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: penicillins attending: chief complaint: corevalve for as major surgical or invasive procedure: perutaneous corevalve after unsuccessful unsuccessful direct approach history of present illness: this 74 year old woman has symptomatic severe aortic stenosis (valve area 0.8-1.0cm2, peak gradient 66 mm hg), as well as a history of pvd,cva, copd how presented for an elective corevalve placement. she reports her symptoms have progressed to shortness of breath block, inability to climb greater than 4 stairs without stopping due to shortness of breath, and worsening fatigue. in addition, she now reports episodes of intermittent chest pain with activity. she presented to on for elective direct aortic corevalve, but was found to have anatomy that was not appropiate following a mini-sternotomy. she ended up undergoing percutanous placement of the valve. she was intubated for the procedure and following the procedure she was taken to cvicu. she was found to be in volumne overload following the procedure and was transfered to the ccu for treament. . vitals on transfer were 98.9 73 115/72 20 100% on assist/control fio2 50%. past medical history: aortic stenosis nyha class iii mi x 2 copd/ emphysema pvd left sfa stents/right iliac stent cerebrovascular aneurysm s/p clipping left renal artery stenosis diverticulosis cholelithiasis hypertension hyperlipidemia cva with no residual s/p left carotid endarterectomy diet controlled diabetes - denies anxiety/depression arthritis mild renal insufficiency c section x 2 partial hysterectomy tonsillectomy as a child social history: psycho/social: divorced primary language english lives with: son and daughter live with her occupation: retired quality control home services: none tobacco: quit 5 yrs ago - prior 1ppd x 40 yrs etoh: no recreational drug use: no family history: mother died at 93 and had congestive heart failure. father died at 53/mi and cancer. brother had cabg in his 40's and was found dead at the age of 50 and no post mortem was performed. physical exam: vs: 98.9 73 115/72 20 100% on assist/control fio2 50% general: wdwn woman, intubated and sedated. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 9 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles bilaterally. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ discharge:vitals - tm/tc: 98.8/97.8 hr:84-100 bp:108-158/42-72 rr:20-22 02 sat:99% 3l in/out: last 24h: 1330/2870 last 8h: weight: 89.7(90.4) ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 9 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles bilaterally. abdomen: soft, ntnd. no hsm or tenderness. extremities: 1+ b/l le pitting edema. no femoral bruits. skin: sternotomy site c/d/ dressing intact. no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: 2d-echocardiogram: pre implant a left-to-right shunt across the interatrial septum is seen at rest. a small secundum atrial septal defect is present. there is moderate symmetric left ventricular hypertrophy. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the ascending aorta. there are complex (>4mm) atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. drs , and were notified in person of the results on at 845 am. post implant corevalve seen in the aortic position. it appears well seated. there is mild perivalvular aortic insufficiency seen. there is mitral mitral regurgitation present. rest of the examination is unchanged. admission labs and pertinent results: 12:45pm blood wbc-6.6 rbc-3.78* hgb-11.9* hct-35.7* mcv-94 mch-31.6 mchc-33.5 rdw-15.0 plt ct-280# 12:45pm blood glucose-102* urean-66* creat-1.3* na-145 k-4.2 cl-102 hco3-34* angap-13 05:24am blood calcium-7.6* phos-2.4* mg-2.7* left femoral us for pseudoanneurysm: conclusion: negative study. cxr findings: the et tube is in similar location. there is a new right ij line with tip in the svc. the ng tube tip is off the film, at least in the stomach. there continues to be severe cardiomegaly. the amount of pulmonary vascular redistribution and perihilar haze has increased. bilateral pleural effusions have increased. volume loss/infiltrate is increased in both lower lobes. the overall impression is that of worsened fluid status and underlying infectious infiltrate in the lower lobes cannot be excluded. hga1c: 08:34pm blood %hba1c-6.8* eag-148* : le doppler: impression: no evidence of deep venous thrombosis in the right lower extremity. disharge labs: 05:21am blood wbc-5.8 rbc-3.02* hgb-9.2* hct-28.5* mcv-95 mch-30.5 mchc-32.3 rdw-14.7 plt ct-319 05:21am blood glucose-117* urean-37* creat-0.8 na-145 k-3.8 cl-100 hco3-39* angap-10 05:21am blood calcium-8.9 phos-3.5 mg-2.2 discharge echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. an aortic corevalve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. well seated, normal functioning aortic corevalve prosthesis. mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. compared with the prior study (images reviewed) of , the findings are similar. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. brief hospital course: ms is a 76 yo female with hx of severe aortic stenosis, cad, chf, copd pod2 s/p elective core valve procedure for critical aortic valve stenosis. course complicated by difficulty extubating and respiratory disress. # severe aortic stenosis. patient is s/p core valve placement on . initially had planned for an "open approach" however secondary to extensive aortic calcification decision made to intervene percutaneously. procedure was uncomplicated and patient's preoperative murmur resolved. posteroperative course was complicated by difficulty extubating patient. pt's bp remained labile following procedure and she was intermittenly on both levophed and phenylephrine for several days. a temporary pacer wire was placed and pulled 2 days following procedure. patient's sternotomy site continued to heal well and was regularly assessed by ct throughout admission. #respiratory distress: following , pt failed extubation. cxr showed bilateral pleural effusions and sputum culture was notable for gnr so patient was started on an 8 day course for vap with vanc/meropenem. ms. had a difficult intubation and a #7ett was used. it was thought that poor sbt trial results were secondary to resistentence of tube. ett was eventually pulled without complication and patient was transitioned to bi-pap for 2 days as o2 saturations remained low. her respiratory distress was most likely multifactorial with underlying hx of copd, chf, and infection playing a role. pt received standing nebulizer treatments and her home copd meds were restarted. she was also diuresed with a lasix drip with improvement in sob. pulmomology saw the patient and believed symptoms were most likely secondary to copd and recommended the patient continue spiriva as an outpt. #chf (acute on chronic diastolic dysfunction: pt has long standing chf and had signs of fluid overload (b/l peripheral edema, cardiogenic pulm edema)over course of admission.diuresis was conservative at first in setting of hypotension. once pressors discontinued, shed failed to have good urine outpt with lasix bolus and was started on a drip. she was transitioned to po toresemide 20mg daily at discharge. she is instructed to weigh herself daily and will follow up with dr. as an outpt. #cad/pvd pt is s/p stent placement to left common iliac and external iliac in 6/. ms. had no episodes of cp, lightheadedness, or dizziness throughout the admission. she was continued on asa, plavix, and simvastatin throughout admission. metoprolol and valsartan were orginally held in setting of hypotension and restarted as pt's bp tolerated. home imdur was held throughout the admission. it is being held on discharge until follow up with dr. . #r foot pain: pt developed plantar surface tenderness several days post op. foot was notable warm and slightly erythemic and the pain was thought to be secondary to gout. pt noted a similar episode during a previous admission. she was started on colchicine with moderate improvement. she also had a doppler venous study of the r extremity to r/o dvt, which was negative. #hyperglycemia: pt had no history of diabetes as an outpt. her post-op course was complicated by hyperglycemia and she was started on a insulin drip while in the ccu. a hga1c was checked and was 6.8. hyperglycemia was most likely secondary to stress response and underlying pre-diabetes. she was transitioned to glargine and humalog with meals with improved blood sugar management. on discharge she is being transitioned to glypizide and will f/up with her pcp and dr.. chronic issues managed: #chronic renal insufficiency: patient has a baseline cr in the 1.2-1.3 range most likely secondary to htn. pt only had a slight increase to 1.4 while on pressors with decreased uo. cr trended down to baseline after hemodymanmics improved. . # hx of htn: patient's bp meds were held post-op secondary to hypotension. metoprolol and valsartan were continued once bp tolerated and imdur was held for entire admission. # hx of depression: patient showed no signs of depression and home regimen of paroxetin continued. . # insomnia:the pt takes occasional alprazolam qhs. she was transitioned to trazodone during admission. # normocytic anemia: chronic anemia with baseline hct of 33-34. continued with ferrous sulfate during admission transitions of care: 1.holding imdur at discharge. will consider redosing as oupt with dr. 2.pt's home lasix 40mg dose transitioned to toresimide 20mg daily 3.pt will continue treatment of copd with home regimen and spiriva added 4. she is started on glypizide on discharge for elevated bs and will follow up with pcp for monitoring. 