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: mitral major surgical or invasive procedure: mitral history of present illness: patient is a 51 year old cantonese speaking man with history of rheumatic mitral stenosis, prior pulmonary embolism, and left atrial clot. he presents today for admission for heparin drip in preparation of tee and mitral . of note, patient was admitted in for chest pain, and was found to be in atrial fibrillation. during that admission, a transthoracic echocardiogram demonstrated rheumatic mitral stenosis with an ejection fraction of 40-50%. a transesophageal echocardiogram demonstrated a left atrial appendage, and he was started on coumadin. a and cardioversion were deferred at that time given the finding of the clot. history done through an interpreter. since admission patient's symptoms have been stable (not worse or better). describes shortness of breath with exertion. tends to feel dizzy when he bends over. denies chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, or syncope. patient describes mild nausea, denies abdominal pain or vomiting. wife states he had an egd which demonstrated ulcers and was started on "medication" for 2 months. denies black or bloody stool. patient aware he is in a hospital for a valve procedure. he has not taken his warfarin since last saturday night. past medical history: - rheumatic mitral stenosis - history of pulmonary embolism - atrial fibrillation social history: worked in a restaurant kitchen. lives with wife. smoked cigarettes daily for 10 years, not currently smoking. no etoh or drug use. family history: father with "enlarged heart" died at age 84. mother has problem, but patient does not know what it is. physical exam: on discharge: vs: t97.8, bp105/84, hr 85, rr12, 100% 2lnc gen: nad, no resp dist. oriented x3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3, 3/6sem heart over precordium chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: soft, nt/nd, positive bowel sounds, no hsm or tenderness. ext: no c/c/e. no femoral bruits, l and r femoral sites without signs of bleed or hematoma. skin: no stasis dermatitis, ulcers, scars, or xanthomas. right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: alt(sgpt)-32 ast(sgot)-24 ld(ldh)-199 alk phos-93 amylase-90 tot bili-0.4 wbc-6.3 rbc-4.31* hgb-13.4* hct-40.2 mcv-93 mch-31.1 mchc-33.3 rdw-14.9 pt-15.1* ptt-32.9 inr(pt)-1.3* h. pylori: positive mitral /cardiac cath : 1. severe mitral stenosis with mean gradient of 15mmhg and area of 0.68cm2. 2. successful transeptal puncture with intracardiac echo guidance. 3. successful mitral using inoue balloon inflated to a maximum diameter of 30mm. post-procedure echos: tte at 12:45:00 pm: study immediately post balloon mitral . overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets are moderately thickened. the mitral valve shows characteristic rheumatic deformity. there is moderate valvular mitral stenosis (area 1.0-1.5cm2). moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. compared with the prior study (images reviewed) of , the mva area is greater and the mean mitral gradient has decreased. there is now moderate mitral regurgitation. tee at 2:40:05 pm: the left atrium is dilated. moderate to severe spontaneous echo contrast and a layering thrombus is present in the left atrial appendage. there is organizinf thrombus in the laa situated deep within the structure and away from the mouth of the structure, measuring 2.2x 2.1cm in maximal diameter. the left atrial appendage emptying velocity is depressed (<0.2m/s). the right atrium is dilated. the right atrial appendage ejection velocity is depressed (<0.2m/s). there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets that are moderately thickened. the left and right leaflet appears fused but frank aortic stenosis ids not present. trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened and shows characteristic rheumatic deformity. there is at least moderate valvular mitral stenosis (area 1.0-1.5cm2). there is no chordal deformation/thickening. trivial mitral regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , the left atrial appendage thrombus is consdierably smaller, not as mobile, and situated away from the mouth of the atrial appendage. ct abdomen/pelvis : 1. resting hemodynamics revealed a mean mitral valve gradient of 15mmhg and estimated valve area of 0.68cm2. 2. successful transeptal puncture and mitral using a an inoue balloon inflated to 26mm, 28mm and 30mm diameter. 