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: 1. mitral valve replacement with a 33-mm st. epic bioprosthesis. 2. full left-sided maze procedure using a combination of atricure bipolar synergy rf device as well as cryocath with resection of left atrial appendage. 1. emergent coronary artery bypass grafting times 1 with reverse saphenous vein graft from aorta to the second obtuse marginal coronary artery. 2. endoscopic greater saphenous vein harvesting. 1. ultrasound-guided puncture of right common femoral artery. 2. third-order catheterization of left superficial femoral artery. 3. balloon occlusion of left superficial femoral artery. 4. ultrasound-guided thrombin injection to the left superficial femoral artery pseudoaneurysm. 5. angiography of left common femoral and superficial femoral arteries. cardiac cath iabp insertion cardiac cath history of present illness: 80 year old male with severe mvr w/pacemaker for sudden cardiac arrest presents with 3 days of worsening doe and new onset of afib with rvr. he was seen by pcp and started on augmentin on for possible pna, with possible infiltrate vs. pulmonary edema. pt notes worsening dyspnea, with significant extertional dyspnea. pt has also had a dry cough that started around monday as well. he denies fever/chills/chest pain/hemoptysis/orthopnea/pnd/extremity edema/pleuritic pain/calf pain. in the ed he was started on heparin gtt, given lasix 20mg iv, and levoquin 500mg po for possible pna on cxr. he was admitted for further workup. past medical history: -pacing/icd: pacemaker, implanted on right side, for sick sinus syndrome. last interrogated in . -dyslipidemia -htn -mitral valve insufficiency -seizure disorder -left anterior wall acetabular fracture in -prostate ca -colonic adenoma -rheumatoid arthritis -anemia -gout -subdural hematoma -lichen simplex chronicus past surgical history: s/p burr holes from sdh s/p pelvic fx social history: race: caucasian last dental exam: lives with: wife occupation: retired mechanical engineer cigarettes: smoked no yes last cigarette hx: other tobacco use: smoked pipe, quit etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use family history: non-contributory physical exam: pulse:104 af resp:20 o2 sat: 95% ra b/p right: 105/72 left: height: 70" weight: 68.5 kg general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur grade ______ abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema __no___ varicosities: none very prominent bilat wrist bones neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 1+ left: 1+ pt : 1+ left: 1+ radial right: 2+ left: 2+ carotid bruit right: no left: no pertinent results: head ct: 1. small subacute subdural hematoma along the right tentorium and left frontal lobe. 2. gliosis in the right frontal lobe likely secondary to prior trauma. . head ct: the subdural collection along the right tentorium and right frontal lobe seen yesterday is not appreciated today. gliosis in the right frontal lobe is unchanged. prominence of the ventricles and sulci is again noted which is likely secondary to age-related involutional changes. white matter hypodensity suggests sequela of chronic small vessel ischemic disease. there is no evidence for acute intracranial hemorrhage, large mass, mass effect, edema, or hydrocephalus. there is preservation of -white differentiation. the visualized portions of the mastoid air cells and paranasal sinuses are well aerated. no skull fracture is seen. prior burr hole in the left parietal skull area is again noted. there is also a similar skull indentation along the left frontal convexity. . head ct: thin subdural hematoma along the left frontal pole, with both chronic and subacute components, unchanged. . head ct: the small left frontal subdural hematoma, intermediate in density, is unchanged in size and demonstrates no evidence of new blood products. there is no mass effect on the underlying left frontal lobe, as the extraaxial spaces and ventricles are enlarged due to cerebral atrophy. a small area of encephalomalacia is again noted in the inferior right frontal lobe, likely secondary to prior trauma, or less likely prior infarction. there are multiple foci of low density in the deep and periventricular white matter of the cerebral hemispheres, as before, likely sequela of chronic small vessel ischemic disease. . cath: 1. selective coronary angiography in this left dominant system demonstrated no angiographically apparent flow limiting stenoses. the lmca, lad, lcx, and rca were patent. 