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: chf major surgical or invasive procedure: cabg x2(lima>lad, svg>pda), avr(#21 stjude epic porcine) history of present illness: this 76-year-old patient who presented recently with an episode of congestive cardiac failure, was investigated and was found to have severe left main stem lesion with a blocked right coronary artery with mitral regurgitation and aortic stenosis with very poor left ventricular ejection fraction in the region of %. cardiac enzymes were elevated during this admission. based on these findings, she was kept in-house for urgent coronary artery bypass grafting and aortic valve and possible mitral valve surgery. past medical history: pmh: none social history: non smoker family history: n/c physical exam: vs: t 98.4, bp 124/80, hr 80, rr 20, o2 sat 98% ra gen: wf elderly afemale in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 6cm; no carotid bruits cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal did not check dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal did not check dp 2+ pt 2+ pertinent results: 07:00am blood wbc-12.4* rbc-3.29* hgb-9.4* hct-28.1* mcv-86 mch-28.6 mchc-33.4 rdw-14.2 plt ct-195 01:01am blood pt-13.6* ptt-31.3 inr(pt)-1.2* 07:00am blood glucose-101 urean-25* creat-1.2* na-136 k-4.1 cl-101 hco3-25 angap-14 7:42 am chest (pa & lat) minimal left apical pneumothorax has decreased in size since the prior study. there is no right pneumothorax. small bilateral pleural effusions are demonstrated as well as bibasal left more than right atelectasis with no significant change since the prior study. the upper lungs are unremarkable. the cardiomediastinal silhouette is unchanged including the post-sternotomy wires echocardiography report , (complete) done results measurements normal range left atrium - peak pulm vein s: 0.7 m/s left atrium - peak pulm vein d: 0.4 m/s left ventricle - septal wall thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.0 cm <= 5.6 cm left ventricle - ejection fraction: 20% >= 55% aorta - annulus: 2.0 cm <= 3.0 cm aorta - ascending: 3.4 cm <= 3.4 cm aortic valve - peak velocity: *2.3 m/sec <= 2.0 m/sec aortic valve - peak gradient: *21 mm hg < 20 mm hg aortic valve - mean gradient: 15 mm hg aortic valve - valve area: *1.0 cm2 >= 3.0 cm2 findings right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. severely dilated lv cavity. severe regional lv systolic dysfunction. severely depressed lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. simple atheroma in ascending aorta. complex (>4mm) atheroma in the aortic arch. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: moderately thickened aortic valve leaflets. moderate-severe as (area 0.8-1.0cm2). moderate (2+) ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. moderate (2+) mr. tricuspid valve: mild tr. pericardium: trivial/physiologic pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. see conclusions for post-bypass data the post-bypass study was performed while the patient was receiving vasoactive infusions (see conclusions for listing of medications). 1.no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity is severely dilated. there is severe regional left ventricular systolic dysfunction with ef 20%. overall left ventricular systolic function is severely depressed (lvef= 20%). 3. right ventricular chamber size and free wall motion are normal. 4.there are simple atheroma in the ascending aorta. there are complex (>4mm) atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. 5. the aortic valve leaflets are moderately thickened. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). the gradients are low across the aortic valve due to depressed myocardium and low cardiac output state. moderate (2+) aortic regurgitation is seen. 6.the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the mitral annulus is 3.4 cm. 7.there is a trivial/physiologic pericardial effusion. 8. dr. was notified in person of the results on at 1000am. post bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine, epinephrine and milrinone. pt was in an intrinsic sinus rhythm. 1. a well-seated bioprosthetic valve is seen in the aortic position with normal leaflet motion and gradients (peak gradient = 20 mmhg) with a cardiac output of 3.6l/min. no aortic regurgitation is seen. 2. there is global left ventricular systolic dysfunction with an estimated lvef of 25 %. 3.right ventricular systolic function is normal. 4. mitral regurgitation remains as 2+ moderate and other valves are as described pre-bypass. 5. aortic contours are intact post-decannulation. brief hospital course: mr. was admitted to the on for surgical management of his coronary artery disease and valve desease. she was taken directly to the operating room where he underwent: operation: 1. off-pump coronary artery bypass graft x2; left internal mammary artery to left anterior descending artery and saphenous vein graft to posterior descending artery. 2. aortic valve replacement with a size 21 st. tissue epic valve. 3. endoscopic harvesting of the long saphenous vein from the leg postoperatively she was taken to the cardiac surgical intensive care unit for monitoring. within 24 hours, he had awoke neurologically intact and was extubated. beta blockade, aspirin and a statin were resumed. s she was then transferred to the step down unit for further recovery. she was gently diuresed towards his preoperative weight. the physical therapy service was consulted for assistance with his postoperative strength and mobility. pt did go into afib. she was given amio she did convert to nsr. no anticoagulation started. pt also had arf from cardiac cath / resolved on dc medications on admission: none discharge medications: 1. carvedilol 3.125 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 5 days. disp:*10 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. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day): take for seven days, then 200 mg daily there after. disp:*60 tablet(s)* refills:*2* 6. 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:*2* 7. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. disp:*30 tablet(s)* refills:*0* 9. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. disp:*30 suppository(s)* refills:*0* 11. lasix 20 mg tablet sig: one (1) tablet po twice a day for 7 days. disp:*14 tablet(s)* refills:*0* 12. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: hospice and vna discharge diagnosis: cad mitral regurgitation and aortic stenosis afib converted to nsr 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. gently pat the wound dry. 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: call pcp: , , schedule an appointment immediatly upon discharge. call . md, cardiothoracic surgery , schedule an appontment for four weeks md procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart (aorto)coronary bypass of one coronary artery open and other replacement of aortic valve with tissue graft extraction of other tooth transfusion of packed cells diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery atrial fibrillation rheumatic heart failure (congestive) other specified cardiac dysrhythmias iatrogenic pneumothorax mitral valve insufficiency and aortic valve stenosis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation accidents occurring in residential institution occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction dental caries, unspecified personal history of peptic ulcer disease 

Answer: The patient is high likely exposed to