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: elective core-valve major surgical or invasive procedure: corevalve implantation for replacement of stenotic aortic valve history of present illness: ms is an 87 year old female with pmh severe as and hx of afib, chf ef 65%, pacemaker (sss), moderate lvh, who is admitted electively for corevalve placement . she recently was transferred to in from for evaluation of avr vs valvuloplasty. she initially presented to with worsening dyspnea and cough x 1 week. she was found to be in af/rvr and acute chf. diuresed and started on metoprolol for rate control which improved her sob. her cough was thought secondary to chf and she was started on tessilon perles for control. she also developed with diuresis and diuretics were held at discharge with f/u labs. workup for avr found no significant cad, of 0.8, av gradient of 41mmhg across the valve which persisted with dobutamine challenge. her aorta was noted to be severely calcified excluding her from open surgical repair of the aortic valve. valvuloplasty as deferred. she was discharged home with a plan to discuss aortic valve replacement with her cardiologist. over the next few months she and her family opted for percutaneous av replacement. her cough improved with continued diuresis. . she currently complains of minimal shortness of breath at rest and is able to ambulate around home slowly with mod to severe doe after ambulating steps. she is limited to only occasional trips outside of home and needs help wtih adl's dementia. she is nyha class ii-iii. sleeps with one pillow. her metoprolol was d/c'ed because of hypotension by dr. but losartan was continued per family. she is quite forgetful and needs frequent cues and reminders of current events. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. she has bilat knee pain attributed to oa. she was recently transitioned to pradaxa instead of coumadin to avoid blood draws. her insurance does not cover this and family is considering switching back. pt went to urologist as an for evaluation of renal mass who recommended no furhter tests at this time, she will return in about one month. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: (-)diabetes, (+)dyslipidemia, (+)hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: : clean coronaries - pacemaker implanted on ( st. , 1336t) device changed in ( nwr20022lh, sesr01) for sick sinus syndrome # af: on coumadin # severe as 3. other past medical history: # dementia # hyperthyroid s/p radioactive iodine social history: lives with husband. -tobacco history: 7 pack year history, quit 70 years ago -etoh: denies -illicit drugs: denies family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: on admission: vs: t= 97.6 bp= 102/62 hr= 90 af rr= 16 o2 sat= 94 ra height: 64 inches weight: 76.8 kg general: wdwm in nad. oriented x1-2 only. mood, affect appropriate. uses confabulation and evasion to answer questions. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 6 cm. no lad cardiac: pmi located in 5th intercostal space, midclavicular line. irreg irreg rhythm. holosystolic murmur at rusb, radiating to lusb but not to carotids. lungs: no chest wall deformities, scoliosis, mild kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheezes or rhonchi. abdomen: soft, ntnd. obese. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits.. extremities: no c/c/e. no femoral bruits. skin: intact, multiple raised pulses: right: carotid 2+ femoral 2+ popliteal 1+ dp 2+ pt 1+ left: carotid 2+ femoral 2+ popliteal 1+ dp 2+ pt 1+ . on discharge: . . tc 97.6, tmax 99.8 132/68 (119/52-134/56) 51-70 98% on 2l, gen: alert, nad, pleasantly demented heent: supple,ij area mild bruise stable, somewhat ttp. jvp = 10-12cm cv: rrr, 2/6 systolic murmur throughout precordium, loudest rusb. no gallops or rubs. resp: faint bibasilar crackles. no wheezes abd: soft, nt, nd extr: trace ankle edema, neuro: extremeties: right and left groin with no echymosis or hematoma, no bruit. pulses: right: dp 2+ pt 1+ left: dp 2+ pt 1+ skin: intact pertinent results: admission labs: . 