2. resting hemodynamics revealed mildly elevated right sided filling pressures with an rvedp of 14 mmhg and severely elevated left sided filling pressures with a mean pcwp of 29 mmhg and a prominent v wave. there was moderate pulmonary artery systolic hypertension with a pasp of 48 mmhg. the cardiac index was depressed at 1.3 l/min/m2. there was low normal systemic arterial systolic pressures with an sbp of 100 mmhg. . carotid u/s: right ica less than 40% stenosis. left ica less than 40% stenosis. . echo: pre-bypass: the patient is av paced, on norepinephrine, epinephrine, and milrinone infusions. no spontaneous echo contrast is seen in the body of the left atrium. no atrial septal defect is seen by 2d or color doppler. the left atrial appendage is not seen status post ligation. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is regional left ventricular systolic dysfunction with severe hypokinesis of the inferior, inferoseptal, and inferolateral walls. overall left ventricular systolic function is mildly depressed (lvef= 40-45 %). the ascending, transverse and descending thoracic aorta are normal in diameter. there is an intra-aortic balloon pump in place 3 cm distal to the takeoff of the right subclavian artery. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the transmitral gradient is normal for this prosthesis. no mitral regurgitation is seen. the tricuspid valve leaflets are moderately thickened. there is no pericardial effusion. dr. was notified in person of the results at time of surgery. post-bypass: the patient is av paced. the patient is on norepinephrine, epinephrine, and milrinone infusions. inferior, inferoseptal, and inferolateral wall hypokinesis appears improved, but remains mildly hypokinetic. no mitral regurgitation is seen. no change in tricuspid regurgitation or aortic regurgitation. the aorta is intact post-decannulation. . echo: the left atrium is dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild global left ventricular hypokinesis (lvef = 45-50%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. moderate (2+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. significant pulmonic regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular function is now mildly depressed and bioprosthetic aortic valve is now in place. . cxr: sternal cerclage wires are intact. a right-sided generator pack with lead position in the region of the right atria, and right ventricle appear stable. there is some increased aeration of the right lung base with decreased effusion and decreased consolidation and atelectasis. the right lung is clear. no pneumothorax is present. a left-sided picc catheter tip appears stable in position in the mid svc. a right ij line has been removed. the mediastinum remains shifted to the left, stable. . 11:50am blood wbc-12.3*# rbc-3.88* hgb-12.5* hct-36.0* mcv-93 mch-32.1* mchc-34.7 rdw-13.6 plt ct-200 01:10pm blood wbc-11.9* rbc-4.12* hgb-12.7* hct-40.1 mcv-97 mch-30.9 mchc-31.7 rdw-13.5 plt ct-325 01:39pm blood wbc-19.2* rbc-3.24* hgb-10.3*# hct-31.8*# mcv-98 mch-31.8 mchc-32.4 rdw-13.8 plt ct-161 02:38am blood wbc-14.5* rbc-3.57* hgb-11.6* hct-34.1* mcv-95 mch-32.4* mchc-33.9 rdw-14.8 plt ct-99* 02:05am blood wbc-12.8* rbc-4.27* hgb-13.4* hct-39.6* mcv-93 mch-31.5 mchc-33.9 rdw-15.8* plt ct-190 06:08am blood wbc-13.8* rbc-3.57* hgb-11.5* hct-35.0* mcv-98 mch-32.4* mchc-33.0 rdw-15.0 plt ct-268 05:21am blood wbc-12.2* rbc-3.57* hgb-11.0* hct-34.2* mcv-96 mch-30.8 mchc-32.1 rdw-14.6 plt ct-352 06:00am blood pt-14.2* ptt-98.4* inr(pt)-1.2* 12:10pm blood pt-17.4* ptt-35.2* inr(pt)-1.5* 12:45am blood pt-13.2 ptt-22.6 inr(pt)-1.1 02:58am blood pt-15.3* ptt-25.2 inr(pt)-1.3* 06:08am blood pt-19.3* ptt-24.3 inr(pt)-1.7* 05:53am blood pt-29.6* inr(pt)-2.9* 11:50am blood glucose-128* urean-30* creat-0.9 na-139 k-5.2* cl-107 hco3-20* angap-17 02:34am blood glucose-139* urean-51* creat-1.0 na-146* k-4.1 cl-106 hco3-29 angap-15 06:08am blood glucose-106* urean-26* creat-0.8 na-146* k-4.0 cl-111* hco3-28 angap-11 05:21am blood urean-25* creat-0.8 na-143 k-4.2 cl-108 07:46pm blood alt-30 ast-47* ld(ldh)-442* alkphos-412* amylase-48 totbili-2.0* 06:08am blood calcium-7.9* phos-2.5* mg-2.0 02:38am blood wbc-12.2* rbc-3.28* hgb-10.5* hct-31.8* mcv-97 mch-31.9 mchc-33.0 rdw-14.7 plt ct-307 02:38am blood pt-26.9* inr(pt)-2.6* 02:38am blood urean-23* creat-0.7 na-138 k-3.6 cl-105 brief hospital course: as mentioned in the hpi, mr. is a 80 year old male with severe mvr w/pacemaker for sick sinus syndrome p/w 3 days of worsening doe and new atrial fibrillation with rvr. he likely had a chf exacerbation and afib in the setting of mv prolapse with severe regurgitation. . pre-op issues: # chf exacerbation: bnp 8563 on . received 20 mg iv lasix in ed, 20 mg iv lasix on the floor, and 40 mg iv lasix x2. was placed on lasix 80 mg on with initial good uop with net negative on of 1.5 l which decreased to ~700 ml net negative on and then fell to net negative 175 ml on and on lasix drip ( ml/ hr) was initiated to titrate to goal net negative of .5l daily. pts sats dropped on the am of with possible flash pulmonary edema. bedside echo noted worsening mitral regurgitation and significant tricuspid regurg and the decision was made to transfer the pt to the ccu, where he was electively intubated. he was taken to the cath lab, where an intra-aortic balloon pump was placed in preparation for surgical mitral valve repair. . # new onset afib observed . rate has been better controlled since admission and remained in the low 100s with metoprolol tartrate 50 mg . tsh wnl. chads2 score was 3; anticoagulation was continued with heparin gtt, holding off on coumadin now due to possibility of surgery. . # mitral valve insufficiency: initial presentation was likely progression of mv dz, or rupture of chordae, mitral valve prolapse. tee showed severe mitral regurgitation secondary to posterior leaflet flail, no thrombus. . # coronaries: troponins and ckmb have been flat. cycle enzymes to romi and they remained negative. cardiac cath prior to surgery to eval for cad showed no coronary artery disease. . # small sub acute left frontal subdural hematoma secondary to fall 2 months: neurosurgery consulted. underwent several head ct's prior to surgery. resolved. no urgent or emergent neurosurgery needed. restart heparin gtt and aspirin. safe for coumadin therapy if required. follow up in the clinic in 4 weeks with a non contrast head ct with dr . . # leukocytosis: wbc 12.3 and 88% pmns on . cxr shows no acute process and pt was afebrile with no cough and satting well albeit doe. lactate 1.6 on . there was low suspicion for pna and so levaquin which was started in the ed was discontinued. wbc remained elevated in the 11-12,000 range with left shift but pt was afebrile from admission to when he was transferred to icu. op/post-op course: cardiac surgery recommended mitral valve replacement and maze and he underwent appropriate work-up for surgery. on he was brought to the operating room where he underwent a mitral valve replacement and maze procedure. please see operative note for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in fair condition. initially on transfer to the cvicu, patient required multiple inotropes and vasopressor support with an extremely low mixed venous sao2 at 48% and cardiac index of 1.5 with on epinephrine and levophed. a transesophageal echo demonstrated inferior wall motion abnormalities and when the patient was not being paced, there were st elevations in the inferior leads. he was taken emergently to the cath lab which demonstrated total occlusion in the mid circumflex distribution after a big dominant obtuse marginal coronary artery had taken off from the main circumflex and very near the cuff of the mitral valve as seen by the radiographic images. the interventional cardiologist attempted to cross the obstructed vessel to intervene but was unsuccessful. he was therefore transferred to the operating room and underwent emergent coronary artery bypass grafting with saphenous vein graft to the distal circumflex system. following this he was transferred back to the cvicu again for invasive management. on this day his iabp was removed. over the next several days he remained sedated and intubated, pressors were slowly weaned and amiodarone and coumadin were started for atrial fibrillation. he was finally weaned from sedation, awoke mostly neurologically intact but slightly disoriented and extubated on post-op day four. electrolytes were repleted as needed, beta-blockers and diuretics were started and he was diuresed towards his pre-op weight. over the next couple of days he was stable but remained somewhat confused but cooperative. on post-op day six he was noted to have increased ecchymosis and swelling in his left groin and was found to have a left femoral artery pseudoaneurysm. vascular surgery was consulted. on he underwent repair of his pseudoaneurysm with thrombin injection to the left superficial femoral artery pseudoaneurysm. following this procedure he was transferred back to the cvicu for monitoring. chest tubes and epicardial pacing wires were removed per protocol. on post-op day ten he was transferred to the step-down floor for further care. of note, he was being treated for a stage 1 blanchable stage 1 coccyx ulcer. over the next couple