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: the patient is a 60 year old man with a history of right-sided congestive heart failure with an ejection fraction of 45 percent, atrial fibrillation, pulmonary hypertension and cardiomyopathy, who presented with progressive shortness of breath, abdominal distention, increasing cough with intermittent fevers up to 100.2. the patient states that his dyspnea has been getting worse over the past two to three weeks and he became increasingly concerned when he noticed abdominal swelling. the patient has been complaining of shaking chills and fever times two days. he denies any chest pain, headache, nausea, vomiting, diarrhea, dysuria, rash, myalgia, arthralgia. the patient had a recent admission for hypotension and congestive heart failure in . past medical history: atrial septal defect repair in . cardiomyopathy. right-sided congestive heart failure. pulmonary hypertension. atrial fibrillation and flutter. mild cirrhotic changes of the liver. chronic hepatic congestion. history of prostate cancer, status post brachytherapy. history of rectal bleeding. obstructive sleep apnea on continuous positive airway pressure at home. allergies: ace inhibitor, possible allergy to barium. medications on admission: 1. digoxin 0.25 mg daily. 2. toprol 25 mg daily. 3. amiodarone 200 mg daily. 4. warfarin 2.5 mg daily. 5. lasix 20 mg daily. 6. pravachol 20 mg daily. 7. trazodone 50 mg q.h.s. 8. lexapro 10 mg daily. 9. flovent 110 daily. 10. atrovent twice a day. 11. diovan 120 daily. social history: remote tobacco use, occasional alcohol use. he is a retired firefighter. physical examination: at the time of admission, temperature 98.1, heart rate 66, blood pressure 108/88, respiratory rate 24, oxygen saturation 95 percent in room air. head, eyes, ears, nose and throat - jugular venous distention to ten centimeters. respiratory - bibasilar crackles, right greater than left. cardiovascular - ii/vi systolic murmur heard best at the apex. the abdomen is soft, no costovertebral angle tenderness. extremities are warm, no lower extremity edema. neurologically, alert and oriented times four, speaking in full sentences. hospital course: the patient was admitted to the medical service. he was worked up for congestive heart failure, probable left lower lobe pneumonia, anemia, and chronic renal insufficiency. initial workup included echocardiogram as well as heart failure consult. over the next several weeks, the patient was followed closely by the medicine service as well as the heart failure service. additionally, pulmonary medicine and cardiology consulted on the patient's case. ultimately the patient went for cardiac magnetic resonance imaging that showed moderate to severe mitral regurgitation with preserved left ventricular function and increased left ventricular size. echocardiogram done shortly after admission showed an ejection fraction of 55 percent with a left atrium that is mildly dilated, right ventricle that was markedly dilated with severe global right ventricular free wall hypokinesis, two plus mitral regurgitation and four plus tricuspid regurgitation and severe pulmonary artery hypertension. ultimately the patient's condition deteriorated. he was transferred to the coronary care unit and, on , he underwent cardiac catheterization that showed severe pulmonary arterial hypertension unresponsive to nitrate and clean coronaries following which cardiothoracic surgery was consulted. the patient was felt to be have multiple medical problems and continued to be followed by the medical and cardiology service while optimizing his medical condition. ultimately on , the patient was brought to the operating room at which time he underwent a redo sternotomy, tricuspid valve annuloplasty with a thirty millimeter ring and a mitral valve replacement with a number twenty-seven - pericardial valve. please see the operating room report for full details. in summary, the patient's bypass time was 112 minutes with a cross clamp time of 80 minutes. he tolerated the operation and was transferred from the operating room to the cardiothoracic intensive care unit. at the time of transfer, the patient had levophed at 0.1 mcg/kg/minute, milrinone at 0.25 mcg/kg/minute and propofol at 50 mcg/kg/minute. he had a mean arterial pressure of 53 and he was v paced at a rate of 80 with a pad of 21. additionally, the patient had epinephrine infusion of 0.3 mcg/kg/minute. the patient did well in the immediate postoperative period. his intravenous medications were weaned as tolerated. his ventilatory status was adequate, and on postoperative day one, he was weaned from the ventilator and successfully extubated. on postoperative day three, the patient returned to the cardiac catheterization laboratory at which time a permanent pacemaker was implanted due to the patient's bradycardic episodes during his preoperative course. by postoperative day seven, the patient was complaining of dyspnea. his chest x-ray showed worsening congestive heart failure. additionally, the patient began to complain that he felt like he had a kidney stone with lower abdominal pain. he became increasingly acidotic and his white blood cell count went to 27.4. he was seen by general surgery as well as by the infectious disease service. abdominal ultrasound showed dilated gallbladder and