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 / aspirin / codeine attending: chief complaint: progressive lower extremity edema major surgical or invasive procedure: mitral valve replacement ( tissue) history of present illness: 76 year old female with a past medical history pertinent for rheumatic heart disease with mitral valve stenosis and severe pulmonary hypertension, atrial fibrillation-on coumadin, type ii diabetes mellitus,hypertension, hyperlipidemia, copd, transient ischemic attack, a-v malformation with recurrent gi bleeds, who was admitted to an outside hospital for exacerabation of hear failure, worsening lower extremity edema, shortness of breath and hyponatremia. past medical history: anemia secondary to arterio-venous malformation, bleed 2' coumadin use, congestive heart failure, atrial fibrillation, type 2 diabetes mellitus, depression, hypertension, hypothyroidism, peripheral neuropathy, hyponatremia, glaucoma, chronic obstructive pulmonary disease, vascular disease-s/p carotid endarterectomy, obstructive sleep apnea-sleep study x2-does not use recommended cpap at home, irritable bowel syndrome w/ chronic constipation/diarrhea social history: lives with:her daughter : intermittent tobacco x 60yr, cigs/day x last 2 months -pt states last cigarette prior to admission at osh etoh:+2 beers/day:pt states last beer ~ 1mo ago family history: non-contributory physical exam: pulse:75, resp: 18, o2 sat: 98% b/p 125/60 height:148 weight:63.5" general:a&ox 3, nad skin: dry intact heent: perrla eomi neck: supple full rom chest: cta heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities:superficial varicosities none neuro: grossly intact pulses: femoral right: left: dp right:1+ left:1+ pt : left: radial right: left: carotid bruit-none right: 2+ left:2+ pertinent results: echocardiography report echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.4 cm <= 4.0 cm left atrium - four chamber length: *5.7 cm <= 5.2 cm right atrium - four chamber length: *6.8 cm <= 5.0 cm left ventricle - septal wall thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.5 cm <= 5.6 cm left ventricle - systolic dimension: 3.0 cm left ventricle - fractional shortening: 0.33 >= 0.29 left ventricle - ejection fraction: 65% >= 55% left ventricle - stroke volume: 91 ml/beat left ventricle - cardiac output: 6.01 l/min aorta - sinus level: 3.1 cm <= 3.6 cm aorta - ascending: 2.9 cm <= 3.4 cm aortic valve - peak velocity: 1.7 m/sec <= 2.0 m/sec aortic valve - lvot vti: 29 aortic valve - lvot diam: 2.0 cm mitral valve - mean gradient: 7 mm hg mitral valve - e wave: 2.0 m/sec mitral valve - e wave deceleration time: *300 ms 140-250 ms tr gradient (+ ra = pasp): *68 mm hg <= 25 mm hg findings left atrium: moderate la enlargement. right atrium/interatrial septum: moderately dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). no resting lvot gradient. right ventricle: rv hypertrophy. mildly dilated rv cavity. rv function depressed. abnormal systolic septal motion/position consistent with rv pressure overload. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: bioprosthetic mitral valve prosthesis (mvr). mvr well seated, with normal leaflet/disc motion and transvalvular gradients. tricuspid valve: normal tricuspid valve leaflets. normal tricuspid valve supporting structures. no ts. mild to moderate +] tr. severe pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. normal main pa. no doppler evidence for pda pericardium: no pericardial effusion. conclusions the left atrium is moderately dilated. the right atrium is moderately dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 65%). the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated with depressed free wall contractility. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. brief hospital course: transferred in from outside hospital after presenting with increased edema and shortness of breath for re evaluation for surgical intervention. she was on heparin for atrial fibrillation and underwent preoperative evaluation. hepatology was consulted, she had abdominal ultrasound that revealed normal liver and spleen, and she was cleared for surgery. additional preoperative workup included dental, pulmonary function test and echocardiogram. she had discomfort at her catheterization site and had vascular ultrasound that revealed no hematoma or pseudoaneurysm. she was brought to the operating room on for surgery however due to increased tenderness at the catheterization site her surgery was cancelled and she was started on ancef for potential cellulitis. vascular surgery was consulted and felt there was no evidence of infection or vascular issues. however her creatinine increased to 1.6, her ace inhibitor and lasix were stopped and the ancef was discontinued. additionally her digoxin was stopped due to increased creatinine and bradycardia. over the next few days her creatinine trended down to baseline 1.1-1.3. she developed diarrhea which resolved within twenty four hours with wbc remaining normal. on she was brought to the operating room and underwent mitral valve replacement. see operative report for further details. she received vancomycin for perioperative antibiotics