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: ace inhibitors attending: chief complaint: fatigue/doe/chf major surgical or invasive procedure: - 1. aortic valve replacement with a 21-mm magna aortic valve bioprosthesis. 2. coronary artery bypass grafting x2, left internal mammary artery to left anterior descending coronary artery; reverse saphenous vein single graft from the aorta to the posterior descending coronary artery.3. concomitant right carotid endarterectomy performed by dr. and dictated separately. - cardiac catheterization history of present illness: 82 year old woman with complex past medical history including pvd, aortic stenosis, and mitral regurgitation who has been experiencing worsening fatigue, dyspnea on exertion, and congestive heart failure. she has had several failed catheterizations secondary to severe pvd (femoral, radial, brachial). she is now admitted for cardiac catheterization and surgical management of her valvular and coronary artery disease. past medical history: dyslipidemia hypertension aortic stenosis mitral regurgitation pvd copd depression osteoporosis chronic systolic dysfunction social history: sheis retired. she is edentulous and therefore will not require dental clearance. she is a 55-pack year history of smoking. she quit smoking last year. she does not use any alcohol at this time. she is widowed and speaks only greek. family history: she has two sisters with hypertension but no premature coronary disease. physical exam: on examination, her heart rate was 68. respiratory rate was 12. blood pressure on the right was 134/50 not taken on the left due to recent brachial artery attempts at catheterization. she was 5 feet tall weighing 110 pounds. overall, she appeared to be quite frail elderly woman in no apparent distress. she was using a cane to ambulate. skin was warm and dry without any cyanosis or edema. she had mild clubbing. her head was normocephalic and atraumatic. pupils were equally, round, and reactive to light. sclerae were anicteric. oropharynx was benign. she was edentulous. her neck was supple with full range of motion and no jvd. carotid bruits were present on both sides. she had bibasilar crackles left greater than right and barrel chest consistent with copd. heart was regular in rate and rhythm with a grade iii/vi systolic ejection murmur and grade i/vi diastolic murmur with s1 and s2 tones present. she had right upper quadrant tenderness today in the office with mild hepatomegaly. her extremities were warm and well perfused with very trace peripheral edema and a little bit of mild clubbing on the left. she had some ecchymosis of her abdomen from heparin shots in the hospital. she had noted varicosities. she was alert and oriented x3 moving all extremities. gait slow and steady using the cane with 4/5 strength. she had 2+ bilateral femoral pulses with a bruit present in her left femoral artery, trace dp bilateral pulses, 1+ bilateral in the pts, and 2+ bilateral radial pulses. pertinent results: 08:43pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:34pm pt-13.7* ptt-25.4 inr(pt)-1.2* 09:34pm wbc-6.9 rbc-3.07* hgb-9.6* hct-29.3* mcv-96 mch-31.3 mchc-32.8 rdw-17.8* 09:34pm alt(sgpt)-19 ast(sgot)-24 alk phos-69 tot bili-0.3 09:34pm glucose-127* urea n-41* creat-1.3* sodium-140 potassium-4.5 chloride-108 total co2-22 anion gap-15 abdominal u/s status post cholecystectomy. common bile duct is dilated, which is not an uncommon finding after cholecystectomy. echo pre-bypass: 1. the left atrium is moderately dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with inferior basal hypokinesis. overall left ventricular systolic function is low normal (lvef 50-55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). moderate (2+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. 6. mild to moderate (+) mitral regurgitation is seen. posterior leaflet appears slightly restricted, jet is central. 7. there is no pericardial effusion. dr. was notified in person of the results. post-bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine and is being av paced. 1. a well-seated bioprosthetic valve is seen in the aortic position with normal leaflet motion and gradients (mean gradient = 7 mmhg). no aortic regurgitation is seen. 2. lv function is unchanged. 3. mr is mild. 4. other findings are unchanged. carotid duplex ultrasound 1. 80-99% right ica stenosis. 2. 60-69% left ica stenosis. 3. high-grade left external carotid artery stenosis. cardiac catheterization showed 80% mid and distal lad, 60% mid lcx, and a complicated 99% calcified proximal rca lesion. brief hospital course: patient was admitted to the hospital on for pre-operative workup. diagnsotic catheterization on showed 80% mid and distal lad, 60% mid lcx, and a complicated 99% calcified proximal rca lesion. an aortogram was performed at the end of the procedure and revealed severe aorto-iliac disease extending into her profunda and superficial femoral arteries bilaterally. also on patient had carotid duplex scans that revealed severe 80-99% right ica stenosis, 60-69% left ica stenosis and a high-grade left external carotid artery stenosis. the vascular surgery service was consulted who recommended a concommittant right carotid endarterectomy. as she had right upper quadrant tenderness, a right upper quadrant ultrasound was obtained which showed a dilated common bile duct which was not an uncommon finding after cholecystectomy. no other abnormalities were seen. on , ms. was taken to the operating room where she underwent an aortic valve replacement with a 21-mm magna aortic valve bioprosthesis, two vessel coronary artery bypass grafting and a concomitant right carotid endarterectomy performed by dr. . please see operative notes from both vascular and cardiac surgery for details. postoperatively she was transferred to the cardiac surgical intensive care unit for further monitoring. within 24 hours, ms. neurologically intact and was extubated. she was transfused with prbcs for postoperative anemia and to maintain hematocrit near 30%. she initially required atrial pacing for an underlying junctional rhythm/sinus node dysfunction, for which beta blockade was initially withheld. she otherwise maintained stable hemodynamics and transferred to the sdu on postoperative day two. on pod 5 the patient developed atrial fibrillation. she was treated with lopressor 5mg ivp and started on lopressor 12.5mg po. approximately one hour after initiation of therapy, the patient converted to sinus rhythm, with a long (22second) conversion pause. the patient's nurse was in the room, witnessed this long pause, and chest compressions were initiated. the patient came to immediately. follow up cxr reveals no rib fractures. the patient remained stable in normal sinus rhythm for the next 24 hours. she was discharged in good condition to rehab on pod 6. medications on admission: asa 81', zocor 40', protonix 40', toprol xl 25', hctz 25', boniva 150 monthly, calcium, vit d, tylenol, duragesic patch 25 discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 8. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed. 9. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 11. furosemide 20 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 12. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours). disp:*60 tab sust.rel. particle/crystal(s)* refills:*2* discharge disposition: extended care facility: discharge diagnosis: aortic stenosis, coronary artery disease - s/p avr/cabg carotid disease - s/p right cea pmh: pvd, htn, hyperlipidemia, history of mi, mr, chf(chronic, systolic), copd discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please call (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. ok to shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for 1 month. followup instructions: clinic in 2 weeks please follow-up with dr. in 1 month. ( please follow-up with dr. in weeks. procedure: venous catheterization, not elsewhere classified single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization diagnostic ultrasound of heart diagnostic ultrasound of heart (aorto)coronary bypass of one coronary artery arterial catheterization open and other replacement of aortic valve with tissue graft aortography endarterectomy, other vessels of head and neck transfusion of other serum destruction of cranial and peripheral nerves procedure on three vessels procedure on vessel bifurcation diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases personal history of tobacco use occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure osteoporosis, unspecified old myocardial infarction chronic systolic heart failure sinoatrial node dysfunction other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of superficial veins of upper extremities atherosclerosis of native arteries of the extremities, unspecified chronic total occlusion of artery of the extremities atherosclerosis of other specified arteries other heart block 

Answer: The patient is high likely exposed to