the patient was brought to the operating room for an open cholecystectomy. the patient's recovery from this open cholecystectomy was slow but, by postoperative day four from his cholecystectomy, he had been weaned back to ventilator settings of continuous positive airway pressure five and five. on postoperative day six from his cholecystectomy, he was extubated. extubation was short lived and within several hours the patient needed to be reintubated. from that point forward, the patient's recovery from ventilatory status was extremely slow. on postoperative day twenty-one from his mvr/tvr, the patient was scheduled for tracheostomy. a percutaneous tracheostomy was done at the bedside following which the patient was noted to be in respiratory distress. a bronchoscopy done after the tracheostomy showed bright red blood within the trachea and the patient was brought to the operating room where they found bleeding from the thyroid isthmus. open tracheostomy was performed. the bleeding was controlled and the patient returned to the cardiothoracic intensive care unit following the exploration. over the next week, attempts were made to wean the patient from his full ventilation with limited success and screening process was begun to place the patient in a pulmonary rehabilitation center. on postoperative day twenty-nine, the patient was noted to have some rectal bleeding. at that time, the patient was receiving both coumadin and heparin. gastroenterology service was consulted and they felt that he had radiation proctitis. his heparin was held. the bleeding resolved and on the following day the patient was restarted on heparin and coumadin. at that time, the patient was also accepted to rehabilitation at in . the patient's physical examination is as follows: temperature 100, heart rate 70, v paced, blood pressure 120/50, respiratory rate 29, oxygen saturation 95 percent on assist control, tidal volume of 550, respiratory rate of 24, fio2 60 percent with 10 of peep. blood gas 7.48, 39, 91. white blood cell count 10.9, hematocrit 29.8, platelet count 324,000. prothrombin time 14.0, partial thromboplastin time 29.3, inr 1.2. sodium 136, potassium 4.1, chloride 102, co2 28, blood urea nitrogen 23, creatinine 1.1, glucose 101. neurologic - alert, responsive, in no acute distress. pulmonary - coarse breath sounds bilaterally. cardiovascular - regular rate and rhythm. sternal incision is clean, dry and intact. abdomen is soft and somewhat distended with positive bowel sounds. extremities are warm with one plus edema bilaterally. medications on discharge: 1. acetaminophen 325 mg to 650 mg q4hours p.r.n. for temperature greater than 38. 2. atrovent two puffs four times a day. 3. albuterol one to two puffs q6hours. 4. escitalopram oxalate 10 mg daily. 5. colace 15 cc twice a day. 6. aspirin 325 mg daily. 7. ________ powder four times a day p.r.n. 8. percocet 5/325 one to two tablets q4-6hours p.r.n. 9. flovent two puffs twice a day. 10. digoxin 0.125 mg daily. 11. amiodarone 200 mg daily. 12. valsartan 40 mg twice a day. 13. nystatin swish and swallow four times a day p.r.n. 14. bisacodyl suppository one pr q.h.s. p.r.n. 15. lasix 20 mg twice a day. 16. pantoprazole 40 mg daily. 17. morphine 1 to 4 mg q4hours p.r.n. 18. lorazepam 0.5 to 1 mg q4hours p.r.n. 19. heparin 800 units per hour. 20. warfarin 2 mg as directed to maintain a goal inr of 1.5 to 2.0. the patient received 2 mg on , and was held on . discharge status: the patient is to be discharged to center. he is to have his partial thromboplastin time inr checked daily with heparin and warfarin doses adjusted accordingly to maintain a partial thromboplastin time of 40 and an inr of 1.5 to 2.0. he has tube feeds that are respalor with the goal rate being 60 cc/hour. follow up: he is to have follow-up with dr. in one month. he is to have follow-up with dr. and the ep device clinic as scheduled. the patient is to call. discharge diagnoses: status post mitral valve replacement with a number twenty-seven - tissue valve as well as tricuspid valve repair with a number thirty annuloplasty band. status post permanent pacemaker. status post open cholecystectomy. status post tracheostomy. atrial fibrillation. status post atrial septal defect repair. pulmonary hypertension. prostate cancer, status post radiation therapy and brachytherapy. radiation proctitis. chronic obstructive pulmonary disease. hypercholesterolemia. , m.d. procedure: extracorporeal circulation auxiliary to open heart surgery fiber-optic bronchoscopy initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle exploratory laparotomy cholecystectomy temporary tracheostomy annuloplasty open and other replacement of mitral valve with tissue graft bronchoscopy through artificial stoma suture of artery right heart cardiac catheterization right heart cardiac catheterization revision of tracheostomy injection or infusion of nesiritide diagnoses: pneumonia, organism unspecified other primary cardiomyopathies pure hypercholesterolemia mitral valve disorders congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of prostate hemorrhage complicating a procedure unspecified sleep apnea unspecified disorder of kidney and ureter primary pulmonary hypertension acute cholecystitis tricuspid valve disorders, specified as nonrheumatic 

Answer: The patient is high likely exposed to