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: ascending aotic dissection major surgical or invasive procedure: - replacement of ascending aorta, aortic valve replacement(19 st. tissue), intra-aortic balloon pump - closure of chest history of present illness: the patient is a 57-year-old woman who was transferred by helicopter from to . we were notified when the patient was in flight that her blood pressure was 40 mmhg systolic and that she had probably tamponade from a type a aortic dissection. it was noted that she was poorly perfused. she was taken emergently to the or 1. the patient presented earlier that morning with shortnesss of breath, chest pain, and a seizure followed by nonresponsiveness. a ct showed a type a dissection involving the arch. in the or, the patient was cyanotic, in a low flow state and nonresponsive but sedated. past medical history: hypertension depression hyperlipidemia social history: smoker, unknown pack years. does not drink alcohol, and there is no history of ivda. family history: mh: aaa (not repaired), htn, hypercholesterolemia, cad fh: one daughter had a sah, and she has a son with chf physical exam: preop exam: critical condition. intubated/sedated. hypotensive. discharge vs t98.5 hr 74sr bp150/90 rr20 o2sat97%ra gen nad neuro a&ox3, nonfocal exam pulm cta bilat cv rrr, no m/r/g. sternum stable, incision cdi with staples abdm soft, nt/nd, +bs ext warm, trace pedal edema bilat pertinent results: echo pre bypass: overall left ventricular systolic function is normal (lvef>55%). the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. a mobile density is seen in the ascending aorta consistent with an intimal flap/aortic dissection. a mobile density is seen in the aortic arch consistent with an intimal flap/aortic dissection. there is no aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. trivial mitral regurgitation is seen. there is no pericardial effusion. post bypass #1: (on infusion of epinephrine 0.03mcg/kg/min there is now moderate aortic regurgitation and mild to moderate mitral regurgitation. moderately dysfunctional rv systolic function. lv volume appears underfilled. no dissection in the descending thoracic aorta. mild tr. post bypass #2: (on infusion of milrinone and epinephrine) moderate rv dysfunction. severe aortic regurgitation. moderate to severe mitral regurgitation. overall lv systolic function was 45%. post bypass #3: moderate rv systolic function. mild global lv hypokinesis. mild to moderate mr> aortic bioprosthesis is intact in the native aortic position with reasonable gradients. after an hour of post bypass, severe rv dysfunction. lv is underfilled. overall lv systolic function may be underestimated. lvef 20% no new dissections seen in the descending thoracic aorta. mild mr> tricuspid valve could not be well visualized because of the poor views. echo during chest closure no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricle displays normal free wall contractility. there are simple atheroma in the aortic arch. there is a dissection flap seen in the aortic arch. an intramural hematoma is also seen in the aortic arch. the descending thoracic aorta is mildly dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis leaflets do not fully coapt and a central defect is seen during diastole. moderate (2+) aortic regurgitation is seen through this defect. the maxim8um gradient through the valve is 33 mm hg with a mean gradient of 17 mm hg. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. an intraaortic balloon is seen with its tip 5 cm below the distal aortic arch. dr. was notified in person of the results in the operating room at the time of the study. admission 11:21pm urea n-21* creat-1.5* chloride-111* total co2-20* 11:21pm wbc-15.2*# rbc-3.31* hgb-10.3* hct-28.8* mcv-87 mch-31.0 mchc-35.7* rdw-14.6 11:21pm plt count-79* 11:21pm pt-17.3* ptt-99.4* inr(pt)-1.6* 08:20pm urea n-20 creat-1.3* chloride-110* total co2-23 08:20pm alt(sgpt)-30 ast(sgot)-75* ld(ldh)-327* alk phos-26* amylase-17 tot bili-0.5 08:20pm lipase-28 08:20pm albumin-1.4* discharge 06:35am blood wbc-13.8* rbc-3.62* hgb-11.2* hct-32.3* mcv-89 mch-30.9 mchc-34.6 rdw-15.5 plt ct-318 06:35am blood plt ct-318 02:06am blood pt-12.9 ptt-27.5 inr(pt)-1.1 06:35am blood glucose-86 urean-21* creat-0.8 na-133 k-4.0 cl-103 hco3-22 angap-12 , l f 61 radiology report chest (portable ap) study date of 9:50 am medical condition: 61 year old woman with rul atelectasis reason for this examination: r/o rul atelectasis final report reason for examination: followup of the atelectasis. portable ap chest radiograph was compared to prior study obtained on at 09:02 a.m. there is interval slight improvement of the right upper lobe opacity consistent with atelectasis that has partially resolved. aspiration would be another possibility, giving the similar appearance. the cardiomediastinal contour is stable. the right internal jugular line tip is at mid svc. there is no change in the right basal opacity consistent with atelectasis. dr. approved: mon 5:06 pm date: signed by , ms slp on affiliation: bedside swallowing evaluation: history: thank you for consulting on this 61 y/o female who was transferred to on from osh via and underwent emergent open chest type a aortic dissection repair, iabp insertion upon admission. chest closure on . patient was extubated on . hospital course c/b episodes of afib. we were consulted to evaluate patient's oral and pharyngeal swallowing function coughing on liquids. rn reported patient has been tolerating a regular diet over the weekend. pmh: htn, aaa evaluation: the examination was performed while the patient was seated upright in the chair on the cvicu. cognition, language, speech, voice: patient was awake and alert, "not feeling very well". cognition, language, speech and voice all wfl. teeth: intact dentition in appropriate condition secretions: normal oral secretions, congested baseline cough oral motor exam: tongue midline. adequate labial and lingual strength, rom and buccal tone. palatal elevation symmetrical. gag deferred. swallowing assessment: po trials