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: codeine / iv dye, iodine containing contrast media attending: chief complaint: dizziness major surgical or invasive procedure: avr ( 21 mm mechanical st. jude valve) history of present illness: ms. is a 61 year old female with known aortic stenosis followed by serial echos was doing fairly well but reports episodes of transient dizziness since to her cardiologist at her follow up echo. she denies chest pain or shortness of breath. cath reveals no significant coronary artery stenosis. aortic valve area =0.7cm'2. she is transferred to for surgical correction/avr. past medical history: past medical history: aortic stenosis hyperlipidemia hypertension diabetes mellitus fibromyalgia past surgical history: right knee menicus repair right carpal tunnel repair t&a as child social history: last dental exam: > 6months lives with: significant other occupation: program counselor - community action tobacco: 30 pack year history etoh:1-2 drinks a month family history: grandfather deceased mi at 60 physical exam: pulse: 78 resp: 18 o2 sat: 96 ra b/p 113/66 general: no acute distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur holosytolic abdomen: soft non-distended non-tender bowel sounds + no palpable mass extremities: warm , well-perfused edema none varicosities: none neuro: grossly intact pulses: femoral right: +1 left: +1 dp right: +1 left: +1 pt : +1 left: +1 radial right: +1 left: +1 carotid bruit right: murmur left: murmur pertinent results: carotid ultrasound impression: right ica near 40% stenosis. left ica with no stenosis. echocardiogram pre-bypass: the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. there is posterior mitral annulus calcification. dr. was notified in person of the results before surgical incision. post bypass: preserved biventricular function. there is a mechanical valve in the aortic position. no ai, no perivalvular leaks. mean gradient 8-9 mm hg, peak gradient 20 mm hg. aortic contours intact . remaining exam is unchanged. all findings discussed with surgeons at the time of the exam. brief hospital course: ms. was admitted to the on via transfer from an outside hospital for surgical management of her aortic valve stenosis. she was worked-up in the usual preoperative manner including a carotid duplex ultrasound which revealed no significant carotid artery disease. a dental consult was obtained for oral clearance for surgery. after obtaining a panorex, no oral contraindication to valve surgery was noted. on , she was taken to the operating room where she underwent an aortic valve replacement. please see the operative note for details. she tolerated the procedure well and was transferred in critical but stable condition to the surgical intensive care unit. she extubated without incident. her chest tubes and epicardial wires were removed and she was started on coumadin for her mechanical aortic valve. she was transferred to the step down floor. by post-operative day six her inr was therapeutic and she was ready for discharge to home with coumadin follow-up and an inr check on . all follow-up appoinments were advised. medications on admission: cartia xt 240 mg daily lisinopril 40mg daily hydrochlorothiazide 12.5 mg daily metformin 500mg twice daily simvastatin 80 mg daily cymbalta 30 mg daily zetia 10 mg daily trazadone 25 mg hs etodolac 400-800 prn albuterol prn discharge medications: 1. cpap autoset cpap at 5 - 15 cm h20 fit for mask 2. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. 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:*2* 6. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily) for 10 days. disp:*10 tablet(s)* refills:*2* 9. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po daily (daily) for 10 days. disp:*20 tablet extended release(s)* refills:*2* 10. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 11. coumadin 5 mg tablet sig: one (1) tablet po once a day: coumadin for mechanical avr, goal . first inr check on with results for dr. fax (. disp:*30 tablet(s)* refills:*2* 12. outpatient lab work first inr check on with results for dr. fax (. coumadin for mechanical avr, goal . discharge disposition: home with service facility: , discharge diagnosis: aortic stenosis s/p avr hyperlipidemia hypertension diabetes mellitus fibromyalgia sleep apnea ( cpap recommended) discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage edema 1+ le discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge ****please use cpap machine as directed- will be delivered to your home **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: wound check cardiac surgery office 2a at 10:45 am surgeon: dr. on thursday at 1:00 pm 2a cardiologist:dr. on at 1:45 pm please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication is mechanical avr goal inr 2.0-3.0 first draw day after discharge, results to dr. phone fax procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled aortic valve disorders personal history of tobacco use other and unspecified hyperlipidemia myalgia and myositis, unspecified 

Answer: The patient is high likely exposed to