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: bactrim attending: chief complaint: eye blurriness and shortness of breath major surgical or invasive procedure: right and left heart catheterization mitral valve valvuloplasty history of present illness: 72 year old female with h/o cad s/p cabg in , pci , and left cea who presented with left eye blurriness one week ago and was found to have severe carotid restenosis of cea. she is being transferred from her outpatient cardiologist's office at . she states that she has had multiple episodes of left eye blurriness that she describes as "grey veil" that comes down over her eye. her most recent episode was 5 days ago and lasted approximately 1-1.5 hours. she denies any other symptoms such as dizziness, ha, weakness, dysphagia, slurred speech, or altered mental status. she does mention that she feels neck tenderness on the left side that developed about the same time as her symptoms. she also mentions chronic progressive dyspnea on exertion that has worsened substantially since the spring of this year. she states that she can walk a flight of stairs, but it takes her a very long time. she gets short of breath going to the bathroom across the room. she denies orthopnea or peripheral edema. she occasionally wakes up at night short of breath, but this happens rarely. she also endorses a chronic cough. she denies any history of chest pain. on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. past medical history: past medical history: 1. cardiac risk factors: diabetes, +dyslipidemia, +hypertension 2. cardiac history: -cad s/p cabg: in following an rca-dissection complicating cardiac catheterization (saphenous vein graft to pda, saphenous vein graft to om1, saphenous vein graft to om2). -aortic valve replacement in with bovine prosthetic valve -mild-to-moderate mitral stenosis percutaneous coronary interventions: non-st elevation myocardial infarction in , subsequent cath showed the distal rca with 80% stenosis, total occlusion of left circ, patent saphenous vein graft to the rca, total occlusion of saphenous vein graft to om1, 80% stenosis the saphenous vein graft to om2 had 80% stenosis with thrombus within the graft which was intervened upon and angioplastied with subsequent placement of two mini vision stents 2.5 x 18 and 2.5 x 12 mm. other medical history -left carotid endarterectomy in and known occluded right subclavian artery -lung cancer status post right upper lobectomy in , deemed currently cured -remote history of ruptured intracranial aneurysm in , status post clipping -copd -obesity social history: lives with her husband in 3 house complex. daughters and grandchildren also live in complex. -tobacco history: prior tobacco use, quit in . -etoh: rarely -illicit drugs: none family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: 97.6 143/97 91 18 93%ra general: awake, alert, in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 8cm. slightly tender to palpation on left. cardiac: pmi located in 5th intercostal space, midclavicular line. regular rate and rhythm with occasional ectopy. iii/vi systolic murmur heard best at lusb. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: admission labs: 02:08pm wbc-7.6 rbc-4.71 hgb-13.6 hct-41.4 mcv-88 mch-29.0 mchc-32.9 rdw-15.2 02:08pm plt count-295 02:08pm glucose-104 urea n-31* creat-1.4* sodium-144 potassium-4.0 chloride-101 total co2-32 anion gap-15 02:08pm %hba1c-7.0* 02:08pm pt-12.2 ptt-23.8 inr(pt)-1.0 ecg: sinus rhythm. normal tracing. compared to the previous tracing there is no significant change. chest xray: mild cardiomegaly and a small right pleural effusion. cta head/neck: 1. high-grade stenosis of the proximal left internal carotid artery associated with soft plaque and presence of a "string sign" extending over an approximately 5-6 mm segment. 2. 40% stenosis of the proximal right internal carotid artery. 3. moderate atherosclerotic disease at the aortic arch with 40-50% stenosis at the origins of the common carotid arteries, bilaterally. 4. high-grade stenosis of the proximal right subclavian artery with what appears to be complete occlusionl, with reconstitution just proximal to the origin of the right vertebral artery, raising the possibility of "subclavian steal" syndrome; this should be closely correlated clinically. 5. 3-mm left anterolaterally-oriented aneurysm arising from the anterior communicating artery, related to aplastic a1 segment of the left aca. 6. post-surgical changes following aneurysm clipping in the region of the right carotid terminus. 7. mediastinal adenopathy and interlobular septal thickening at the left apex, which could be further evaluated with a dedicated chest ct. reportedly, the patient does have a history of lung cancer, which further raises concern of recurrent or metastatic disease given the superior mediastinal adenopathy; there is possible lymphangitic carcinomatosis in the left lung apex (these findings are incompletely imaged). : transthoracic echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. the right ventricular free wall is hypertrophied. the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the diameters of aorta at the sinus, ascending and arch levels are normal. the number of aortic valve leaflets cannot be determined. there is no significant aortic stenosis or regurgitation. the mitral valve leaflets are severely thickened/deformed. there is severe thickening of the mitral valve chordae. there is moderate to severe mitral stenosis (area 1.0 cm2). the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets fail to fully coapt. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate to severe mitral stenosis. small and hypertrophied left ventricle with preserved global systolic function. dilated and hypertrophied right ventricle with mild systolic dysfunction and evidence of pressure overload. severe tricuspid regurgitation. severe pulmonary hypertension. ct chest with contrast: no comparison is available. status post right upper lobectomy. no evidence of local recurrence. small bilateral pleural effusions. postsurgical scarring without evidence of lung nodules. findings consistent with chronic airways disease, including mucus bronchial plugging. no pathologically lymph node enlargement in the mediastinum. status post cholecystectomy. no adrenal pathology. cardiac catheterization: 1. selective coronary angiography of this right dominant system demonstrated a severe three vessel disease with patent svg to rca and svg to om1. the lmca had a proximal 20% stenosis. the lad had mild disease throughout with 10% stenoses. the lcx was occludded. the rca was known to be occludded. 2. venous conduit arteriography showed that the svg/om1 was occluded. the svg to rca was widely patent with a long 20-30% stenosis. the svg to om2 had a widely patent stent and no flow limiting stenoses. 3. limited resting hemodynamic revealed elevated rvedp at 19 mmhg. the mean pa pressure was 46 mmhg (phasic 90/26 mmhg). the pcwp was 29 mmhg. the cardiac index was mildly depressed at 2 l/min/m2. the mean systemic arterial blood pressure was 101 mmhg (phasic 145/72 mmhg). 4. distal aortography revealed mild diffuse distal disease. the renal arteries were patent bilaterally. the cia, iia, cfa, pfa and proximal sfa were all widely patent bilaterally. final diagnosis: 1. severe two vessel coronary artery disease with patent svg to om2 and rca. 2. occluded svg to om1. 3. severe right ventricular diastolic dysfunction. 4. severe pulmonary hypertension. 5. unchanged coronary artery disease. 6. patent distal vasculature. carotid series complete right ica stenosis 70-79%. retrograde flow right vertebral artery with monophasic flow right brachial artery representing a right subclavian steel. left ica stenosis 80-99%. transthoracic echo the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic valve is reported to be a bioprosthesis, but is not well seen. the measured transvalvular gradients would be normal for an aortic bioprosthesis. the mitral valve leaflets are severely thickened/deformed. there is moderate valvular mitral stenosis (area 1.0-1.5cm2). mild (1+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: moderate valvular mitral stenosis. severe tricuspid regurgitation. mild symmetric left ventricular hypertrophy with preserved global and regional systolic function. dilated and hypokinetic right ventricle with signs of pressure overload. severe pulmonary hypertension. transthoracic echo a secundum type atrial septal defect is present. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. no aortic regurgitation is seen. the mitral valve leaflets are severely thickened/deformed. there is moderate valvular mitral stenosis (area 1.3cm2). no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the transmitral gradient is lower, the estimated pulmonary artery systolic pressure is slightly reduced and a secundum type atrial septal defect is now seen with bidirectional flow. no significant pericardial effusion is seen on either study. femoral ultrasound no evidence of hematoma or pseudoaneurysm. brief hospital course: 72 year old female with h/o cad s/p cabg in , pci , and left cea who presented with shortness of breath on exertion and transient left-sided visual blurriness. #. shortness of breath/mitral stenosis: she has a known diagnosis of copd and was found to have moderate-severe mitral stenosis (mean gradient 15mmhg, mv area 1.0cm2) on transthoracic echo. she also had severe pulmonary hypertension and evidence of right-sided pressure overload on admission. she was aggressively diuresed after admission. she underwent right and left heart catheterization which showed significantly elevated right and left-sided filling pressures. her mitral stenosis improved to moderate with diuresis but she remained with significant dyspnea even with ambulating a few steps. she was also given scheduled nebulizers for wheezing which gave her a small amount of subjective improvement. she underwent mitral valvuloplasty without complication and her shortness of breath substantially improved after the procedure. repeat echo showed a lower transmitral gradient, slightly reduced pulmonary artery systolic pressure, and a secundum type asd (mean gradient 8mmhg, mv area 1.3cm2). she was able to ambulate without oxygen on discharge. #. hypotension: after her mitral valvuloplasty, she was admitted to the ccu overnight for transient hypotension. she required phenylephrine briefly in pacu but none in the icu. cath sites were intact and she had a negative groin check. #. coronary artery disease: she remained without chest pain throughout her admission. she was continued on aspirin and her dose of pravastatin was increased to 80mg daily. her plavix was held during most of the hospitalization in preparation for possible intervention. #. cea: she originally presented with transient left eye blurriness that was concerning for amaurosis fugax. she was evaluated by neurology and ophthalmology who felt that her symptoms were not typical of amaurosis fugax but felt that carotid stenosis was the major concern. cta head/neck and carotid duplex showed tight stenosis (80-99%) of the left internal carotid artery and significant stenosis of the right internal carotid artery (70-79%). she was evaluated by vascular surgery who felt that carotid endarterectomy was very