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: lasix attending: chief complaint: chest pain, shortness of breath major surgical or invasive procedure: aortic valve replacement(21mm porcine). mitral valve replacement(29mm porcine). two vessel coronary artery bypass grafting utilizing the lima to lad, and vein graft to obtuse marginal. cardiac catheterization history of present illness: mr. is a 76 year old male with chronic diastolic congestive heart failure(aortic stenosis, mitral regurgitation) and chronic atrial fibrillation who presented to outside hospital with progressive shortness of breath and chest pain for the last six months. he admits to occasional rest pain as well. during that admission, he was found to be anemic and transfused with several units of prbc's. endoscopy found a nonbleeding av malformation in the proximal duodenum. given his above cardiac status, he was transferred to the for further evaluation and treatment. past medical history: -coronary artery disease, prior pci -aortic stenosis -mitral regurgitation -chronic diastolic congestive heart failure -cerebrovascular disease, prior tia's, s/p right carotid stent, s/p right cea -hypertension -dyslipidemia -chronic atrial fibrillaton -chronic renal insufficiency -copd -anemia -history of gib, av malformation(duodenum) -bph, s/p turp social history: lives alone. quit tobacco about one months ago, prior heavy tobacco use. he denies etoh. family history: father died at age 36 from mi. physical exam: admit pe: 5'" 67.1 kg t afebrile, bp 169/90, hr 69, r 20, 93% on 2l thin male in nad perrl, eomi, oropharynx benign neck supple, no jvd, no carotid bruits irreg, irreg, 3/6 systolic murmur at rusb and llsb lungs clear anteriorly abdomen soft, slightly distended, non tender with normoactive bowel sounds extremities cool, no edema, decreased distal pulses alert and oriented, cn2-12 grossly intact, no focal deficits noted pertinent results: 05:47am blood wbc-8.8 rbc-2.98* hgb-9.5* hct-27.1* mcv-91 mch-32.0 mchc-35.2* rdw-16.3* plt ct-189 05:15pm blood wbc-5.7 rbc-3.47* hgb-10.6* hct-29.8* mcv-86 mch-30.7 mchc-35.7* rdw-15.7* plt ct-214 05:58am blood pt-18.6* ptt-33.5 inr(pt)-1.7* 05:47am blood plt ct-189 05:15pm blood plt ct-214 05:15pm blood pt-15.5* ptt-114.6* inr(pt)-1.4* 05:58am blood glucose-90 urean-25* creat-1.7* na-136 k-4.2 cl-104 hco3-26 angap-10 05:15pm blood glucose-134* urean-25* creat-1.8* na-135 k-3.5 cl-100 hco3-26 angap-13 12:40pm blood alt-24 ast-29 ld(ldh)-243 alkphos-70 totbili-0.5 05:58am blood calcium-8.6 mg-1.9 12:40pm blood %hba1c-5.6 , m 76 cardiology report ecg study date of 10:16:10 am atrial fibrillation with controlled ventricular response. diffuse non-specific st-t wave changes. compared to the previous tracing of the rhythm is now atrial fibrillation and the other findings are similar. read by: , v. intervals axes rate pr qrs qt/qtc p qrs t 59 0 90 470/468 0 71 -32 echocardiography report , (complete) done at 9:40:48 am final referring physician information , w. , status: inpatient dob: age (years): 76 m hgt (in): 71 bp (mm hg): 128/66 wgt (lb): 136 hr (bpm): 68 bsa (m2): 1.79 m2 indication: intraop management for avr/mvr/cabg. icd-9 codes: 440.0, 424.1, 424.0, 786.05, 786.51, 799.02 test information date/time: at 09:40 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2008aw2-: machine: 2 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.1 cm <= 4.0 cm left ventricle - septal wall thickness: *1.6 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.4 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.5 cm <= 5.6 cm left ventricle - systolic dimension: 3.8 cm left ventricle - fractional shortening: *0.16 >= 0.29 left ventricle - ejection fraction: 45% to 50% >= 55% aorta - annulus: 2.2 cm <= 3.0 cm aorta - sinus level: 3.0 cm <= 3.6 cm aorta - sinotubular ridge: 2.6 cm <= 3.0 cm aorta - ascending: *3.5 cm <= 3.4 cm aorta - arch: 2.7 cm <= 3.0 cm aorta - descending thoracic: *2.7 cm <= 2.5 cm aortic valve - peak velocity: 1.9 m/sec <= 2.0 m/sec aortic valve - peak gradient: 14 mm hg < 20 mm hg aortic valve - mean gradient: 13 mm hg aortic valve - lvot pk vel: 0.50 m/sec aortic valve - lvot diam: 2.1 cm aortic valve - valve area: *0.7 cm2 >= 3.0 cm2 findings left atrium: moderate la enlargement. mild spontaneous echo contrast in the body of the la. no mass/thrombus in the laa. right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: moderate symmetric lvh. normal lv cavity size. mildly depressed lvef. lv wall motion: regional left ventricular wall motion findings as shown below; remaining lv segments contract normally. right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending aorta diameter. normal aortic arch diameter. simple atheroma in aortic arch. mildly dilated descending aorta. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: ?# aortic valve leaflets. severely thickened/deformed aortic valve leaflets. severe as (aova <0.8cm2). moderate (2+) ar. eccentric ar jet directed toward the anterior mitral leaflet. mitral valve: moderately thickened mitral valve leaflets. myxomatous mitral valve leaflets. mild mitral annular calcification. mr vena contracta is >=0.7cm severe (4+) mr. tricuspid valve: tricuspid valve not well visualized. mild tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. results were personally reviewed with the md caring for the patient. conclusions prebypass 1. the left atrium is moderately dilated. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. no atrial septal defect of pfo is seen by 2d or color doppler. 2. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 45-50 %). the remaining left ventricular segments contract normally. 