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: congestive heart failure major surgical or invasive procedure: aortic valve replacement(21 mm on-x, mitral valve replacement 25/33 on-x conform-x mechanical valve). history of present illness: mr. is a 59-year-old gentleman who is well known to dr. for previous consultations for surgical correction of his aortic valve and mitral valve. in he had a septic left wrist. he subsequently became bacteremic and developed endocarditis and hip osteomyelitis. he had a very complex series of events which includes end-stage renal disease secondary to glomerulonephritis for which he underwent kidney transplant in , which had failed subsequently and was removed in . he is currently receiving hemodialysis every monday, wednesday, and friday. dr. had initially seen mr. in for mssa endocarditis, however, he was not a surgical candidate at that time. on he presented complaining of 5 days of abdominal pain and 3 months of abdominal distention. he has received clearance from gi and general surgery and now presents for surgery. past medical history: h/o mitral endocarditis h/o aortic endocarditis h/o septic wrist endstage renal failure on hemodialysis s/p renal transplant in s/p transplant nephrectomy in . hypertension atrial fibrillation coronary artery disease diastolic chf with remote history of systolic chf h/o mssa endocarditis h/o vre septic arthritis. h/o left wrist mssa arthritis s/p right femoral neck fracture s/p right hip hemiarthroplasty s/p right prosthetic hip infection with explantation h/o ischemic colitis/ileitis s/p subtotal colectomy and terminal ileal resection with diverting loop ileostomy and gastrostomy tube placement. s/p revision left radiocephalic arteriovenous fistula,endarterectomy radial artery s/p removal right hip hemiarthroplasty. s/p right ring finger closed reduction percutaneous pinning for mallet finger.left index and long ring finger pip joint manipulation social history: owner of a clothing store in . patient has been hospitalized/in rehab since . prior to this, he lived in with his mother and brother. current tobacco and alcohol use but notes intermittent tobacco use in the past (~3 pack-years). denies illicit drug use. hiv negative family history: positive for cancer (father-prostate), (mother). father deceased. brother has fibromyalgia. daughter in good health. physical exam: admission pulse: 81 af resp: 16 o2 sat:99% ra b/p right: 94/41 general:a&o x3, nad skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur: hsm iv/vi, ii/vi at rsb abdomen: soft non-distended non-tender bowel sounds+ ascites, rlq colostomy bag. +gastric- external fistula c/d/i extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right: left: dp right: 2+ left:2+ pt : left: radial right: left: carotid bruit-none right: 2+ left:2+ pertinent results: echo: the left atrium is markedly dilated. the right atrium is markedly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 60%). the right ventricular free wall is hypertrophied. the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic root is mildly dilated at the sinus level. a bileaflet aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. a bileaflet mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small to moderate sized pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , the aortic and mitral valves have been replaced. the left ventricular ejection fraction is increased. the right ventricle remains dilated and hypocontractile. a small-to-moderate pericardial effusion is now present. 06:15am blood wbc-4.3 rbc-2.90* hgb-8.5* hct-26.6* mcv-92 mch-29.2 mchc-31.9 rdw-19.0* plt ct-101* 04:44pm blood wbc-4.1 rbc-4.00* hgb-11.8* hct-36.8* mcv-92 mch-29.5 mchc-32.0 rdw-20.3* plt ct-114* 06:15am blood pt-24.8* ptt-45.1* inr(pt)-2.4* 12:12pm blood pt-22.8* ptt-37.1* inr(pt)-2.2* 01:39am blood pt-22.6* ptt-84.1* inr(pt)-2.1* 03:00am blood pt-19.4* inr(pt)-1.8* 06:15am blood glucose-87 urean-18 creat-4.2*# na-132* k-3.7 cl-95* hco3-30 angap-11 04:44pm blood glucose-87 urean-35* creat-6.6*# na-136 k-5.3* cl-99 hco3-25 angap-17 08:30am blood wbc-5.0 rbc-2.91* hgb-8.6* hct-26.6* mcv-91 mch-29.6 mchc-32.4 rdw-19.0* plt ct-115* 04:29am blood hct-31.0* 08:30am blood plt ct-115* 04:29am blood pt-35.6* inr(pt)-3.6* 08:30am blood glucose-82 urean-28* creat-5.5*# na-132* k-4.4 cl-94* hco3-27 angap-15 04:29am blood na-133 k-3.8 cl-96 brief