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 / sulfa (sulfonamides) / keflex / diovan / ciprofloxacin / ace inhibitors / quinine / levaquin / novocain / lidocaine attending: chief complaint: dsypnea and fatigue major surgical or invasive procedure: - 1. redo sternotomy with aortic valve replacement with a 19-mm st. medical biocor epic supra tissue heart valve. 2. mitral valve replacement, 27-mm st. medical biocor epic tissue valve. - cardiac catheterization history of present illness: 68f w/cad s/p cabg '(lima/lad, svg/om1, svg/rca) c/b occlusion of lima/lad graft s/p des to lad ', nstemi due to lad in-stent stenosis s/p repeat des, recurrrent nstemi during hd run in context of lgib & cath demonstrating patent vein grafts & lad stent and an echo indicating moderate to severe aortic stenosis ( 0.8-1.0) at that time who is seen today as an inpatient consultation to evaluate her appropriateness for avr/mvr. had recent episode of sub-sternal chest pain after hd; responsive to slntg. sent to ed for eval and subsequently to cath lab. past medical history: iddm cad, s/p cabg chf esrd on hemodialysis tues, thurs and sat anemia pvd, s/p right bka irritable bowel syndrome diverticulitis social history: patient lives iwth her daughter and son-in-law as well as granddaughter. she does not work. she reports recent significant stressors as 2 family members have died in the last month and a great-grandaughter was born. tobacco: smoked as a teenager etoh: rare glass of wine drugs: denies family history: mother died of colon ca; she also had diabetes. father died of heart disease. physical exam: pulse: 68 bp: 100/46 resp: 16 o2 sat: 97/2l height: weight: general: nad skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally bibasilar crackles heart: rrr irregular murmur iii/vi at base > neck abdomen: soft non-distended non-tender extremities: warm , well-perfused r bka neuro: grossly intact pulses: femoral right: nd left: palp dp right: na left: - pt : na left: - radial right: na left: palp carotid bruit obscured by murmur pertinent results: cardiac catheterization 1. two vessel coronary artery disease. 2. patent native lad, svg-om, and svg-rca unchanged from prior. 3. severe aortic stenosis. 4. severe mitral regurgitation. 5. mild systolic ventricular dysfunction. 6. elevated biventricular filling pressures. 7. severe pulmonary hypertension. echo pre-bypass: 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. the left ventricular cavity size is normal. there is mild global left ventricular hypokinesis (lvef = 45 %). the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are simple atheroma in the ascending aorta. there are complex (>4mm) 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. there is severe mitral annular calcification. there is severe thickening of the mitral valve chordae. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is no pericardial effusion. carotid duplex ultrasound impression: right ica stenosis <40%. left ica stenosis <40%. pre-op: 09:49pm glucose-196* urea n-55* creat-5.7*# sodium-135 potassium-5.0 chloride-95* total co2-22 anion gap-23* 09:49pm ck(cpk)-28* 06:50am blood wbc-9.0 rbc-3.25* hgb-11.0* hct-33.0* mcv-102* mch-33.9* mchc-33.4 rdw-14.5 plt ct-213 06:50am blood plt ct-213 09:49pm blood glucose-196* urean-55* creat-5.7*# na-135 k-5.0 cl-95* hco3-22 angap-23* 06:50am blood alt-5 ast-15 ck(cpk)-22* alkphos-99 06:50am blood ck-mb-notdone ctropnt-0.28* 06:50am blood %hba1c-6.0* eag-126* 06:25am blood pth-559* post-op: 03:51am blood wbc-11.8* rbc-2.91* hgb-9.7* hct-31.0* mcv-107* mch-33.2* mchc-31.1 rdw-21.8* plt ct-335 03:51am blood plt ct-335 03:51am blood glucose-181* urean-43* creat-5.0* na-132* k-4.7 cl-90* hco3-30 angap-17 radiology report chest (portable ap) study date of 5:22 pm final report chest radiograph indication: triple lumen change over wire, evaluation of line placement. comparison: . findings: as compared to the previous examination, the right central venous introduction sheath has been removed and exchanged against a central venous access line. the tip of this access line projects over the leads of the pacemaker and is difficult to visualize but appears to be positioned at the inflow tract of the right atrium. no evidence of complications, notably no pneumothorax. subtle increase of bilateral basal opacities. unchanged size of the cardiac silhouette. the study and the report were reviewed by the staff radiologist. dr. dr. oropharyngeal videofluoroscopic swallowing evaluation evaluation: an oral and pharyngeal swallowing videofluoroscopy was performed today in collaboration with radiology. thin