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic arch. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. there are complex (>4mm) atheroma in the descending thoracic aorta. 5. the aortic valve leaflets are moderately thickened. there is severe aortic valve stenosis (area <0.8cm2). moderate (2+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. 6. the mitral valve leaflets are moderately thickened. the mitral valve leaflets are myxomatous. the mitral regurgitation vena contracta is >=0.7cm. severe (4+) mitral regurgitation is seen. 7. there is no pericardial effusion. 8. dr. was notified in person of the results on at 827. postbypass 1. patient is on phenylephrine infusion 2. a well seated, well functioning valve is seen in the mitral position. no perivalvular leak is noted. mean gradient 3.1 mmhg. 3. a well seated, well functioning valve is seen in the aortic position. no perivalvular leak is noted. mean gradient is 5.4 mmhg. 4. aortic contour is smooth after decannulation 5. ef is 50%. 6. all other portions of the exam remain unchange. 7. dr. notified at 1227 i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 13:45 brief hospital course: mr. was admitted to the cardiology service with chronic diastolic heart failure and unstable angina. cardiac catheterization revealed severe three vessel coronary artery disease. it was also notable for moderate-severe aortic stenosis, severe pulmonary arterial hypertension and mild biventricular diastolic dysfunction. lv gram was deferred secondary to his renal dysfunction. cardiac surgery was therefore consulted and further evaluation was performed. echocardiogram confirmed aortic stenosis but also revealed severe mitral and tricuspid regurgitation. additional workup included a carotid ultrasound which found a totally occluded left internal carotid artery with a patent right internal carotid artery stent. he otherwise remained pain free on medical therapy and was eventually cleared for surgery. on , dr. performed aortic and mitral valve replacements along with coronary artery bypass grafting surgery. for surgical details, please see separate dictated operative note. following the operation, he was brought to the cvicu for invasive monitoring. extubated on pod #1 and developed melanotic stools, has pre existing avm in the duodeum, hematocrit remained stable was started on protonix with no further issues. beta blockade and amiodarone started postoperatively when he was in normal sinus rhythm but atrial fibrillation returned was treated with cardizem. he developed bradycardia and all av nodal blocking agents were discontinued, coumadin started and electrophysiology consult. plan to hold av nodal blocking agents and monitor rhythm that is atrial fibrillation 50-60 and follow up with cardiologist as outpatient. antihypertensives were titrated for blood pressure management. his foley catheter was removed twice with failure to void and urinary retention, remains in place at discharge and plan to follow up with outpatient urologist. he was ready for discharge to rehab on post op day 8. medications on admission: transfer meds: protonix 40 qd, cardizem 240 qd, metoprolol 12.5 tid, finasteride 5 qd, fexofenadine 60 , mvi, ferrous sulfate 300 , sulcralfate 1 tid, flomax 0.4 qd, lovenox 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. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 6. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 7. diuril 250 mg/5 ml suspension sig: one (1) po once a day for 7 days. 8. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 9. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po twice a day. 10. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: please dose based on inr - goal 2.0-2.5 for atrial fibrillation . 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: life care center - discharge diagnosis: coronary artery disease s/p cabg aortic stenosis s/p avr mitral regurgitation s/p mvr bradycardia urinary retention cardiomyopathy cerebrovascular disease, prior tia's, prior carotid stent, s/p rcea hypertension dyslipidemia chronic atrial fibrillaton discharge condition: good. discharge instructions: 1) shower daily. wash incisions with soap and water. no creams, lotions, or ointments to incisions. 2) no driving for at least one month. 3) no lifting more than 10 lbs for at least 10 weeks. 4) please call cardiac surgeon office if there is concern for sternal wound infection or fever greater than 100. 5) please follow up with pcp for radiographic follow up on sclerotic lesion right clavicle 6) sternal staples may be removed at rehab on or call if questions or concerns 7) hold all betablockers and ca channel blockers until follow up with cardiologist due to bradycardia followup instructions: please call to schedule all appointments dr. in 4 weeks dr. after discharge from rehab dr. after discharge from rehab dr (urologist) on at 1:50 pm. ( procedure: venous catheterization, not elsewhere classified single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters (aorto)coronary bypass of one coronary artery open and other replacement of aortic valve with tissue graft open and other replacement of mitral valve with tissue graft transfusion of packed cells diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases atrial flutter chronic kidney disease, unspecified hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) blood in stool mitral valve insufficiency and aortic valve stenosis chronic diastolic heart failure other specified retention of urine 

Answer: The patient is high likely exposed to