07:28pm blood wbc-8.4 rbc-4.33 hgb-12.7 hct-35.9* mcv-83 mch-29.2 mchc-35.3* rdw-13.9 plt ct-212 07:28pm blood pt-13.4 ptt-22.7 inr(pt)-1.1 07:28pm blood glucose-217* urean-25* creat-1.3* na-137 k-3.2* cl-95* hco3-28 angap-17 07:28pm blood alt-34 ast-47* alkphos-84 totbili-0.5 07:28pm blood probnp-1214* 07:28pm blood albumin-4.4 calcium-8.8 phos-2.5* mg-1.7 07:28pm blood %hba1c-7.0* eag-154* 07:28pm blood tsh-13* . discharge labs: 07:40am blood wbc-10.2 rbc-3.71* hgb-10.8* hct-31.7* mcv-85 mch-29.2 mchc-34.2 rdw-14.9 plt ct-170 10:40am blood pt-13.5* inr(pt)-1.2* 06:25am blood glucose-131* urean-38* creat-1.2* na-135 k-3.4 cl-97 hco3-26 angap-15 05:56am blood alt-21 ast-40 ld(ldh)-256* alkphos-79 totbili-0.7 06:25am blood probnp-1893* 06:25am blood calcium-8.5 phos-3.9 mg-1.9 12:50pm blood %hba1c-7.0* eag-154* . imaging: . . echocardiography pre-tavi: the left atrium is markedly dilated. moderate to severe spontaneous echo contrast is present in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. dr. was notified in person of the results. post-tavi: the patient is on a phenylephrine infusion. an aortic valve implant is seen, there is trave aortic insufficiency. the mitral regurgitation is unchanged. . . pre-discharge: the left atrium is mildly dilated. the right atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is dilated with normal free wall contractility. there is abnormal septal motion/position. an aortic corevalve prosthesis is present. the transaortic gradient is normal for this prosthesis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , the degree of mr have slightly increased. the corevalve appears similar. . ecg study date of 8:13:30 am: underlying atrial fibrillation with a slow ventricular rate of 57 beats per minute which is regular and has a right bundle-branch block/right axis deviation morphology. in the absence of apparent pacemaker spikes, this is consistent with complete heart block. inferior and anterolateral st-t wave changes are non-diagnostic and could be due to prior ventricular pacing, ischemia, etc. compared to the previous tracing of atrial fibrillation appears to be unchanged with the previous tracing showing probable right ventricular pacing at a rate of 69 beats per minute. clinical correlation is suggested regarding pacemaker function on the present tracing, etc. brief hospital course: a/87 yo f with severe as who was admitted electively for corevalve (percutaneous aortic valve replacement) on . . # severe as, s/p core-valve placemnt: has done well post procedure with good result on echocardiography and only slight fluid retention in her post-procedure course which was treated with duresis. has pacer so chb was not a concern. aspirin and plavix were started for anti-platelet therapy and coumadin was continued for af. will likely need 1 month course of plavix, 3 months of aspirin and subsequently may be covered with coumadin alone which is indicated for her atrial fibrilation. will follow-up with dr. who will guide her out patient medication regimen as appropriate. . outpatient issues; - follow-up with dr. . #hyperglycemia: no history of diabetes prior to this admission, but hyperglycemia noted during this hospitalization, hba1c = 7.0 consistent with new diagnosis of type 2 dm. patient was treated with iss during her hospital stay. metformin was not started as had borderline renal function. team communicated with husband, daughter and provider . who anti-hyperglycemics in the out patient setting. . outpatient issues; - follow-up with dr. . # chf: has known prior dchf. post procedure echo demonstrated biatrial dilatation right > left, mild symmetric left ventricular hypertrophy, lvef>55%. dilated rv. presence of aortic corevalve prosthesis is presence with normal gradient for this prosthesis with mild ar. moderate (2+) mitral regurgitation and moderate to severe tricuspid regurgitation which have slightly increased compared to pre-procedure. had slight fluid retention in her post-procedure course which manifested as trace bil pre-tibial edema and mild doe. she was treated with iv furosamide and appeared euvolemic at discharge. discharged on po furosamide 40mg . outpatient issues; - follow-up with dr. - teds stockings are recommended. . # atrial fibrillation. chads 3. paced. was followed by ep with pacemaker interrogations and readjustments as needed. discharge on settings for ventricular pacing at 60 bpm during day and 50 nocturnal mode. patient had previously been on pradexa but started on coumadin in house. restarted warfarin at 2.5 mg increased to 5mg daily on . inr 1.2 at discharge. will continue following inr with vna and dose adjustment for goal inr . outpatient issues; - continue following inr with vna and dose adjustment for goal inr . . #ckd: baseline 1.0-1.2, trended up during this admission to 1.5, likely due to poor forward flow in the setting of some fluid overload. improved with duresis. cr. 1.2 on discharge. outpatient issues; -- monitor chemistry panel as an outpatient . #dementia: # dementia: throughout hospitalization patient at baseline. occassional confused and easily re-oriented. while in house enacted; patient was frequently re-oriented, benzos were avoided and fall precautions were in place. restarted memantine at discharge. . # hyperlipidemia. continued on home pravastatin in house. . # hypertension. patient largely normotensive in house. patient continued on home losartan. due to concern for mild volume overload patients diuretic regimn was increased from 40mg qd to 40mg po bid x4 days. outpatient issues: -- follow-up blood pressure as outpatient at 5/19 appt . # ct findings of lung nodules and left renal mass found on last admission on . recommended 3 month ct chest follow up and renal ultrasound. as above, pt has seen urologist and will f/u after procedure. oupatient issues: -- need for follow-up imaging of pulmonary nodules. . # dvt prophylaxis - recieved sq heparin during this admission. . # code status: full during this admission, discussed with daughter/hcp . medications on admission: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. rivastigmine 6 mg capsule sig: one (1) capsule po twice a day. 3. memantine 10 mg tablet sig: one (1) tablet po once a day. 4. pravastatin 20 mg tablet sig: one (1) tablet po daily (daily). 5. lumigan 0.03 % drops sig: one (1) drop in each eye ophthalmic once a day. 6. levothyroxine 100 mcg tablet sig: one (1) tablet po once a day. 7. losartan 50 mg daily 8. lasix 40 mg daily 9. pradaxa 150 mg 10. spiriva 1 capsule inhaled daily 11. advair 1 puff 12. fish oil 13. multivitamin discharge medications: 1. outpatient lab work please check chem-7 and inr on wednesday with results to , address: 27 dr, , phone: fax: 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. rivastigmine 6 mg capsule sig: one (1) capsule po twice a day. 4. memantine 10 mg tablet sig: one (1) tablet po once a day. 5. pravastatin 20 mg tablet sig: one (1) tablet po at bedtime. 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. fish oil concentrate oral 10. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 11. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 13. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. lumigan 0.03 % drops sig: one (1) gtt ophthalmic once a day: each eye. 15. advair diskus inhalation discharge disposition: home with service facility: vna of southeastern ct discharge diagnosis: critical aortic stenosis s/p corevalve placement hyperglycemia acute on chronic kidney disease coronary artery disease chronic diastolic congestive heart failure atrial fibrillation discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). ecg: v paced echo: discharge instructions: you had a tight aortic valve and receieved a corevalve to replace the old valve. this procedure went very well and you had no complications. you will need to take aspirin and plavix every day until dr. tells you to stop. you will need to have regular checkups with your doctors at and with the cardiologists at to monitor you per the study protocol. your blood sugars were high during your hospital stay. we checked a a1c, a measure of your blood sugar over a few months and it was 7.0. you will need to talk to dr. about this measurment and he will start a medicine to lower your blood sugar. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1. start taking aspirin and plavix to prevent blood clots on the valve. you will need to take this every day without fail until dr. tells you to stop. 2. stop taking pradaxa, start warfarin again to prevent a stroke from the atrial fibrillation. you will be started on 5.0 mg per day and will need to have your inr checked on wednesday . 3. decrease losartan to 25 mg daily 4. increase lasix to 40 mg twice daily 5. discontinue digoxin for now 6. continue your other medicines at home. followup instructions: name: , address: 27 dr, , phone: fax: at noon . department: cardiac services when: thursday at 11:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: left heart cardiac catheterization open and other replacement of aortic valve aortography percutaneous balloon valvuloplasty diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified atherosclerosis of aorta hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders personal history of tobacco use other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified other and unspecified hyperlipidemia long-term (current) use of anticoagulants cardiac pacemaker in situ examination of participant in clinical trial chronic diastolic heart failure 

Answer: The patient is high likely exposed to