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: macrolide antibiotics / sulfa (sulfonamides) attending: chief complaint: doe major surgical or invasive procedure: - mvr(29mm st. mechanical ; asd closure. history of present illness: 56 yo f with chf & increasing doe. history of heart murmur since age 19. past medical history: pmh: ms/mr, chf, rf(child), afib, htn, psh: lumbar disc, lft shoulder, tubal ligation, c-section x3, hyst, social history: unemployed current tob, 40 pack year history no etoh lives with husband family history: father with mi @ 37 physical exam: pleasant women in nad full dentures lungs ctab heart rrr soft diastolic murmur abdomen benign extrem warm, no edema, 2+ pulses bilateral carotid bruits pertinent results: 06:05am blood wbc-16.4* rbc-3.30* hgb-9.9* hct-29.1* mcv-88 mch-29.9 mchc-34.0 rdw-14.3 plt ct-531* 12:19am blood wbc-33.7* rbc-3.73* hgb-11.2* hct-34.0* mcv-91 mch-30.0 mchc-32.9 rdw-14.4 plt ct-225 07:35pm blood wbc-15.5* rbc-4.35 hgb-13.3 hct-38.6 mcv-89 mch-30.5 mchc-34.5 rdw-13.3 plt ct-329 11:25am blood neuts-70.0 lymphs-19.3 monos-6.8 eos-3.1 baso-0.8 07:35pm blood neuts-65.8 lymphs-24.8 monos-5.3 eos-3.4 baso-0.8 06:05am blood plt ct-531* 06:05am blood pt-24.7* inr(pt)-2.5* 07:35pm blood plt ct-329 07:35pm blood pt-11.3 ptt-22.0 inr(pt)-1.0 06:05am blood glucose-84 urean-14 creat-0.8 na-139 k-4.8 cl-101 hco3-31 angap-12 07:35pm blood glucose-114* urean-15 creat-0.9 na-140 k-4.5 cl-100 hco3-29 angap-16 07:35pm blood alt-49* ast-35 alkphos-116 amylase-50 totbili-0.3 07:35pm blood lipase-50 06:15am blood calcium-8.7 phos-3.3 mg-2.3 07:35pm blood %hba1c-5.4 2:30 pm urine source: cvs. **final report ** urine culture (final ): no growth. radiology final report chest (pa & lat) 2:47 pm chest (pa & lat) reason: evaluate ? effusion medical condition: 56 year old woman with mr reason for this examination: evaluate ? effusion two-view chest, comparison: . indication: status post mitral surgery. there has been median sternotomy and mitral replacement. cardiomediastinal contours are stable in appearance since the previous postoperative radiograph. improving areas of atelectasis are present in both lower lobes with predominantly discoid areas of atelectasis remaining. small residual left pleural effusion is present, decreased in size. there is no pneumothorax. impression: resolving basilar atelectasis and improving small left pleural effusion. dr. approved: 5:12 pm cardiology report ecg study date of 1:03:46 pm baseline artifact. sinus rhythm at upper limits of normal rate. since the previous tracing of probably no significant change. read by: , a. intervals axes rate pr qrs qt/qtc p qrs t 96 150 78 56 cardiology report echo study date of patient/test information: indication: intraoperative tee for mvr height: (in) 60 weight (lb): 140 bsa (m2): 1.61 m2 status: inpatient date/time: at 09:51 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw4-: test location: anesthesia west or cardiac technical quality: suboptimal referring doctor: dr. r. measurements: left atrium - long axis dimension: *6.4 cm (nl <= 4.0 cm) left ventricle - ejection fraction: 60% to 65% (nl >=55%) aorta - ascending: 2.5 cm (nl <= 3.4 cm) mitral - mean gradient: 10 mm hg mitral - pressure half time: 245 ms - mva (p t): 1.5 cm2 interpretation: findings: left atrium: marked la enlargement. no spontaneous echo contrast is seen in the laa. good (>20 cm/s) laa ejection velocity. no thrombus in the laa. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. left-to-right shunt across the interatrial septum at rest. small secundum asd. left ventricle: suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending aorta diameter. simple atheroma in ascending aorta. simple atheroma in aortic arch. simple atheroma in descending aorta. aortic : mildly thickened aortic leaflets (3). no as. no ar. mitral : mildly thickened mitral leaflets. mild mitral annular calcification. moderate valvular ms (mva 1.0-1.5cm2) mild to moderate (+) mr. tricuspid : normal tricuspid leaflets with trivial tr. pulmonic /pulmonary artery: pulmonic not well seen. pericardium: trivial/physiologic pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. suboptimal image quality. the patient appears to be in sinus rhythm. results conclusions: pre-bypass: 1. the left atrium is markedly dilated. 