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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: : 25 mm tissue avr, coronary artery bypass graft x 3 with left internal mammory artery-> left anterior descending, reverse saphenous vein graft--> obtuse marginal, posterior descending artery permanent pacer history of present illness: 80 year old male who slowly developed worsening sypmtoms from aortic stenosis. he currently complains of dyspnea on exertion and chest discomfort. he recently underwent a cardiac echo which showed moderate to severe aortic stenosis with of 1.01cm2. he was referred for surgical management and now found to have three vessel disease. he is referred for an aortic valve replacement and revascularization. past medical history: diastolic heart failure chronic atrial fibrillation pulmonary hypertension obstructive sleep apnea, not on cpap history of falls, walks with a cane obesity hyperlipidemia prostate cancer, s/p radiation and pellet implantation diabetes mellitus, diet controlled history of gib from overdose of coumadin arthritis past surgical history:gall bladder removal, achilles tendon repair, r shoulder replacement, bilateral cataracts, repair of r leg fracture social history: race:caucasian last dental exam:more than one year ago lives with:alone, family lives nearby occupation: retired tobacco:never etoh:1.5 rum/ginger beers/day family history: father dies at age 45 of heart disease physical exam: pulse:49 resp: 16 o2 sat: 99% ra b/p right:172/61 left: 183/75 height: 5'" weight: 283 lbs general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur ii/vi sem abdomen: soft non-distended non-tender bowel sounds + ruq incision extremities: warm , well-perfused edema +le varicosities: left leg neuro: grossly intact pulses: femoral right: 1+ left: 1+ dp right: 1+ left: 1+ pt : 1+ left: 1+ radial right: 2+ left: 2+ carotid bruit right:- left:- pertinent results: 01:49pm blood wbc-12.7* rbc-3.04* hgb-10.7* hct-30.1* mcv-99* mch-35.1* mchc-35.5* rdw-16.5* plt ct-92* 12:09am blood glucose-131* urean-22* creat-1.2 na-132* k-4.2 cl-98 hco3-25 angap-13 tte: pre-bypass: the left atrium is dilated. moderate to severe spontaneous echo contrast is seen in the body of the left atrium. moderate to severe spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. 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 moderate aortic valve stenosis (valve area 1.0-1.2cm2). trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results prior to surgical incision. post-bypass: biventricular systolic function remains preserved. there is a well seated, well functioning bioprosthesis in the aortic position. no aortic insufficiency is visualized. the mr remains mild to moderate. the remaining study is unchanged compared to prebypass echo the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is mildly dilated with borderline normal free wall function. a bioprosthetic aortic valve prosthesis is present. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. well seated, normally functioning aortic valve bioprosthesis. preserved global left ventricular systolic function. mild-moderate mitral regurgitation. pulmonary artery systolic hypertension. compared with the prior study (images reviewed), the overall findings are similar (image quality is better on the current study, but remains suboptimal). chest ct indication: 80-year-old male status post aortic valve replacement and pacemaker placement. followup evaluation of sternal dehiscence and left pleural effusion. technique: multidetector helical ct scan of the chest was obtained without the administration of contrast. axial reconstructions in standard and lung algorithm were performed. coronal and sagittal reformations were prepared. comparison: ct examinations dated and . correlation with multiple prior radiographs, most recent dated . findings: the patient is status post median sternotomy, cabg, aortic valve replacement, and pacemaker placement. again seen are seven sternal wires, the most inferior three no longer bridge the sternum, which is separated to a similar degree to the examination of . a fluid collection located at the level of the inferior sternum and inferior to the sternum measuring up to 4.5 x 2.6 cm (2:49), previously measured 4.5 x 2.8 cm, not significantly changed. the extent and size of a loculated left pleural effusion is unchanged from the prior examination. associated atelectasis also appears similar. previously seen trace right pleural effusion is essentially resolved with residual atelectasis at the right base. no pneumothorax is seen. there are secretions within the trachea and right mainstem bronchus. there is trace pericardial effusion. cardiomegaly is stable. the pacemaker lead in the right ventricle, mediastinal clips and appearance of the aortic valve are unchanged. there are coronary calcifications. multiple mediastinal lymph nodes are not pathologically enlarged. the osseous structures appear unchanged with dehiscence of the inferior portion of the sternum and a 5 mm gap in the superior portion of the sternum. multilevel degenerative changes of the thoracic spine include marginal osteophyte formation and vertebral body endplate irregularities. limited views of the upper abdomen show a hyperdensity in the right upper quadrant which is unchanged and may represent a surgical clip. impression: 1. similar appearance of sternal dehiscence and size of adjacent fluid collection. 2. unchanged loculated left pleural effusion with associated atelectasis. 3. essentially resolved small right pleural effusion with residual atelectasis at the right base. the study and the report were reviewed by the staff radiologist. head ct findings: the patient is intubated. there is no acute intracranial hemorrhage, edema, mass effect, or major vascular territorial infarcts. the prominent ventricles and sulci are similar in appearance and compatible with age-related involutional changes. there is no shift of normally midline structures. the -white matter differentiation is preserved. there is no acute fracture. the paranasal sinuses and mastoid air cells are clear. moderate fluid pools in the posterior nasal passage, likely retained secretion back up from the cuff of the endotracheal tube. impression: 1. no acute intracranial pathologic process. of note, ct is not sensitive to detect subtle infectious/inflammatory changes. 