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: amiodarone attending: chief complaint: elective corevalve major surgical or invasive procedure: percutaneous aortic valve replacement endotracheal intubation central line history of present illness: 86 year old woman with severe as (valve area = 0.4, peak gradient 100), lvef 55%, paf, amiodarone lung toxicity, pulmonary fibrosis, pacemaker for tachybrady syndrome, scleroderma/crest syndrome and severe pulmonary hypertension. patient was adl independent at home untill her most recent admission to in with small bowel obstruction and pneumonia compicated by left basilic vein dvt from a picc line which was replaced prior to her discharge on . she was started on vanco + cefepim , she had negative blood cultures and sputum grew mrsa, cefepim was given for 5 days and vanco for 10 days (last dose 5/11). patient was worked up during her admission for aortic valve procedure to treat her critical as. she is now readmited electively from rehab for the procedure. antibiotics for pneumonia have been completed and patient is afebrile. bowel obstruction has since resolved and patient is tolerating soft diet. coumadin was discontinued on and switrched to fundaparinaux. she does report frequent loose stools, repeated assays for c. diff have been negative. . untill her recent admission patient had been adl independent and taking care of her demented year old husband at home. she dressed, cooked and shopped on her own and got cleaning help once weekly. she did have base-line doe and was not able to walk more than 20 paces without stopping. she has had significant unintentional weight loss over the past 4-5 years. she was on oxygen at home for hypoxia attributed to her chronic pulmonary fibrosis. she has chronically low systolic blood pressure, running 70-90's. she had intermittent dizziness upon standing. she had orthopnea x 1 pillow. nocturia x2. she denies leg swelling. at rehab she was able to walk upto 10 paces with walker and had to stop d/t sob. she reports an episode of epigastic/lower anterior chest pain yesterday after a meal which she attributes to her scleroderma related gerd. pain was continous for 2 hours and resolved with analgesia. ecg was checked and was reportedly unchanged. she denies any chronic angina. gu: voiding spontaneously, occasional inconteince. . hct on --27.7 . no evidence of bleeding. hct initally was around 33 at rehab, but has trended down to 27-28 and has remained stable since . . on review of systems, she denies prior history of stroke, tia, pulmonary embolism, bleeding at the time of surgery, cough, hemoptysis, black stools or red stools. denies recent fevers, chills or rigors. . cardiac review of systems - notable for absence of paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope past medical history: 1. aortic stenosis (valve are = 0.8) 2. left ventricular systolic dysfunction with ejection fraction of 45-55%. 3. paroxysmal atrial fibrillation. 4. amiodarone lung toxicity. 5. pulmonary fibrosis, on home oxygen. phtn (pap = 80) 6. tachybrady syndrome, status post permanent pacemaker. 7. history of breast cancer. 8. gastroesophageal reflux disease. 9. scoliosis. 10. diverticulosis. 11. hypothyroidism. 12. basal cell carcinoma. 13. left rotator cuff tendinitis and partial tear in . 14. scleroderma with gi manifestations and lung manifestations, but without renal manifestations. 15. severe pulmonary hypertension. 16. left basilic vein thrombosis, picc induced : left basilic vein thrombosis: picc induced during previous admission , considered superficial thrombosis. picc on left pulled and no anticoagulation was indicated 17. s/p left shoulder injury with rotator cuff tear 18. partial sbo social history: retired, a registered nurse . until her previous admission in patient reports she had been adl independent and taking care of her demented year old husband at home. she dressed, cooked and shopped on her own and got cleaning help once weekly. she did have base-line doe and was not able to walk more than 20 paces without stopping. she has been in rehab since her discharge on , there she was able to walk up to 10 paces with walker. . her 4 kids live in the area. (daughter) is her hcp (tel: ). . . -tobacco