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: history of present illness: (via a translator, the patient is spanish-speaking) a 64-year-old male who complains of intermittent headache times two weeks and lethargy times one week. also complains of increasing right-sided tremulousness over the past week. tremulousness had been noticed in the past after a cerebrovascular accident. the patient has also noticed increased difficulty swallowing since . past medical history: (the patient's past medical history is significant for) 1. coronary artery disease; he was catheterized in of this year which showed 70% stenosis of the posterior descending artery with an ejection fraction of 40%, global hypokinesis, and mildly elevated pulmonary artery hypertension, severe aortic stenosis with a valve area of 0.7 cm2. 2. he had a gastrointestinal bleed in the past with a colonoscopy in which showed colonic ulcers consistent with nonsteroidal antiinflammatory drug use. a repeat colonoscopy in was negative for ulcers. 3. paroxysmal atrial fibrillation with a left atrial thrombus. 4. fatigue times several months. 5. right lower lobe effusion/lung mass. 6. spinal stenosis. 7. type 2 diabetes mellitus. 8. right eye injury. medications on admission: (his medications taken at home include) 1. nph insulin 8 units q.a.m. 2. neurontin 300 mg p.o. q.i.d. 3. aldactone 25 mg p.o. q.d. 4. glucophage 850 mg p.o. q.d. 5. coumadin 2 mg p.o. q.d. 6. amiodarone 200 mg p.o. q.d. 7. lasix 20 mg p.o. q.d. 8. digoxin 0.125 mg p.o. q.o.d. 9. zebeta 1.25 mg p.o. q.o.d. 10. glipizide 10 mg p.o. q.d. 11. altace 2.5 mg p.o. q.d. 12. regular insulin sliding-scale. 13. protonix 40 mg p.o. q.d. allergies: he has no known drug allergies. social history: he is a 64-year-old male from who moved to the united states in of this year. he quit tobacco times 35 years. no alcohol use. physical examination on admission: physical examination at the time of admission revealed vital signs with temperature of 97.9, heart rate 68, blood pressure 98/63, respiratory rate 16, oxygen saturation 98% on 2 liters. alert and talkative, in no acute distress. pupils were equally round and reactive to light. right surgical pupil. no jugular venous distention. no lymphadenopathy. a regular rate and rhythm. positive aortic stenosis murmur. diminished breath sounds bilaterally, bibasilar rales. the abdomen was soft, nontender, and nondistended. no masses. positive bowel sounds. periphery revealed no edema. no clubbing or cyanosis. no calf tenderness. neurologically nonfocal with right hand paresis. laboratory data on admission: laboratory data at the time of admission revealed sodium of 133, potassium 4.2, chloride 95, bicarbonate 28, bun 17, creatinine 0.6, glucose 139. white blood cell count 5.8, hematocrit 25, platelets 625. calcium 8.8, magnesium 1.9. digoxin level 0.4. pt 18, ptt 28, inr 2.1. alt 14, ast 47, alkaline phosphatase 84, total bilirubin 0.2, albumin 3.3, amylase 40, lipase 13. urinalysis was negative. radiology/imaging: head ct revealed old left cerebellar infarct, old left occipital calcification. chest x-ray revealed bilateral small pleural effusions with atelectasis. no change from prior study. electrocardiogram revealed normal sinus rhythm at 63, with normal axis and intervals, slight lateral st depressions and j point elevation in v2 through v3; unchanged from . hospital course: the gastrointestinal and the neurology services were consulted. the patient was transfused with packed cells shortly after admission. prior to admission he had been scheduled for an aortic valve replacement at the end of , and so cardiothoracic surgery was notified of the patient's admission. the patient also had a chest ct and an upper gastrointestinal series. the upper gastrointestinal showed transient spasms in the middle to distal esophagus; however, following 2 units of packed red blood cells the patient's hematocrit remained stable, and no further endoscopic procedures were scheduled. the patient also underwent a speech and swallow evaluation. the patient also had a chest cat scan which showed persistent ground glass/solid nodule of the left apex with a morphology suggestive of bronchoalveolar cancer. a right lower lobe opacity consistent with atelectasis, and adjacent pleural thickening, and thickening of the esophageal wall in the subcarinal region, as well as several mediastinal nodes in the aorticopulmonary window, right paratracheal and paracarinal areas. this showed no changes compared with a prior chest ct except for the enlarged nodules. no further workup of this was pursued at that time. the patient's swallow study was significant for mild oropharyngeal swallowing dysfunction. diet was to consist of ground solids with honey thickened liquids and aspiration precautions. following his medical workup the patient was scheduled for his aortic valve replacement; however, due to equipment difficulties in the operating room, aortic valve replacement was postponed. following the postponement of the patient's surgery, it was noted that his sodium level had fallen to a level of 125. he was therefore seen by the renal service, and after being cleared by the renal service was brought to the operating room on , where he under coronary artery bypass graft times one with a vein graft to the posterior descending artery as well as an aortic valve