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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea major surgical or invasive procedure: aortic valve replacement with 19mm st. mechanical valve, mitral valve ring with a 26mm ring, tricuspid valve ring with a 26mm ring, coronary artery bypass grafting times one (saphenous vein graft to posterior descending artery) history of present illness: 60 year old female with complex past medical history who has developed progressive and worsening dyspnea and fatigue. workup revealed single vessel coronary artery disease, moderate to severe mitral regurgitation, moderate tricuspid regurgitation and mild to moderate aortic insufficiency. a nuclear stress test was performed which did not reveal any perfusion defects or myocardial ischemia. originally it was planned to manage her medically however she has been severely limited by dyspnea with minimal to no exertion and fatigue which classifies her as a grade heart failure. additionally, cardiac cath reveals single vessel coronary artery disease. given the severity of her symptoms and extent of her disease, she has been referred to dr. for surgical management. past medical history: - coronary artery disease - mitral,aortic and tricuspid regurgitation - likely rheumatic heart disease - peripheral vascular disease - atrial fibrillation on dabigatran/coumadin. both stopped - hypertension - diabetes mellitus - hyperlipidemia - iga nephropathy s/p dcd kidney transplant in , with subsequent ckd - osteoporosis - breast ca ~ . no radiation. - hearing impaired - varicose veins with history of venous ulcer - asthma - kidney transplant - appendectomy - right thumb surgery - right mastectomy social history: ms. tobacco, alcohol or illicit drug use. family history: ms. mother died at 71 from myocardial infarction, her father died at 71 from myocardial infarction, and her brother died at 62 from myocardial infarction. physical exam: pulse: 80 af resp: 18 o2 sat: 100% b/p right: r mastectomy left: 102/58 height: 60" weight: 122 general: wdwn in nad skin: warm, dry and intact. well healed rlq/flank scar. heent: ncat, perrla, eomi, sclera anicteric, neck: mild jvd, supple full rom chest: lungs clear bilaterally heart: irregular rate and rhythm, iii/vi systolic and i/vi diastolic rumble abdomen: soft non-distended non-tender bowel sounds + mild hepatomegally. no frank ascites appreciated. extremities: warm , well-perfused trace edema varicosities: legs grossly varicosed posteriorly. vein stripped from left leg below knee. varicosities noted below knee in both legs and upper groin region. right thigh appears best area for vein. neuro: grossly intact pulses: femoral right:1 left:1 dp right:tr left:tr pt :tr left:tr radial right:2 left:2 carotid bruit transmitted vs. bruit r>l pertinent results: echocardiography report , (complete) done at 10:12:45 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 60 f hgt (in): 60 bp (mm hg): 110/45 wgt (lb): 110 hr (bpm): 70 bsa (m2): 1.45 m2 indication: atrial fibrillation. coronary artery disease. mitral valve disease. valvular heart disease. icd-9 codes: 427.31, 786.51, 395.1, 424.1, 396.9, 424.0 test information date/time: at 10:12 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2011aw-:2 machine: 2 echocardiographic measurements results measurements normal range aorta - sinus level: 2.8 cm <= 3.6 cm aorta - ascending: 2.2 cm <= 3.4 cm aorta - arch: 2.1 cm <= 3.0 cm findings left atrium: moderate la enlargement. right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. dilated coronary sinus (diameter >15mm). left ventricle: normal lv wall thickness and cavity size. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. simple atheroma in ascending aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. minimal as. moderate to severe (3+) ar. mitral valve: severely thickened/deformed mitral valve leaflets. characteristic rheumatic deformity of the mitral valve leaflets with fused commissures and tethering of leaflet motion. severe (4+) mr. tricuspid valve: normal tricuspid valve leaflets. moderate to severe tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions prebypass: normal lv systolic function with lvef >55%, with no segmental wall motion abnormalities. the left atrium is moderately dilated. the coronary sinus is dilated (diameter >15mm) and left arm contrast is seen entering coronary sinus prior to entering ra confirming persistent left svc. left ventricular wall thicknesses and cavity size are normal. right ventricular chamber size and free wall motion are normal. there are simple atheroma in the ascending aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is a minimally increased gradient consistent with minimal aortic valve stenosis but this is in the setting of decreased lv antegrade stroke volume with severe mr . moderate to severe (3+) aortic regurgitation is seen. ai jet height/lvot diameter > 65%, ai vena contracta > 0.6 cm. the mitral valve leaflets are severely thickened/deformed. the mitral valve shows characteristic rheumatic deformity. severe (4+) mitral regurgitation is seen due type 3a leaflet motion (restricton in both systole and diastole). moderate to severe tricuspid regurgitation is seen. initially the tr was moderate but this changed to severe during the exam (holosystolic hepatic venous flow reversal was initially not present, but this developed during the exam and the vena contracta increased to > 0.7 cm). there is no pericardial effusion. postbypass: post aortic valve replacement, mitral valve repair, tricuspid valve repair single vessel cabg on epi and milrinone. av mechanical st- valve with good function. tv repair with good result, trace to mild tr with no tricuspic stenosis. mv with moderate to severe mr following mitral valve annuloplasty ring. no aortic dissection seen after cannula removed. normal lv systolic function. normal rv funciton initially post pump, but there was mild rv dysfunction at the end of the exam. results discussed with the surgical team. 05:40am blood wbc-8.2 rbc-3.63* hgb-12.0 hct-36.5 mcv-101* mch-33.0* mchc-32.8 rdw-18.7* plt ct-478* 04:48am blood wbc-8.2 rbc-3.50* hgb-11.2* hct-34.1* mcv-98 mch-32.0 mchc-32.8 rdw-17.8* plt ct-472* 05:40am blood pt-29.9* inr(pt)-2.9* 10:52am blood pt-26.2* inr(pt)-2.5* 02:05am blood pt-23.9* ptt-40.5* inr(pt)-2.2* 02:16am blood pt-31.3* ptt-45.6* inr(pt)-3.1* 04:06am blood pt-57.8* ptt-45.8* inr(pt)-6.3* 02:31am blood pt-52.1* ptt-46.0* inr(pt)-5.6* 05:34am blood pt-43.8* ptt-43.1* inr(pt)-4.6* 07:43pm blood pt-29.2* ptt-41.6* inr(pt)-2.8* 10:54am blood pt-65.1* ptt-55.1* inr(pt)-7.2* 09:09am blood pt-59.0* ptt-52.5* inr(pt)-6.4* 03:22am blood pt-16.7* ptt-32.3 inr(pt)-1.5* 01:35am blood pt-13.2 ptt-27.4 inr(pt)-1.1 05:40am blood glucose-125* urean-150* creat-4.7* na-130* k-4.9 cl-90* hco3-24 angap-21* 04:48am blood glucose-97 urean-151* creat-5.5* na-136 k-4.5 cl-94* hco3-23 angap-24* 02:05am blood glucose-76 urean-148* creat-5.5* na-135 k-4.5 cl-96 hco3-24 angap-20 brief hospital course: the patient underwent the routine pre-operative work-up. she was found to have a positive urinalysis and was started on cipro. the patient was brought to the operating room on where the patient underwent avr (19mm mechanical), mvr (26mm ring), tvr (26mm ring), cabg x 1 (svg-pda) with dr. . overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. anti-coagulation was started with coumadin and heparin bridge for the mechanical valve. renal followed for her history of renal transplant. anti-rejection drugs were resumed. bactrim was discontinued per the renal team. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. she did develop tachypnea and was transferred to the icu for lasix drip. echo showed small pericardial effusion without evidence of tamponade. she improved with diuresis and was transferred back to the floor. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod 10 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to care center of in good condition with appropriate follow up instructions. of note- lung nodule was found on pre-op chest ct and 1 year follow-up is recommended. medications on admission: amlodipine - 5 mg tablet - 1 tablet(s) by mouth daily atorvastatin - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day azathioprine - 50 mg tablet - one tablet(s) by mouth once a day dabigatran etexilate - (prescribed by other provider) - 150 mg capsule - 1 capsule(s) by mouth twice a day ld friday (on hold since ) digoxin - (prescribed by other provider) - 125 mcg tablet - 1 tablet(s) weekly- wednesdays fenofibrate - 54 mg tablet - 1 tablet(s) by mouth once a day insulin aspart - (prescribed by other provider) - 100 unit/ml solution - 15 units daily before dinner insulin glargine - (prescribed by other provider) - 100 unit/ml (3 ml) insulin pen - 30 units qhs carvedilol 50 mg twice daily lasix 40 mg daily prednisone - (prescribed by other provider) - 1 mg tablet - 2 tablet(s) by mouth once a day sulfamethoxazole-trimethoprim - 400 mg-80 mg tablet - 1 tablet(s) by mouth daily tacrolimus - (prescribed by other provider) - 0.5 mg capsule - 1.5 capsule(s) by mouth twice a day medications - otc ferrous sulfate - (prescribed by other provider) - 325 mg (65 mg elemental iron) tablet - 1 tablet(s) by mouth once a day fish oil-dha-epa - (prescribed by other provider) - 1,200 mg-144 mg capsule - 1 capsule(s) by mouth twice a day discharge medications: 1. outpatient lab work labs: pt/inr for coumadin ?????? indication mechanical avr goal inr 2.5-3.0 first draw 2. tramadol 50 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*60 tablet(s)* refills:*0* 3. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). 4. azathioprine 50 mg tablet sig: one (1) tablet po daily (daily). 5. prednisone 1 mg tablet sig: two (2) tablet po daily (daily). 6. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever/pain. 9. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 10. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 11. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 12. warfarin 1 mg tablet sig: one (1) tablet po daily (daily): dose to change daily for goal inr 2.5-3.0. 13. aluminum hydroxide gel 600 mg/5 ml suspension sig: five (5) ml po q 8h (every 8 hours) for 3 days. 14. hydromorphone 2 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 15. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po daily (daily) as needed for constipation. 16. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itchy skin. 17. fenofibrate micronized 48 mg tablet sig: one (1) tablet po daily (). 18. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 19. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nares . 20. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 21. outpatient lab work check bun, cr on results to dr. fax: 22. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed): per attached sliding scale. discharge disposition: extended care facility: care center - discharge diagnosis: moderate to severe mitral regurgitation. mild mitral stenosis. mild to moderate aortic regurgitation. moderate tricuspid regurgitation. simple aortic atheroma. discharge condition: alert and oriented x3 nonfocal deconditioned incisional pain managed with incisions: sternal - healing well, no erythema or drainage edema- trace discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: , md phone: date/time: 1:15 cardiologist: dr. phone: date/time: 11:30 , md phone: date/time: 10:20 please call to schedule appointments with your primary care dr., s. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication mechanical avr goal inr 2.5-3.0 first draw ***4mm nodule noted on chest ct- recommend f/u in 1 year*** procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve (aorto)coronary bypass of one coronary artery annuloplasty diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atherosclerosis of aorta atrial fibrillation acute on chronic diastolic heart failure asthma, unspecified type, unspecified personal history of malignant neoplasm of breast chronic kidney disease, unspecified other and unspecified hyperlipidemia hemorrhage complicating a procedure unspecified disease of pericardium surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation osteoporosis, unspecified multiple involvement of mitral and aortic valves other and unspecified coagulation defects diseases of tricuspid valve chronic diastolic heart failure kidney replaced by transplant solitary pulmonary nodule 

Answer: The patient is high likely exposed to