2. moderate secretion retained in the posterior nasal passage, likely secondary to intubation. video swallow oropharyngeal swallowing video fluoroscopy was performed in conjunction with the speech and swallow division. multiple consistencies of barium were administered. findings: barium passes freely through the oropharynx and esophagus without evidence of obstruction. there was no gross aspiration with any consistency of barium. there was penetration with thin and nectar-thick liquids. for details, please refer to speech and swallow division note in omr. impression: penetration with thin and nectar-thick liquids, but no aspiration. brief hospital course: on mr. was taken to the operating room and underwent aortic valve replacement (#25mm porcine)/coronary artery bypass grafting x 3 (left internal mammary artery grafted to left anterior descending/saphenous vein grafted to obtuse marginal/posterior descending artery) with dr.. please refer to operative report for further surgical details. cross clamp time=80 minutes, cardiopulmonary bypass time=110 minutes. he tolerated the procedure well and was transferred to the cvicu intubated and sedated in critical but stable condition requiring pressor support. he awoke neurologically intact and was weaned from the ventilator and extubated. he continued to require inotropic support until pod#2. on pod#3 he was hemodynamically stable and was transferred to the stepdown unit for ongoing post-op care. on pod#4 he had a witnessed syncopal event, was intubate and rec'd cpr. he was transferred back to the cvicu. he was hemodynamically stable. he was extubated later that day. he was evaluated by ep for possible pacer placement. a trial of betablocker (2.5mg iv ) was trialed w/hr 40's. a perm pacer was placed on and after lead placement was confirmed and pacer was interrogated, he was transferred to the stepdown unit. anticoagulation resumed for afib. on mr. suffered a pea arrest and was successfully resusitated and transferred back to the cvicu. pacer was checked and found to be functioning properly. he is v-paced at 60. on the next day he was weaned from pressors and weaned from the ventilator and extubated. he was confused and has been slow to clear neurologically. he became hypercarbic and was re-intubated on . a head ct was done which showed no acute process. he was again weaned and extubated on . he was thought to have a component of sleep apnea and intermittantly tolerates bipap at night. he is presently alert and oriented but remains intermittantly confused. a speech and swallow consult was done and he was cleared for po diet w/o signs of aspiration. he remained in the icu until for ongoing post-op care. he was followed by physical therapy for chset pt and stength and conditioning and rehab was recommended for ongoing strength training and chest pt. he was screened and accepted by rehabiliation center for the aged macu and was transferred there on via ambulance. all discharge intructions were advised. medications on admission: fluticasone-salmeterol - (prescribed by other provider) - 250 mcg-50 mcg/dose disk with device - 1 puff twice daily furosemide - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day ipratropium-albuterol - (prescribed by other provider) - 18 mcg-103 mcg (90 mcg)/actuation aerosol - 1 puff as needed lisinopril - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth twice a day oxybutynin chloride - (prescribed by other provider) - 5 mg tablet - 1 tablet(s) by mouth daily simvastatin - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth daily warfarin - (prescribed by other provider) - 2 mg tablet - 1 tablet(s) by mouth once a day zolpidem - (prescribed by other provider) - 5 mg tablet - 1 tablet(s) by mouth once a day as needed for bedtime acetaminophen - (prescribed by other provider) - 500 mg tablet - 2 tablet(s) by mouth as needed for pain aspirin - (prescribed by other provider) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day multivitamin - (prescribed by other provider) - dosage uncertain discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 9. lisinopril 5 mg tablet sig: one (1) tablet po bid (2 times a day). 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain or fever . 12. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation every four (4) hours as needed for sob/wheezing. 14. multivitamin tablet sig: one (1) tablet po daily (daily). 15. erythromycin 5 mg/gram (0.5 %) ointment sig: one (1) ophthalmic qid (4 times a day). 16. warfarin 1 mg tablet sig: dose per inr tablet po daily (daily): indication: afib goal inr 2.0-2.5. 17. lantus 100 unit/ml solution sig: twenty five (25) units subcutaneous once a day. 18. chest pt chest pt q6hrs 19. humalog insulin humalog insulin per sliding scale discharge disposition: extended care facility: discharge diagnosis: aortic stenosis coronary artery disease s/p coronary artery bypass grafts,aortic valve replacement diastolic heart failure chronic atrial fibrillation pulmonary hypertension obstructive sleep apnea obesity hyperlipidemia prostate cancer, s/p radiation and pellet implantation noninsulin dependent diabetes mellitus osteoarthritis bradycardic/pea arrest x2 permanent pacer discharge condition: alert and oriented x3- nonfocal ambulating with assist of one incisional pain managed with tylenol incisions: sternal - healing well, no erythema or drainage leg left - healing well, no erythema or drainage. edema:trace 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 **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: surgeon: dr on at 1:00pm cardiologist:dr. on at 11:00 am please call to schedule appointments with: primary care: dr. () in weeks device clinic phone: **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of two coronary arteries insertion of endotracheal tube insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization open and other replacement of aortic valve with tissue graft initial insertion of transvenous lead [electrode] into ventricle initial insertion of single-chamber device, not specified as rate responsive diagnoses: obstructive sleep apnea (adult)(pediatric) 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 atrial fibrillation personal history of malignant neoplasm of prostate aortic valve disorders other chronic pulmonary heart diseases pulmonary collapse other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias cardiac arrest surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation chronic diastolic heart failure mechanical complication due to coronary bypass graft 

Answer: The patient is high likely exposed to