history: ~ 50 pack years, stopped in -etoh: untill recently used to drink one vodka- with olive per evening. -illicit drugs: none family history: mother with breast ca. physical exam: on admission: vs: t= 95.6...bp=109/49...hr=69...rr=20...o2 sat= 97% general: cachectic, frail appearing woman, nad, tachypneic to 25 with speech dyspnea, a+ox3. appropriate affect. heent: perrla, eomi, sclerae anicteric, mmm, op clear. neck: supple, no thyromegaly, no carotid bruits, jvd to the angle of the jaw. heart: irregularly irregular, 3/6 sem max at lusb with out radiation to the carotids. no rg. lungs: faint crackles to the scapulas bilaterally, rare scattered exp wheezes. abdomen: normal bowel sounds, soft/nt/nd, no masses or hsm, no rebound/guarding mid lower abdomen, left knee, right sholder skin: surgical scars extremities: wwp, trace pre-tibial edema, no c/c, vertical surgical scar over left knee neuro: awake, a&ox3, cns ii-xii grossly intact. motor 4-5/5 throughout, sensory intact except for loss of proprioception in 3rd through 5th toes of right foot. lines: picc right arm - no erythema, tenderness, discharge or swelling. pulses r/l: radial -/-; brachial ++/+; tp +/+; dp -/- . on discharge: expired pertinent results: on admission: 04:40pm blood wbc-5.7 rbc-3.05* hgb-9.7* hct-30.7* mcv-101* mch-31.9 mchc-31.8 rdw-15.5 plt ct-334 04:40pm blood pt-14.8* ptt-29.7 inr(pt)-1.3* 04:40pm blood glucose-100 urean-15 creat-0.7 na-141 k-5.2* cl-106 hco3-28 angap-12 04:40pm blood alt-13 ast-14 ld(ldh)-230 alkphos-91 totbili-0.4 03:07am blood lipase-28 04:40pm blood ck-mb-3 probnp-* 04:40pm blood albumin-3.0* calcium-8.5 phos-4.2 mg-2.2 iron-23* . tte: focused study. overall left ventricular systolic function is normal (lvef>55%). an aortic corevalve prosthesis is present. mild (1+) aortic regurgitation is seen. there is no pericardial effusion. . tte: the left atrium is elongated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is markedly dilated with moderate global free wall hypokinesis. an aortic corevalve prosthesis is present. the prosthetic aortic valve leaflets appear normal the transaortic gradient is normal for this prosthesis. a mild (1+) anterior paravalvular aortic valve leak is present. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normally-functioniong corevalve aortic prosthesis with mild paravalvular regurgitation. normal global and regional left ventricular systolic function. severe pulmonary hypertension with dilated right ventricle with moderate global systolic dysfunction. moderate mitral regurgitation. compared with the prior study (images reviewed) of , estimated pa pressures are higher still and rv appears slightly more dilated. the other findings are similar. . on 03:33am blood wbc-17.5* rbc-2.68* hgb-8.3* hct-25.5* mcv-95 mch-30.8 mchc-32.3 rdw-21.0* plt ct-89* 02:06am blood pt-20.1* ptt-90.9* inr(pt)-1.8* 03:33am blood glucose-178* urean-94* creat-4.8* na-142 k-4.8 cl-108 hco3-14* angap-25* 02:06am blood alt-62* ast-132* alkphos-109* amylase-610* totbili-0.5 02:06am blood lipase-1540* 04:16am blood probnp-* 06:14am blood type-art temp-37.8 po2-103 pco2-34* ph-7.30* caltco2-17* base xs--8 comment-axillary t 06:14am blood lactate-6.7* brief hospital course: 86 year old woman with severe as (valve area = 0.4, peak gradient 100), lvef 55%, paf, amiodarone lung toxicity, pulmonary fibrosis, pacemaker for tachybrady syndrome, scleroderma/crest syndrome and severe pulmonary hypertension who was admitted electively for core-valve placement, expired on . . # critical as: valve area = 0.4, peak gradient 100. patient not deemed a surgical candidate for surgery due to her co-morbidities therefore scheduled for core-valve on . patient with uneventful pre-operative course. intra-procedure patient plavix loaded. procedure complicated by inability to pull right groin shealth necessitating open closure per vasculature. patient extubated and transferred to the ccu. follow-up tte demonstrated stable, properly placed corevalve. . # pump: chf, ef 45% per osh. tte prior to procedure 55%. post-procedure, tte demonstrated overall normal left ventricular systolic function, (lvef>55%). an aortic corevalve prosthesis is present. mild (1+) aortic regurgitation is seen. there is no pericardial