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: worsening shortness of breath for 6 months major surgical or invasive procedure: transcatheter aortic-valve implantation (corevalve) history of present illness: mrs is a 65 year old woman female with h/o cad/cabg, dm, chf, cva, copd, who is admitted to the ccu pod #1 following corevalve placement for critical aortic stenosis. . history obtained from omr. patient was diagnosed with as at age 15. in the past 3-5 years she has developed progressive symptoms of dyspnea and chest pain. she is primarily bed-bound, with ambulation limited to ~ 10 feet without shortness of breath. in the past a few weeks, with mild exertion, patient also felt mild midsternal chest pain, described as "burning", with no radiation. on admission she denied history of syncope. recent echo reveals lvef 60% aortic valve area of 0.7cm2, mean gradient 81mmhg, and jet velocity of 5.5 m/sec. patient was evaluated by cardiothoracic surgery, and was deemed high risk candidate for surgery and she was enrolled into the corevalve trial. today, she was taken to the or for corevalve placement under general anesthesia. access through the right femoral artery was obtained with a 18f sheath. a temporary pacer wire was placed. balloon aortic valvuloplasty was performed and a 29mm corevalve device was deployed. in the proceedure, the patient developed hypotension to sbp 89 and was given ivns, and briefly on phenylephrine, intra operative hct was 29.9 (down from 32.3) she was transfused one unit prbc. in total, she received 3500cc ivns intra operatively. other medications given intraop included furosemide 80mg iv, cefazolin 2g, and vancomycin 1.5g. following the proceedure, the patient was transferred to the ccu for close monitoring. the patient was received intubated in the ccu vitals were t: 97.1 bp 147/73 p:87 sao2 97%, vent settings ac vt600, rr16 peep5 100% fio2. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension (in the past, now hypotension) 2. cardiac history: -cabg x3: with a lima to the - patent lima->lad, patent svg->om1, occluded svg->pda. -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: diabetes on insulin & metformin hypothyroidism hiatal hernia copd (not on home o2, on advair only) stroke --> mild gait imbalance after rehab peripheral neuropathy cholecystectomy hysterectomy surgery for disk herniation , , . social history: worked at the social service at , retired after stroke in one son, husband deceased currently lives with son's family in a duplex house in -tobacco history: 1 pky remote hx -etoh: none -illicit drugs: none family history: mother: dm, htn, died from heart attack at age 67 father: disease, died from heart attack at age 84 22 biological siblings sister: diet from uremia kidney failure sister: breast ca at age 40s sister: subarachnoid hemorrhage at age 49 brother: subarachnoid hemorrhage at age 49 brother: lung cancer at age 66 brother: died from heart attack at age 67 brother: died from kidney and heart failure at age 67 sister: cad s/p cabg at age 68 physical exam: admission physical examination: t: 97.1 bp 147/73 p:87 sao2 97% general: obese woman intubated, arousable, uncomfortable, moving all extremites. heent: ncat. sclera anicteric. perrla, mucous membs dry, et tube in place. neck: right ij in place with surrounding clotted blood. jvp not assessed due to habitus cardiac: rrr, s1, soft s2 no murmurs/rubs/gallops lungs: transmitted breath sounds bl in anterior lung fields. abdomen: overweight, midline sternotomy scar, and diagonal ruq scar, reducible periumbilical hernia. extremities: 1+ pitting edema to ankle bilaterally skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ discharge physical exam: physical exam: vitals - tm/tc: 98/97.4 bp: 82/41-121/67 hr:67-83 rr:18 02 sat:96\ra last 24h: 1180/2600 general: oob in chair, in no acute distress. speaking comfortably. heent: perrla, no pharyngeal erythemia, mucous membs moist, no lymphadenopathy, chest: ctabl no wheezes, no rales, no ronchi, decreased bases cv: s1 s2 normal in quality and intensity rrr, murmer lsb abd: soft, non-tender, non-distended, bs normoactive. no rebound/guarding, neg hsm. neg sign. (+)visible hernia with forceful cough), nontender ext: wwp, no edema. dps, pts 2+. 3+ lower extremity edema, taut, shiny, left greater than right, no drainage, no lesions. lower calf erythema bilaterally, improved from admission, baseline according to patient secondary to longterm stocking use. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl (biceps, achilles, patellar). sensation intact to lt, pain, temperature, vibration, proprioception. cerebellar fxn intact (ftn, hts). ambulating indep with walker. skin: bilateral groin excoriations to skin fold, moist, clean in appearance. psych: verbalizing good understanding of discharge planning, asking questions approp. calm and receptive. pertinent results: admission labs ============== 05:20pm blood wbc-11.2* rbc-4.32 hgb-10.0* hct-32.3* mcv-75* mch-23.2* mchc-31.0 rdw-18.7* plt ct-213 05:20pm blood neuts-72.7* bands-0 lymphs-17.4* monos-3.1 eos-6.1* baso-0.7 09:35am blood pt-14.3* inr(pt)-1.2* 05:20pm blood glucose-231* urean-41* creat-1.0 na-142 k-3.4 cl-100 hco3-31 angap-14 05:20pm blood alt-12 ast-15 ck(cpk)-28* alkphos-73 totbili-0.7 05:20pm blood albumin-3.7 02:43pm blood calcium-7.9* phos-3.4 mg-2.0 . cardiac enzymes =============== 05:20pm blood ck-mb-2 probnp-852* 12:00am blood ck-mb-3 05:05am blood ck-mb-3 ctropnt-0.01 04:55am blood ck-mb-2 ctropnt-<0.01 pertinent studies # cardiac cath comments: ascending aortogram was obtained using a sizing omniflush catheter at 14/14 lao/ projection to ensure that all the cusps were at the same level. thereafter a 5 fr sizing pigtail catheter was used to obtain the distal aortogram with visualization of bilateral ileofemoral arteries to assess feasibility of femoral access. at the end of the procedure tr band was applied to the left radial access site with excellent hemostasis. no immediate complications. final diagnosis: 1. sinus of valsalva diameter 30 mm ( adequate for corevalve placement) 2. bilateral iliac and femoral diameter > 8 mm with minimal tortuosity 3. minimal aortic regurgitation by supravalvular aortography . # cxr impression: pa and lateral chest reviewed in the absence of prior chest radiographs, but read in conjunction with ct imaging of the chest on a torso ct examination performed elsewhere on : pulmonary vascular plethora, mild interstitial abnormality, moderate-to-severe cardiomegaly and pulmonary arterial dilatation are all unchanged since . there is no pneumonia, interstitial pulmonary edema or pleural effusion. the extent of central adenopathy and of calcification in the aortic valve is much better demonstrated on ct images. . # echo (tee) pre valve implantation study very poor image quality overall. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. 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. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the mitral valve shows characteristic rheumatic deformity. moderate to severe (3+) mitral regurgitation is seen. drs and was notified in person of the results on at 900 am post implantation. stented valve seen in the aortic position. it appears well seated. two small perivalvular leaks noted. mild aortic insufficiency present. the mitral regurgitation is 2+. . # cxr findings: ap single view of the chest has been obtained with patient in sitting semi-upright position. comparison is made with the next preceding similar study obtained on at 20:14 hours. frontal views are compared. patient is now intubated, the ett terminates in the trachea some 4 cm above the level of the carina. a right internal jugular sheath has been placed, and a temporary pacing wire has been advanced into the right ventricle. it projects into the apical portion of the right ventricle. special amended copy with high contrast allows the delineation of a tubular network superimposed on the aortic valve area and the proximal portion of the ascending aorta. this is consistent with the appropriate location of a corevalve prosthesis. remarkable is that the cardiac contours including evidence of previous bypass surgery and sternotomy have not undergone any significant interval change. no pneumothorax has developed. there is slightly more advanced perivascular haze in the pulmonary circulation which may be related to temporary fluid overload. no new parenchymal abnormalities are seen, and the lateral pleural sinuses remain free from major fluid accumulations. no pneumothorax is present in the apical area. impression: satisfactory findings following corevalve replacement intervention. . # echo (tte) conclusions the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). an aortic corevalve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: corevalve well-seated with normal transvalvular gradients and no regurgitation. mild pulmonary hypertension. mild mitral regurgitation. moderate symmetric left ventricular hypertrophy with preserved global left ventricular systolic function. compared with the prior study (images reviewed) of /201, a corevalve prosthesis is now in place and aortic stenosis has resolved. . # cxr findings: in comparison with study of , the monitoring and support devices have been removed. continued enlargement of the cardiac silhouette with tortuosity of the aorta. there may be minimal elevation of pulmonary venous pressure. no evidence of acute focal pneumonia. . # echo the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with normal free wall contractility. the diameters of aorta at the sinus, ascending and arch levels are normal. an aortic corevalve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is mild functional mitral stenosis (mean gradient 5 mmhg) due to mitral annular calcification. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , no change. labs @ discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:05 8.5 3.57* 8.5* 27.4* 77* 23.7* 30.9* 21.7* 234 renal & glucose glucose urean creat na k cl hco3 angap 06:05 105*1 27* 0.9 140 4.0 101 29 14 brief hospital course: mrs is a 65 year old female with pmh cad/cabg, dm, chf, cva, copd, with severe aortic stenosis admitted for transcatheter aortic-valve/corevalve implantation. . active issues . # corevalve placement patient has long history aortic stenosis. her functional status exacerbated to be bed-bound most of time. pre-op echo showed aortic valve area of 0.7 cm2 and mean trans-aortic valve gradient of 81 mmhg. patient's pre-op studies, including ecg, aortography, echo, cxr and standard lab testings did not show contraindications. in addition, plavix 300 mg was provided. on hd#2, a 29 mm corevalve was placed via transcatheter aortic valve implantation (tavi). the procedure went smoothly, with complete disappearance of trans-aortic valve pressure gradient. there was no aortic regurgiation seen intra-op aortography following valve replacement. transesophageal echo showed a 1+ paravalvular aortic regurgitation. there was a new bundle branch block observed on ekg after the deployment of the corevalve, with no angiographic evidence of coronary artery compromise. a temporary pacing wire was placed at the end of procedure. patient remained hemodynamically stable throughout the procedure. . # post-op corevalve placement patient was extubated successfully two hours post-op and was transferred to ccu in stable condition. her ekg continued to show the new lbbb, with no other changes. there were no elevation in cardiac enzymes within 24 hours postop. she continued to take aspirin 81 mg, clopidogrel 75 mg and lovastatin 40 mg, and discontinued her cardizam. patient maintained stable blood pressure without additional pressors or activation of pacer throughout the post-op recovery. the pacing wire and cordis were removed 48 hours after the procedure. the central line was removed at 72 hours post-op. patient was transferred to regular floor afterwards, with standard care including physical therapy. echo one week post-op showed corevalve was well seated, normal gradients, no , normal. outpatient issues - started plavix 75 mg daily - started lisinopril 2.5 mg once a day. - will get cr check in two weeks, and consider up-titrating lisinopril if blood pressure tolerates for nephroprotection in the setting of diabetes. . # left bundle branch block a new left bundle branch block was observed after the placement of corevalve. ekg changes did not meet sgarbossa criteria for acute mi. new lbbb may have been induced in the proceedure either by direct myocardial injury or by local tissue edema. of note, there were no cardiac enzyme elevation. outpatient issues - will consider repeat ekg in two weeks for documentation purpose. there is a possibility that this lbbb will spontaneously resolve. . # diastolic dysfunction preop echo shows lvef 55% with e/e' ratio 30 suggesting diastolic dysfunction. this is most likely a result of chronic aortic stenosis and might also be contributed by prior hypertension. patient takes furosemide 60 mg daily at home prior to the procedure. her i/os and daily weight were clearly monitored during the recovery and lasix was titrated to maintain a slight negative fluid balance. outpatient issues - patient was discharged on home dose of furosemide 60 mg . please adjust dose accordingly. . # cornary artery disease patient had documented history of cornary artery disease s/p cabg in . cardiac cath in performed in showed 95% mid lad stenosis with patent lima->lad, lcx with 90% stenosis, svg-om1, occluded svg->pda. there was no angiographic changes post-op. the new lbbb was unlikely a result of acute myocardial ischemia. the home dose of her aspirin,and lovastatin were continued. . # anemia on admission, patient had a hct of 32.3, with mcv of 75, and takes iron supplement at baseline. she received one prbc post-op on the second hospital day, but otherwise maintain stable hct. she has slightly lower iron of 26, with otherwise normal ferritin and transferrin. there was no evidence of hemolysis on lab. we continued her ferrous sulfate at 324 mg daily, but suspect that there could have been a secondary cause to her microcytic anemia. outpatient issues - patient need pcp follow up on sustained microcytic anemia on daily iron supplement. . chronic issues # peripheral neuropathy patient has a documented history of peripheral neuropathy. we continued her home dose of lyrica 150 mg . . # diabetes patient has documented history of diabetes, and was on insulin prior to admssion. her metformin was discontinued. she received a combination of standing dose insulin at night and sliding scale insulin during the day, which