days he continued to improve with resolving delirium and working with physical therapy for strength and mobility. on post-op day twelve he was going to be discharged to rehab but became slightly lethargic in later am. neurology was consulted and a stat head ct was performed. head ct was negative for acute event, his mental status improved on reexamination in afternoon and appeared to be back at baseline. neurology felt that the event may have been a seizure. overnight he complained of inability to void, flomax was started, foley catheter was inserted and output was 450cc. ua and culture were sent. on the pod 13 he was doing well, neurologically intact and was discharged to rehab facility () with the appropriate medications and follow-up appointments. foley will remain in place and will need a voiding trial done at rehab. cipro was started prophylactically for possible urinary tract infection (pending ua with recent valve surgery). medications on admission: -phenytoin sodium extended 100 mg cap: take 1 capsule every morning and 2 capsules every evening -cholecalciferol (vitamin d3) 1,000 unit tab, 1 daily -mvi daily -asa 81mg daily -glucosamine hcl oral discharge medications: 1. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po daily (daily). 2. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po hs (at bedtime). 3. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. glucosamine hcl 500 mg tablet sig: one (1) tablet po once a day. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): please take 2 200mg tablets twice daily for 5 days. then 1 200mg tablet twice daily for 7 days. then 1 200mg tablet once daily until stopped by cardiologist. 10. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 11. warfarin 1 mg tablet sig: 1-2 tablets po once a day: adjust for a goal inr of .5 for atrial fibrillation. coumadin held d/t inr of 2.9. 12. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. 13. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 14. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 15. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 16. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours): please d/c when foley is removed. discharge disposition: extended care facility: - discharge diagnosis: new-onset atrial fibrillation s/p maze procedure mitral valve insufficiency s/p mitral valve replacement occluded mid circumflex artery s/p coronary artery bypass graft x 1 pseduoaneurysm left femoral s/p repair ?post-op urinary tract infection heart failure exacerbation sick sinus syndrome dyslipidemia hypertension discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with tylenol incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema - trace lower ext, 1+ upper ext 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: dr. on at 2pm cardiologist: dr. on at 2:50pm neurosurgery: dr. on at 11am at , ., non-contrast head ct on at 10am at , radiology please call to schedule appointments with your primary care dr. 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: atrial fibrillation goal inr 2-2.5 first draw procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances arteriography of femoral and other lower extremity arteries (aorto)coronary bypass of one coronary artery injection or infusion of other therapeutic or prophylactic substance implant of pulsation balloon implant of pulsation balloon open and other replacement of mitral valve with tissue graft right heart cardiac catheterization operations on chordae tendineae excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: subendocardial infarction, initial episode of care mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified cardiac complications, not elsewhere classified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure hematoma complicating a procedure other chronic pulmonary heart diseases other and unspecified hyperlipidemia peripheral vascular complications, not elsewhere classified cardiogenic shock malignant neoplasm of prostate long-term (current) use of anticoagulants other complications due to other cardiac device, implant, and graft pressure ulcer, lower back cardiac pacemaker in situ rheumatoid arthritis epilepsy, unspecified, without mention of intractable epilepsy surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation urinary complications, not elsewhere classified subdural hemorrhage delirium due to conditions classified elsewhere lichenification and lichen simplex chronicus pressure ulcer, stage i aneurysm of artery of lower extremity rupture of chordae tendineae 

Answer: The patient is high likely exposed to