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: patient recorded as having no known allergies to drugs attending: chief complaint: chest pain on exertion major surgical or invasive procedure: - 1) cabgx5 (left internal mammary artery to left anterior descending artery, saphenous vein graft sequential to obtuse marginal one and two, saphenous vein grafts to right coronary artery and the posterior descending artery). 2) mitral valve repair with size 26 physio ring. history of present illness: ms. is a 67 yo female with a history of hypertension, diabetes, hyperlipidemia, and past tobacco use who presented to osh ed on saturday, , with several weeks of exertional chest pain. upon admission to the osh pt ruled out for mi with negative enzymes and negative troponin levels. a nuclear ett was performed yesterday, during which the patient exercised for 7 minutes on protocol with no chest pain or shortness of breath. nuclear images showed lateral ischemia. pt is now transferred for cardiac catheterization and possible surgical intervention. past medical history: hyperlipidemia, hypertension, diabetes mellitus, rheumatoid arthritis, s/p ovarian cyst removal, s/p tonsillectomy, s/p bilat. cataract removal social history: lives alone in . has a daughter, , who lives in me, and a son who lives near . rare social etoh. quit tobacco use 8 years ago after 30 pack years. family history: pt??????s brother died at age 52 of ??????congestive heart failure??????, described by pt as a sudden death after presenting with uri symptoms. no known family history of cad. physical exam: wdwn female lying on stretcher, nad. vs: 118/58 ?????? 149/58 hr 60??????s sr sat 99% ra neck: no bruits lungs: clear bilaterally heart: s1s2 rrr no m/r/g abd: soft, ntnd +bs ext: no edema. r dp/pt dop/2+, l dp/pt dop/dop feet warm. pertinent results: cxr: there has been a recent median sternotomy and mitral valve replacement. cardiac and mediastinal contours are slightly widened but are stable in the postoperative period. bilateral pleural effusions, small on the right and small to moderate on the left, are without change with persistent adjacent basilar atelectasis. additional foci of discoid atelectasis are present in the mid lung regions. echo: pre cpb no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and systolic function are 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 but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate central (2+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. post cpb normal right ventricular systolic function. left ventricle displays mild inferior hypokinesis with an overall ejection fraction of about 55%. there is a mitral valve annuloplasty ring in situ. it is well seated. there is now trace mr. the maximum gradient across the mitral valve is 8.5 mm hg with a mean of about 5 mm hg. at one point in the post cpb period after surgical maipulation of the heart, the cvp trace revealed a large v wave and moderate tr was seen on the tee exam. this resloved within about 5 minutes to the trace tr seen pre-cpb. the thoracic aorta appeared intact after decannulation. 01:13pm blood wbc-8.5 rbc-4.06* hgb-12.6 hct-34.9* mcv-86 mch-31.1 mchc-36.1* rdw-13.2 plt ct-299 06:55am blood wbc-11.9* rbc-3.34* hgb-10.4* hct-30.2* mcv-90 mch-31.1 mchc-34.5 rdw-13.7 plt ct-413# 01:13pm blood pt-12.0 ptt-26.3 inr(pt)-1.0 02:38am blood pt-11.8 ptt-26.0 inr(pt)-1.0 01:13pm blood glucose-165* urean-15 creat-0.7 na-139 k-4.3 cl-106 hco3-26 angap-11 06:55am blood urean-14 creat-0.7 na-144 k-4.1 cl-102 hco3-33* angap-13 06:00am blood calcium-8.4 phos-3.3 mg-2.4 brief hospital course: ms. was admitted to the on via transfer for a cardiac catheterization. this revealed severe three vessel coronary artery disease and a normal ejection fraction. given the severity of her disease, the cardiac surgical service was consulted for surgical management. ms. was worked-up in the usual preoperative manner. plavix was allowed to clear from her system. on , ms. was taken to the operating room where she underwent coronary artery bypass grafting to five vessels and a mitral valve repair. please see operative note for details. postoperatively she was taken to the intensive care unit for monitoring. by postoperative day one, ms. had awoke neurologically intact and was extubated. she was then transferred to the step down unit for monitoring. she was gently diuresed towards her preoperative weight. the physical therapy service was consulted for assistance with her postoperative strength and mobility. chest tubes and epicardial pacing wires were removed per protocol. she remained stable over the next couple days and was discharged home on post-op day five with the appropriate follow-up appointments. medications on admission: at home: paxil 20 mg po daily, metformin 1000 mg po bid, accupril 10 mg po bid, nph insulin 14 units sc bid at osh: paxil, lopressor, metformin, plavix, aspirin, prilosec, zocor discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. potassium chloride 20 meq packet sig: one (1) packet po q12h (every 12 hours) for 7 days. disp:*14 packet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. 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* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*50 tablet(s)* refills:*0* 6. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days. disp:*14 tablet(s)* refills:*0* 9. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: coronary artery disease s/p coronary artery bypass graft x 5 mitral regurgitation s/p mitral valve repair pmh: hyperlipidemia, hypertension, diabetes mellitus, rheumatoid arthritis, s/p ovarian cyst removal, s/p tonsillectomy, s/p bilat. cataract removal discharge condition: stable discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for 1 month. 7) call with any questions or concerns. followup instructions: follow-up with dr. in 1 month. ( follow-up with cardiologist dr. in 2 weeks. follow-up with pcp . in weeks. please call all providers for appointments. md procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery angiocardiography of left heart structures left heart cardiac catheterization coronary arteriography using a single catheter (aorto)coronary bypass of four or more coronary arteries annuloplasty diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome mitral valve disorders unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other and unspecified hyperlipidemia left heart failure rheumatoid arthritis diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to