she tolerated fairly well. blood glucose was monitored daily. preop hgaic was 7.8 - she will need to followup with her endocrinologist. outpatient - patient will benefit from tighter glucose control. . # hypothyroidism patient has a documented history of hypothyroidism. she received her home dose of synthroid 175 mcg daily. tsh 8.4/t4 5.9 in this hospitalization. patient by definition has subclinical hypothyroidism, which could contribute to her symptoms including weight gain, nonpitting edema. outpatient issues - please follow up and consider increasing synthyroid dose. . # osa patient has a documented history of osa. she used her home cpap during this hospitalization. . transitional issues - patient maintained a full code throughout this admission - patient has a followup appointment with dr. on medications on admission: lovastatin 40mg dialy pantoprozole a40mg daily asa 81 mg daily levothyroxine 175mcg daily furosemide 60mg (7a - 12p) lyrica 150mg q12 (8a-8p) advair diskus 500/50 1 puff q12 (8a-8p) ferrous gluconate 324mg tid (6a, 12p,6p) cardizem cd 360mg daily novolog 70/30 - 30units s/c qam, 60units s/c qhs metformin 1000mg xanax 0.25mg qhs prn insomnia meclizine 25mg po tid discharge medications: 1. lovastatin 40 mg tablet sig: one (1) tablet po at bedtime. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 5. furosemide 40 mg tablet sig: 1.5 tablets po bid (2 times a day). 6. pregabalin 75 mg capsule sig: two (2) capsule po q12h (every 12 hours). 7. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 8. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po tid (3 times a day). 9. metformin 500 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po bid (2 times a day). 10. alprazolam 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for insomnia. 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 14. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 15. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 16. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 17. insulin nph & regular human 100 unit/ml (70-30) suspension sig: thirty (30) units subcutaneous once a day: 30units before breakfast, 60units before dinner. 18. outpatient lab work chem 7 and cbc on discharge disposition: extended care facility: rehab discharge diagnosis: 1. critical aortic stenosis - s/p corevalve placement 2. coronary artery disease - s/p coronary artery bypass grafting 3. diabetes mellitus type ii 4. congestive heart failure, acute on chronic diastolic dysfunction 5. hypertension 6. hperlipidemia 7. obstructive sleep apnea 8. chronic obstructive pulmonary disorder 9. obesity 10. gastroesophageal reflux disease 11. hypothyroid 12. lymphedema discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mrs. , you have undergone elective percutaneous aortic valve placement with the corevalve as treatment for your symptomatic severe aortic stenosis. your intraoperative course went very well. you did have some bleeding at the vascular access site for which you received one unit of blood. your postoperative course was uneventful. an done at your time of discharge showed the aortic corevalve with good placement (well seated), normal leaflet/disc motion and normal transvalvular gradients. overall left ventricular systolic function is normal (lvef>55%). you will receive a list of instructions which will include weighing yourself every morning, call dr if weight goes up more than 3 lbs in one day, or five pounds in 3 days. . we made the following changes to your medicines: 1. your cardizem cd 360mg has been discontinued. 2. lisinopril 2.5mg daily has been started instead to treat your high blood pressure in patients who are diabetic. 3. clopidrogel (plavix)75 mg daily has been started as part of the corevalve protocol. 4. colace 100mg twice a day has been added to prevent constipation. 5. senna tab has been added of needed for constipation 6. miconazole powder to both groin areas has been added to treat those excoriated areas - apply twice daily. 7. ultram 50mg every 6 hours if needed for pain has also been added followup instructions: provider: phone: date/time: 11:00 on - / provider: , md phone: date/time: 12:00 on - procedure: combined right and left heart cardiac catheterization open and other replacement of aortic valve aortography percutaneous balloon valvuloplasty diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified coronary atherosclerosis of autologous vein bypass graft acute on chronic diastolic heart failure aortic valve disorders constipation, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin other left bundle branch block iron deficiency anemia, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits obesity, unspecified unspecified hereditary and idiopathic peripheral neuropathy examination of participant in clinical trial dermatophytosis of the body 

Answer: The patient is high likely exposed to