included ice chips, thin liquids (tsp/cup), bites of applesauce and cracker. oral phase grossly wfl. laryngeal elevation felt timely and slightly reduced to palpation. no change in vocal quality. no throat clearing, coughing or choking was noted during po trials. o2 sats remained stable at 95%. summary / impression: ms. appeared to tolerate today's po trials without overt s/sx of aspiration at the bedside. she is recommended to continue a regular solid diet with thin liquids. however, silent aspiration cannot be r/o at the bedside and recommend continued monitoring of cxr as there is ? of aspiration immediately following extubation several days ago. if cxr appears to worsen and there is concern of aspiration with this diet, please reconsult and we will be happy to return. if patient noted with any coughing while taking pills, please give them whole with applesauce. this swallowing pattern correlates to a dysphagia outcome severity scale (doss) rating of level 6, wfl. recommendations: 1. continue po intake of thin liquids and regular solids. 2. pills may be taken whole with water or if difficulty, whole with puree. 3. please continue to monitor for any s/sx of aspiration during meals and via cxr. if cxr appears to worsen with concern for aspiration, please reconsult and we will be happy to return. these recommendations were shared with the patient, nurse and medical team. ____________________________________ , m.s., ccc-slp pager # brief hospital course: mrs. was admitted to the emergently via from on . she was taken directly to the operating room where she underwent an emergent repair of a type a aortic dissection with replacement of her ascending aorta and aortic valve as well as placement of an intra-aortic balloon pump. please see operative note for details. postoperatively she was taken to the intensive care unit in critical condition with an open chest. she required multiple blood product transfusions given her postoperative bleeding. over the next several days, her inotropes were slowly weaned off. the neurology service was consulted for assistance in her care. an eeg was negative for seizure activity. when sedation was weaned, she was able to mover her extremities and follow simple commands. on , she was taken back to the operating room where closure of her chest was performed. he iabp was removed without issue. vancomycin, ciprofloxacin and zosyn were started for a pulmonary infiltrate. a hit assay was sent given her thrombocytopenia however this remained negative. on , mrs. awoke neurologically intact and was extubated. she developed atrial fibrillation which was treated with amiodarone. diamox was used to treat metabolic alkalosis. a bedside swallowing exam was normal and she was cleared for a regular diet. on , mrs. was transferred to the step down unit for further recovry. once on the floor she had an uneventful hospital course. she was gently diuressed towards her preoperative weight. the physical therapy service was consulted for assistance with her postoperative strength and mobility. on pod 14/10 she was ready for discharge to rehabilitation. she was transferred to care center in n , ma medications on admission: lisinopril 10', propanolol sa 120", zetia 10' hctz 25', cymbalta 60', enablex 7.5' discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 2. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours): while on lasix. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 6. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous qac&hs. 7. alprazolam 0.25 mg tablet sig: 0.5 mgs po tid (3 times a day) as needed. 8. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 9. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). 10. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 11. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 12. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 13. lasix 40 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: discharge diagnosis: ascending aortic dissection abdominal aortic aneurysm hypertension depression hypercholesterolemia discharge condition: good discharge instructions: no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks shower daily, no baths or swimmign no lotions, creams or powders to incisions report any redness of, or discharge from incisions report any fever greater than 100.5 take all medications as directed report any weight gain greater than 2 pounds a day or 5 pounds a week no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks shower daily, no baths or swimmign no lotions, creams or powders to incisions report any redness of, or discharge from incisions report any fever greater than 100.5 take all medications as directed report any weight gain greater than 2 pounds a day or 5 pounds a week followup instructions: 1) follow-up with dr. in 2 weeks () 2) follow-up with dr. in 2 weeks. 3) follow-up with dr. in weeks. call all providers for appointment. 4) you have an appt with dr at on at 2:30 pm. please call ( with questions. you will need a referral from your pcp. 5) see dr. in 6 months with a follow-up ct scan. call ( for an appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery fiber-optic bronchoscopy open and other replacement of aortic valve with tissue graft resection of vessel with replacement, thoracic vessels closed [endoscopic] biopsy of bronchus implant of pulsation balloon closure of skin and subcutaneous tissue of other sites transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: thrombocytopenia, unspecified tobacco use disorder unspecified essential hypertension atherosclerosis of aorta atrial fibrillation other convulsions mitral valve insufficiency and aortic valve insufficiency depressive disorder, not elsewhere classified pulmonary collapse other and unspecified hyperlipidemia hemorrhage complicating a procedure alkalosis surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cardiogenic shock nausea alone abdominal aneurysm without mention of rupture other and unspecified coagulation defects dissection of aorta, thoracic cardiac tamponade 

Answer: The patient is high likely exposed to