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: acute shortness of breath major surgical or invasive procedure: aortic valve replacement (21mm pericardial) cardiac cath history of present illness: 67 year old female with severe aortic stenosis who presented with acute dyspnea to . this morning patient woke up at 3:15 am with acute dyspnea which did not improve with rest. at the time she was reaching for a towel. she called 911 and went to . received albuterol and nitropaste in er. was transferred to for cath to assess aortic stenosis and coronary arteries (report below in medical decision making). patient describes worsening shortness of breath for 3 weeks duration. sob occurs at rest and on exertion. has not been able to go recently due to sob. describes episodes of paroxysmal nocturnal dyspnea. the episode this am was more severe and lasted for over 20 minutes, patient was "very scared". patient more comfortable breathing when sitting up right (+ orthopnea). describes fatigue over the past 3 weeks. denies dizziness, episodes of syncope or pre-syncope. denies chest pain. denies lower extremity edema and palpitations. past medical history: aortic stenosis, hypertension, hyperlipidemia, copd, cri, neuropathy, retinal thrombosis, nephrolithiasis, s/p appendectomy, s/p tonsillectomy social history: she is divorced and lives alone. she smoked 40+ years 1 pack/day, quit 3 years ago. does not drink. she works part-time in an office, but has not been able to go recently due to sob. close to sister who is a nurse. her phone number is . family history: father died of a stroke at age 79. mother had mitral valve valve surgery at age 68. brother passed away at age 42 secondary to stroke. physical exam: vs - 97.5, 136/75, 71, 18, 96 ra. gen: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 9 cm. cv: rrr, pan-systolic murmur that radiates to carotids and abdomen. no thrills, lifts. chest: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no tenderness. positive bowel sounds. ext: no c/c/e. skin: no stasis dermatitis, ulcers, scars. pulses: right: dp 2+, pt 2+ left: dp 2+, pt 2+ pertinent results: cath : 1. selective coronary angiography of this right dominant system revealed no angiographically significant coronary artery disease. the lmca, lad and rca had mild diffuse disease throughout. the lcx had moderate diffuse disease throughout. 2. resting hemodynamics demonstrated normal systemic arterial pressures (136/67). left (lvedp 23 mmhg, mean pcw 22 mmhg) and right sided filling pressures (mean ra 10mmhg, rvedp 15 mmhg) were elevated. there was mild pulmonary hypertension (mean pap 32 mmhg). the calculated cardiac index was 1.9l/min/m2. peak to peak aortic gradient was 76mmhg with a mean gradient of 55 mmhg. calculated aortic valve area was 0.4cm2, indicating critical aortic stenosis. 3. left ventriculography was not performed due to the patient's chronic kidney impairment (baseline cr 1.2-1.6). final diagnosis: 1. no angiographically apparent flow limiting coronary artery disease. 2. critical aortic stenosis. 3. biventricular diastolic dysfunction. 4. mild pulmonary hypertension. 5. reduced cardiac index. . cxr impression: 1. no acute cardiopulmonary abnormality. 2. mild cardiomegaly with suggestion of left atrial and ventricular enlargement. . carotid series complete : 80-99% proximal right ica stenosis. . echo pre bypass: 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. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the descending thoracic aorta is mildly dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). severe (4+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. post bypass: there is preserved biventricular systolic function. there is a well seated, well functioning bioprosthesis in the aortic position. no aortic insufficiency is visualized. the remaining study is unchanged from prebypass. . cxr : as compared to the previous radiograph, there is no relevant change. the introducing sheath has been removed from the right internal jugular vein. the size of the cardiac silhouette as well as the blunting of the left costophrenic angle is unmodified. there is no evidence of newly appeared parenchymal opacities suggestive of pneumonia. signs of overhydration are not present. 