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: left main coronary artery disease and mitral stenosis major surgical or invasive procedure: coronary artery bypass grafts x 2(lima-lad,svg-om),mitral valve replacement(27mm st. epi tissue),maze history of present illness: this 72 year old white male with a history of rheumatic heart disease recently developed atrial fibrillation. he has was previously catheterized elsewhere to reveal mitral stenosis and left main coronary artery disease. he was admitted for heparin, cessation of coumadin and elective surgery. past medical history: rheumatic heart disease mitral stenosis atrial fibrillation (new onset) colonic polyps, adenomatous erectile dysfunction social history: race: caucasian last dental exam: 1-2 months ago (had extraction for infected tooth) lives with: alone, has 3 grown children occupation: retired mechanical engineer tobacco: denies etoh: rare family history: father s/p mi age 65, mother with valvular heart disease and died during childbirth; brother died of ? problem age 65 physical exam: admission: pulse:72 resp:18 o2 sat:98% ra b/p right: 113/72 left: height:5'6" weight:168# general: well-developed male in no acute distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur iii/vi diastolic murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema/varicosities: none neuro: grossly intact pulses: femoral right: 2+ left: 2+ righ cath site - no hematoma dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right/left: none pertinent results: 04:50am blood wbc-8.2 rbc-3.04* hgb-9.5* hct-28.8* mcv-95 mch-31.2 mchc-32.9 rdw-15.6* plt ct-214# 04:50am blood pt-24.0* ptt-34.7 inr(pt)-2.3* 04:50am blood glucose-119* urean-31* creat-0.9 na-139 k-3.8 cl-98 hco3-34* angap-11 , m 72 radiology report chest (pa & lat) study date of 11:39 am , fa6a 11:39 am chest (pa & lat) clip # reason: ? effusions.please do this morning-hope to discharge today final report type of examination: chest pa and lateral. indication: 72-year-old male patient with mitral valve replacement and bypass surgery. evaluate for pleural effusion as the patient has to be discharged today. findings: pa and lateral chest views were obtained with patient in upright position. comparison is made with the next preceding postoperative chest examination of . as before, status post sternotomy and the presence of multiple surgical clips in the anterior mediastinum are compatible with previous bypass surgery. radiopaque structures of mitral valve prosthesis cannot be identified. there is moderate cardiac enlargement, but the pulmonary vasculature is not congested. crowded appearance of the pulmonary vasculature exists in the retrocardiac area and this coincides with a blunted posterior pleural sinus indicating a small amount of remaining pleural effusion. no evidence of acute pulmonary infiltrates and no pneumothorax is identified. comparison is also made with the preoperative chest examination of . mild-to-moderate cardiac enlargement existed already at that time so that there is no significant interval change in the cardiac enlargement. the pulmonary vasculature showed a degree of upper zone redistribution which now has normalized. the same holds also for the previously identifiable mild degree of fluid in the interlobar fissures, which now have normalized. the now present localized small amount of pleural effusion on the left base and posteriorly, however, is new and a followup in a few weeks is recommended to document complete normalization. an additional finding is rather gas distended large bowel loops. no evidence of small-bowel obstruction. dr. approved: tue 5:30 pm echocardiography report , (complete) done at 8:39:34 am final referring physician information , c. , status: inpatient dob: age (years): 72 m hgt (in): 66 bp (mm hg): 105/70 wgt (lb): 167 hr (bpm): 81 bsa (m2): 1.85 m2 indication: aortic valve disease. atrial fibrillation. coronary artery disease. mitral valve disease. shortness of breath. icd-9 codes: 427.31, 786.05, 395.2, 394.0 test information date/time: at 08:39 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 #: 2010aw001-0:00 machine: aw5 echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 50% to 55% >= 55% aortic valve - valve area: *1.8 cm2 >= 3.0 cm2 mitral valve - mva (p t): 1.2 cm2 findings left atrium: marked la enlargement. moderate to severe spontaneous echo contrast in the body of the la. mild spontaneous echo contrast in the laa. depressed laa emptying velocity (<0.2m/s) no thrombus in the laa. right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness and cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). mild as (area 1.2-1.9cm2). trace ar. mitral valve: characteristic rheumatic deformity of the mitral valve leaflets with fused commissures and tethering of leaflet motion. moderate valvular ms (mva 1.0-1.5cm2) trivial mr. tricuspid valve: normal tricuspid valve leaflets. moderate tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. mild pr. pericardium: small 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. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. conclusions pre-bypass: the left atrium is markedly dilated. moderate to severe spontaneous echo contrast is seen in the body of the left atrium. mild spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). trace aortic regurgitation is seen. the mitral valve shows characteristic rheumatic deformity. there is moderate valvular mitral stenosis (area 1.0-1.5cm2). trivial mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is a small pericardial effusion. post-bypass: the patient is not receiving inotropic support post-cpb. there is a well-seated bioprosthetic valve in the mitral position with good leaflet excursion. there is no paravalvular or transvalvular regurgitation. the mean pressure gradient across the valve is 5 mm hg at a cardiac output of 4.1 l/min. biventricular systolic function is preserved and all other findings are consistent with pre-bypass findings. the aorta is intact post-decannulation. all findings were discussed with the surgeon intraoperatively preliminary report developed by a cardiology fellow. not reviewed/approved by the attending echo physician. certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 14:13 brief hospital course: the patient was admitted and started on heparin and routine labs sent. he was taken to the operating room on and underwent mvr(27mm st. porcine)/cabgx2(lima-lad, svg->om)/maze. see operative note for details. he tolerated the procedure well and was transferred to the icu in stable condition. he was extubated easily and cts and temporary pacing wires were removed per protocol. he was begun on beta blockers and diuresed towards his preoperative weight. he was begun on coumadin again and had sinus rhythm and atrial fibrillation (controlled)postoperatively. physical therapy worked with him for strength and mobility. ep was consulted (dr. ) to suggest antiarrhythmics in an attempt to maintain sinus. wounds were clean and healing well at discharge. his coumadin will be controlled by who did so previously, with an inr goal of .5. he was discharged home with instructions regarding medications, follow up and precautions. dr. saw the patient in consultation regarding pharmacologic intervention to maintain sinus. amiodarone was recommended and was, therefore, begun. he is to be sent to rehab with of hearts for further monitoring of his rhythm. he will follow up with her after discharge. thyroid functions were sent as a baseline. he was discharged to of on pod#7 in stable condition. medications on admission: metoprolol tartrate 25mg po bid lasix 40mg po daily warfarin 2.5mg tabs- last dose (2.5 mg on tues/sat, 3.75 mg all other days) asa 81mg po daily mvi i tab daily viagra prn clotrimazole 1% cream- apply to rash on chest daily discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. 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:*2* 3. coumadin 2.5 mg tablet sig: as directed tablet po once a day: inr goal 2-2.5. disp:*100 tablet(s)* refills:*2* 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever/pain. disp:*120 tablet(s)* refills:*0* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 4 weeks. disp:*50 tablet(s)* refills:*0* 6. lisinopril 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 7. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day): one tablet twice daily for 4 weeks then one daily until instructed otherwise. disp:*60 tablet(s)* refills:*2* 8. furosemide 20 mg tablet sig: one (1) tablet po daily (daily) for 7 days. disp:*7 tablet(s)* refills:*0* 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily) for 7 days. disp:*7 tab sust.rel. particle/crystal(s)* refills:*0* discharge disposition: extended care facility: of discharge diagnosis: mitral stenosis atrial fibrillation s/p mitral valve replavement,maze,coronary artery bypass coronary artery disease rheumatic heart disease h/o colonic polyps discharge condition: alert and oriented x3, nonfocal. ambulating with steady gait. incisional pain managed with oral analgesics. incisions: sternal - healing well, no erythema or drainage leg left - healing well, no erythema or drainage. edema:none discharge instructions: 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. 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, until follow up with surgeon. 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 tuesday, at 1:15pm please call to schedule appointments with: primary care: dr. () in weeks *please call cardiac surgery office with any questions or concerns (). answering service will contact on call person during off hours.** labs: pt/inr for coumadin (atrial fibrillation) goal inr:2-2.5 first draw: procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization excision or destruction of other lesion or tissue of heart, open approach (aorto)coronary bypass of one coronary artery open and other replacement of mitral valve with tissue graft diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery atrial fibrillation long-term (current) use of anticoagulants sinoatrial node dysfunction diseases of tricuspid valve personal history of colonic polyps impotence of organic origin mitral valve stenosis and aortic valve insufficiency 

Answer: The patient is high likely exposed to