effusion. patient was continued on metoprolol, digoxin. . #. atrial fibrillation: pre-opertively patient had been on coumadin which had been transitioned to lovenox and subsequently switched to fondaparinaux. -- rate control: patient rate controlled with digoxin and metoprolol. -- anticoagulation: pre-opertively patient had been on coumadin which had been transitioned to lovenox and subsequently switched to fondaparinaux patient initially anticoagulated post-procedure with heparin iv however due to concern for hit, heparin was stopped and argatroban started. hit antibody returned negative and patient restarted on heparin gtt on . . # hypotension. post-procedure patient noted to be hypotension with maps in 50s and sbps in 80s necessitating pressure support. initial hypotension attributed to fluid shifts s/p core valve and blood pressure augmented with neo. neo resulted in pronounced peripheral vasoconstriction with resulting left extremity cyanosis. however patient persistently hypotension thought secondary to probable sepsis. patient started on broad spectrum antibiotics and decision made to aggressively hydrate with ivf and transition pressure support to levophed and vasopression. on , the patient became increasingly hypotensive requiring pressor support with levophed, vasopressin, and dopamine. despite pressors, lactate continued to climb into the 7 range until aggressive measures were withdrawn. . # thrombocytopenia. platlets with precipitous drop while hospitalized; ~300 pre-procedure with nadir in the 60s. differential diagnosis at that time included sepsis, dic medication side effect and hit. dic labs negative. patients 4 t score ~6 (especially after ue us with evidence of new left brancial thrombosis). concern for hit prompted transition to argatroban and send out of the hit antibody. on hit returned negative and patient transitioned back to iv heparin. likely drop reflective of underlying infectious process as hit ruled out and dic labs negative. . # acute kidney injury. patient with elevation in creatinine and decrease in urine production post-corevalve. ct with evidence of renal infarct thought to have occurred intra-procedure. etiology to likely multifactorial in setting of renal infarct as well as hypovolemia in setting of hypotension. patients kidney function was monitored daily, medications were renally dosed. the patient remained oliguric for several days and became net + 13l. cr stabilized around 4.8 and urine output improved transiently on a lasix gtt before the patient began to deteriorate and urine output again declined. . # peripheral vasoconstriction/left hand cyanosis. post-procedure patient with complaints of numbness and tingling in left hand. decision made to pull left axillary arterial line after which symptoms subsided. patient with hypotension s/p procedure necessitating augmented pressure support with neo. additional vasoconstriction in setting of neo in a patient with scleroderma likely resulted in aggravated peripheral vasoconstriction of left hand. pressors transitioned from neo to vasopression with some improvement in perfusion. . # elevated lfts. likely secondary to shocked liver in the setting of hypotension and sepsis. lfts stabilized and began to slowly trend down after initiation of broad spectrum antibiotics and normalization of blood pressure. . #. cad. left cath undertaken in as part of work-up for core-valve demonstarted left dominant system with singel vessel disease: ~50-70% lesion in om1. patient without complaints of chest pain in house. continued on asa 81 as well as bb. . # lung disease. pateint with history of extensive interstitial pulmonary fibrosis secondary to to amiodarone exposure vs scleroderma vs radiation injury (got radiation for breast cancer in the past. per chart biopsy, baseline home oxygen 2-3l. pre-procedure chest ct and severe pulmonary htn on rhc which showed pa systolic pressure of 80mmhg in the presence of nopmal wedge pressure (16mmhg). post-extubation patient continued on home nebulizer treatments. on , the patient acute desaturated to the 80s. she was deep suctioned with improvement in her sats. there was concern that the patient was not protecting her airway because of altered mental status and she was