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 / ceclor / avelox / ceftin / levaquin / erythromycin base / tetracycline / antihistamines / beta-adrenergic blocking agents attending: chief complaint: 71m with increased fatigue and sob over past 6 months. major surgical or invasive procedure: mv repair (#28 annuloplasty band) history of present illness: this 71f has a h/o , af, , mr, and tr, and has had increasing fatigue and shortness of breath over the past 6 months. an echo on revealed: pulm. , biatrial enlargement, +mr, and 3+tr. cardiac cath showed nl coronaries, 55% lvef, 3+mr and ^filling pressures. she is now admitted for mv repair. past medical history: chronic af mr copd ^chol. mild incontinence pvd social history: cigs: smoked 2ppd for 37 yrs. quit 20 yrs. ago. etoh: quit 30 yrs. ago lives with her husband. family history: +cad physical exam: elderly wf in nad afeb p:100 r:15 bp:137/75 heent:nc/at, perla, eomi, oropharynx benign neck: supple, from, no lymphadenopathy or thyromegaly, carotids 2+= bilat. without bruits lungs: clear to a+p abd: +bs, soft, nontender, without masses or hepatosplenomegaly ext: no c/c/e, pulses: fem 2+= bilat. dp dopp bilat. pt dopp bilat. rad 2+= bilat neuro: nonfocal pertinent results: 04:57am blood wbc-7.8 rbc-3.20* hgb-10.2* hct-29.3* mcv-92 mch-31.9 mchc-34.9 rdw-14.2 plt ct-112* 06:00am blood pt-17.6* ptt-27.9 inr(pt)-1.6* 04:57am blood glucose-80 urean-22* creat-1.2* na-134 k-4.7 cl-102 hco3-23 angap-14 radiology final report chest (pa & lat) 1:23 pm chest (pa & lat) reason: eval post op medical condition: 71 year old woman s/p mvr reason for this examination: eval post op reason for the study: evaluation postop. technique of the study: pa and lateral view of the chest. comparison is done to the study done on . findings: there are bilateral small pleural effusions that are new compared to the previous study. there is improved retrocardiac opacity. there is spina bifida occulta at the level of t3 thoracic vertebra. heart size, mediastinal and hilar contours are normal. impression: new mild bilateral pleural effusions. improving retrocardiac atelectasis. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 4:13 pm cardiology report echo study date of patient/test information: indication: intraoperative tee for mitral valve repair versus replacement height: (in) 64 weight (lb): 153 bsa (m2): 1.75 m2 bp (mm hg): 127/68 hr (bpm): 65 status: inpatient date/time: at 12:49 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2006aw2-: test location: anesthesia west or cardiac technical quality: suboptimal referring doctor: dr. . measurements: left atrium - four chamber length: *5.5 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.6 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 0.9 cm (nl 0.6 - 1.1 cm) left ventricle - ejection fraction: 45% to 50% (nl >=55%) aorta - valve level: 2.0 cm (nl <= 3.6 cm) aorta - ascending: 2.6 cm (nl <= 3.4 cm) interpretation: findings: left atrium: elongated la. no spontaneous echo contrast or thrombus in the body of the laa. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. pfo is present. bidirectional shunt across the interatrial septum at rest. left ventricle: normal lv wall thickness. mild regional lv systolic dysfunction. mildly depressed lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. normal ascending aorta diameter. simple atheroma in aortic arch. normal descending aorta diameter. there are complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: myxomatous mitral valve leaflets. mild mvp. normal mitral valve supporting structures. moderate to severe (3+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. moderate tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: small pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the rhythm appears to be atrial fibrillation. results were conclusions: prebypass 1.the left atrium is elongated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. a patent foramen ovale is present. there is a bidirectional shunt across the interatrial septum at rest. 2.left ventricular wall thicknesses are normal. there is mild regional left ventricular systolic dysfunction. overall left ventricular systolic function is mildly depressed. 3. right ventricular chamber size and free wall motion are normal. 4.there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. 5. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. 6.the mitral valve leaflets are myxomatous. there is mild mitral valve prolapse of a3 and p3 portion.. moderate to severe (3+) mitral regurgitation is seen. the regurgitant jet is central. the vena contracta measures 0.6 cm. there is systolic blunting noted in all four pulmonary veins. 7.the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. 8. there is a small pericardial effusion. poor transgastric views. the tee probe was placed in a very atraumatic manner given the patient has a history of esophageal dilatation. currently asymptomatic. post pt is a paced, on epi at .02 mcg/kg/min 1. a prosthetic ring is in place in the mitral position. mean gradient is 3 mm hg, peak 16 mm hg.. 2. there is 1+ mitral regurgitation (mild). 3. tricuspid regurgitation is unchanged at moderate 4. aortic contours are intact/unchanged. 5. the remaining exam is unchanged from pre bypass. 6. all findings discussed with surgeons at the time of the exam. electronically signed by , md on 15:19. physician: () brief hospital course: the patient was admitted on for cath prior to mv repair. she underwent cardiac cath which revealed clean coronaries, slightly ^ filling pressures, 3+mr, and an ef of 55%. on she underwent mv repair with a 28 mm annuloplasty band. cross clamp time was 38 mins and total bypass time was 56 mins. she tolerated the procedure well and was transferred to the csru on epi, propofol and neo. she was extubated on the post op night and was weaned off her drips. she required aggressive resp. rx. and was transferred to the floor on pod#1. her chest tubes were d/c'd and on pod#3 her epicardial wires were d/c'd. anticoagulation with coumadin was restarted and on pod#5 she was discharged to home in stable condition. dr. will follow her inr post op and adjust her coumadin for an inr of .5 medications on admission: advair 100/50 1 puff daily albuterol prn protonix 40 mg po daily diltiazem 240 mg po daily benicar 20 mg po daily coumadin 1 mg po daily detrol 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. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 4. tolterodine 1 mg tablet sig: one (1) tablet po bid (2 times a day). 5. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. 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* 7. albuterol 90 mcg/actuation aerosol sig: 2-4 puffs inhalation q4h (every 4 hours) as needed. 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 9. diltiazem hcl 180 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*0* 10. furosemide 20 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 1 weeks. disp:*14 tablet(s)* refills:*0* 11. potassium chloride 20 meq packet sig: one (1) packet po q12h (every 12 hours) for 1 weeks. disp:*14 packet(s)* refills:*0* 12. warfarin 1 mg tablet sig: one (1) tablet po daily (daily): check inr with results to dr. . disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: vna of discharge diagnosis: mr atrial fibrillation copd incontinence s/p lumpectomy s/p eye surgery discharge condition: good. discharge instructions: call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. no heavy lifting or driving. followup instructions: dr. 2 weeks dr. 2 weeks and for coumadin follow up dr. 3-4 weeks (office here or in , ri ) procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart annuloplasty diagnoses: esophageal reflux mitral valve disorders congestive heart failure, unspecified atrial fibrillation other and unspecified hyperlipidemia long-term (current) use of anticoagulants chronic obstructive asthma, unspecified diseases of tricuspid valve 

Answer: The patient is high likely exposed to