and was transferred to the intensive care unit for post operative management. that evening, she was weaned from sedation, awoke neurologically intact, and was extubated without complications. however later she was noted to have increasing pulmonary and systolic pressures with no response to milirone, nipride, and nicardipine. her medications were adjusted and on post operative day one she was started on diuretics, ace inhibitor, and beta blocker. on post operative day two her pulmonary catheter was removed and she remained in the intensive care unit for hemodynamic management. her epicardial wires and chest tubes were removed per protocol. she continued to have betablockers adjusted for heart rate management and lasix for diuresis. additionally she was treated for hyponatremia with free water restriction and sodium tablets. she was restarted on coumadin for atrial fibrillation and then on post operative day four was transferred to the floor for the remainder of her care. physical therapy worked with her on strength and mobility. on post operative day eight she was ready for discharge to rehab - in . medications on admission: coumadin 2.5 mg fri-wed/5 mg thurs digoxin 0.125mg daily glucophage 500 mg lasix 80 mg daily omeprazole 20 mg daily synthroid 150 mcg daily zocor 20 mg daily lisinopril 20 mg daily b-12 injections ambien 5 mg hs discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. warfarin 4 mg tablet sig: one (1) tablet po once a day: received 4 mg on - to have inr checked for further dosing - see coumadin referral form for dosing and inr . 4. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 5. metolazone 5 mg tablet sig: one (1) tablet po daily (daily): give with lasix daily . 6. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 7. levothyroxine 150 mcg tablet sig: one (1) tablet po once a day. 8. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 11. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 12. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 15. combivent 18-103 mcg/actuation aerosol sig: two (2) puffs puffs inhalation every six (6) hours. 16. amlodipine 2.5 mg tablet sig: three (3) tablet po daily (daily): 7.5 mg daily . 17. lantus 100 unit/ml solution sig: twelve (12) untis units subcutaneous at bedtime: 12 units at bedtime . 18. insulin sliding scale insulin sc sliding scale breakfast lunch dinner bedtime regular regular regular regular glucose insulin dose insulin dose insulin dose insulin dose 0-70 mg/dl proceed with hypoglycemia protocol proceed with hypoglycemia protocol proceed with hypoglycemia protocol proceed with hypoglycemia protocol 71-119 mg/dl 0 units 0 units 0 units 0 units 120-159 mg/dl 2 units 2 units 2 units 2 units 160-199 mg/dl 4 units 4 units 4 units 4 units 200-239 mg/dl 6 units 6 units 6 units 6 units 240-279 mg/dl 8 units 8 units 8 units 8 units also note to receive lantus at bedtime 19. potassium chloride 10 meq capsule, extended release sig: capsule, extended releases po once a day. 20. outpatient lab work labs: pt/inr for coumadin ?????? indication: atrial fibrillation goal inr 2.0-2.5 first draw please check pt/inr monday, wednesday, and friday for two weeks then decrease as instructed by physician coumadin to be managed by rehab physician then please arrange for follow up with pcp when discharged from rehab 21. outpatient lab work please check chem 7 to evaluate once a week due to lasix/zaroxlyn/lisinopril/potassium discharge disposition: extended care facility: discharge diagnosis: mitral valve stenosis s/p mvr atrial fibrillation diabetes mellitus type 2 hyponatremia rheumatic heart disease pulmonary hypertension hypertension hyperlipidemia chronic obstructive pulmonary disease transient ischemic attack a-v malformation with recurrent gi bleeds depression hypothyroidism peripheral neuropathy hyponatremia glaucoma carotid disease osteoarthritis discharge condition: alert and oriented x3 nonfocal ambulating with 1 assist incisional pain managed with tylenol as needed incisions: sternal - healing well, no erythema or drainage edema +1 lower extremity 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. on at 1:30pm cardiologist: dr. on at 10:45am 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** labs: pt/inr for coumadin ?????? indication: atrial fibrillation goal inr 2.0-2.5 first draw please check pt/inr monday, wednesday, and friday for two weeks then decrease as instructed by physician coumadin to be managed by rehab physician then please arrange for follow up with pcp when discharged from rehab procedure: extracorporeal circulation auxiliary to open heart surgery pulmonary artery wedge monitoring open and other replacement of mitral valve with tissue graft diagnoses: cellulitis and abscess of trunk unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation hematoma complicating a procedure other chronic pulmonary heart diseases alcohol abuse, unspecified rheumatic heart failure (congestive) other specified cardiac dysrhythmias cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of anticoagulants unspecified hereditary and idiopathic peripheral neuropathy mitral stenosis alcoholic fatty liver 

Answer: The patient is high likely exposed to