hospital course: mr. was admitted prior to surgery for surgical work-up, iv heparin bridge and . on he was brought to the operating room where he underwent aortic and mitral valve replacement. please see operative report for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. within 24 hours he was weaned from sedation, awoke neurologically intact and extubated. he did require pressors for hemodynamic support for several days post-op while in the cvicu. was continued post-op while being followed by renal until discharge. chest tubes and epicardial pacing wires were removed per protocol. cardiology was consulted to evaluate the patient's second degree av block (not felt to be a candidate for pacemaker). heparin was initiated as a bridge until the inr was therapeutic on coumadin. he was finally weaned off pressors on post-op day six and was transferred to the telemetry floor for further care. physical therapy worked with patient during post-op period for strength and mobility. he was ambulatory and has a good home support system and was, therfor, discharged to home. coumadin was titrated for target inr 3-3.5. this will be managed by clinic (). on post-op day 10 he was discharged to home with the appropriate medications and follow-up appointments.inr today 3.4 . first blood draw by vna is tomorrow .he will resume hd schedule of m-w-f. medications on admission: medications at home: - lisinopril 2.5mg(1),- warfarin - 2 mg tablet - up to 3 (three) tablet(s) by mouth daily (afib)- b complex-vitamin c-folic acid - 1 mg (1),- cinacalcet - 60(1) - ciprofloxacin - 500 (1),- epoetin alfa - at hd tiw; dosage uncertain - protonix 40mg daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily) as needed for cad. 2. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain. 3. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily) as needed for crf. 5. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily) as needed for cholesterol. 6. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals) as needed for crf. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 8. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain for 4 weeks. disp:*50 tablet(s)* refills:*0* 9. outpatient lab work 10. outpatient lab work please draw pt/inr on , and then and phone result to clinic at 617=. target inr 3.0-3.5 11. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 12. coumadin 2 mg tablet sig: one-half tablet po once today for 1 days: dose today 1 mg ( half tab), then all further daily dosing per coumadin clinic . disp:*50 tablet(s)* refills:*1* discharge disposition: home with service facility: homecare discharge diagnosis: h/o aortic endocarditis h/o mitral endocarditis h/o septic arthritis wrist mitral regurgitation aortic stenosis aortic regurgitation s/p aortic and mitral valve replacement end stage renal failure on hemodialysis h/o right hip abscess,hemiarthroplasty and removal of hardware, debridements s/p subtotal colectomy for ischemic gut s/p carpal tunnel releases s/p right hand finger surgeries s/p multiple revisions of av fistulae discharge condition: alert and oriented x3, nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternum clean and healing well, no drainage edema: 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 **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 1:45 pm () cardiologist: dr. on at 8:40 am () please call to schedule appointments with: 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: mechanical valves goal inr 3 - 3.5 first blood draw on call results to clinic at procedure: extracorporeal circulation auxiliary to open heart surgery hemodialysis open and other replacement of aortic valve open and other replacement of mitral valve diagnoses: end stage renal disease renal dialysis status anemia, unspecified coronary atherosclerosis of native coronary artery tobacco use disorder congestive heart failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation other chronic pulmonary heart diseases atrial flutter hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of anticoagulants multiple involvement of mitral and aortic valves secondary hyperparathyroidism (of renal origin) diastolic heart failure, unspecified ileostomy status other specified diseases of pericardium other second degree atrioventricular block acquired absence of intestine (large) (small) 

Answer: The patient is high likely exposed to