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: sulfonamides / dicloxacillin attending: chief complaint: chest pain major surgical or invasive procedure: vavuloplasty history of present illness: 87f pmh cad, htn, hyperlipidemia, atrial fibrillation off warfarin, diastolic chf ef 70%, sss s/p ppm, severe as who presents with cp at nh, not good historian. ems gave asa 325 mg, sln x 2 with resolution of chest pain. . of note, recent admission for worsening sob. . in the ed, vitals: t: bp: p: rr: spo2: ekg unchanged from previous. chest x-ray with robable small left-sided pleural effusion. first set of cardiac enzymes ck: 36 mb: notdone trop-t: 0.01. hematocrit at baseline 34. creatinine 1.2 above baseline 1.0. . ros: pt denies fever or chills. no night sweats or recent weight loss or gain. denied headache, rhinorrhea or congestion. denied cough, shortness of . denied chest pain or tightness, palpitations. no orthopnea, pnd, le edema. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no melena or brbpr. no dysuria. denied arthralgias or myalgias. no rash. past medical history: - atrial fibrillation: off coumadin secondary to epistaxis - sinus syndrome: temporary pacer placed during admission, was to return for permanent placement, which was again deferred during admission secondary to medical illness - hx of vt with torsades morphology in , was on amiodarone, recently stopped for hypothyroidism - aortic stenosis-> echo showing peak gradient 76 mm hg. - cad s/p nstemi in and s/p ballooning of lad - diasolic chf (ef 70%) - htn - hyperlipidemia - chronic venous stasis - squamous cell carcinoma: right medial calf, s/p excision , positive margins on 1st and 2nd excision attempts, needs xrt to area 6 weeks after the wound heals. - uti - rectal ulcers: possibly from constipation and straining - history of c diff colitis - anemia: from blood loss after gi bleed - urge incontinence - depression - colon adenoma in : last colonoscopy in , no polyps - s/p hysterectomy - hypothyroidism social history: currently living in chestnut park . no tobacco use. no history of alcohol abuse. her husband is deceased. she has a social worker at who follows her closely. family history: non contributory physical exam: vs: t 96.7, bp 90-109/60-72, hr v paced at 70, rr 14, o2 98% on 4l nc gen: elderly female in nad heent: ncat. sclera anicteric. perrl, eomi. neck: supple w/o jvd cv: rrr, nl s1, s2, iii/vi sem at apex chest: mod bibasilar crackles 1/4 up lung fields, no labored breathing abd: soft, nd, nt, no hsm, no tenderness. ext: no c/c/e. no femoral bruits. skin: right shin with shallow skin ulcer pulses: +dp/pt pulses b/l pertinent results: 08:40am blood ck-mb-notdone ctropnt-0.03* 12:55pm blood ck-mb-notdone ctropnt-0.03* 08:10am blood ck-mb-notdone ctropnt-0.03* 08:29am blood ck-mb-notdone ctropnt-0.05* 08:40am blood tsh-12* 12:55pm blood tsh-14* . 06:07am blood digoxin-2.1* 06:07am blood digoxin-1.8* 06:07am blood digoxin-1.8* 06:07am blood digoxin-1.9 . chem 7 : na 136, k 4.1, cl 100, bicarb 26, bun 19, cr 1.0 . 02:04am blood type-art po2-72* pco2-40 ph-7.34* caltco2-23 base xs--3 intubat-not intuba 12:15pm blood type-art o2 flow-4 po2-98 pco2-38 ph-7.47* . cxr : impression: persistent opacity in the retrocardiac left lower lobe has the appearance of atelectasis. small left-sided pleural effusion. stable cardiomegaly. . cxr : in comparison with study of , there is diffuse perihilar haziness extending out toward the periphery, consistent with pulmonary vascular congestion. substantial left pleural effusion persists, and there has been development of a right-sided effusion as well. . cxr : in comparison with earlier study of this date, the degree of prominence of the pulmonary vessels is substantially decreased. the right hemidiaphragm is now sharply seen. the retrocardiac opacification consistent with atelectasis or effusion is again noted. . cxr : dense opacity at the left lung base has increased, now completely obscuring the left hemidiaphragm, consistent with effusion. increased opacity in the retrocardiac region is consistent with atelectasis given increased leftward shift of the mediastinum. left-sided is again noted with leads unchanged. there is a rightward curvature of the upper lumbar spine representing either scoliosis or positional factors given recent comparisons do not include this region. . echo: the left atrium is mildly dilated but quite elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate global left ventricular hypokinesis (lvef = 25-30 %). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. no aortic regurgitation is seen. there is severe aortic stenosis ( 0.4 cm2). the mitral valve leaflets are mildly thickened. there is moderate thickening of the mitral valve chordae. there is a minimally increased gradient consistent with trivial mitral stenosis due to mitral annular calcification. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . cardiac cath and valvuloplasty: 1. initial angiography in this left-dominant circulation revealed the following:left coronary artery with diffuse moderate calcification. lm minimal luminal irregularity. lad: mid 50-60% re-stenosis in area of prior ptca site. otherwise, the lad had mild diffuse luminal irregularity. the lcx and marginals were large vessels free of significant disease. the diagonals were normal. the rca was known to be occluded and not injected. it filled via collaterals from the left system. 2. hemodynamics revealed a central aortic pressure pre-valvuloplasty of 111/69. there was a peak to peak gradient across the aortic valve of 70mm hg which improved s/p valvuloplasty to 36mm hg. fick cardiac output improved from 2.83 to 2.96 post procedure. 3. the aortic valve was crossed with an 035 straight glidewire. our pigtail catheter was inserted into the lv and pressures measured as above, confirming critical aortic stenosis. heparin was used prophylactically for the procedure. a stiff amplatz wire was then exchanged over our pigtail catheter. a 20 mm, 8 french compatible tyshak ii 6cm balloon was then inflated x 3 total inflations. there was still a residual gradient of 45mm hg. thus, the valve was dilated with a 22 mm, 8 french tyshak ii balloon x 2 total inflations. final pressure showed a reduction in the peak to peak gradient across the aortic valve to 36mm hg. the patient tolerated the procedure well and left the lab free of angina and in stable condition. final diagnosis: 1. one vessel coronary artery disease. 