high risk and recommended stenting. this was deferred on this hospitalization, but she will likely need carotid stenting in the near future. she was instructed to follow-up with vascular surgery as an outpatient. #. atrial flutter: she had multiple transient episodes of atrial flutter with rapid ventricular response that converted back to normal sinus rhythm without intervention. she remained mainly in normal sinus rhythm and was started on a heparin drip for anticoagulation with plan to bridge to coumadin. she was also started on a beta blocker for rate control. #. hypertension: she was continued on her home lisinopril. amlodipine was also added for hypertension temporarily which she tolerated well, but this was discontinued after her mitral valvuloplasty as her blood pressure returned to range after this procedure. #. prophylaxis: she was given sq heparin for dvt prophylaxis #. code status: she was full code during this admission medications on admission: plavix 75mg po daily spiriva daily pravastatin 40mg po daily aspirin 325mg po daily furosemide 20mg po daily lisinopril 20mg po bid tricor 48mg po daily albuterol prn calcium vitamin d centrum ibuprofen prn for pain discharge medications: 1. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) puff inhalation once a day. 2. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. furosemide 20 mg tablet sig: one (1) tablet po once a day: please start taking this medication on . 5. tricor 48 mg tablet sig: one (1) tablet po once a day. 6. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every 4-6 hours as needed for shortness of breath or wheezing. 7. calcium oral 8. vitamin d oral 9. lisinopril 20 mg tablet sig: one (1) tablet po twice a day: please stop taking this medication now. do not restart until you see your primary care doctor. 10. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*60 tablet(s)* refills:*2* 11. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: mitral stenosis carotid stenosis secondary diagnosis: coronary artery disease copd discharge condition: good, alert and oriented, ambulating independently. slightly orthostatic on discharge. discharge instructions: you were admitted to the hospital due to shortness of breath. you were found to have stenosis (narrowing) of the mitral valve in your heart. you underwent a cardiac catheterization to measure the pressures in your heart. you then underwent a mitral valvuloplasty in order to help open up your mitral valve. you had an ultrasound (echocardiogram) of your heart after the procedure which showed that your valve is now more open than it was previously. you were also found to have significant stenosis (narrowing) of the carotid arteries in your neck. it was decided to delay any treatment for this narrowing until your shortness of breath had resolved. you should follow up with a vascular surgeon regarding these stenoses. while you were in the hospital, your heart went into an abnormal rhythm called atrial flutter. your heart rate has been very well-controlled on a new medication called metoprolol. you were also started on a blood thinner called coumadin (warfarin). you will need to have your blood levels of this drug checked very closely. please have your primary care doctor check your inr on friday, . on the day of discharge, your blood pressure dropped slightly when you were standing. please drink lots of fluids today and don't take your dose of lasix tomorrow. please have your primary care doctor check your blood pressure while sitting and standing (orthostatic blood pressure) during your next appointment. changes to your medications: stop taking plavix start taking coumadin 2mg by mouth daily start taking metoprolol succinate 25mg by mouth daily hold (do not take) lisinopril 20mg by mouth daily until you see your primary care doctor hold (do not take) your lasix tomorrow, then restart lasix at 20mg by mouth daily if you experience any of the following, please return to the hospital: worsening shortness of breath dizziness syncope (passing out) or feeling as though you are going to pass out chest pain if you experience any of the following, please call your primary care doctor: worsening swelling in your legs fever or chills nausea vomiting diarrhea followup instructions: you have the following appointments scheduled: dr. , medical associates 541 main steet, , , phone: fax: friday, at 3:00pm please also call and make an appointment with your cardiologist, dr. or whoever you choose to follow up with within the next 2 weeks. you should also follow up with a vascular surgeon. the telephone number for the vascular surgery clinic is ( if you would like to follow up with the vascular surgeons at our hospital. md, procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters other and unspecified coronary arteriography aortography arteriography of other intra-abdominal arteries percutaneous balloon valvuloplasty diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of bronchus and lung other chronic pulmonary heart diseases personal history of tobacco use percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia old myocardial infarction long-term (current) use of anticoagulants obesity, unspecified chronic obstructive asthma, unspecified heart valve replaced by transplant chronic diastolic heart failure acquired absence of both cervix and uterus radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure tricuspid valve disorders, specified as nonrheumatic other diuretics causing adverse effects in therapeutic use acquired absence of organ, lung transient retinal arterial occlusion body mass index 31.0-31.9, adult 

Answer: The patient is high likely exposed to