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: lactose attending: chief complaint: fatigue/dyspnea on exertion major surgical or invasive procedure: - aortic valve replacement(19mm st. mechanical valve) history of present illness: this 46 year old female has a history of a heart murmur since age 5 and bicuspid aortic valve has has been followed with serial echocardiograms. over the past 6 months, she has noticed a decrease in exercise tolerance with symptoms of fatigue, chest heaviness and dyspnea on exertion. despite her symptoms, she remains very active with biking and walking. her most recent echocardiogram showed severe aortic stenosis with worsened gradients. given the progression of her disease and worsened symptoms, she has been referred for surgical evaluation. past medical history: bicuspid aortic valve aortic stenosis asthma gastroesophageal reflux chronic pain syndrome allergic rhinitis hypothyroidism erythema nodosum osteopenia social history: last dental exam:every 6 months. recently seen within last 2 months. lives with: husband in contact: phone # ation: does not work cigarettes: smoked no yes last cigarette _____ hx: other tobacco use: etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use family history: no premature coronary artery disease physical exam: pulse: 56 resp: 16 o2 sat: 99% b/p right: 108/65 left: 102/60 height: 62" weight: 100 general: wdwn in nad skin: warm, dry and intact. no lesions or rashes. no c/c/e heent: ncat, perrla, eomi, sclera anicteric, op benign. teeth in good repair. neck: no jvd, supple, full rom. chest: lungs clear bilaterally heart: rrr, iii/vi sem abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused trace le edema varicosities: small superficial varicosity at right knee unlikely to be related to gsv. neuro: grossly intact pulses: right groin with bruit noted. small hematoma present. mildly tender to palpation. femoral right:2 left:2 dp right:trace left:1 pt :1 left:1 radial right:2 left:2 carotid bruit - transmitted murmur radiates to bilateral carotids pertinent results: echo: pre-bypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is bicuspid. 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 appears structurally normal with trivial mitral regurgitation. post-bypass:the patient is av-paced, on no inotropes. there is a prosthetic aortic valve which is well-seated, with no ai and no leaks.residual mean gradient = 5 mmhg.trace mr. . preserved biventicular systolic fxn. aorta intact. 01:25pm blood wbc-6.3 rbc-3.31* hgb-10.6* hct-32.6* mcv-98 mch-32.0 mchc-32.6 rdw-13.1 plt ct-236 01:25pm blood pt-22.1* ptt-97.4* inr(pt)-2.1* 11:47pm blood pt-17.4* ptt-90.0* inr(pt)-1.6* 08:44am blood pt-15.3* ptt-40.3* inr(pt)-1.4* 03:47pm blood pt-15.2* ptt-80.8* inr(pt)-1.4* 04:30am blood pt-16.7* inr(pt)-1.6* 04:50am blood pt-25.4* inr(pt)-2.4* 12:15pm blood pt-33.4* inr(pt)-3.2* 01:25pm blood na-137 k-4.5 cl-100 03:06am blood glucose-89 urean-10 creat-0.7 na-138 k-4.2 cl-109* hco3-23 angap-10 05:55am blood pt-27.7* inr(pt)-2.7* brief hospital course: she was admitted to the on for surgical management of her aortic valve disease. she was taken to the operating room where she underwent aortic valve replacement using a 19mm st. regent mechanical valve. please see operative note for details. of note, an on-x valve was not used due to size mismatch. postoperatively she was taken to the intensive care unit for monitoring. over the next several hours, she awoke neurologically intact and was extubated. on postoperative day one, she was transferred to the step down unit for further recovery. beta blocker was initiated and she was gently diuresed towards her preoperative weight. chest tubes and pacing wires were discontinued without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. heparin was initiated as a bridge to coumadin for her mechanical valve. it took several days for the inr to become therapeutic on coumadin. at the time of discharge on the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged home in good condition with appropriate follow up instructions. coumadin management will be arranged as she no longer deals with . results if inr to be called to our office and we will speak with dr. . she would like to use hospital's anticoagulation service. she's to take 2.5mg of coumadin 3/24&25. medications on admission: albuterol inhaler, clotrimazole, betamethasone ointment, hydrocortisone ointment, elocon, and zovirax ointment. discharge medications: 1. outpatient lab work labs: pt/inr for coumadin ?????? indication: avr mechanical valve goal inr: 2.0-3.0 first draw , then prn results to phone cardiac surgery () we will instruct where next result to be sent 2. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain. 3. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 4. calcium citrate-vitamin d3 315-250 mg-unit tablet sig: one (1) tablet po bid (). 5. fexofenadine 180 mg tablet sig: one (1) tablet po once a day. 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). disp:*45 tablet(s)* refills:*2* 7. ranitidine hcl 150 mg tablet sig: two (2) tablet po daily (daily). 8. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 10. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 11. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 12. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain for 4 weeks. disp:*50 tablet(s)* refills:*0* 13. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 14. multivitamin tablet sig: one (1) tablet po daily (daily). 15. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety for 4 weeks. disp:*30 tablet(s)* refills:*0* 16. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical tid (3 times a day). 17. coumadin 2.5 mg tablet sig: as directed tablet po once a day: 2.5mg (one tablet) on & 25, then as directed after that on . disp:*100 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: aortic stenosis s/p aortic valve replacement asthma gastroesophageal reflux chronic pain syndrome allergic rhinitis hypothyroidism erythema nodosum osteopenia discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage edema none discharge instructions: 1) 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. 2) please no lotions, cream, powder, or ointments to incisions. 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) no driving for approximately one month and while taking narcotics. driving will be discussed at follow up appointment with surgeon when you will likely be cleared to drive. 5) no lifting more than 10 pounds for 10 weeks 6) 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 wound check: at 10:30am in , surgeon: dr. (on at 1pm cardiologist: dr. on at 1:15p provider: (nhb) phone: date/time: 1:00 provider: , md phone: date/time: 3:00 **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: avr mechanical valve goal inr: 2.0-3.0 first draw hospital results to phone . we will arrange coumadin follow up through clinic or dr. on procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: acidosis other iatrogenic hypotension esophageal reflux unspecified acquired hypothyroidism asthma, unspecified type, unspecified aortic valve disorders long-term (current) use of anticoagulants congenital insufficiency of aortic valve disorder of bone and cartilage, unspecified chronic pain syndrome encounter for therapeutic drug monitoring erythema nodosum postprocedural fever 

Answer: The patient is high likely exposed to