again intubated on . . # provoked left basilic vein thrombosis. picc induced during previous admission , considered superficial thrombosis. monitored clinically in house . # scleroderma: clinically suspected on past admission on the basis of her ild and chronic gerd complaints. rheumatology were consulted and serology showed positive + anticentromere ab with neg scl70, rna ab and b2 glycoprotein. impression was of crest syndrome. no systemic therapy was started. patient continued on ppi for treatment of gerd . # nutrition. post-procedure course complicated by extubation necessitating intubation. of note patient is significantlly cachectic with hypoalbuminemia (alb = 2.7 ) likely to her various chronic diseases and poor po intake. there was concern for mesenteric ischemia post-procedure because of complaints of abdominal pain, and tpn was started. . # hypothyroidism: tsh = 2.6. patient continued on home 75mcg . on , the patient was re-intubated for altered mental status and inability to protect her airway. the patient was noted to have oliguria, worsening lactic acidosis, evidence of pancreatitis and persistent respiratory failure. discussions about goals of care were held with the patient's family - including her daughter who served as her hcp. the decision was made to transition the patient to comfort measures only. she passed away shortly after pressors were discontinued on the morning of . medications on admission: digoxin 125 mcg tablet 1 tablet(s) by mouth once a day levalbuterol hcl 0.63 mg/3 ml solution for nebulization inh four times a day levothyroxine 75 mcg tablet 1 tablet(s) by mouth once a day metoprolol tartrate 25 mg tablet 1 tablet(s) by mouth q8hrs omeprazole 20 mg capsule, delayed release(e.c.) 1 capsule(s) by mouth twice a day potassium chloride 10 meq capsule, extended release 1 capsule(s) by mouth once a day aspirin 81 mg tablet, delayed release (e.c.) 1 tablet(s) by mouth once a day cholecalciferol (vitamin d3) 2,000 unit tablet 1 tablet(s) by mouth once a day arixtra sq 2.5 mg qd lidoqain patch was started in rehab on sucralfat 1g qid in rehab also got: zolpidem, guiafenasine, maalox, glycolax, ondasternon discharge medications: n/a discharge disposition: expired discharge diagnosis: cardiopulmonary arrest severe aortic stenosis s/p percutaneous aortic valve replacement atrial fibrillation pulmonary fibrosis tachybrady syndrome hypothyroidism scleroderma pulmonary hypertension discharge condition: expired discharge instructions: patient made comfort measures only on after developing cardiogenic shock and multi-system organ failure. this was in the setting of having received a percutaneous aortic valve replacement on . followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization parenteral infusion of concentrated nutritional substances insertion of endotracheal tube insertion of endotracheal tube open and other replacement of aortic valve arterial catheterization aortography cardiopulmonary resuscitation, not otherwise specified endarterectomy, lower limb arteries percutaneous balloon valvuloplasty procedure on single vessel diagnoses: acidosis thrombocytopenia, unspecified hemangioma of intra-abdominal structures coronary atherosclerosis of native coronary artery esophageal reflux acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified acute and subacute necrosis of liver unspecified septicemia unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders other chronic pulmonary heart diseases personal history of malignant neoplasm of breast sepsis acute respiratory failure personal history of other malignant neoplasm of skin cardiac arrest other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation postinflammatory pulmonary fibrosis 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 other complications due to other cardiac device, implant, and graft cardiac pacemaker in situ sinoatrial node dysfunction accidents occurring in residential institution urinary complications, not elsewhere classified examination of participant in clinical trial acute pancreatitis vascular disorders of kidney oliguria and anuria systemic sclerosis cyanosis lung involvement in systemic sclerosis chronic venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to