for this prosthesis. there is no pericardial effusion. post-bypass (on milrinone): mild lv global dysfunction. overall lvef 45%. aortic contour is maintained. mitral valve prosthesis appears similar to prebypass. a bileaflet aortic prosthesis visualized,well seated and no periprosthetic leaks seen. the images are poor due to acoustic shadowing . normal rv systolic function. electronically signed by , md on 15:46. physician: brief hospital course: ms. was admitted to the cardiac surgical service. she remained on heparin with no clinical signs of active gi bleed. she was started on ciprofloxacin for a urinary tract infection. given her recent history of massive gi bleed and known av malformations, the gi service was consulted to evaluate for any potential sources of bleeding prior to heparinization with cardiopulmonary bypass. capsule study was performed along with eus, egd and colonoscopy. egd found two polypoid lesions in the stomach adjacent to the ge junction. colonoscopy revealed a few non-bleeding diverticula. the diverticulosis appeared mild in severity. she was eventually cleared by the gi service to proceed with cardiac surgical intervention. (there are no official results of the eus and capsule study at the time of this dictation.) the rest of her hospital course was unremarkable. on , dr. performed redo sternotomy with single vessel cabg and aortic valve replacement. for further surgical details, please see seperate dictated operative note. following the operation, she was brought to the csru for invasive monitoring. she was slow to wake but eventually extubated on postoperative day three. she gradually weaned from neosynephrine and milrinone. she maintained stable hemodynamics and remained in a rate controlled atrial fibrillation. heparin was resumed for a subtherapeutic prothrombin time while warfarin anticoagulation was restarted. she was pan-cultured for a leukocytosis, white count peaked to 25k on postoperative day three. she did not experience fevers. sputum and blood cultures were negative while urine culture grew out yeast. white count gradually improved and no additional antibiotics were given. a bedside swallow examination was performed on postoperative five for a coughing episode following thin liquids. evaluation showed no overt signs of aspiration but silent aspiration could not be ruled out. a thin liquid/soft solid diet was recommended along with close supervision. her csru course was otherwise uneventful and she transferred to the sdu on postoperative day six. she continued to progress and was ready for discharge to rehab on pod 9 with plan for inr to be checked goal inr 3-3.5 medications on admission: aspirin 81 qd, lipitor 80 qd, aldactone 25 qd, lasix 80 , toprol xl 50 qd, allopurinol 300 qd, digoxin 0.125 qd, kdur, iv heparin/warfarin discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. lasix 40 mg tablet sig: two (2) tablet po twice a day. 7. acetaminophen-codeine 300-30 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 8. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours). 11. coumadin 3 mg tablet sig: three (3) tablet po once a day for 2 days: please take 3mg on and - have inr checked for further dosing. discharge disposition: extended care facility: - discharge diagnosis: congestive heart failure, aortic stenosis, atrial fibrillation, coronary artery disease with recent history of myocardial infarction, hypertension, hypercholesterolemia, chronic obstructive lung disease, interstitial lung disease, obesity, history of rheumatic heart disease - s/p mitral valve commisurotomy in , s/p mitral valve replacement(bjork shiley) and single vessel coronary artery bypass grafting(vein graft to left anterior descending) in , history of gi bleed(secondary to av malformations), cerebrovascular disease - history of cva in , chronic renal insufficiency, history of gout, history of gastritis/gerd, history of pulmonary embolus, recent deep vein thrombosis - s/p ivc filter in , anemia discharge condition: good discharge instructions: shower, no baths. no creams, lotions or ointments to incisions. no driving for at least one month. no lifting more than 10 lbs for at least 10 weeks from the date of surgery. monitor wounds for signs of infection. please call with any concerns or questions. monitor prothrombin time as directed. warfarin should be adjusted for goal inr between 3-3.5. followup instructions: dr. in weeks, please call for appt dr. in weeks, please call for appt dr. in weeks, please call for appt procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of aortic valve colonoscopy transfusion of packed cells endoscopic excision or destruction of lesion or tissue of stomach injection or infusion of oxazolidinone class of antibiotics other diagnostic procedures on stomach diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation chronic kidney disease, unspecified rheumatic heart failure (congestive) heart valve replaced by other means postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants personal history of venous thrombosis and embolism obesity, unspecified surgical or other procedure not carried out because of contraindication diverticulosis of colon (without mention of hemorrhage) rheumatic aortic stenosis angiodysplasia of stomach and duodenum with hemorrhage von willebrand's disease 

Answer: The patient is high likely exposed to