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: history of present illness: a 44-year-old male with sudden onset of substernal chest pain around 9:30 pm on while working. he reports associated shortness of breath, nausea, but denies any lightheadedness, syncope, or back pain. he went to the outside hospital on , and was found to have a slight troponin leak, but no electrocardiogram changes consistent with acute ischemia, and was started on some nitroglycerin with some relief of pain. ct scan of the chest showed ascending aortic aneurysm of 5.5 cm without any dissections seen. the patient was transferred to for further evaluation and treatment. in the emergency department, the patient was hemodynamically stable. ct scan of the contrast films from the outside hospital was reviewed by our in-house radiologist, and showed no signs of dissection or aortic hematoma. cardiothoracic surgery evaluated the patient and recommended aortogram, cardiac catheterization, and transesophageal echocardiogram. cardiac catheterization was done showing a large ascending aortic aneurysm, severe + aortic regurgitation, but no aortic dissection. the patient had clean coronary arteries, also had a pulmonary capillary wedge pressure of 29. cardiac output of 5.3, cardiac index of 2.3. the transesophageal echocardiogram was done on arrival to the cardiac care unit showing bicuspid aortic valves, + aortic insufficiency with an ejection fraction of 25-30%, borderline dilated left ventricle, moderate left ventricular hypertrophy, and markedly dilated ascending aorta of 5.1 cm. again, no aortic dissection was seen. no aortic valve stenosis was seen. there are no vegetations on the transesophageal echocardiogram that was seen. the patient had 1+ mitral regurgitation. past medical history: hypertension, the patient had previously been treated with zestril, but had stopped two years ago when he lost health insurance and since acquiring health insurance again, he has not seen a physician, has not been restarted on any antihypertensives. medications: no medications. social history: no known drug history. he lives with his long term girlfriend. denies any alcohol history which is confirmed with his girlfriend. has a 30 pack year tobacco history. he smokes about two packs per day and is a welder. family history: he reports a family history of coronary artery disease in his uncle. physical examination: on physical examination, the patient was afebrile, heart rate 94, blood pressure 112/51, respiratory rate 24, and 96% on 4 liters nasal cannula. he is a middle aged man sedated in no acute distress. mucous membranes are moist, anicteric. jugular venous pressure was unable to be assessed. heart was a regular, rate, and rhythm with a 3/6 systolic ejection murmur at the left upper sternal border with 1/6 diastolic murmur with the right upper sternal border with a left ventricular heave. lungs were clear to auscultation anteriorly and laterally. abdomen was soft, nontender, nondistended with normoactive bowel sounds. there is no clubbing, cyanosis, or edema in his extremities. he had 2+ dorsalis pedis pulses bilaterally. he was alert and oriented times three. cranial nerves ii through xii are intact. neurologic examination is grossly nonfocal. left femoral swan-ganz catheter was in place. laboratory data: white count of 10.4, hematocrit of 38.0, platelets 161. sodium 138, potassium 4.3, chloride 103, bicarbonate 23, bun 17, creatinine 1.3, glucose 90, inr 1.2. ptt 54.0. arterial blood gas showed a ph of 7.34, co2 of 44,medial and o2 of 110. differential on the white count: 69% neutrophils, 21% lymphocytes, 5% monocytes, 3.6% eosinophils, and 0.4% basophils. troponin peaked at 1.6 and decreased thereafter. cks were flat ranging between 50s and 60s. electrocardiogram: showed normal sinus rhythm at 92 beats per minute, left atrial enlargement, normal intervals, q in , depressions in i and v6, j-point elevation in v1 through v3 with some st elevations, t-wave inversion in i and l, v4 through v6, left ventricular hypertrophy by criteria. chest x-ray: widen mediastinum with mild congestive heart failure, small left pleural effusion. ct scan from the outside hospital showed a 5.5 cm descending aortic aneurysm with no dissection or hematoma. urine culture showed skin flora. urinalysis was negative. blood cultures were negative at the time of discharge. a transthoracic echocardiogram showed an ejection fraction of 25-30% with ascending aorta of 5.8 cm. trivial mitral regurgitation, 3+ aortic regurgitation, and minimal aortic stenosis. the patient was admitted for treatment of his congestive heart failure as well as close monitoring of his hemodynamics. he was started on lasix and for diuresis, and started on an ace inhibitor for afterload reduction. she was weaned off his oxygen. he had stable blood pressure. the patient's aortic insufficiency was thought to be chronic due to his congenital bicuspid valve. his thoracic aneurysm was thought to be due to his uncontrolled hypertension, however, his rpr and esr were sent. esr came back at 46, and his rpr was unreactive. however, the quantitative rpr in the treatment of treponemal antibody was sent to state laboratory and was still pending at the time of discharge. the patient was also started on nicotine patch for his nicotine withdrawal symptoms. he was followed by cardiothoracic surgery who felt that the patient required surgery for valve repair and aortic aneurysm repair. he was scheduled for surgery in 1.5 weeks. he remained stable, and was discharged home with a diagnoses of aortic insufficiency, congenital systolic and diastolic congestive heart failure, hypertension, thoracic aortic aneurysm without rupture. he was to followup with dr. in cardiothoracic surgery on , and also with his primary care physician. discharge medications: 1. lisinopril 10 mg q day. 2. lasix 20 mg po q day. 3. nicotine patch. 4. ativan prn. dr , 12.270 dictated by: medquist36 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart aortography diagnoses: tobacco use disorder congestive heart failure, unspecified unspecified essential hypertension thoracic aneurysm without mention of rupture family history of ischemic heart disease congenital insufficiency of aortic valve 

Answer: The patient is high likely exposed to