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: sob major surgical or invasive procedure: avr ( ), cabg x 1 (lima->lad) history of present illness: yo f with known as, admitted to and treated for pneumonia. she had continued sob which showed severe as. she was transferred to after cardiac cath. past medical history: htn lipids hypothyroid s/p bilat lens transplant legally blind iron deficiency anemia s/p fall with ? head bleed/infected leg wound s/p orif of l ankle social history: lives alone in an apartment above her daughter. family history: nc physical exam: preop vs hr 77 bp 140/73 rr 16 o2sat 94% on ra neuro non focal- legally blind cv rrr 3/6 sem rad to carotids resp + rhonchi on r, cta left gi + bs, soft/nt/nd extrem no edema, warm, well perfused, small amount chronic swelling over left malleolus pulses rad fem dp/pt r 2+ 2+ 1+ 1+ l 2+ 2+ 1+ 1+ discharge vs t 97 hr 52af bp 115/55 rr 18 o2sat 94%ra gen nad neuro a&ox3, mae, follows commands. nonfocal exam cv irreg-irreg. sternum stable, incision cdi. pulm cta bilat abdm soft, nt/nd/nabs ext warm well perfused. trace edema bilat pertinent results: 0 bld inr-1.2 08:50am blood wbc-17.2* rbc-4.07* hgb-11.7* hct-35.2* mcv-87 mch-28.8 mchc-33.2 rdw-17.1* plt ct-341# 04:45am blood wbc-19.6* rbc-3.89* hgb-11.4* hct-33.1* mcv-85 mch-29.3 mchc-34.4 rdw-17.0* plt ct-190 06:20am blood wbc-22.6* rbc-3.98* hgb-11.6* hct-34.4* mcv-87 mch-29.3 mchc-33.8 rdw-17.1* plt ct-147* 02:27am blood wbc-25.2* rbc-4.06* hgb-11.8* hct-34.0* mcv-84 mch-29.2 mchc-34.9 rdw-17.1* plt ct-143* 08:50am blood plt ct-341# 08:50am blood pt-12.7 inr(pt)-1.1 08:50am blood glucose-179* urean-31* creat-1.0 na-134 k-4.5 cl-98 hco3-25 angap-16 04:50am blood urean-27* creat-0.8 k-4.3 radiology final report chest (pa & lat) 2:30 pm chest (pa & lat) reason: r/o effusion medical condition: year old woman with s/p cabg/avr reason for this examination: r/o effusion chest history: cabg, avr, rule out effusion. two views. comparison with the previous study done . pulmonary vascular congestion and small bilateral pleural effusions are again demonstrated. the patient is status post median sternotomy and cabg, as before. mediastinal structures are unchanged. compared with the previous study, the right pleural effusion has probably decreased somewhat. impression: interval decrease in pleural fluid on the right. no other significant change. dr. cardiology report echo study date of patient/test information: indication: cad, as, ai, mr evaluate ventricular function, valve status, aortic atheroma intraop for cabg/avr height: (in) 59 weight (lb): 137 bsa (m2): 1.57 m2 bp (mm hg): 106/39 hr (bpm): 67 status: inpatient date/time: at 10:15 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw2-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. r. measurements: left atrium - long axis dimension: *5.3 cm (nl <= 4.0 cm) left atrium - four chamber length: *6.3 cm (nl <= 5.2 cm) right atrium - four chamber length: *5.4 cm (nl <= 5.0 cm) left ventricle - inferolateral thickness: 0.8 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: *6.0 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 4.9 cm left ventricle - fractional shortening: *0.18 (nl >= 0.29) left ventricle - ejection fraction: 50% to 60% (nl >=55%) left ventricle - peak resting lvot gradient: 3 mm hg (nl <= 10 mm hg) aorta - valve level: 2.1 cm (nl <= 3.6 cm) aorta - ascending: 2.9 cm (nl <= 3.4 cm) aorta - arch: 2.7 cm (nl <= 3.0 cm) aorta - descending thoracic: 2.0 cm (nl <= 2.5 cm) aortic valve - peak velocity: *3.0 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 36 mm hg aortic valve - mean gradient: 19 mm hg aortic valve - valve area: *0.9 cm2 (nl >= 3.0 cm2) mitral valve - peak velocity: 2.3 m/sec mitral valve - mean gradient: 12 mm hg mitral valve - pressure half time: 135 ms mitral valve - e wave: 2.3 m/sec mitral valve - a wave: 1.2 m/sec mitral valve - e/a ratio: 1.92 mitral valve - e wave deceleration time: 220 msec interpretation: findings: left atrium: moderate la enlargement. elongated la. right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. moderately dilated lv cavity. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: severely thickened/deformed aortic valve leaflets. moderate as (aova 0.8-1.19cm2). moderate to severe (3+) ar. mitral valve: severely thickened/deformed mitral valve leaflets. severe mitral annular calcification. calcified tips of papillary muscles. moderate to severe (3+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. moderate tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: trivial/physiologic pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. see conclusions for post-bypass data conclusions: pre-bypass: 1. the left atrium is moderately dilated and elongated. 