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: metoprolol attending: chief complaint: dyspnea major surgical or invasive procedure: mitral (28mm ring) and tricuspid valve (28mm ring) repair cardiac cath history of present illness: ms. is n 80-year-old woman with longstanding mvp and moderate-to-severe mr who is recovering from multiple hospitalizations, most recently due to severe congestive heart failure in . currently she admits to feeling stronger. her endurance remains poor, and she continues to experience exertional dyspnea. her appetite is good, and she is eating three meals per day and two snacks. the head of her bed remains elevated at all times to prevent aspiration. ** per cardiology, she is unable to tolerate dabigatran, and she cannot have a tee because of her esophageal issues. she is on warfarin **. given mitral and tricuspid regurgitation with worsening pa pressures, she was admitted for cardiac cath today and found to have clean coronaries. she will be placed on heparin drip and await mvr on . past medical history: mitral and tricuspid valve regurgitation s/p mitral and tricuspid valve repair past medical history: - congestive heart failure - pulmonary hypertension - history of aspiration pneumonia's - restrictive/interstitial lung disease - osteoporosis - "patulous" esophagus/achalasia - s/p botox injections - atrial fibrillation - history of shingles - leiomyoma, s/p tah - cyst on back removed in . - s/p tonsillectomy. - s/p breast fibroadenoma left aspiration, social history: lives with: husband occupation: retired professor literature cigarettes: quit smoking at 41, approximately 20-25 pk yr hx etoh: < 1 drink/week illicit drug use: denies family history: father died of a heart attack in his 70's. mother died of congestive heart failure at age 88. she is married with three stepchildren and four grandchildren. physical exam: pulse: 112 resp: 16 o2 sat: 94% b/p right: 111/67 left: 113/70 height: 5'4" weight: 97lbs general: thin elderly female in no acute distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur grade abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema - trace right>left varicosities: none neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 1+ left: 2+ pt : 1+ left: 1+ radial right: cath site left: 2+ carotid bruit right: - left: radiating pertinent results: 03:50am blood wbc-10.7 rbc-3.67* hgb-11.2* hct-36.6 mcv-100* mch-30.5 mchc-30.6* rdw-15.3 plt ct-417 02:48am blood wbc-10.2 rbc-3.25* hgb-10.0* hct-32.1* mcv-99* mch-30.7 mchc-31.1 rdw-14.5 plt ct-342 04:46am blood wbc-8.9 rbc-3.21* hgb-10.0* hct-31.7* mcv-99* mch-31.2 mchc-31.7 rdw-14.5 plt ct-330 03:50am blood pt-17.2* ptt-27.9 (pt)-1.6* 02:48am blood pt-15.8* (pt)-1.5* 04:46am blood pt-13.7* ptt-28.1 (pt)-1.3* 01:53am blood pt-14.8* ptt-28.4 (pt)-1.4* 02:47am blood pt-15.6* ptt-28.9 (pt)-1.5* 02:46am blood pt-17.5* (pt)-1.6* . cath: 1. selective coronary angiography in this right dominant system demonstrated no angiographically apparent flow-limiting cad although atherosclerosis was evident. the lmca had an ostial 20% lesion. the lad had a ostial 25% lesion, large d2 and distal vessel that wraps around the apex. the lcx had a 40% ostial stenosis and tortuous large om3 and lpl. the rca had a vertical origin, luminal irregularities to 30% in the mid and distal section. tortuous rpda, rpl1 and am vessels were noted as well as a modest caliber rpl2. 2. resting hemodynamics revealed elevated biventricular filling pressures with a mean pcwp 35mm hg and mean rvedp 17mmhg at rest. severe pulmonary arterial hypertension with systolic, diastolic, and mean pa pressures of 70/28/44mm hg. prominent v waves consistent with significant mitral regurgitation was also noted. low cardiac output cardiac index was reduced at 1.50 l/min/m2. entry pvr of 328 dyne-sec/cm5 and svr of 3138 dyne-sec/cm5 was noted. . echo: unable to pass tee probe. resistance in upper esophagous limited epicardial study prebypass: the aortic valve leaflets are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. moderate to severe (3+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. lv systolic function appeaqrs to be moderately globally depress (lvef-35-40%) post bypass: the patient is on epinephrine 0.05 uck/kg/min lv function now appears normal in the setting of inotropes (lvef~ 55%) there are ring prosthese in the mitral and tricuspid position. no residual mr is visualized. . head ct ct head w/o contrast study date of 11:58 am , r. csurg csru 11:58 am ct head w/o contrast clip # reason: eval for cva in patient with right sided weakness, lethargy medical condition: 80 year old woman s/p mv repair, tv repair reason for this examination: eval for cva in patient with right sided weakness, lethargy s/p mv repair, tv repair contraindications for iv contrast: none. final addendum comment: the above findings were made at 2:55 p.m, and discussed with ms. , n.p., cardiac surgery service (and not "ms. , n.p." as incorrectly stated in the original report), via telephone, at 3:00 p.m, on . the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 1:54 pm , r. csurg csru 11:58 am ct head w/o contrast clip # reason: eval for cva in patient with right sided weakness, lethargy medical condition: 80 year old woman s/p mv repair, tv repair reason for this examination: eval for cva in patient with right sided weakness, lethargy s/p mv repair, tv repair contraindications