liquid, nectar-thick liquid, and pureed consistency barium were administered. results follow: recommendations: 1. po diet: soft solids, thin liquids 2. po meds whole with thin liquids as tolerated 3. tid oral care 4. strict aspiration precautions including: a) sit fully upright for all po intake b) alternate between bites and sips to clear oropharynx c) swallow twice per bite as needed to clear oropharynx d) swallow-cough-swallow with all liquids including when taking meds 5. ent eval in if vocal quality does not continue to improve 6. swallow follow up in rehab setting to ensure tolerating diet, re-assess need for swallow-cough-swallow maneuver. these recommendations were shared with the patient, the nurse and the medical team. m.s., ccc-slp brief hospital course: ms. was admitted to the on for work up of her chest pain during hemodialysis. she underwent a cardiac catheterization which revealed two vessel coronary artery disease with patent grafts froom her previous bypass syrgery. severe aortic stenosis and mitral regurgitation were also noted. given the severity of her valvular disease, the cardiac surgical service was consulted for evaluation for redo surgery. she was accepted for avr/mvr and on she was brought to the operating room for aortic and mitral valve replacement. please see or report for details, in summmary she had: 1. redo sternotomy with aortic valve replacement with a 19-mm st. medical biocor epic supra tissue heart valve. 2. mitral valve replacement, 27-mm st. medical biocor epic tissue valve. she tolerated the operation well and was transferred from the operating room to the cardiac surgery icu in stable condition. she was sedated through the night on the surgical day, the following day see awoke and followed commands but remained intubated as she was somewhat lethargic and she needed to have hemodialysis prior to extubation to support her pulmonary status. she was dialyzed on a daily basis and was ultimately extubated on pod3. she remained hemodynamically stable throughout this period. on pod4 she was transferred from the icu to the stepdown floor for further recovery. she made slow progress in her physical activity and was transferred to rehabilitation at care and rehab in ,ma on pod 11 medications on admission: plavix 375mg today, aspirin 324mg today lopressor 25mg, tums, ntp (held), insulin sliding scale, celexa, lantus at hs, prilosec, renagel, vitamin c, 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. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 7. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 8. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 9. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 10. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous qac&hs. 11. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 12. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). discharge disposition: extended care facility: sunbridgecare and rehab for discharge diagnosis: aortic valve stenosis s/p avr mitral valve regurgitation s/p mvr s/p cabg '(lima/lad, svg/om1, svg/rca) c/b occlusion of lima/lad graft s/p des to lad ', nstemi due to lad in-stent stenosis s/p repeat des, chf(ef50% 2/09) htn hyperlipidemia, iddm2 esrd on hd(tu-th-sa) anemia irritable bowel syndrome diverticulitis pad s/p r bka discharge condition: alert and oriented x3 nonfocal s/p bka: prostetic device not yet fitting stump, unable to ambulate sternal pain managed with percocet prn sternal wound 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 until follow up with surgeon 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 followup instructions: surgeon dr. @ 1pm wound check appointment - 6 () - your nurse will schedule please call to schedule appointments: primary care dr. () in weeks outpatient cardiologist: in weeks procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures hemodialysis open and other replacement of aortic valve with tissue graft open and other replacement of mitral valve with tissue graft diagnoses: acidosis anemia in chronic kidney disease end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled aortocoronary bypass status other chronic pulmonary heart diseases peripheral vascular disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot other and unspecified hyperlipidemia long-term (current) use of insulin mitral valve insufficiency and aortic valve stenosis occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction below knee amputation status venous (peripheral) insufficiency, unspecified irritable bowel syndrome chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to