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: history of present illness: this is a 73-year-old woman who was admitted to the hospital on for congestive heart failure. she had a recent hospitalization at prior to this visit in with congestive heart failure, paroxysmal atrial fibrillation, and acute-on-chronic renal failure. she was discharged home on with plans for rehabilitation and recovery at home and then possible mitral valve repair in the future for her known mitral regurgitation. the patient reported two admissions to outside hospitals since her discharge on and weakness as well as gastrointestinal bleed. one admission on showed an inr of 10.65. a colonoscopy was also done at that time. gastrointestinal bleed thought induced by an elevated inr. on she presented again to an outside hospital with bright red blood per rectum and progressive weakness. inr on admission to the outside hospital was 5.62. her inr was reversed. she is now transferred to for further evaluation and treatment as well as workup for possible aortic valve replacement/mitral valve replacement with dr. . she denied any angina, palpitations, diaphoresis, nausea, or vomiting. she reported edema, fatigue, weakness, and dyspnea on exertion. the patient had no catheterization of record on here; but appears to have had her last catheterization in at an outside hospital with clean coronaries. on a transesophageal echocardiogram had been done at which showed an ejection fraction of 30 to 35 percent, moderate global left ventricular hypokinesis, trace aortic insufficiency, 3 plus mitral regurgitation, 2 plus tricuspid regurgitation, and no noted af at the time. past medical history: 1. atrial fibrillation. 2. hypertension. 3. congestive heart failure. 4. chronic obstructive pulmonary disease. 5. chronic renal insufficiency (with a baseline creatinine of 2). 6. osteoarthritis. 7. gout. 8. mitral regurgitation. 9. af. 10. tricuspid regurgitation. 11. diverticulitis. 12. history of gastrointestinal bleed. 13. hernia. past surgical history: 1. hysterectomy. 2. cholecystectomy. 3. appendectomy. 4. tonsillectomy. allergies: she has multiple drug allergies including sulfa, aspirin, codeine, allopurinol, colchicine, and digoxin. medications on admission: when she was seen by cardiac surgery on included coreg 3.125 mg p.o. twice daily, amiodarone 200 mg p.o. once daily, coumadin 2.5 mg p.o. once daily, lasix 60 mg p.o. twice daily, protonix 40 mg p.o. once daily, advair 100/50 twice daily, and caltrate 500 mg p.o. twice daily. summary of hospital course: in preparation for impending valve surgery the patient underwent a number of studies and also was seen daily by the medicine service and the cardiology service for resolution of her congestive heart failure. preoperative carotid ultrasounds also showed a probable occluded left vertebral artery, but less than 40 percent bilaterally in her common carotid artery. shin the hospital approximately 10 days prior to her surgery with plans to obtain either repeat pulmonary function tests from an outside hospital or new pulmonary function tests at . dr. determined the patient needed a new cardiac catheterization as the prior one was almost 10 months old. a gi consultation was discussed, although there was bleeding in the setting of an elevated inr. cardiothoracic surgery also recommended a possible neurology consultation as the patient reported presyncope and syncopal symptoms over the past two months. the patient could not clearly say if the episodes were with atrial fibrillation or a gastrointestinal bleed or if they were independent. she also reported visual changes and the sudden onset of blurred vision that lasted minutes at a time. she had a ct scan at an outside hospital in , for which the cardiothoracic surgery team was trying to obtain the films for neurologic review. colonoscopy from the outside hospital from showed diffuse moderate-to- severe diverticulosis of the sigmoid and descending colon and a colon polyp. a small-bowel series on also at an outside hospital showed a distended third portion of the duodenum with recommendations for abdominal ct. the patient was also instructed to her family bring in her prior pulmonary function tests but that they would not have to be repeated if they were within six months. the patient did have a foley catheter in place. she was treated for a urinary tract infection from to with levaquin. the foley was removed on . she also received two doses of macrodantin for a urinary tract infection. heparin was stopped overnight on midnight on the night prior to surgery. a preoperative chest x-ray was unremarkable. her pulmonary function tests showed a fev1 of 0.76 (which is 47 percent of predicted). preoperative laboratories were as follows. sodium was 141, potassium was 4.1, chloride was 102, bicarbonate was 29, blood urea nitrogen was 35, creatinine was 2.6, with a blood sugar of 85. white blood cell count was 4.6, the hematocrit was 34, and the platelet count was 195,000. her last pt on the heparin drip was 150. this was discontinued at 12 midnight. a dental consultation was not done. on the patient underwent aortic valve replacement, mitral valve replacement, tricuspid valve repair, replacement of ascending aorta, closure of asd/isd, and a partial maze radiofrequency ablation. the patient received a 23-mm ce pericardial aortic valve, a 27-mm mitral thermafix pericardial valve, a 32-mm partial tricuspid ring, a 26-mm gel weave tube graft in the ascending aortic position. the patient was transferred to the