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: no known allergies / adverse drug reactions attending: chief complaint: critical aortic stenosis major surgical or invasive procedure: corevalve placement pulmonary intubation with uvula trauma history of present illness: adapted form dr. note : . mr. is a 79 year old man with known severe as, chf, htn, hyperlipidemia, pulmonary hypertension, cad s/p cabg, carotid stenosis, afib, dm, ckd, copd on home o2 who was being transferred from for evaluation for aortic stenosis treatment options. he has been on home oxygen therapy since a chf exaccerbation approximately one year ago. . five months ago he underwent an emergent appendectomy secondary to rupture () followed by prolonged hospitalization complicated by chf and volume overload. since then, he has had 7 readmissions for shortness of breath, chf, ileus, and pneumonia. . on he was admitted to with chf exacerbation. he also complained of intermittent chest pressure at rest and with exertion. he was diuresed and by report lost 10 pounds. he was transferred to for evaluation of avr. at , he was noted to have severe aortic stenosis with a valve area of 0.7cm2, peak gradient of 71mmhg, and mean gradient of 42mmhg, also lvh and lvef 70% and pulmonary artery hypertension at 63mmhg. he was evaluated for percutaneous aortic valve repair, it was noted that his aortic valve area is 25mm which is too large to accomodate the valves used by the partners . was evaluated by for surgical aortic valve replacement and the mortality calculated was 14%, making him a candidate for percutaneous aortic valve replacement. . according to the discharge summary, he also had a ct angiogram which showed that his iliac arteries are too narrow to allow a trans femoral approach using the device (6 mm). he underwent cardiac cath which showed severe three vessel disease with patent lima to lad and svg to circumflex grafts but severely diseased svg to rca that was not ameniable to percutaneous intervention. . as part of his workup at , he underwent carotid ultrasound which showed patent s/p endarterectomy but the was severely narrowed, he underwent carotid angiogram which confirmed 80% stenosis of the . vascular surgery was consulted who recommended deferring endartectomy until after aortic valve repair. . he complained of minimal shortness of breath at rest and is able to ambulate around home slowly with mod doe. he has not used his o2 in about 1 month since furosemide dose increased and swelling improved. he is nyha class ii. . on review of systems, he denied any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, joint pains, cough, hemoptysis, black stools or red stools. he denied recent fevers, chills or rigors. he denied exertional buttock or calf pain. he had very itchy and burning le bilat that was keeping him awake at night. also c/o " horse" cramping in his right neck area, but has not taken any pain medicine for this. all of the other review of systems were negative. . cardiac review of systems was notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: + diabetes, +dyslipidemia, +hypertension . 2. cardiac history: -cabg: s/p cabgx3(lima->lad, svg->lcx, pda) -percutaneous coronary interventions: last at : severe native three vessel disease with patent lima to lad and svg to circumflex grafts but severely diseased svg to rca that was not ameniable to percutaneous intervention. -pacing/icd: none . 3. other past medical history: 1. severe aortic stenosis 2. cad 3. atrial fibrillation 4. hyperlipidemia 5. pulmonary hypertension 6. right carotid artery stenosis 7. diabetes 8. chronic kidney disease 9. copd, has not used o2 in the past month 10. bph 11. anemia 12. obesity 13. right shoulder nerve injury secondary to trauma 14. s/p l cea 15. s/p ruptured appendix-s/p laparascopic appy 16. s/p r foot fx social history: he has been widowed 6 years. retired penitentiary worker. landscaping/tree surgeon up to 8yrs ago. lives with daughter , sister lives in . independent adl's. walks with a cane to go up and down stairs. is at home with him at all times. has visting nurse. has home telemonitoring. rn comes once/week. has o2 that he used 24 hours in the past but none x 1 month after aggressive diuresis. followed by at : at to reschedule at discharge. . -tobacco history: 3 ppd for about 35 years. 120 pack year. quit 35 years ago. -etoh: recovered alcoholic, stopped drinking x 14 years ago. -illicit drugs: none. family history: father had cad, died post-operatively from hernia repair of dehissance. mother died at 83 from stroke. brother with stroke, sisters healthy but with htn. physical exam: vs: t= 97.7 bp=157/80 hr=74 rr= 16 o2 sat= 100% ra height: 66 inches weight: 87.5 kg . general: wdwm in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. spittiing saliva into a facecloth. neck: supple with jvp of 6 cm. has mobile 1 cm mass post to carotid lymph nodes that is non-tender and chronic per pt. cardiac: pmi located in 5th intercostal space, midclavicular line. irreg irreg rhythm. holosystolic murmur at rusb, radiating throughout the precordium and to right carotid. left carotid with soft bruit. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles at right base, no wheezes or rhonchi. abdomen: soft, ntnd. obese. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. has scattered small hematomas on right upper quad from insulin shots per pt. extremities: no c/c/e. no femoral bruits. skin: has reddened non-raised red plaques, left> right with closing open areas d/t scratching. pulses: right: carotid 2+ with bruit femoral 2+ popliteal 1+ dp trace pt dopp left: carotid 2+ femoral 2+ popliteal 1+ dp trace pt dopp pertinent results: labs on admission: 01:20pm blood wbc-8.8 rbc-3.52* hgb-8.8* hct-27.1* mcv-77* mch-25.0* mchc-32.4 rdw-15.7* plt ct-276 01:20pm blood pt-16.0* ptt-24.8 inr(pt)-1.4* 01:20pm blood glucose-111* urean-30* creat-1.5* na-137 k-4.0 cl-95* hco3-33* angap-13 01:20pm blood alt-16 ast-20 ck(cpk)-33* alkphos-83 totbili-0.5 01:20pm blood albumin-4.2 calcium-8.8 phos-4.5 mg-2.1 . labs on discharge: 07:05am blood wbc-6.7 rbc-3.65* hgb-9.4* hct-29.0* mcv-80* mch-25.7* mchc-32.4 rdw-15.1 plt ct-205 07:05am blood pt-22.3* ptt-29.1 inr(pt)-2.1* 07:05am blood glucose-143* urean-26* creat-1.4* na-139 k-3.7 cl-98 hco3-33* angap-12 04:45am blood alt-11 ast-20 ld(ldh)-201 alkphos-61 totbili-0.5 07:05am blood probnp-3091* 07:05am blood calcium-8.9 phos-4.5 mg-1.8 04:45am blood hapto-213* 04:55am blood caltibc-251* ferritn-124 trf-193* . last echo: : the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic root is mildly dilated at the sinus level. an aortic corevalve prosthesis is present. the transaortic gradient is normal for this prosthesis. a paravalvular aortic valve leak is probably present. mild (1+) aortic regurgitation is seen. there is mild functional mitral stenosis (mean gradient 6 mmhg) due to mitral annular calcification. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , mild paravalvar ar (para corevalve) is now seen. . ecg : atrial fibrillation with two wide complex beats of uncertain mechansim but maybe ventricular escape beats or possible pacer fusion complexes. consider left ventricular hypertrophy, although it is non-diagnostic. delayed r wave progression with late precordial qrs transition. lateral lead st-t wave chnages are non-specific but cannot exclude possible left ventricular hypertrophy or ischemia. findings are non-specific. clinical correlation is suggested. since the previous tracing or delayed r wave progression is less prominent and intermittent wide complex beats are present. . cxr : reason for exam: status post corevalve placement. comparison is made with prior study performed a day earlier. cardiomegaly is stable. right ij catheter tip is in the cavoatrial junction or upper atrium. if any, there is a small left pleural effusion. bibasilar atelectasis have worsened. the patient is status post corevalve placement. small right pleural effusion is also stable. there is minimally increase in mild vascular congestion. sternal wires are aligned. . cath report pending brief hospital course: # severe as: s/p corevalve placement percutaneously. tolerated procedure well. complication of uvula trauma from intubation. uvula hematoma noted with ecchymotic area and some bleeding immediately post extubation. cold water gargles and lidocaine spray recommended. has since resolved. all pre admission cardiac medicines restarted and uptitrated once bp was stable. coumdin restarted. pt will need aspirin and plavix daily for one month to prevent blood clots on corevalve. . # coronary artery disease: s/p cabg (currently with diseased svg to rca that is not amenable to percutaneous intervention). pt did not have chest pain or signs of acs during hospital stay. aspirin was continued. plavix started as above. imdur was dicontinued in the setting of low blood pressure immediately after corevalve placment and not restarted on discharge. metoprolol was held during post procedure phase for evidence of transient lbbb and pauses during his ccu stay. as bradycardia and hb is a known complication of corevalve placement, would restart metoprolol as outpt. . # chronic diastolic congestive heart failure: euvolemic during hospital stay. furosemide restarted and uptitrated to 120 mg , from 180 on admission. lisinopril was started and tolerated well by pt. pt instructed on daily weights and low na diet. . # atrial fibrillation: long standing issue for pt, has been stable on coumadin. restarted coumadin and inr 2.1 at discharge. communicated with at at discharge. should restart metoprolol as above. . # anemia: has baseline microcytic anemia with hct 28-29, elevated rdw, on chronic iron supplementation, trended down 5.5 points since admission and was transfused prbc x1 on for hct 22 with bump to 24.8. stable since. workup reveals low