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: congestive heart failure (acute, systolic) severe aortic stenosis major surgical or invasive procedure: intubated cardiac catheterization x 2 removal of 3 teeth aortic valve replacement history of present illness: 48 m with a h/o htn, hyperlipidemia, bicuspid aortic valve, and tobacco abuse who was transferred from an osh for further management of chf and severe aortic stenosis. pt has a known h/o bicuspid aortic valve. did not seek medical care for the past three years for his cardiac history. he presented to his cardiologist on with progressive sob and le edema. he was tried on bb but he did not tolerate to weakness and sob. tte in revealed a bicuspid aortic valve with moderate aortic stenosis. he also had mild-to-moderate aortic root dilatation and mild-to-moderate concentric lvh with normal ef. cardiac catheterization on which revealed mild as, valve area 2.1, normal coronaries, and normal lv function. he was then lost to f/u, re-presented on . most recent tte revealed severe aortic stenosis with worsening lv function. ef was 25%. rv pressure was 41 and had biatrial enlargement. noted to have 2+ aortic insufficiency with mild mr . he was sent home from cardiology clinic with lasix and bb (which he did not tolerate), continued to have worsening sob and le edema, and finally presented to the osh for evaluation. osh course: he was admitted to the osh on with chf and le edema. ces negative. d. dimer positive. treated for ethanol withdrawal with ciwa scale. tte revealed severe aortic stenosis with an ef of 25% with lv dilitation. the am of transfer, he developed acute respiratory distress with chest pain. he was given lasix 80 mg iv x 1, sl nitro x 2, and morphine. he was transferred to the ccu on a 100%nrb. abg was 7.55/20/172. he was then intubated. right ij was placed. cxr confirmed placement per osh notes. i/o 120/360. upon arrival to ccu, he was hemodynamically stable. he then vomited (had no og tube in place). he arrived with a r ij and on the ventilator. family accompanied the pt who confirmed the history. past medical history: hypertension severe aortic stenosis, bicuspid aortic valve tobacco abuse, 0.5 ppd h/o heavy alcohol use, now 6-12 beers on the weekend hyperlipidemia s/p hernia repair social history: tobacco abuse, 0.5 ppd h/o heavy alcohol use, now 6-12 beers on the weekend family history: noncontributory physical exam: pe on admission: t 100.2 hr 74 bp 93/64 rr 16 99% cmv tv 550 rr 10 peep 5 fio2 40% general: 48 m, intubated and sedated, nad. heent: nc/at. pupils pinpoint and reactive. et tube in place. og tube in place. right ij in place with 1/3 of line out of neck. neck: no jvd. cv: s1, s2 with grade iii/vi systolic ejection murmur, rusb, radiating to the carotids. pulm: faint bibasilar crackles, otherwise ctab. abd: soft, nt/nd with normoactive bs. ext: 2+ pitting edema b/l to mid-thigh. distal pulses intact. cool toes. skin: no rash. discharge: pertinent results: all urine, blood and sputum cultures without growth. echo : there is symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20 %). the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. the ascending aorta is moderately dilated. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. significant aortic stenosis is present (not quantified). mild (1+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is severe mitral annular calcification. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: severe global biventricular contractile dysfunction with significant (possibly severe) aortic stenosis echo : left ventricular hypertrophy with cavity dilation and severe global hypokinesis. severe aortic valve stenosis with underlying bicuspid aortic valve. dilated ascending aorta. mild pulmonary artery systolic hypertension. abdominal us : 1. gallbladder sludge. mild gallbladder distention without evidence of wall edema or pericholecystic fluid. no intra- or extra-hepatic biliary dilatation. 2. mildly heterogeneous liver echotexture. this may be related to the patient's underlying cardiac disease. 3. right pleural effusion, incompletely imaged. head ct : no acute intracranial process. chest ct : bilateral pleural effusions with bibasilar atelectasis, superimposed infection cannot be excluded. left lower lobe nodular opacity versus infiltrate. follow up is suggested. cardiomegaly. ectatic ascending aorta measuring 4.4 cm. ascites. abd us : 1. normal gallbladder. interval resolution of gallbladder sludge. no intra- or extra-hepatic biliary ductal dilatation. 2. left pleural effusion. carotid us : blunted common carotid artery waveforms bilaterally consistent with known severe aortic stenosis. moderate heterogeneous plaque with bilateral 1-39% ica stenosis. tte : the left atrial volume is markedly increased (>32ml/m2). the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular cavity is mildly dilated the right ventricular cavity is dilated with depressed free wall contractility. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve is bicuspid. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cardiac cath : 1. no angiographically apparent flow-limiting coronary artery disease. 2. moderate-severe aortic regurgitation. 3. aortic root calcification. 4. moderate ascending aortic enlargement. tte : there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20-30 %). the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve leaflets are severely thickened/deformed. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. cardiac cath : 1. right heart catheterization revealed a mildly elevated right ventricular endiastolic pressure at 11 mmhg. the systolic and diastolic pulmonary artery pressure were moderately elevated at 50 and 29 mmhg, respectively. the pvr at rest was 131 dynes*s-1*cm-5. the pvr did not change significantly with inhalation of 100% o2 (91 dynes*s-1*cm-5) or nitric oxide (118 dynes*s-1*cm-5). the cardiac index was depressed at 1.6 l/min/m2 under resting conditions and changed only modestly with inhalation of oxygen and nitric oxid to 1.8 l/min/m2. final diagnosis: 1. moderately elevated pcw pressure indicating increased left ventricular preload 2. moderately elevated pulmonary artery pressure with normal pvr non-responsive to either inhaled o2 and nitric oxide 3. depressed cardiac output brief hospital course: 48 m with htn, hyperlipidemia, severe as, and tobacco abuse who was transferred from an osh for further evaluation and management of his heart failure, aortic stenosis, and acute respiratory distress. on presentation, pt was in severe heart failure, thought to be multifactorial. the considered causes included secondary to known severe bicuspid as, nutritional deficiency (pt with confirmed vit c deficiency, presumed general malnutrition given alcohol abuse). pt developed secondary pulmonary edema and respiratory distress, requiring intubation at osh. pt was treated with aggressive diuresis (at one point being net negative 14l) and nutritional repletion (vit c, multivitamins, thiamine, folate). pt appeared dry after diuresis and was repleted with small ivf boluses and then allowed to autoregulate. pt was medically managed with beta-blocker. there were no indications for aspirin as he did not have any known cad, and there were contraditions for acei (preload dependency) and statin (lft abnormalities). patient had an echo, confirming critical aortic stenosis and showing left ventricular hypertrophy with cavity dilation and severe global hypokinesis, severe aortic valve stenosis with underlying bicuspid aortic valve, dilated ascending aorta, mild pulmonary artery systolic hypertension. the patient underwent a preop workup for valvular replacement, with preop chest ct scan and carotid us (showing moderate heterogeneous plaque with bilateral 1-39% ica stenosis). he also underwent a second cardiac cath with right heart cath to evaluate his pulm art pressures which showed no angiographically apparent flow-limiting coronary artery disease. the patient was intubated on presentation and not immediately extubated as he was being aggressively diuresed, and required egd. his extubation was then furthur delayed by the development of an aspiration pneumonia requiring increased fio2. there was difficulty assessing pt's readiness for extubation due to his alternating sedation and agitation when sedatives removed. once extubated he had breathing with frequent periods of apnea without desaturation. this was attributed to his severe chf and toxic metabolic for unclear reasons. he was treated with several days of diamox to increase his respiratory drive. his abgs and cxrs all continued to be normal. his respiratory status continued to improve to allow weaning of supplemental oxygen and improvement of shortness of breath sensation. he eventually was sating normally on room air without shortness of breath. on presentation pt was significantly jaundiced with a peak t bili of 7.2, alt and ast of 302 and 521 respectively. liver was consulted and recommended checking viral hepatitis studies, and multiple antibodies, all negative. pt had an abdominal ultrasound which showed gallbladder sludge. there was also "mild gallbladder distention without evidence of wall edema or pericholecystic fluid, and no intra- or extra-hepatic biliary dilatation. mildly heterogeneous liver echotexture. this may be related to the patient's underlying cardiac disease." ltfs trended down very slowly and plateaued at a t bili around 4, with persistent jaundice and transaminases in the 70s. repeat us showed resolution of gallbladder sludge. his elevated lfts were thought to be due to hepatic congestion from his right heart failure. on he underwent an aortic valve replacement with a 29mm mosaic porcine valve. please see the operative note for details. he tolerated the procedure well and was transferred in critical but stable condition to the surgical intensitve care unit. he was extubated and weaned from his pressors. his chest tubes were removed. by post-operative day three he was ready for transfer to the surgical step-down floor. his epicardial wires were removed. he was seen in consultation by physical therapy. by post-operative day 4 he was ready for discharge. medications on admission: home medications: lasix 40 mg po daily potassium 20 meq po daily toprol xl 25 mg po daily (stopped secondary to sob) medications upon transfer: colace pneumoccoccal vaccine, influenza vaccine toprol xl 25 mg po daily potassium 40 meq po daily lasix 40 mg po daily, then 40 iv, then 80 iv thiamine mvi folic acid oxazepam ciwa scale prn maalox ativan prn milk of mag prn ambien prn morphine prn tylenol prn zofran prn discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours) for 1 months. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 6. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. nicotine 14 mg/24 hr patch 24 hr sig: one (1) transdermal daily (daily) for 4 weeks. disp:*qs * refills:*0* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily) for 1 weeks. disp:*7 tablet(s)* refills:*0* 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once a day for 1 weeks. disp:*14 tab sust.rel. particle/crystal(s)* refills:*0* 10. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 11. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: , discharge diagnosis: congestive heart failure, acute systolic discharge condition: good discharge instructions: please stop smoking. information was given to you on admission regarding smoking cessation. please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr in 4 weeks () please call for appointment dr in weeks () please call for appointment dr. 2 weeks wound check appointment 2 as instructed by nurse () procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery other endoscopy of small intestine left heart cardiac catheterization coronary arteriography using a single catheter coronary arteriography using a single catheter open and other replacement of aortic valve with tissue graft angiocardiography of right heart structures right heart cardiac catheterization other surgical extraction of tooth diagnoses: tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified protein-calorie malnutrition aortic valve disorders other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus pressure ulcer, buttock acute systolic heart failure congenital insufficiency of aortic valve unspecified gastritis and gastroduodenitis, without mention of hemorrhage dental caries, unspecified ulcer of heel and midfoot alcohol withdrawal other esophagitis duodenitis, with hemorrhage pressure ulcer, stage iii ulcer of ankle ascorbic acid deficiency 

Answer: The patient is high likely exposed to