2. critical aortic stenosis 3. successful aortic valvuloplasty brief hospital course: pt was admitted with chest pain. however by admission, chest pain had resolved with sl nitroglycerin x 2. pt had negative cardiac markers x 3, q8 hours. no ischemic ecg changes noted. she was thought to be dry on exam. lasix and lisinopril were held. that evening, she developed respiratory distress and was found to be in acute congestive heart failure. she had severely labored breathing, extensive rales and pulmonary edema on cxr. she was also hypoxic. she was transfered to the icu where she was briefly on a nitro drip and received lasix. overnight, her respiratory status improved with decreased hypoxia, less labored breathing and improved mental status. in the setting of chronic low bp which had been labile in the past, she was kept in the icu on a gentle lasix drip. she was subsequently switched to lasix 60mg daily. lisinopril and metoprolol were discontinued to raise her blood pressure. digoxin was also started with a load with a target level of 0.8, but then discontinued as her dig levels persistantly high at 1.8-1.9. given her recent admission with chf and her tenous fluid status, she was evaluated for avr and valvuloplasty. the cardiothoracic surgery team decided she was not a good surgical candidated. dr and dr determined that valvuloplasty would be her best option to control her chf. this assessment was discussed with her case manager and her pcp . . she underwent cardiac catheterization and valvuloplasty successfully without complication and with decrease in peak gradient from 70 mmhg to 36mm hg. she had a brief episode of chest pain two days later which was determined not to be cardiac with rapid resolution with tylenol, unchanged ekg and negative cardiac enzymes. she was discharged on lasix 60mg daily. on discharge, her breathing was unlabored, but she continued to have mod rales and an o2 requirement (98% 4lnc). . she was also followed by wound care for her right leg ulcer. the wound care nurse incidentally noted two possible nodules under the skin. dr. , the surgeon who performed the squamous cell removal, was contact. the plastic surgery team evaluated the patient and performed a punch biopsy. a follow up appointment was made with dr. . medications on admission: 1. becaplermin 0.01 % gel sig: one (1) appl topical daily (daily): to r calf ulceration. . 2. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 7. calcium 500 500 mg (1,250 mg) tablet sig: one (1) tablet po three times a day. 8. ergocalciferol (vitamin d2) 400 unit tablet sig: 2.5 tablets po once a day. 9. senna 8.6 mg tablet sig: one (1) tablet po daily (daily) as needed for constipation. 10. toprol xl 25 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day: 37.5mg daily. 11. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 13. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 14. multiple vitamin tablet sig: one (1) tablet po once a day. 15. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation every six (6) hours as needed for shortness of or wheezing. 16. atrovent hfa 17 mcg/actuation aerosol sig: one (1) puff inhalation three times a day. 17. furosemide 20 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 2. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 3. hexavitamin tablet sig: one (1) cap po daily (daily). 4. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 5. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: disk with devices inhalation (2 times a day). 8. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. ipratropium bromide 0.02 % solution sig: inhalation q6h (every 6 hours) as needed. 12. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: inhalation q6h (every 6 hours) as needed for shortness of or wheezing. 13. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 14. docusate sodium 100 mg tablet sig: one (1) tablet po bid (2 times a day). 15. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for consitpation: please use if senna and docusate do not resolved constipation. 16. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 17. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: extended care facility: of discharge diagnosis: primary aortic stenosis secondary coronary artery disease discharge condition: stable, chest pain free discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet . you were admitted with chest pain. your chest pain had improved by the time you were admitted. your labs showed that you did not have a heart attack. . the follow changes were made to your medications: 1. toprol xl was discontinued 2. lasix was increased to 60mg daily . if you have any of the following symptoms, you should return to the ed or call your pcp: pain, difficulty breathing, palpitations, fevers, chills or any other serious concerns. followup instructions: chem 7 should be drawn on . please contact dr. office with the results: . dr. office will call you with a follow up appointment. . provider: , m.d. date/time: 10:30 provider: , .d. date/time: 13:00 provider: clinic date/time: 13:30 . please follow up with dr. ( on at 10:45 am at . . provider: phone: date/time: 1:55 provider: phone: date/time: 1:40 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters non-invasive mechanical ventilation closed biopsy of skin and subcutaneous tissue percutaneous balloon valvuloplasty diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension other pulmonary insufficiency, not elsewhere classified unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia old myocardial infarction cardiac pacemaker in situ sinoatrial node dysfunction dehydration ulcer of heel and midfoot personal history of colonic polyps acute on chronic combined systolic and diastolic heart failure ulcer of calf 

Answer: The patient is high likely exposed to