replacement with a #21 pericardial tissue valve and a maze. the patient tolerated the operation well. please see the operative report for full details. he was transferred from the operating room to the cardiothoracic intensive care unit. at the time of transfer, the patient was av paced at a rate of 90. he had a mean arterial blood pressure of 75, a central venous pressure of 15. he was transferred on a milrinone infusion as well as neo-synephrine infusion. at the time of transfer he had an arterial line, a swan-ganz catheter, two ventricular and two atrial pacing wires, and a mediastinal chest tube. the patient did well in the immediate postoperative period. he was weaned off all cardioactive infusions. his anesthesia was reversed, and the patient was weaned from and extubated shortly after arrival in the cardiothoracic intensive care unit. he remained hemodynamically stable overnight on the day of his operation, and on postoperative day one his swan-ganz catheter was discontinued. his chest tubes were removed, and he was transferred to far six for continuing postoperative care and cardiac rehabilitation. following his surgery, the patient was seen by the electrophysiology service given his previous history of paroxysmal atrial fibrillation and to comment on the need for beta blocker and amiodarone use in the postoperative period, as well as the need for continued pacemaker use to maintain hemodynamic stability in the postoperative period. over the next several days, the patient's hemodynamic status and underlying cardiac rhythm were monitored. on postoperative day four, it was decided that he would require a permanent pacemaker, and he was brought to the cardiac catheterization laboratory at that time where he underwent placement of a permanent pacemaker. please see the catheterization laboratory report for full details. in summary, at that time he underwent permanent pacemaker placement with a ddd pacemaker. there were no complications on the permanent pacemaker implantation. following the permanent pacemaker implantation, the patient was restarted on coumadin. he continued to be seen by physical therapy, and his activity level was advanced over the next several days. on postoperative day eight, it was decided that the patient was stable and ready for discharge to home with support of the and home physical therapy. condition at discharge: the patient's status at discharge was stable. physical examination on discharge: his physical examination at the time of discharge included vital signs with temperature of 97.8, heart rate 80, blood pressure 106/60, respiratory rate 18, oxygen saturation 97% on room air. weight preoperatively was 58.8 kg, at discharge was 69.4 kg. laboratory data on discharge: laboratory data on the day of discharge revealed white blood cell count of 10, hematocrit of 29, platelet count of 381. pt was 14.4, ptt was 28.1, inr was 1.4. sodium was 137, potassium 4.8, chloride 97, bicarbonate 33, bun 23, creatinine 0.7, glucose 157. physical examination revealed alert, responsive, moved all extremities. breath sounds were diminished in the left base; otherwise, clear to auscultation. heart sounds revealed a regular rate and rhythm, s1 and s2, with a 2/6 systolic ejection murmur. the abdomen was soft, nontender, and nondistended, positive bowel sounds. extremities were warm and well perfused with 1 to 2+ pedal edema. his sternum was stable. sternal incision with steri-strips, open to air, clean and dry. the patient's incision in the left shoulder was covered with a dry sterile dressing, also clean and dry. medications on discharge: 1. amiodarone 600 mg p.o. q.d. times 10 days; then 400 mg p.o. q.d. 2. lopressor 12.5 mg p.o. b.i.d. 3. glucotrol 5 mg p.o. q.d. 4. protonix 40 mg p.o. q.d. 5. neurontin 300 mg p.o. t.i.d. 6. lasix 20 mg p.o. b.i.d. 7. potassium chloride 20 meq p.o. b.i.d. 8. 70/30 insulin 12 units q.a.m. and 6 units q.p.m. 9. regular insulin sliding-scale q.a.c. and q.h.s. 10. percocet 5/325 one to two tablets p.o. q.4h. p.r.n. 11. coumadin (dose per the clinic). discharge diagnoses: 1. coronary artery disease. 2. status post coronary artery bypass graft times one with an saphenous vein graft to the posterior descending artery. 3. aortic stenosis, status post aortic valve replacement with a #21 tissue valve. 4. paroxysmal atrial fibrillation, status post maze, status post permanent pacemaker placement with a ddd. 5. type 2 diabetes mellitus. 6. gastrointestinal bleed. 7. right eye surgery. 8. cerebrovascular accident. 9. pleural effusion/lung mass. 10. spinal stenosis. 11. hypertension. die followup: the patient was to have followup with dr. in three to four weeks and with the cardiology service, dr. , in four to six weeks. discharge status: he was to be discharged home with and home physical therapy. , m.d. dictated by: medquist36 d: 10:10 t: 18:08 job#: procedure: extracorporeal circulation auxiliary to open heart surgery initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle (aorto)coronary bypass of one coronary artery insertion of temporary transvenous pacemaker system open and other replacement of aortic valve with tissue graft transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation aortic valve disorders hemorrhage of gastrointestinal tract, unspecified other disorders of neurohypophysis 

Answer: The patient is high likely exposed to