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: shortness of breath. major surgical or invasive procedure: cardiac catherization s/p aortic valve replacement (21mm pericardial) mitral valve repair (28mm ring) coronary artery bypass graft (left internal mammary > left anterior descending artery, saphenous vein graft > diagonal, saphenous vein graft > posterior descending artery) history of present illness: 70 year old woman who over the last six months has experienced decline in exercise capacity, becoming short of breath while performing her daily activities. in she was admitted to hospital after becoming severely dyspneic, and was found to have a rll pneumonia. she was treated with (unclear length of course),and required tap of the pleural effusion. her functional capacity was improved on discharge however she noticed continued swelling of her ankles, dyspnea on exertion, a non productive cough, paroxysmal nocturnal dyspnea and developed two pillow orthopnea. on she became acutely dyspneic, presenting to the ed at hospital, where she was started on supplemental 02, and admitted for management of her dyspnea. she was transferred for further evaluation and treatment. cadriac workup revealed aortic stenosis, mitral regurg, and coronary artery disease. dr. was consulted for surgical intervention. past medical history: hypertension atrial fibrillation hyperlipididemia coronary artery disease heart failure diabetes mellitus type 2 pneumonia obesity obstructive sleep apnea on cpap s/p appendectomy s/p cholecytectomy s/p hernia repair social history: retired lives with daughter denies etoh tobacco quit 40 years ago family history: father s/p cabg, sister s/p "valve" surgery, died age 61, brother with stents physical exam: pulse: 59 resp: 20 o2 sat: 97% ra b/p right:121/80 left:113/76 height:5'4" weight:208 lbs general:awake, alert & oriented x3 skin: dry intact other: +yeast infection groin and under r breast- skin with cracks heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally - crackles, no stridor or wheezing heart: rrr irregular murmur sys murmur radiating to carotids and axillae abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema light distal edeme varicosities: on rle neuro: grossly intact pulses: femoral right:+2 left:+2 dp right:+2 left:+2 pt :+2 left:+2 radial right:+2 left:+2 carotid bruit right:+2 left:+2 pertinent results: 04:45am blood wbc-9.7 rbc-2.78* hgb-8.2* hct-26.5* mcv-95 mch-29.4 mchc-30.9* rdw-15.1 plt ct-314 04:00pm blood wbc-7.7 rbc-3.83* hgb-12.1 hct-36.1 mcv-95 mch-31.6 mchc-33.5 rdw-15.9* plt ct-173 04:45am blood pt-22.2* ptt-35.8* inr(pt)-2.1* 04:03pm blood pt-27.3* ptt-34.6 inr(pt)-2.7* 04:45am blood glucose-101 urean-12 creat-0.7 na-135 k-5.2* cl-96 hco3-34* angap-10 echocardiography report , (complete) done at 11:59:47 am final referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 70 f hgt (in): 64 bp (mm hg): 109/67 wgt (lb): 208 hr (bpm): 54 bsa (m2): 1.99 m2 indication: intraoperative tee for cabg, avr and mitral valve repair. aortic valve disease. congenital heart disease. coronary artery disease. left ventricular function. mitral valve disease. preoperative assessment. prosthetic valve function. pulmonary hypertension. right ventricular function. shortness of breath. icd-9 codes: 428.0, 786.05, 786.51, 440.0, 424.1, 424.0, 424.2 test information date/time: at 11:59 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2009aw5-: machine: aw5 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: *1.3 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 40% to 45% >= 55% aorta - annulus: 2.1 cm <= 3.0 cm aorta - sinus level: 2.7 cm <= 3.6 cm aorta - ascending: 3.0 cm <= 3.4 cm aortic valve - peak velocity: *4.1 m/sec <= 2.0 m/sec aortic valve - peak gradient: *68 mm hg < 20 mm hg aortic valve - lvot diam: 1.8 cm aortic valve - valve area: *0.5 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: mild symmetric lvh. normal regional lv systolic function. mildly depressed lvef. right ventricle: moderately dilated rv cavity. moderate global rv free wall hypokinesis. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. simple atheroma in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: severely thickened/deformed aortic valve leaflets. critical as (area <0.8cm2). no ar. mitral valve: moderately thickened mitral valve leaflets. moderate mitral annular calcification. moderate to severe (3+) mr. tricuspid valve: moderate tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no 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. results were conclusions prebypass no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. regional left ventricular wall motion is normal. overall left ventricular systolic function is mildly depressed (lvef= 45 %). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. moderate to severe (3+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results on at 1130am. postbypass the post bypass exam was performed while the patient was receiving 0.03 mcg/kg/min of epinephrine, 0.25 mcg/kg/min of milrinone, 1.5 mcg/kg/min of phenylephrine. there is a well-seated aortic valve bioprosthesis without paravalvular regurgitation and without residual valvular stenosis. there is well-seated mitral annuloplasty ring with mild residual regurgitation. the mean gradient across the mitral valve is 4 mm hg. overall ventricular function is preserved at approximately 45%. the aorta is intact post decannulation. the surgical staff was notified of all findings intraoperatively. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 17:11 ?????? caregroup is. all rights reserved. brief hospital course: mrs. was admitted for heart failure requiring aggressive diuresis. cardiac work up revealed an aortic valve area of 0.6 and 3+ mitral regurgitation,and coronary artery disease.preoperatively it was noted that she had candidial intertrigo in the bilateral groin, presenting a risk for infection at the proposed catheter insertion site for surgery, and the surgery was subsequently postponed until her intertrigo resolved with oral diflucan therapy and topical miconazole therapy. she underwent aortic valve replacement(#21mmpericardial), mitral valve repair (#28mm ring), and coronary artery bypass graft (left internal mammary artery grafted to left anterior descending artery/saphenous vein grafted to diag/posterior descending artery).cross clamp time= 125 minutes. cardiopulmonary bypass time= 140 minutes. see dr operative report for further details. she tolerated the procedure well and was transferred in critical but stable condition to the cvicu requiring pressors for optimimal cardiac output and hemodynamics. she awoke neurologically intact and was extubated without complications. she remained in the intensive care unit on milirone which was weaned off post operative day 2 but remained in neosynephrine to augment her blood pressure. on the evening of postoperative day two she was found to be asystolic under the epicardial pacer and ep was consulted. she had not yet received any betablockers postoperatively. mrs. continued to be paced until she went into rate controlled atrial fibrillation in the 80's, which is her baseline. on post operative day three she was pan cultured for elevated white blood cell count and the blood culture bottles were positive for staph coag negative from aline, vancomycin was started, id consulted, and repeat blood cultures obtained. epicardial wires were maintained and heparin started due to atrial fibrillation. she remained in the intensive care unit to monitor her rhythm until pod# 7 when her rhythm showed stable recovery and ep determined that a ppm was not warranted at this time and low dose beta-blocker could be used if necessary to rate control her atrial fibrillation. anticoagulation was resumed with coumadin. she was transferred to the step down unit for further monitoring. vancomycin was continued for a 7 day course as per id, to cover for blood culture believed to be a contaminant. pod#11 she was found to be c-difficile positive and was placed on flagyl x 14day course. physical therapy was consulted and evaluated mrs strength and mobility with plans for discharge to home with vna. on pod 13 dr. cleared mrs. for discharge to home with vna. all follow up appointments were advised. medications on admission: amlodipine 5mg azithromycin 500mg daily ceftriaxone 1g piggyback /day digoxin 125 mcg daily nitrobid 2% ointment topically q6h. potassium chloride 20meq warfarin 5mg last dose sunday aspirin 81mg discharge medications: 1. outpatient lab work first inr should be drawn on thursday with results sent to the office of at (. plan confirmed with dotty on . inr goal for afib is 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. outpatient lab work lfts to be drawn 1st week in results 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 6. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 9. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for c-diff for 12 days: through . disp:*36 tablet(s)* refills:*0* 10. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. disp:*30 tab sust.rel. particle/crystal(s)* refills:*2* 12. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 13. warfarin 5 mg tablet sig: one (1) tablet po once a day: dose will change daily for goal inr , to manage. disp:*30 tablet(s)* refills:*2* 14. captopril 12.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: tba discharge diagnosis: coronary artery disease s/p cabg aortic stenosis s/p avr mitral regurgitation s/p mv repair acute on chronic systolic heart failure diabetes mellitus type 2 hypertension atrial fibrillation elevated lipids obstructive sleep apnea on cpap obesity c-difficile discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr in 4 weeks () please call for 1-2 weeks () please call for appointment dr in weeks () please call for appointment first inr should be drawn on thursday with results sent to the office of at (. plan confirmed with dotty on . inr goal for atrial fibrillation md procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries intraoperative cardiac pacemaker diagnostic ultrasound of heart diagnostic ultrasound of heart open and other replacement of aortic valve with tissue graft open heart valvuloplasty of mitral valve without replacement diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia cardiac complications, not elsewhere classified atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases constipation, unspecified other and unspecified hyperlipidemia anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified cardiac dysrhythmias intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation obesity, unspecified staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus internal hemorrhoids with other complication acute on chronic systolic heart failure hematuria, unspecified first degree atrioventricular block candidiasis of skin and nails tricuspid valve disorders, specified as nonrheumatic 

Answer: The patient is high likely exposed to