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: percocet / oxycodone / lorazepam / codeine / amiodarone / metoprolol attending: chief complaint: non-healing right toe ulcers. major surgical or invasive procedure: procedures: 1. right superficial femoral artery to posterior tibial artery bypass using left upper arm vein. 2. angioscopy history of present illness: this is a 72-year-old female who has undergone endovascular procedures on both legs and is recently status post right first and second toe amputations which were found in the clinic to not be healing well. the patient was admitted for repeat angiography which revealed no endovascular options. the patient was then deemed a candidate for a distal bypass. past medical history: - chf (dx in , last echo with lvef of 60-65% wit pcwp of 18, 1+ mr, 2+ tr) - cad (s/p triple cabg) - as (moderate, 0.8-1.19cm2 valve area) - type ii dm, now insulin-dependent (last hba1c was 6.0 in per patient) - cri secondary to diabetes (recent baseline cr 3.4-4.6, has been slowly rising) -pvd-s/ p angoiplasty of b/l feet in . toe on left foot amputated. has b/l stents in her legs. last vasc study: right abi 0.82, patent left popliteal and tibial angioplasty site with greater than 50% stenosis at the proximal tibial peroneal trunk. - htn - migratory polyarthritis (dx years ago) - hypothyroidism -anemia (baseline hct 28-34, nl recent iron studies) social history: no smoking, etoh, drugs lives with husband family history: father had mi at age 60, mother had valvular heart disease physical exam: a/o x 3 nad laying in bed cta / abd- benign coccyx pressure ulcer: nonstageable, approx. 5 x 4.5 cm, 75% black soft tissue, 25% yellow. there is a large amount of serous yellow drainage with odor. the wound bed is irregular. the periwound tissue is intact with no erythema, edema, induration, fluctuance or crepitus. she c/o pain with palpation of the site. pulses: fem dp pt rt 2+ - mono 2+ lt 2+ - mono surgical inc: c/d/i pertinent results: 12:00pm blood wbc-7.2 rbc-3.23* hgb-9.8* hct-31.3* mcv-97 mch-30.4 mchc-31.3 rdw-17.8* plt ct-214 12:00pm blood plt ct-214 03:06am blood pt-14.4* ptt-33.2 inr(pt)-1.3* 04:18am blood glucose-85 urean-21* creat-2.6* na-133 k-3.5 cl-97 hco3-28 angap-12 04:18am blood calcium-8.8 phos-2.9 mg-2.3 cardiology report echo study date of measurements: left atrium - long axis dimension: *5.9 cm (nl <= 4.0 cm) left atrium - four chamber length: *6.2 cm (nl <= 5.2 cm) right atrium - four chamber length: *5.4 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 1.1 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.9 cm (nl <= 5.6 cm) left ventricle - ejection fraction: 30% (nl >=55%) aorta - valve level: 2.7 cm (nl <= 3.6 cm) aorta - ascending: *3.5 cm (nl <= 3.4 cm) aortic valve - peak velocity: *4.2 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 70 mm hg aortic valve - mean gradient: 40 mm hg aortic valve - lvot peak vel: 0.80 m/sec aortic valve - lvot diam: 1.9 cm aortic valve - valve area: *0.7 cm2 (nl >= 3.0 cm2) mitral valve - pressure half time: 45 ms mitral valve - e wave: 1.3 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 1.86 mitral valve - e wave deceleration time: 196 msec tr gradient (+ ra = pasp): *48 mm hg (nl <= 25 mm hg) pulmonic valve - peak velocity: 1.0 m/sec (nl <= 1.0 m/s) interpretation: findings: left atrium: moderate la enlargement. right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. normal ivc diameter (1.5-2.5cm) with >50% decrease during respiration (estimated rap 5-10 mmhg). left ventricle: normal lv wall thickness. normal lv cavity size. moderate regional lv systolic dysfunction. no lv mass/thrombus. tdi e/e' >15, suggesting pcwp>18mmhg. no resting lvot gradient. no vsd. right ventricle: mild global rv free wall hypokinesis. aorta: normal aortic diameter at the sinus level. mildly dilated ascending aorta. no 2d or doppler evidence of distal arch coarctation. aortic valve: moderately thickened aortic valve leaflets. severe as (aova <0.8cm2). trace ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. moderate mitral annular calcification. mild to moderate (+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. mild to moderate +] tr. moderate pa systolic hypertension. conclusions: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with inferior and infero-lateral akinesis. the remaininf segmetns are hypokinetic. no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. there is mild global right ventricular free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is severe aortic valve stenosis (area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. compared to the prior study (reviewed) dated , the overall lvef has decreased. the as remains severe. electronically