for iv contrast: none. final report indication: 80-year-old woman, status post mitral and tricuspid valve repair, with now right-sided weakness and lethargy. comparison: none. technique: mdct images were acquired through the head without intravenous contrast. findings: there is no evidence of intracranial hemorrhage, edema, mass, or mass effect. a new relatively well-defined hypodense region in the medial left frontal lobe, in the aca territory, is consistent with an acute infarction. a tiny focus of hyperdensity in the parasagittal frontal location (2:8) may represent a focal "hyperdense aca" with intramural thrombus versus plaque. no intracranial hemorrhage is detected. there is mild mass effect on the frontal of the ipsilateral lateral ventricle. no rightward shift of midline structures is seen. the basal cisterns are normal. the imaged paranasal sinuses and mastoid air cells are clear. impression: acute left aca territory infarct, with possible focal hyperdensity in the a2/a3 segment of the left aca, which may represent in situ thrombus versus embolized atheromatous plaque (or other material). comment: the above findings were made at 2:55 p.m, and discussed with ms. , n.p. (cardiac surgery service) at 3:00 p.m on . the study and the report were reviewed by the staff radiologist. dr. dr. approved: wed 4:55 pm imaging lab . mr final report indication: stroke, status post mvr. comparison: ct head . technique: mri and mra of the head was obtained without contrast and mra of the neck was obtained before and after administration of contrast per department protocol. findings: mri head: there is an area of slow diffusion in the left frontal lobe extending into the corpus callosum with accompanying flair signal abnormality. there is no signal abnormality on the gradient echo images to suggest hemorrhage. there is no mass effect or midline shift seen. ventricles and sulci are age appropriate. the major intracranial flow voids appear preserved. a 6mm size t1 hyperintense lesion is noted within the anterior pituitary. visualized orbits and mastoid air cells are unremarkable. there is mild mucosal thickening in the ethmoid air cells bilaterally. mra head: the mra of the head is compromised by motion artifacts. in the left a2 segment is not well visualized. bilateral internal carotid arteries, vertebral arteries, basilar arteries are patent with no evidence of flow-limiting stenosis, occlusion, dissection or aneurysm formation. the right vertebral artery is dominant. mra neck: aortic arch shows normal three-vessel takeoff. bilateral common carotid arteries, vertebral arteries in the neck and internal carotid arteries are patent with no evidence of stenosis, occlusion, dissection or pseudoaneurysm formation. the left vertebral artery is seen arising directly from the aortic arch. impression: 1. left a2 occlusion with early subacute infarct in the left aca territory as described above. no evidence of hemorrhagic transformation. 2. 6mm size t1 hyperintense lesion is noted within the anterior pituitary, may represent a rathke cleft cyst, and less likely hemorrhagic adenoma. 2. unremarkable mra of the neck. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 5:48 pm imaging lab . echo conclusions the left atrium is elongated. no mass/thrombus seen in the left or right atrium, but this study is not adequate to fully exclude atrial/atrial appendage thrombus ((ie atrial appendages not well visualized). there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe global left ventricular hypokinesis (lvef = 15 %). the estimated cardiac index is depressed (<2.0l/min/m2). no masses or thrombi are seen in the left ventricular apex. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity dilated with severe global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened without aortic stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. a mitral valve annuloplasty ring is present. no mitral regurgitation is seen, though cannot exclude fully due to acoustic shadowing from the ring. the tricuspid valve leaflets are mildly thickened. a tricuspid valve annuloplasty ring is present. physiologic tricuspid regurgitation is seen, though may be underestimated due to shadowing. the estimated pulmonary artery systolic pressure is normal. the pulmonic valve leaflets are thickened. there is no pericardial effusion. impression: severely reduced global systolic function of the left and right ventricle. mitral and tricuspid annuloplasty rings present. no mass or thrombi seen in the atria, though cannot fully exclude by transthoracic echocardiography. mildly dilated aortic sinus. compared with the prior study (images reviewed) of , the left ventricular function is markedly depressed. mitral and tricuspid annuloplasty rings are now noted. if suspicion for atrial thrombus is high, consideration can be given to other imaging studies (eg cardiac mri, ct), as the patient is unable to undergo tee. . ruq ultrasound final report indication: 80-year-old woman with increasing lfts, assess for portal vein thrombus. comparisons: . the liver is normal in echotexture without focal lesion, intra- or extra-hepatic biliary ductal dilatation. the portal vein and its major branches are patent. pulsatile flow is seen in the portal vein which may reflect underlying cardiac dysfunction. common bile duct is not dilated measuring 4 mm. small amount of sludge is seen in the gallbladder which is otherwise unremarkable in appearance without wall thickening, distention or pericholecystic fluid to suggest cholecystitis. trace perihepatic ascites is seen. impression: 1. patent portal vein without evidence of thrombus. pulsatility in the portal vein could reflect underlying cardiac disease. 