cardiothoracic intensive care unit on a milrinone drip at 0.25 mcg/kg/min, a nitroglycerin drip at 0.7 mcg/kg/min, and an epinephrine drip at 0.02 mcg/kg/min. over the course of the next several days, the patient exhibited both bradycardia and a rapid atrial fibrillation. she remained on an epinephrine drip and a neo-synephrine drip for several days for pressor support. electrophysiology consulted on the patient and determined that she had tachy- brady syndrome and would require a pacemaker. she was also seen by physical therapy for initial evaluation and case management for future discharge planning. on , she continued to make good progress. she was weaned off her drips and was transferred out to the two. over the course of the next couple of days, she did complain of some pain in her right foot which was similar to her gout pain. on , she received a pacemaker by dr. . of the electrophysiology service. she was started on toprol and amiodarone. again, she refused to restart coumadin given her increased bleeding risk and prior gastrointestinal bleeds. this was elected not to be given to the patient. also on , a chest x-ray showed small bilateral effusions, but the patient made excellent progress on the floor after her pacemaker and was discharged from the hospital. a repeat cardiac catheterization showed a normal left main, normal lad, a normal ramus, a 30 percent om1 lesion of the circumflex, and a normal rca, as well as severe aortic stenosis. on the day of discharge, the patient's examination was as follows. the blood pressure was 124/56, a paced right-handed at 70, the temperature was 97, and the respiratory rate was 20. her weight was 70.8 kilograms on this - her 15th postoperative day. she was saturating on 96 percent on room air. her laboratories prior to discharge were as follows. white count was 6.4, the hematocrit was 27.2, and the platelet count was 420,000. sodium was 141, potassium was 4.4, chloride was 107, bicarbonate was 27, blood urea nitrogen was 27, creatinine was 1.9 (which was below the patient's baseline), and blood sugar was 101. she was alert and oriented with a nonfocal examination. she had decreased breath sounds at the bases. her heart was regular in rate and rhythm in her paced rhythm. her chest incision had no drainage or erythema. she had positive bowel sounds. she had 1 plus peripheral edema, but her extremities were warm. her central venous line had been removed. her epicardial pacing wires had been removed. her pacemaker site was unremarkable in her upper chest area. discharge disposition: the patient continued to make very good progress and was discharged to home with vna services on . condition on discharge: stable. medications on discharge: 1. colace 100 mg p.o. twice daily. 2. protonix enteric coated 40 mg p.o. once daily. 3. metoprolol 25 mg p.o. once daily. 4. enteric coated aspirin 325 mg p.o. once daily. 5. fluticasone/salmeterol 100/50 mcg dosing disk one disk with device inhalation twice daily. 6. percocet 5/325 one to two tablets p.o. q.4h. as needed (for pain). 7. albuterol sulfate 0.083 percent solution 1 inhalation q.6h. as needed. 8. amiodarone 400 mg p.o. once daily for three days; then amiodarone 200 mg p.o. once daily (until the patient is seen by her cardiologist dr. or visit with dr. ). die instructions: 1. the patient was instructed to continue amiodarone until she saw either dr. or dr. . 2. the patient was also instructed to follow up in the clinic one week post discharge (telephone number ). 3. the patient was also instructed to follow up with her referring physician . one to two weeks after discharge. 4. the patient was also instructed to follow up with dr. - her heart failure cardiologist - in two to three weeks after discharge. 5. the patient was also instructed to see dr. in his office on a postoperative surgical visit in four weeks. discharge diagnoses: 1. status post aortic valve replacement, mitral valve replacement, tricuspid valve repair, radiofrequency maze procedure, repair of atrial septal defect with closure and replacement of ascending aorta. 2. congestive heart failure. 3. atrial fibrillation. 4. mitral regurgitation. 5. tricuspid regurgitation. 6. paroxysmal atrial fibrillation with tachy-brady syndrome. 7. status post pacemaker implantation. 8. hypertension. 9. chronic obstructive pulmonary disease. 10. arthritis/gout. 11. diverticulitis with a history of gastrointestinal bleeds. discharge status: the patient was discharged to home in stable condition on . , m.d. procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle excision or destruction of other lesion or tissue of heart, open approach open and other replacement of aortic valve with tissue graft resection of vessel with replacement, thoracic vessels other and unspecified repair of atrial septal defect open and other replacement of mitral valve with tissue graft open heart valvuloplasty of tricuspid valve without replacement injection or infusion of nesiritide diagnoses: acute kidney failure, unspecified thoracic aneurysm without mention of rupture chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation other chronic pulmonary heart diseases rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease mitral valve insufficiency and aortic valve stenosis anticoagulants causing adverse effects in therapeutic use sinoatrial node dysfunction other and unspecified coagulation defects diverticulosis of colon with hemorrhage diseases of tricuspid valve acquired cardiac septal defect 

Answer: The patient is high likely exposed to