signed by , md on 17:10. brief hospital course: mrs. , c was admitted on with non-healing right toe ulcers. she agreed to have an elective surgery. pre-operatively, she was consented. a cxr, ekg, ua, cbc, electrolytes, t/s - were obtained, all other preperations were made. pt with known aortic stenosis, cardiology consulted. cleared for surgery pt also on hd pre-operative, renal was consulted. they followed the pt closely. recommendations were adhered to. she recieved regular hd on her scheduled day. it was decided that she would undergo a right superficial femoral artery to posterior tibial artery bypass using left upper arm vein. she was prepped, and brought down to the operating room for surgery. intra-operatively, she was closely monitored and remained hemodynamically stable. she tolerated the procedure well without any difficulty or complication. post-operatively, she was extubated and transferred to the csru for further stabilization and monitoring. she remained in the csru vetilated with pressure support for a number of days. while she was there she developed a pna. this was treated with antibiotics. she was then transferred to the vicu for further recovery. while in the vicu she recieved monitered care. when stable she was delined. her diet was advanced. a pt consult was obtained. when she was stabalized from the acute setting of post operative care, she was transfered to floor status on the floor, she remained hemodynamically stable with his pain controlled. she progressed with physical therapy to improve her strength and mobility. she continues to make steady progress without any incidents. she was discharged home with services. to note pt recommended rehab / pt refused rehab. pt did not want to stay in the hospital for any longer. she and the family decided that she would be better off at home. medically pt is stable for home. but physically she is not. medications on admission: : lopid 600'', levothyroxine 200, diltizem 120'' on non dialyisis days, neurontin 100, coumadin 1 mg, simvastatin 40 discharge medications: 1. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 2. gabapentin 100 mg capsule sig: one (1) capsule po daily (daily). 3. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal prn (as needed). disp:*10 pramoxine-mineral oil-zinc (rectal) 1-12.5 % ointment* refills:*2* 4. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 5. ibuprofen 600 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. disp:*40 tablet(s)* refills:*0* 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. diltiazem hcl 120 mg tablet sig: one (1) tablet po non dialysis days. 11. coumadin 1 mg tablet sig: one (1) tablet po once a day: moniter you inr in the usual fashiion. discharge disposition: home with service facility: partners discharge diagnosis: non-healing right toe ulcers. hyponatremia post operative confusion pna coccyx ulcer htn, chol, dm2 w retinopathy, neuropathy, esrd (hd mwf thru rt ij tunnel), anemia of chronic dz, hypothyroid, ra, chf(diastolic), severe aortic stenosis discharge condition: good discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. division of vascular and endovascular surgery lower extremity bypass surgery discharge instructions what to expect when you go home: 1. it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? increase your activities as you can tolerate- do not do too much right away! 2. it is normal to have swelling of the leg you were operated on: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated 3. it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal what to report to office: ?????? redness that extends away from your incision ?????? a sudden increase in pain that is not controlled with pain medication ?????? a sudden change in the ability to move or use your leg or the ability to feel your leg ?????? temperature greater than 100.5f for 24 hours ?????? bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions followup instructions: provider: , apg (sb) phone: date/time: 11:10 follow - up with dr on at 1500 hrs.in his office. provider: , md phone: date/time: 3:00 please get your hd on the scheduled days procedure: hemodialysis other (peripheral) vascular shunt or bypass diagnoses: pneumonia, organism unspecified end stage renal disease congestive heart failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism aortic valve disorders unspecified transient mental disorder in conditions classified elsewhere hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot pressure ulcer, other site diastolic heart failure, unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled atherosclerosis of native arteries of the extremities with ulceration 

Answer: The patient is high likely exposed to