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: penicillins / sulfa (sulfonamide antibiotics) attending: chief complaint: transfer from osh for severe mr / sob major surgical or invasive procedure: cardiac catheterization mv repair ( 26mm 3d profile ring)/ cabg x1 ( svg to rca) history of present illness: 76 yo f with h/o copd, pvd and htn presented to osh on with sob, thought to be pna vs. copd exac. pt reports being in her usual state of health (active, without o2 requirement or dyspnea) until developing acute onset shortness of breath worsening over several minutes after walking her dog on . she describes difficulty catching her breath and diaphoresis, without any associated pain, nausea. based on initial workup was thought to be due to pneumonia, copd exacerbation and chf and thus was treated with abx, steroids, diuresis. was then noted to have severe mr murmur, with associated elevated bnp (663). echo revealed 4+ mr and could not rule out flail leaflet. she had ef 75% without wma. ecg and ce also without evidence of ischemia. hospital course also significant for lack of fever, but leukocytosis to 24 in setting of steroids. creatinine also increased to 1.6 on diuresis. vital signs on transfer: afebrile, 104/43, 80 sr, 20, 95% on 2liters on review of systems completely negative other than mentioned in hpi including history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors, exertional buttock or calf pain. cardiac cath done which showed severe mr chordae and 70-80% rca lesion. referred for surgery. past medical history: hypertension chronic obstructive pulmonary disease - no oxygen at home peripheral vascular disease s/p aorto-bifemoral bypass glaucoma hyperlipidemia panic attacks stomach ulcer social history: lives in e with son and . 1 of 11 kids, has 4 kids, 9 , 3 great . -tobacco history: former heavy smoker -1ppd x 60 years, quit 3 years ago. -etoh: none -illicit drugs: none very active at baseline->gardens, vacuums, takes dog for walk 6x/day family history: extensive heart disease including mi in father in 40s, sudden death in brother, murmur in brother, "arteries cleaned" in sister, sons with cad physical exam: 61" 111# vs: afeb, 93, 140/79, 21, 97% on 2l general: wdwn woman in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. no xanthalesma. neck: supple with jvp to earlobe. cardiac: prominent pmi irregularly irregular, normal s1, soft s2. loud systolic high pitched murmur at apex radiating to axilla. soft diastolic murmur at apex lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi anteriorly. unable to assess posteriorly because has to lay flat post-cath. abdomen: soft, ntnd. no tenderness. extremities: no c/c/e. no femoral bruits. strong distal pulses pertinent results: osh labs/radiology: inr-1.1 bun 41 cr 1.60 (was 1.02) lytes otherwise wnl wbc 24.4 from 8.7 on hct 42.3 plt 181 myoglobins: 92-->100-->193 () troponin i: 0.02, 0.02, 0.035 () urine: 25 leuks, 5-10wbc abg: 7.44/31/62 bnp: 663 cardiac cath right dominant lmca diffuse w/ ostial 30% lad 40% after d1 lcx mild diffuse rca diffuse disease w/ serial 70-80% stenosis throughout moderately elevated l sided pressures w/ giant v wave c/w mr htn rvedp 7 pcw mean 32 pa mean 34 lvedp 17 ct chest : 5mm incidental lung nodule. recommend f/u ct scan in a few months. final read pending. conclusions prebypass no atrial septal defect is seen by 2d or color doppler. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is partial mitral leaflet flail. an eccentric, anteriorly directed jet of severe (4+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. dr. was notified in person of the results on at 1430. post bypass patient is av paced and receiving an infusion of phenylephrine, epinephrine and milrinone. lvef is globally reduced to 35% annuloplasty ring seen in the mitral position. appears well seated and there is mild mitral regurgitation. mean gradient across the mitral valve is 4 mm hg. there is no systolic anterior motion. aorta appears intact post decannulation. mild aortic insufficiency persists. the tricuspid regurgitation is now mild to moderate dr aware of post bypass findings. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 11:15 brief hospital course: # sob: this was thought likely due to severe acute mr leading to pulmonary edema. had been getting moxifloxacin at osh but post diuresis cxr showed no evidence of infection. cxr showed no infiltrate. antibiotics were discontinued. steroids were discontinued as well. patient remained afebrile and euvolemic prior to surgery. # mitral regurgitation: possible etiologies include 1. ischemia although never had cp has significant rfs inc. htn, hl, family history, and with rca at 70-80% stenosis could have infarcted posterior leaflet 2. infection but denies recent sick symptoms inc. fevers and no signs endocarditis on exam, 3. trauma but patient denies history of trauma. ct surgery was consulted and recommended mvr vs mvr. patient had pre-op carotid studies showing 40-59% stenosis bilaterally as well as chest ct and cxr that showed a pulmonary nodule that will need to be follow up as an outpatient in a few months. # cad: no h/o cad, no h/o cp per patient. had cardiac cath (via radial artery as has bilateral le bypasses) to assess severity of valve disease and cad for potential bypass in conjunction with mvr if necessary. cath with mild lcx and lad disease and tight rca disease not intervened upon. has rca with significant stenosis by numbers (no pressure or ivus done). plan to have 1 vessel cabg during mv surgery. continued asa, statin. after cath done, pre-op workup completed. underwent surgery with dr. on . transferred to the cvicu in stable condition on epinephrine, milrinone, and propofol drips.extubated the next day but developed acute renal failure.had rapid a fib and was treated with amidoarone drip and subsequent oral dosing. ep was consulted for management. creatinine continued to decline and she was transferred to the floor on pod #5 to begin increasing her activity level. coumadin was started for a fib. ace-i added for tighter bp control. ef noted to be approx 35% post-cpb in or. chest tubes and pacing wires removed per protocol. cleared for discharge to rehab on pod #9. target inr is 2.0-2.5 for a fib. medications on admission: medications at home: -albuterol nebs q4h -alprazolam 0.75mg qhs -carvedilol 3.125mg -lisinopril 20mg -pantoprazole 40mg daily -simvastatin 20mg daily -asa 325mg daily medications on transfer: moxifloxacin 400mg daily advair 100/50 spiriva 18mcg albuberol nebs solumedrol 40mg iv q6h bumex 1mg iv bid lisinopril 40mg daily simvastatin 40mg daily carvedilol 3.125mg asa 325mg daily alprazolam 0.25mg daily pantoprazole 40mg daily tylenol prn discharge medications: 1. aspirin 81 mg , delayed release (e.c.) sig: one (1) , delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): for one month. 3. simvastatin 40 mg sig: 0.5 po daily (daily). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. pantoprazole 40 mg , delayed release (e.c.) sig: one (1) , delayed release (e.c.) po q24h (every 24 hours). 7. alprazolam 0.25 mg sig: one (1) po bid (2 times a day) as needed. 8. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. 9. oxycodone-acetaminophen 5-325 mg sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb soln 0.083% inhalation q4h (every 4 hours) as needed. 11. acetaminophen 325 mg sig: two (2) po q4h (every 4 hours) as needed. 12. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 13. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 14. warfarin 1 mg sig: daily md po once daily at 4 pm: daily dosing per hcp- target inr 2.0-2.5. 15. amiodarone 200 mg sig: two (2) po daily (daily) for 7 days: 400 mg daily for 7 days until ; then 200 mg daily ongoing. 16. lisinopril 5 mg sig: one (1) po daily (daily). 17. metoprolol tartrate 25 mg sig: one (1) po bid (2 times a day). 18. furosemide 20 mg sig: one (1) po bid (2 times a day). 19. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. discharge disposition: extended care facility: of discharge diagnosis: mitral regurgitation s/p mv repair/cabg x1 coronary artery disease postop atrial fibrillation hypertension hyperlipidemia peripheral vascular disease s/p aorto-bifem bypass graft chronic obstructive pulmonary disease glaucoma panic attacks stomach ulcer discharge condition: deconditioned 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 any incision no driving for one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: call and schedule the following appointments; dr. in 4 weeks pcp . in weeks cardiologist dr. in weeks **** will need chest ct in future to follow-up on pulmonary nodule as outpatient with pcp procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures open heart valvuloplasty of mitral valve without replacement diagnoses: acidosis anemia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified atherosclerosis of aorta atrial fibrillation other chronic pulmonary heart diseases peripheral vascular disease, unspecified personal history of tobacco use unspecified glaucoma occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia iatrogenic pneumothorax surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants other diseases of lung, not elsewhere classified gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction urinary complications, not elsewhere classified tricuspid valve disorders, specified as nonrheumatic occlusion and stenosis of basilar artery without mention of cerebral infarction panic disorder without agoraphobia atherosclerosis of other specified arteries 

Answer: The patient is high likely exposed to