2. the left ventricular cavity is moderately dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic arch and descending thoracic aorta. 5. the aortic valve leaflets are severely thickened/deformed. there is moderate to severe aortic valve stenosis (area 0.9 cm2). moderate to severe (3+) aortic regurgitation is seen. 6. the mitral valve leaflets are severely thickened/deformed. there is severe mitral annular calcification. based on mean mitral valve gradients of , there is likely at least moderate mitral stenosis. pressure half time was not useful to measure the mva pre-bypass given the significant ai. using flow convergence/pisa techniques and pressure half time after replacement of the aortic valve, the mva is estimated to be between 1.3-1.7 cm2 (moderate ms). moderate to severe (3+) eccentric mitral regurgitation is seen, with a coanda wrapping to the posterior wall of the left atrium. 7. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. 8. there is a trivial/physiologic pericardial effusion. post-bypass: patient is av paced, on phenylepherine infusion. 1. overall biventricular function remains preserved. septal wall motion is consistent with av pacing. 2. mitral regurgitation appears mild to moderte, mitral stenosis is unchanged. 3. there is a bioprosthetic arotic valve insitu. there is no aortic insuffiency or stenosis. there is no perivalvular leak. 4. aortic contours are intact. 5. remaining exam is unchanged. all findings discussed with the surgeons at the time of the exams. electronically signed by , md on 07:09. brief hospital course: she was admitted to cardiac surgery. carotid u/s and echo were performed. a dental consult was called after her home dentist reported a broken tooth on last exam, and recommended perioperative coverage with antibiotics. penicillin was started.she remained in the hospital until she was taken to the operating room on where she underwent a avr and cabg x1.she was extubated and her vasoactive drips were weaned to off on pod #1. she was transferred to the floor on pod #2. she was cultured for a white count of 25, no growth to date, cxr showed small bilat effusions. she had several episodes of rate controlled atrial fibrillation for which she was anticoagulated with coumadin and started on amiodarone/metoprolol. she was discharged to rehab on pod# 7 in stable condition. medications on admission: asa 325' diovan/hctz 320/12.5' feso4 325' fosamax 70 q week levoxyl 100' lipitor 20' lisinopril 20' norvasc 5' zetia 10' tums and vit d 1500' discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 7. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 8. tramadol 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 9. amiodarone 200 mg tablet sig: two (2) tablet po once a day: 400 mg daily x 1 week, then 200 mg daily ongoing (until dc'd by cardiologist). 10. penicillin v potassium 250 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 11. warfarin 1 mg tablet sig: as directed tablet po daily (daily): target inr 1.5-2. pt received 2.5mg and 1mg . 12. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day): x 1 week then qd. 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: as, cad s/p avr/cabg pmh: htn lipids hypothyroid s/p bilat lens transplant legally blind iron deficiency anemia s/p fall with ? head bleed/infected leg wound s/p orif of l ankle discharge condition: good. discharge instructions: call with fever,redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. shower, no baths, no lotions, creams or powders to incisions. no heavy lifting (> 10 pounds) or driving until follow up with surgeon. followup instructions: dr. 4 weeks dr 3-4 weeks dr. 2 weeks after discharge from rehabilitation procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart arterial catheterization open and other replacement of aortic valve with tissue graft transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery unspecified pleural effusion unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases other and unspecified hyperlipidemia long-term (current) use of anticoagulants iron deficiency anemia, unspecified legal blindness, as defined in u.s.a. 

Answer: The patient is high likely exposed to