reticulocyte counts and iron profile consistent with anemia of inflammation rather than iron deficiency (low iron, low tibc, ferritin > 100). hemolysis labs negative. tsh normal. stool guaiac is positive likely due to hemoptysis. unclear when last colonoscopy is but may consider to r/o occult bleeding. . # hyperlipidemia: stable, crestor was continued. . # diabetes mellitus type 2: gets nph 25 qam + 15 qpm at home + novolog iss. this was continued during hospitalization and at discharge. . # copd: stable. on advair and spiriva at home, these were continued at discharge. . # chronic kidney disease: creatinine at baseline ~ 1.5. furosemide dose is lower on discharge. . communication: with daughter : cell home medications on admission: 1. fluticasone-salmeterol diskus (500/50) 1 inh ih 2. furosemide 80 mg 2 tabs po/ng once 3. metoprolol tartrate 50 mg, 0.5 tabs 4. omeprazole 20 mg po daily 5. potassium chloride 20 meq po bid 6. rosuvastatin calcium 40 mg po hs 7. tamsulosin 0.4 mg po hs 8. tiotropium bromide 1 cap ih daily 9. travoprost 0.004 % os daily 10. vitamin d 1000 unit po/ng daily 11. docusate sodium 100 mg po bid 12. ferrous sulfate 325 mg po/ng 13. magnesium oxide 400 mg po/ng daily 14. nph 25 units before breakfast, 15 units before dinner 15. novolov sliding scale 16. imdur 60 mg daily 17. warfarin 5mg daily, has not had in 5 days. 18. aspirin 81 mg daily discharge medications: 1. oxygen therapy o2 2-4 l continuous via np at rest and portable for o2 sat 85% on ra. 2. outpatient lab work please check inr, chem-7 and cbc on wednesday with chem-7 and cbc results to dr. at cell and fax and inr to at : at 3. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. furosemide 40 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po qpm (once a day (in the evening)). 6. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po twice a day. disp:*60 tablet, er particles/crystals(s)* refills:*2* 7. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. 8. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 10. travoprost 0.004 % drops sig: one (1) drop ophthalmic once a day: left eye. 11. cholecalciferol (vitamin d3) 1,000 unit capsule sig: one (1) capsule po once a day. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po twice a day. 14. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 15. nph insulin human recomb 100 unit/ml suspension sig: twenty five (25) units subcutaneous once a day: before breakfast, 15 units before dinner. disp:*1 bottle* refills:*2* 16. novolog 100 unit/ml solution sig: 0-12 units subcutaneous four times a day: as per sliding scale. 17. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 18. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 19. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 20. ascorbic acid 500 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 21. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: critical aortic stenosis s/p corevalve placement acute on chronic diastolic congestive heart failure coronary artery disease chronic obstructive pulmonary disease atrial fibrillation chronic kidney disease diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a corevalve replacement of your aortic valve on . you had a pacer wire for a few days and you tolerated the procedure well. during the intubation, your uvula was traumatized and there was some bleeding. this has resolved and is healing well. you were anemic and needed a transfusion of blood. you were continued on your iron to treat your anemia. you needed more oxygen during your hospital stay and will need to go home with portable oxygen in addition to the oxygen tank. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1. decrease furosemide to 120 mg twice daily to diurese extra fluid 2. discontinue metoprolol for now 3. stop imdur 4. start lisinopril to lower your blood pressure and help your heart pump better 5. start vitamin c to take with the iron to help the iron absorb from your stomach 6. start clopidogrel (plavix) every day to prevent blood clots on the new valve. you should not miss or stop taking this medicine unless dr. tells you to. followup instructions: primary care: , j. at 3pm . cardiology: , md at , please confirm time (already booked) . department: cardiac services when: friday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 10:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters open and other replacement of aortic valve aortography percutaneous balloon valvuloplasty diagnoses: anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders accidental puncture or laceration during a procedure, not elsewhere classified chronic kidney disease, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation accidental cut, puncture, perforation or hemorrhage during other specified medical care accidents occurring in residential institution examination of participant in clinical trial 

Answer: The patient is high likely exposed to