5. full code . medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. alprazolam 0.25 mg po tid:prn anxiety 2. clopidogrel 75 mg po daily 3. fluticasone-salmeterol diskus (250/50) 1 inh ih 4. furosemide 80 mg po once duration: 1 doses 5. isosorbide mononitrate (extended release) 30 mg po daily 6. metoprolol tartrate 50 mg po bid 7. nitroglycerin sl 0.3 mg sl prn cp 8. paroxetine 10 mg po daily 9. potassium chloride 10 meq po daily hold for k > 10. simvastatin 40 mg po daily 11. timolol maleate 0.5% 1 drop both eyes daily 12. valsartan 160 mg po daily 13. aspirin 81 mg po daily 14. ferrous sulfate 325 mg po daily 15. fish oil (omega 3) 1000 mg po tid discharge medications: 1. aspirin 81 mg po daily 2. clopidogrel 75 mg po daily 3. metoprolol tartrate 25 mg po bid hold for sbp <100, hr <60 4. paroxetine 10 mg po daily 5. simvastatin 40 mg po daily 6. timolol maleate 0.5% 1 drop both eyes daily 7. valsartan 80 mg po daily hold for sbp <100 8. docusate sodium 100 mg po bid 9. miconazole powder 2% 1 appl tp 10. ferrous sulfate 325 mg po daily 11. fish oil (omega 3) 1000 mg po tid 12. fluticasone-salmeterol diskus (250/50) 1 inh ih 13. nitroglycerin sl 0.3 mg sl prn cp 14. potassium chloride 10 meq po daily hold for k > 15. outpatient lab work please check fasting chem 7(basic chemistry) in 1 week. please fax results to np. 16. acetaminophen 650 mg po/pr q4h:prn temperature >38.0 17. milk of magnesia 30 ml po daily:prn constipation 18. oxycodone-acetaminophen (5mg-325mg) tab po q4h:prn pain 19. senna 1 tab po bid 20. tiotropium bromide 1 cap ih daily 21. torsemide 20 mg po daily 22. alprazolam 0.25 mg po tid:prn anxiety 23. glipizide xl 2.5 mg po daily may need to increase dose pending blood glucose levels 24. albuterol inhaler 2 puff ih q4h:prn sob, wheezing discharge disposition: extended care facility: life care center of discharge diagnosis: aortic stenosis- s/p transcatheter percutaneous aortic valve replacement with the corevalve device. myocardial infarction x 2 copd/ emphysema pvd cerebrovascular aneurysm s/p clipping x 2 hypertension hyperlipidemia cva with no residual s/p left carotid endarterectomy diet controlled diabetes mild renal insufficiency depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance discharge instructions: dear ms. , it has been a pleasure to have had the opportunity to care for you here at . you came her for treatment for your severe symptomatic aortic stenosis. you noted your symptoms of fatigue and shortness of breath to be worsening and increasing in frequency. studies determined you to be a candidate for the corevalve transcatheter aortic valve replacement procedure. the initial plan for the procedure was through the front of the chest using a incision. however, your aorta was found to be heavily calcified and therefore the change was made to a transfemoral approach. your postoperative course was complicated by your copd disease and a pulmonologist was consulted who made some changes in your inhalers. it is important that you continue to take them consistently and as directed. during your stay you received followup instructions: department: cardiac services when: wednesday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: wednesday at 11:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours combined right and left heart cardiac catheterization intraoperative cardiac pacemaker angioplasty of other non-coronary vessel(s) aortography pericardiotomy procedure on single vessel central venous catheter placement with guidance endovascular replacement of aortic valve diagnoses: other iatrogenic hypotension anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atherosclerosis of aorta hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified acute on chronic diastolic heart failure aortic valve disorders other chronic pulmonary heart diseases peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure old myocardial infarction other emphysema personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits ventilator associated pneumonia accidents occurring in residential institution 

Answer: The patient is high likely exposed to