3. improvement of mean gradient to 6mmhg and valve area to 1.98cm2. patient left cathlab in stable condition. cxr : moderate-to-marked cardiomegaly is stable. small bilateral pleural effusions are unchanged. there is no overt chf. there are bibasilar atelectases. ultrasound : no evidence of bilateral groin hematoma, fluid collections or vascular abnormalities in the common femoral vessels. brief hospital course: mitral stenosis secondary to rheumatic disease: mitral . intra-procedure sbps 70s-110 and required doputamine support. post-procedure sbp 70s and was transferred to ccu for observation. hypotension differential included tamponode vs. bleed (rp or groin). echo x 2 negative for tamponode or effusion. groin sites intact and ct ab/pelvis negative for bleed. most likely related to procedure medications and new onset mr. was stable in unit and transferred back to the floor on . on patient developed hematoma at r cath site, heparin was continued but coumadin was held. blood pressure and hct were stable, ultrasound imaging on was negative for hematoma b/l. patient developed mild-moderate mr . patient's sbp averaged 100s and felt too low to start afterload reducer inpatient. consider outpatient afterload reducer if bp tolerates. follow-up echo in weeks. rhythm: atrial fibrillation. no rvr during entire admission, heart rate < 100. tee demonstrated persistant left atrial thrombus, though smaller and less mobile since tee. unable to convert due to thrombus. continued metoprolol tartrate 50 mg po bid for rate control during admission, discharged on toprol xl 100 mg. anti-coagulation: required for 1) l atrial thrombus 2) history of pe 3) a fib. on weight-based heparin drip throughout admission. restarted coumadin 4 mg qhs during admission, discharged on lovonex until therapeutic. mild nausea: patient reported mild nausea on admission. no abnormalities on ct abdomen or pelvis. all stools guaiac negative. started and discharged on omeprazole 20 mg qd. h. pylori positive, pending at discharge. will contact primary care provider regarding results. patient was discharged on omeprazole, but will require course of antibiotics. medications on admission: - coumadin 4 mg qhs - metoprolol xr 100mg qd discharge medications: 1. lovenox 100 mg/ml syringe sig: one (1) subcutaneous once a day for 10 days: 10 day supply . disp:*10 syringe* refills:*0* 2. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm: take as instructed. 3. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: mitral stenosis status post valvuplasty secondary: atrial fibrillation with left atrial thrombus history of pulmonary embolism discharge condition: ambulating with stable vitals. pain free. discharge instructions: you were admitted for a mitral valvuplasty for your mitral stenosis. it was necessary to give you heparin and stop your coumadin due to your history of clot in your heart and lung. you underwent the mitral and were monitored in the cardiac intensive care unit afterwards. you were started on lovenox, a medication to thin your blood, until your coumadin level (called inr) was therapeutic. . please call your primary care physician or cardiologist if you experience any bleeding, shortness of breath, chest pain, or other concerning symptoms. you will need a follow up echocardiogram to assess your heart function and valve function. . you will need to take the lovenox injections once daily until your coumadin level (inr) is at goal. you will see dr. on to have your coumadin level (inr) checked. . you were started on lovenox and should take this until instructed otherwise. you were started on a medication called omeprazole for symptoms of reflux. please take this for one month and discuss further with your primary care provider. no other medications were changed. followup instructions: please attend the following appointments: 1) cardiology: please follow up with dr. in the department of cardiology at an appointment made for you on at 4:15 pm. the number for dr. office is (. please have them schedule a follow-up echo in weeks for mitral regurgitation. 2) primary care provider: follow up with dr. at an appointment made for you on , at 10:00 am. you will need your coumadin level (inr) checked at that time to determine whether you should continue the lovenox injections. procedure: diagnostic ultrasound of heart percutaneous balloon valvuloplasty diagnoses: other iatrogenic hypotension atrial fibrillation hematoma complicating a procedure other chronic pulmonary heart diseases rheumatic heart failure (congestive) old myocardial infarction long-term (current) use of anticoagulants personal history of venous thrombosis and embolism nausea alone mitral stenosis 

Answer: The patient is high likely exposed to