2. no spontaneous echo contrast is seen in the left atrial appendage. no thrombus is seen in the left atrial appendage. 3. a left-to-right shunt across the interatrial septum is seen at rest. a small secundum atrial septal defect is present. 4. overall left ventricular systolic function is normal (lvef>55%). poor imaging prevents complete exclusion of a focal wall motion abnormality. 5. right ventricular chamber size and free wall motion are normal. 6. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 7. there are three, mildly thickened, aortic leaflets. no aortic regurgitation is seen. 8. the mitral leaflets are mildly to moderately thickened and calcified. the anterior mitral leafllet displays a rheumatic type deformity. there is moderate mitral stenosis. mild to moderate mitral regurgitation is seen. post-bypass: 1. biventricular systolic function is well preserved. 2. a bileaflet prosthetic is located in the mitral position. it is well seated and displays normal leaflet function. mild valvular mitral regurgitation, normal for this prosthesis, is seen. small perivalvular leaks can not be ruled out. peak gradient across the is 12.2 mmhg and mean gradient across the is 4.6mmhg. 3. the small secundum asd is noted s/p attempted closure though the jet width is decreased compared to pre-cpb exam. 4. aortic contours post-decannulation are intact. electronically signed by , md on 12:29. physician: pathology examination name birthdate age sex pathology # , 56 female report to: dr. . gross description by: dr. /dif specimen submitted: mitral . procedure date tissue received report date diagnosed by dr. /nbh diagnosis: mitral : fibromyxoid degeneration. clinical: mitral regurg/mitral replacement. gross: the specimen is received fresh labeled with ", ", the medical record number and "mitral " and consists of two pieces of mitral tissue measuring 6.4 x 2.4 x 0.5 cm. the specimen is thickened but is otherwise unremarkable. the specimen is represented in a. brief hospital course: mr. was admitted preoperatively for iv heparin and preoperative work. on she was taken to the operating room where she underwent an mvr with a st. mechanical . she was transferred to the icu in critical but stable condition. she awoke and was extubated later that same day. she was transferred to the floor on pod #1. she was started on coumadin & heparin gtt for her mechanical . she awaited therapeutic inr. her white count remained elevated with no fever or signs or symptoms of infection. wbc was 16 and was discharged home with plan for wbc in 3 days. medications on admission: ecotrin lopressor discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 3. 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* 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 5. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily) for 5 days. 8. coumadin 5 mg tablet sig: goal inr 3-3.5 tablets po once a day. disp:*90 tablet(s)* refills:*0* 9. coumadin 1 mg tablet sig: goal inr 3-3.5 tablets po once a day. disp:*90 tablet(s)* refills:*0* 10. coumadin you have been given prescription for 5mg and 1mg coumadin tablets please take 6mg fri, sat, sun. blood draw monday with results to dr for further dosing of your coumadin 11. outpatient work pt/inr for coumadin dosing mon-wed-fri goal inr 3-3.5 for mechanical mitral results to dr office # fax 12. outpatient work wbc - please draw monday with results to dr office # fax # discharge disposition: home with service facility: vna discharge diagnosis: ms/mr s/p mvr (29mm st. mechanical)and asd closure asd chf hyperlipidemia rheumatic fever af htn 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 followup instructions: follow-up with dr. in 1 month. ( follow-up with dr. in weeks. follow-up with pcp . in weeks. please call all providers for appointments. wound check 2 please schedule with rn labs wbc with results to dr pt/inr for coumadin dosing mon-wed-fri goal inr 3-3.5 for mechanical mitral results to dr office # fax procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of mitral valve other and unspecified repair of atrial septal defect diagnoses: unspecified essential hypertension atrial fibrillation rheumatic heart failure (congestive) other and unspecified hyperlipidemia acquired cardiac septal defect mitral stenosis with insufficiency 

Answer: The patient is high likely exposed to