2. trace perihepatic ascites. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 7:33 am . brief hospital course: as mentioned in the hpi, ms. cardiac cath on and was admitted following cath. she was medically managed, including heparin, and further surgical work-up. on she was brought to the operating room where she a mitral and tricuspid valve repair. she received vancomycin and kefzol for prophylaxis given her inpatient length of stay greater than 24 hours. please see operative note for surgical details. following surgery she was transferred to the cvicu for invasive monitoring in stable condition. within 24 hours she was weaned from sedation, and extubated. she was initially drowsy. later, on pod 1, she failed to follow commands and exhibited right sided weakness. neurology was consulted. head ct revealed left aca infarct. neurology continued to follow. anti-coagulation was initiated with heparin and coumadin. eeg was instituted to assess for seizure activity. she remained in atrial fibrillation. digoxin was resumed and lopressor titrated as tolerated. she was initially loaded with keppra for seizure activity noted on eeg, however due to worsening somnolence, it was discontinued. infarct was followed on ct to evaluate for hemorrhagic conversion in the setting of anti-coagulation for atrial fibrillation. lfts became elevated. ruq ultrasound did not reveal acute findings. she remained in the cvicu for close observation of airway protection in the setting of her infarct and rhoncherous secretions. a dobhoff tube was placed for tube feeds. all lines and drains were discontinued per protocol. current clinical picture is consistent with left aca infarct likely due to embolic etiology and exam shows profound abulia with a right hemiparesis. her level of arousal is depressed. she remains hemodynamically stable in rate controlled afib. in light of her neuro status she successful open j -tube on pod#13 and had been tolerating her tube feeds well. on pod 15 she was discharged to in . all follow up appointments were advised. medications on admission: atenolol 25 mg daily digoxin .0625 mcg daily furosemide 20 mg daily warfarin - 5 mg tablet - take 1 tablet(s) by mouth once a day or as directed by anticoag coumadin clinic (dr. ****last dose calcium carbonate-vitamin d3 - 600 mg-400 unit daily discharge medications: 1. outpatient lab work coumadin for afib goal 2-2.5 next check , then please check monday, wednesday, friday x 2 weeks. please arrange for coumadin follow-up prior to discharge from rehab 2. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po daily (daily) as needed for constipation. 3. warfarin 1 mg tablet : one (1) tablet po daily (daily): dose to change daily for goal 2-2.5. 4. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 6. ipratropium bromide 0.02 % solution : one (1) inhalation q4h (every 4 hours) as needed for sob. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q4h (every 4 hours) as needed for sob. 8. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. metoprolol tartrate 50 mg tablet : one (1) tablet po tid (3 times a day). 11. digoxin 125 mcg tablet : 0.5 tablet po qod. 12. acetaminophen 500 mg/5 ml liquid : po every hours as needed for fever or pain. discharge disposition: extended care facility: discharge diagnosis: mitral and tricuspid valve regurgitation s/p mitral and tricuspid valve repair past medical history: - congestive heart failure - pulmonary hypertension - history of aspiration pneumonia's - restrictive/interstitial lung disease - osteoporosis - "patulous" esophagus/achalasia - s/p botox injections - atrial fibrillation - history of shingles - leiomyoma, s/p tah - cyst on back removed in . - s/p tonsillectomy. - s/p breast fibroadenoma left aspiration, discharge condition: somnolent, deconditioned incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage no edema discharge instructions: please 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 please 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 and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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. date/time: 1:15 cardiologist: , np (for dr. date/time: 2:00 please call to schedule appointments with your 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** procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters other enterostomy enteral infusion of concentrated nutritional substances annuloplasty diagnoses: mitral valve disorders congestive heart failure, unspecified unspecified protein-calorie malnutrition chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases other convulsions personal history of tobacco use osteoporosis, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants pressure ulcer, lower back cerebral embolism with cerebral infarction encephalopathy, unspecified hyperosmolality and/or hypernatremia diseases of tricuspid valve hemiplegia, unspecified, affecting unspecified side iatrogenic cerebrovascular infarction or hemorrhage pressure ulcer, stage ii achalasia and cardiospasm chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to