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: penicillins attending: chief complaint: asymptomatic major surgical or invasive procedure: -mitral valve repair (30mm - ring) -redo sternotomy, mitral valve replacement (#27mm st. mechanical) history of present illness: 51 year old male who has a history of a heart murmur for his entire life. has had echocardiograms the last couple of years after increasing intensity of his mitral regurgitation murmur was noted. recent echocardiograms have shown severe mirtral regurgitation with a flail p2 and torn chordae. he is currently asymptomatic but given state of his regurgitation along with dilated left atrium he was referred to dr. for evaluation in . he returns now for preadmission testing for surgery on . past medical history: mitral regurgitation hypertension hypercholesterolemia past surgical history s/p left acl surgery social history: lives with: wife contact: wife phone # occupation: firefighter cigarettes: smoked no yes last cigarette _____ hx: other tobacco use: denies etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use: denies family history: +premature coronary artery disease father mi < 55 mother < 65 cabg in 50's father with cabg in 60's. uncles with cabgs. physical exam: admission physical exam pulse: 80 resp: 18 o2 sat: 99% b/p right: 144/77 left: 150/82 height: 5'" weight: 185 lbs general: well-developed male in no acute distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr, iii/vi systolic murmur best heard at apex abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused no edema varicosities: none neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right: - left: - pertinent results: intra-op tee: pre-bypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are myxomatous. there is moderate/severe p2 leaflet mitral valve prolapse. there is partial p3 mitral leaflet flail. an eccentric, anteriorly directed jet of severe (4+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results at time of surgery. post-bypass: biventricular systolic function remains normal. there is a ring prosthesis in the mitral position. with initial post bypass loading conditions there was significant with lvot velocities >3 m/sec. with volume and increase of sbp from 80 to 110 the decreased, with lvot gradient ~15 mm hg. no early closure of the av, lvot patent on 3d images. trace residual mr. the study is otherwise unchanged from prebypass i that i was present for this procedure in compliance with hcfa regulations. echocardiography report , (complete) done at 9:16:45 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 52 m hgt (in): 70 bp (mm hg): / wgt (lb): 187 hr (bpm): bsa (m2): 2.03 m2 indication: h/o cardiac surgery. left ventricular function. mitral valve disease. preoperative assessment. shortness of breath. icd-9 codes: 424.0 test information date/time: at 09:16 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 #: 2012aw-:1 machine: us6 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *5.9 cm <= 5.6 cm left ventricle - ejection fraction: 55% to 60% >= 55% left ventricle - stroke volume: 330 ml/beat left ventricle - peak resting lvot gradient: *43 mm hg <= 10 mm hg aorta - annulus: 2.6 cm <= 3.0 cm aorta - sinus level: 3.3 cm <= 3.6 cm aorta - sinotubular ridge: 2.9 cm <= 3.0 cm aorta - ascending: 2.5 cm <= 3.4 cm aorta - arch: 2.8 cm <= 3.0 cm aorta - descending thoracic: 1.9 cm <= 2.5 cm aortic valve - peak velocity: *4.0 m/sec <= 2.0 m/sec aortic valve - peak gradient: *64 mm hg < 20 mm hg aortic valve - lvot pk vel: 3.37 m/sec aortic valve - lvot vti: 73 aortic valve - lvot diam: 2.4 cm mitral valve - peak velocity: 1.7 m/sec mitral valve - mean gradient: 6 mm hg findings left atrium: no spontaneous echo contrast in the body of the laa. right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: normal lv wall thickness. mildly dilated lv cavity. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. no atheroma in ascending aorta. normal aortic arch diameter. no atheroma in aortic arch. normal descending aorta diameter. aortic valve: normal aortic valve leaflets (3). no ar. mitral valve: mitral valve annuloplasty ring. of mitral valve leaflets. no ms. (4+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: trivial/physiologic pericardial effusion. general comments: written informed consent was obtained from the patient. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. see conclusions for post-bypass data conclusions pre-bypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. the mean lvot gradient is 16 mmhg. no aortic regurgitation is seen. a mitral valve annuloplasty ring is present. there is systolic anterior motion of the mitral valve leaflets. severe (4+) mitral regurgitation is seen at a systolic blood pressure of 100 to 120 mmhg.. mitral regurgitation is mild (1+) at a blood pressure of 174/84 achieved by phenylephrine with continued systolic anterior motion of the mitral valve. there is a trivial/physiologic pericardial effusion. there is a left pleural effusion. dr. was notified in person of the results at time of surgery. post-bypass #1: patient is in sinus rhythm. the patient is on a norepinephrine infusion. left ventricular function is unchanged. right ventricular function appears mildly depressed. there is a well-seated mitral annuloplasty ring in place. the height of the posterior leaflet of the mitral valve appears smaller compared to pre-bypass. there is still moderate to severe (3+) mitral regurgitation at a blood pressure of 95/54. there is still significant systolic anterior motion of the mitral valve with turbulent flow through the lvot suggesting lvot obstruction. post-bypass #2: patient is in sinus rhythm. the patient is on norepinephrine. left ventricular function remains unchanged. right ventricular function is normal. there is a well-seated mechanical prosthetic valve in the mitral position. characteristic washing jets are seen. no mitral regurgitation is seen. there is a mean gradient of 2 mmhg at a cardiac output of 4.8 l/min. there is no resting lvot gradient. the aorta is intact post-decannulation. prebypass exam and post bypass exam #1 reviewed by dr , , and . post #2 reviewed by dr and that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:05 ?????? caregroup is. all rights reserved. 