06:05am blood wbc-7.8 rbc-3.94* hgb-10.9* hct-32.1* mcv-82 mch-27.8 mchc-34.0 rdw-16.2* plt ct-187 05:55am blood wbc-9.9 rbc-3.60* hgb-10.1* hct-30.1* mcv-84 mch-28.0 mchc-33.5 rdw-15.8* plt ct-102* 06:05am blood pt-13.0 inr(pt)-1.1 11:38am blood pt-14.7* ptt-42.5* inr(pt)-1.3* 06:05am blood glucose-111* urean-29* creat-1.2* na-145 k-4.5 cl-107 hco3-28 angap-15 09:40am blood glucose-120* urean-16 creat-1.1 na-136 k-3.7 cl-97 hco3-28 angap-15 05:55am blood urean-20 creat-1.2* k-3.4 06:05am blood albumin-4.1 calcium-9.1 phos-4.2 mg-2.2 06:05am blood alt-24 ast-21 ld(ldh)-226 alkphos-79 totbili-0.5 brief hospital course: ms. was admitted to the on for a cardiac catheterization in prepearation for an aortic valve replacement. her cardiac catheterization revealed critical aortic stenosis and no significant coronary artery disease. the cardiac surgical service was consulted and ms. was worked-up in the usual preoperative manner. a carotid duplex ultrasound was performed which showed an asymptomatic 80-99% stenosis of her right internal carotid artery. no intervention was planned at this time however vascular follow-up will be needed. an opthalmology consult was obtained for clearance for heparin given her history of a retinal hemorrhage. no contraindication for cardiac surgery or heparin was found on exam and ms, was cleared for surgery. on , ms. was taken to the operating room where she underwent an aortic valve replacement using a 21mm pericardial valve. please see operative note for details. postoperatively she was taken to the intensive care unit for monitoring. within 24 hours, ms. neurologically intact and was extubated. she was transfused for postoperative anemia. beat blockade, aspirin and her pletal were resumed. later on postoperative day one, she was transferred to the step down unit for further recovery. the physical therapy service was consulted for assistance with her postoperative strength and mobility. she was gently diuresed towards her preoperative weight. she continued to make steady progress and was discharged to rehabilitation on post-operative day 6. she will follow-up with dr. , her cardiologist and her primary care physician as an outpatient. medications on admission: amlodipine 10mg, hctz 12.5mg, asa 81mg, chilostizal 100mg, atenolol 25mg, lipitor 20mg, spiriva 18 mcg (inhaler), albuterol inhaler, pletal 100mg discharge medications: 1. 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:*0* 2. furosemide 20 mg tablet sig: one (1) tablet po once a day for 5 days. disp:*5 tablet(s)* refills:*0* 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 6. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*0* 7. potassium chloride 10 meq tablet sustained release sig: one (1) tablet sustained release po once a day for 5 days. disp:*5 tablet sustained release(s)* refills:*0* 8. norvasc 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 9. amiodarone 200 mg tablet sig: two (2) tablet po twice a day: please take 400mg twice a day until then decrease to 400mg daily for 7 days, then decrease to 200mg daily and follow up with cardiologist . disp:*80 tablet(s)* refills:*0* 10. albuterol 90 mcg/actuation aerosol sig: one (1) puff inhalation every six (6) hours as needed for wheezing. disp:*qs qs* refills:*0* 11. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 12. cilostazol 100 mg tablet sig: one (1) tablet po bid () as needed for maintain preop platelet inhibition for retinal clot. disp:*60 tablet(s)* refills:*0* 13. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 14. warfarin 2 mg tablet sig: one (1) tablet po once (once) for 1 doses: please take 2mg on - drawn on tuesday for further dosing . disp:*60 tablet(s)* refills:*0* 15. outpatient work pt/inr for coumadin dosing - goal inr 1.5-2.0 for atrial fibrillation first draw tuesday 16. outpatient work bmp with results to dr office # and dr office # discharge disposition: home with service facility: vna of southeastern mass. discharge diagnosis: aortic stenosis s/p aortic valve replacement pmh: hypertension, hyperlipidemia, copd, cri, neuropathy, retinal thrombosis, nephrolithiasis, s/p appendectomy, s/p tonsillectomy 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 please have drawn thrusday with results to pcp and dr followup instructions: dr. () 4 weeks dr. in weeks dr. in weeks labs bmp with results to dr office # and dr office # pt and inr please draw tuesday goal inr 1.5-2.0 for atrial fibrillation procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters open and other replacement of aortic valve with tissue graft transfusion of packed cells diagnoses: anemia, unspecified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders personal history of tobacco use chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia personal history of venous thrombosis and embolism personal history of urinary calculi acute on chronic systolic heart failure mononeuritis of unspecified site 

Answer: The patient is high likely exposed to