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: demerol / chocolate attending: chief complaint: elective pvi major surgical or invasive procedure: pulmonary vein isloation and mitral annular flutter ablation history of present illness: 64 year old female with a history of rheumatic heart disease s/p st. mechanical mvr , endocarditis, cva, paf and aflutter s/p elective pvi and mitral annular flutter ablation admitted to ccu for monitoring. patient tolerated the procedure well, sheaths removed. for sedation, received fentanyl 300mcg, propofol 180mcg, midazolam 4mg. in the pacu, she was moving all 4 extremities, but was quite somnolent. given history of cvas, patient was admitted to ccu for monitoring. of note, patient is on coumadin, and inr today was 4. patient initially had ep study in for non-inducible rvot tachycardia, atrial fibrillation status post a cardioversion on at . she also has a history of cva with residual mild right arm weakness, and history of multiple tias with right arm numbness and visual changes. patient has monthly inrs followed by dr office. currently, patient feels sleepy. she reports b/l proximal le pain which she has baseline. denies sob, palpitations, chest pain, light headedness. . review of systems as above . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: history of rheumatic heart disease mvr mechanical valve 21 years ago, on coumadin s/p ep studies not inducible rvot tachycardia s/p catheterization , no intervention atrial fibrillation diagnosed a few years ago s/p cardioversion at history of cva with mild right arm weakness history of multiple tias with right arm numbness and visual changes breast cancer s/p left lumpectomy, rad rx. with right nipple removal d/t bleeding gi bleed post colonoscopy oopherectomy hysterectomy tonsillectomy social history: -lives with husband and mother. as cashier at target. -tobacco: never -etoh: occasional beer family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: 98.7 77 118/60 19 95 ra general: wdwn f in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no jvd cardiac: . rr, normal s1, s2. mechanical valve click. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. groin site slightly tender to touch, no bleeding, no bruit pulses: right: dp 2+ with doppler, not palpable left: dp 2+ neuro: cn ii-xii intact, sensation intact in ues/ /l, strenght except r prox/distal ue (this is residual deficit from prior stroke) discharge exam unchanged pertinent results: labs: 04:10pm blood wbc-3.9* rbc-4.00* hgb-12.4 hct-37.7 mcv-94 mch-31.0 mchc-32.9 rdw-14.2 plt ct-218 04:10pm blood neuts-62.1 lymphs-29.3 monos-5.6 eos-2.3 baso-0.6 01:21am blood wbc-8.2# rbc-4.03* hgb-12.4 hct-38.0 mcv-94 mch-30.7 mchc-32.5 rdw-14.3 plt ct-203 04:10pm blood pt-40.9* inr(pt)-4.0* 01:21am blood pt-35.1* ptt-40.2* inr(pt)-3.4* 04:10pm blood glucose-99 urean-13 creat-0.6 na-144 k-3.0* cl-107 hco3-25 angap-15 01:21am blood glucose-126* urean-10 creat-0.5 na-145 k-3.2* cl-107 hco3-27 angap-14 01:21am blood calcium-7.8* phos-3.3 mg-1.7 01:38am blood freeca-1.03* echo : no mass/thrombus is seen in the left atrium or left atrial appendage. mild spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). the right atrial appendage ejection velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). there are simple atheroma in the descending thoracic aorta and aortic arch. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. trace aortic regurgitation is seen. a bileaflet mitral valve prosthesis is present. a mechanical mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. tricuspid regurgitation is present but cannot be quantified. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild left atrial appendage spontaneous echo contrast without evidence of discrete thrombus. depressed right and left atrial appendage emptying velocities. simple atheroma in the descending thoracic aorta and aortic arch. well-seated, normal appearing bileaflet mechanical mitral valve prosthesis. borderline pulmonary artery systolic hypertension. brief hospital course: brief clinical summary: 64 year old female with a history of rheumatic heart disease s/p st. mechanical mvr , endocarditis, cva, paf and aflutter s/p elective pvi and mitral annular flutter ablation admitted to ccu for monitoring. no events or complications in the icu. issues: # s/p pvi and flutter ablation: patient tolerated the procedure well. no chest pain, no sob, no palpitations. inr supratherapeutic at 4. quite sedated, but neuro exam nonfocal except mild r arm weakness which is residual from prior stroke and currently at baseline per patient. pt had no acute issues in icu overnight and her mental status improved after sedation wore off. continued coumadin at 6mg ( home dose). continued home metoprolol xl 150 qd. per ep recs, placed pt on aspirin 325mg qd and omeprazole 20mg daily for 1 month s/p procedure. continued digoxin as well as other home cardiac meds. arranged for outpatient follow up with cardiologist and of hearts monitor for 2 weeks. # rheumatic heart disease s/p mvr: coumadin 6mg as above. pt to check inr on and fax results to pcp. # htn: continued home amlodipine, lisinopril, metoprolol, lasix # hld: continued simvastatin. transitional issues: 1. follow up of hearts medications on admission: amlodipine 5 mg po qam digoxin 125 mcg tablet po qam furosemide 20 mg tablet po qam lisinopril 40 mg tablet po qam metoprolol succinate 150 mg er po qam potassium chloride crys cr 20 meq po bid simvastatin 20 mg po qhs warfarin mon/wed/fri/ 12.5 mg, all other 10mg. discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 3. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 4. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 5. metoprolol succinate 100 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day. 6. warfarin 10 mg tablet sig: one (1) tablet po once a day: -take this only on tues, thurs, sat, sun -take this plus 2.5mg on mon, weds, fri. 7. coumadin 2.5 mg tablet sig: one (1) tablet po mon, weds, fri: please take a 2.5mg tab plus a 10mg tab on mon, weds, fri. 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily) for 30 days. disp:*30 tablet(s)* refills:*0* 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day for 30 days. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 10. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain: please take as needed for pain at groin site. disp:*30 tablet(s)* refills:*0* 11. multivitamin tablet sig: one (1) tablet po once a day. 12. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po twice a day. 13. outpatient lab work please check inr on and fax results to: , md fax: phone: 14. digoxin 125 mcg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: paroxysmal atrial fibrillation atrial flutter discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you came to the hospital for elective ablation of your abnormal heart rhythm. the procedure went very well. you were admitted to the intensive care unit for monitoring overnight after ablation and did well. we have made the following changes to your medications: -increase aspirin to 325mg for 1 month and then resume taking 81mg daily -start omeprazole 20mg daily for 1 month after procedure -start tylenol as needed for pain at groin site, do not exceed 4g in 1 day please have your inr checked on (tuesday). prescription included. you will also wear a heart monitor for 2 weeks which dr. , the doctor who did the procedure, will follow up and communicate to your cardiologist. please follow up with your primary care doctor/cardiologist as scheduled below. it was a pleasure taking care of you, we wish you all the best. followup instructions: name: , location: cardiology address: , ste#404, , phone: appt: at 11:45am md procedure: diagnostic ultrasound of heart other electric countershock of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach cardiac mapping diagnoses: unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of breast atrial flutter other and unspecified hyperlipidemia other late effects of cerebrovascular disease other malaise and fatigue 

Answer: The patient is high likely exposed to