04:40am blood wbc-7.8 rbc-2.67* hgb-8.0* hct-25.2* mcv-94 mch-30.1 mchc-31.9 rdw-13.8 plt ct-240 11:52am blood wbc-15.4*# rbc-3.72* hgb-11.5*# hct-34.5*# mcv-93 mch-30.9 mchc-33.3 rdw-12.9 plt ct-115* 04:40am blood pt-23.1* inr(pt)-2.2* 11:52am blood pt-12.5 ptt-26.5 inr(pt)-1.2* 04:40am blood glucose-102* urean-21* creat-0.8 na-140 k-5.4* cl-104 hco3-31 angap-10 11:52am blood urean-15 creat-0.7 na-139 k-4.7 cl-108 hco3-23 angap-13 04:45am blood hct-28.5* 12:45pm blood pt-25.8* ptt-66.2* inr(pt)-2.5* 04:45am blood urean-19 creat-0.8 na-138 k-5.4* cl-101 brief hospital course: mr. was brought to the operating room on where he underwent mitral valve repair (#30mm ce ring)with dr. . overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. he awoke neurologically intact. he remained on neo for hemodynamic support and was slow to wean off. on pod 2, mr. had increasing oxygen requirements and continued to require pressor support. trans thoracic echo per cardiology revealed well seated mitral valve annuloplasty ring. hyperdynamic left ventricular systolic function with at least moderate resting left ventricular outflow tract obstruction secondary to systolic anterior motion of the mitral valve leaflets. moderate to severe mitral regurgitation. he was volume resuscitated for and beta-blockade optimized as bp tolerated. mr. did not progress. repeat trans thoracic echo compared with the prior study of per cardiology, the lvot obstruction was minimally decreased (from 56 mmhg to 46 mmhg). severe mitral regurgitation now readily apparent; previously it was moderate to severe. dr. discussed with mr. the need for reoperation in the am to address this, and the likelihood of a mitral valve replacement. on he was taken to the operating room and underwent a mitral valve replacement with #27mm mechanical valve. please see operative report for further surgical details. he tolerated the procedure well and was transferred to the cvicu for hemodynamic monitoring and recovery. he required pressor support and was ultimately weaned off. he awoke neurologically intact and was extubated. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. anticoagulation was initiated for his mechanical valve. all lines and drains were discontinued per protocol. he made progress and was transferred to the telemetry floor for further recovery. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod #9 and #5 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to home with vna services. all follow up appointments were advised. medications on admission: pravastatin 40mg daily lisinopril 5mg daily discharge medications: 1. aspirin 81 mg , delayed release (e.c.) sig: one (1) , delayed release (e.c.) po daily (daily). disp:*60 , delayed release (e.c.)(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. pravastatin 20 mg sig: two (2) po daily (daily). disp:*60 (s)* refills:*2* 4. ranitidine hcl 150 mg sig: one (1) po bid (2 times a day). disp:*60 (s)* refills:*2* 5. metoprolol tartrate 25 mg sig: one (1) po tid (3 times a day). disp:*90 (s)* refills:*2* 6. potassium chloride 10 meq extended release sig: one (1) extended release po bid (2 times a day) for 10 days. disp:*20 extended release(s)* refills:*0* 7. lasix 40 mg sig: one (1) po twice a day for 10 days. disp:*20 (s)* refills:*0* 8. hydromorphone 2 mg sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*50 (s)* refills:*0* 9. ibuprofen 600 mg sig: one (1) po q6h (every 6 hours) as needed for pain. disp:*50 (s)* refills:*0* 10. warfarin 5 mg sig: one (1) po once (once) for 1 doses. disp:*1 (s)* refills:*0* 11. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 12. tramadol 50 mg sig: one (1) po q4h (every 4 hours) as needed for pain. disp:*50 (s)* refills:*0* 13. warfarin 2.5 mg sig: md once a day: at 4 pm. disp:*180 (s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: mitral regurgitation hypertension hypercholesterolemia past surgical history s/p left acl surgery discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 **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: wound check at cardiac surgery office surgeon dr. date/time: at 1:30 cardiologist dr. on at 3:45 pcp: . , follow inr/coumadin dosing. inr indication: mechanical mvr (#27mm st.) inr goal: 2.5-3.5 please fax results to: attention dr., fax# phone# **first draw please call to schedule the following: primary care dr. , r. 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 extracorporeal circulation auxiliary to open heart surgery open and other replacement of mitral valve open heart valvuloplasty of mitral valve without replacement open heart valvuloplasty of mitral valve without replacement operations on chordae tendineae diagnoses: other iatrogenic hypotension anemia, unspecified pure hypercholesterolemia mitral valve disorders unspecified essential hypertension mechanical complication due to heart valve prosthesis 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 family history of ischemic heart disease volume depletion, unspecified cardiomegaly rupture of chordae tendineae 

Answer: The patient is high likely exposed to