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: syncope major surgical or invasive procedure: cardiac catheterization tooth extraction aortic valve replacment utilizing a . mechanical valve history of present illness: this is a 59m with htn x 20 years admitted to on with near syncope x 2. ck/trop (-) x3. head ct showed mild cerebral atrophy, carotid u/s showed minimal plaque. stress test was done. 5 minutes into protocol the patient's blood pressure dropped to 60/30, pt became diaphoretic and ashen and ekg showed 4mm st depressions ant/lat. patient transferred to for cardiac catheterization. past medical history: aortic stenosis, hypertension, history of nosebleeds, bilateral carpel tunnel syndrome - s/p wrist surgery, syncope, s/p appendectomy social history: patient works for reebok. he is a non-smoker and denies excessive etoh intake. he lives with his mother. family history: family history of cad, unknown age physical exam: pe t99, bp116/82, hr 83, r20, o2sat 97%ra gen: nad, lying on back (s/p cath) heent: mmm, op clear heart: nl rate, s1s2, iii/vi crescendo/ decrescendo murmur lusb, no parvus et tardus lungs: cta b/l abd: soft, round protuberant, no bruits ext: 2+dp, no edema groin: right groin cite c/d/i pertinent results: cardiac catheterization: 1. selective coronary angiography of his right dominant system revealed no angiographic evidence of flow limiting coronary artery disease. 2. resting hemodynamics revealed elevated left sided filling pressures and a reduced ci of 2.2 l/min/m2. 3. there was a 70mmhg gradient across the aortic vavlve upon pullback of the cathter from the left ventricle to the aorta. the calculated valve area is 0.63 cm2. left ventriculography revealed and ef of 57% and 1+ mitral regurgitation. echocardiogram: 1. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. 2. the ascending aorta is moderately dilated. 3. the aortic valve leaflets are severely thickened/deformed. there is moderately severe aortic valve stenosis. trace aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. 05:55am blood hct-25.0* 07:10am blood wbc-14.9* rbc-3.02* hgb-9.3* hct-26.1* mcv-87 mch-30.7 mchc-35.5* rdw-13.9 plt ct-156 06:20am blood pt-20.4* ptt-37.7* inr(pt)-2.0* 07:24pm blood pt-17.6* ptt-41.8* inr(pt)-1.6* 05:55am blood pt-14.8* ptt-29.1 inr(pt)-1.3* 05:55am blood k-4.2 07:10am blood glucose-128* urean-15 creat-0.7 na-135 k-4.4 cl-102 hco3-26 angap-11 06:05am blood calcium-8.5 phos-4.4 mg-2.1 06:25am blood triglyc-175* hdl-55 chol/hd-2.9 ldlcalc-68 brief hospital course: mr. was admitted and underwent cardiac catheterization which revealed normal coronary arteries. it confirmed aortic stenosis with a 70mmhg gradient across the aortic valve. the calculated valve area was 0.63 cm2. left ventriculography revealed an lvef of 57% and there was 1+ mitral regurgitation. further evaluation included an echocardiogram and dental consultation. the again showed severe aortic stenosis with trace ai. there was mildly thickened mitral valve leaflets, and only trivial mr. was also notable for a normal aortic root diameter, and a moderately dilated ascending aorta, measuring 4.0 centimeters. dental consultation revealed poor oral hygiene with several cracked teeth and tooth extraction was recommended. on , tooth extraction was performed without complication. his preoperative course was also remarkable for unexplained fevers. he was empirically maintained on intravenous antibiotics. pan cultures were obtained but no infectious etiology was identified. head ct scan was notable for findings consistent with sinusitis which may have explained his fevers. once his fevers improved, he was cleared for surgery. on , dr. performed an aortic valve replacement with a . mechanical valve. his ascending aorta was not replaced as it appeared smaller than 4.0 centimeters on visual inspection with good tissue quality. the operation was otherwise uneventful and he transferred to the csru for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated. he weaned from inotropic support without difficulty. he maintained stable hemodynamics and transferred to the sdu on postoperative day two. beta blockade was resumed and advanced as tolerated. he remained in a normal sinus rhythm without atrial or ventricular arrhythmias. warfarin was started and dosed for a goal inr between 2.0 -3.0. over several days, he made clinical improvements with diuresis as medical therapy was optimized. he was cleared for discharge to home on postoperative day four. he will follow up with dr. for outpatient warfarin dosing. medications on admission: lotrel qd, aspirin qd discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*90 tablet, delayed release (e.c.)(s)* refills:*2* 4. ferrous gluconate 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. hydromorphone 2 mg tablet sig: 1-2 tablets po every 6-8 hours as needed. disp:*60 tablet(s)* refills:*0* 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. warfarin 2.5 mg tablet sig: two (2) tablet po qpm: take as directed by md. daily dose may vary according to inr. goal inr is 2.0 - 3.0. disp:*90 tablet(s)* refills:*2* 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*1* 10. furosemide 20 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 2 weeks: take 40mg twice daily for 1 week, then 20mg twice daily for 1 week. disp:*42 tablet(s)* refills:*0* 11. potassium chloride 20 meq packet sig: one (1) packet po q12h (every 12 hours) for 2 weeks. disp:*28 packet(s)* refills:*0* discharge disposition: home with service facility: so. coast vna discharge diagnosis: aortic stenosis - s/p mechanical avr, dilated ascending aorta, hypertension, history of nosebleeds, s/p wrist surgery, history of syncope discharge condition: good discharge instructions: patient may shower, no baths. no creams, lotions or ointments to incisions. no driving for at least one month. no lifting more than 10 lbs for at least 10 weeks from the date of surgery. monitor wounds for signs of infection. please call with any concerns or questions. dr. will monitor your warfarin as an outpatient. adjust for goal inr between 2.0 - 3.0. followup instructions: cardiac surgeon, dr. in weeks. local pcp, . in weeks. dr. will arrange follow up with local cardiologist as an outpatient. procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures open and other replacement of aortic valve other surgical extraction of tooth diagnoses: anemia, unspecified unspecified essential hypertension thoracic aneurysm without mention of rupture aortic valve disorders dental caries, unspecified unspecified sinusitis (chronic) 

Answer: The patient is high likely exposed to