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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: mitral valve replacement(29 st. porcine valve) and tricuspid valve repair(30mm annuloplasty band) dental extraction cardiac catheterization history of present illness: mr. is an 83 yr old male who was admitted to with increasing shortness of breath. he states that on the morning of his admission to the osh, he woke up with cough and inability to catch his breath. studies during his admission to the osh included an echocardiogram which reportedly showed mitral regurgitation with partial flail leaflet. he was ruled out for myocardial infarction. pt initially treated conservatively with diuretics but dr. did not feel that the pt has improved clinically. he was subsequently referred pt for cardiac catheterizaton and possible surgical intervention. of ntoe, he has a new diagnosis of paroxysmal atrial fibrillation. on arrival here, he states, he still has doe and cough productive of clear phlegm. cardiac review of systems is notable for absence of chest pain, orthopnea, ankle edema, palpitations, syncope. he does state he has had pnd for the last 1 month, doe worsening for last 5 months and felt presyncopal when during the episode which resulted in his admission to the osh. past medical history: hypertension paroxsymal atrial fibrillation - newly diagnosed degenerative joint disease, osteoarthritis spinal stenosis benign prostatic hypertrophy gout s/p bilateral hip replacements monoclonal gammopathy ? copd history of nephrolithiasis skin cancer- 2 basal cells on ears per pt disease social history: -tobacco history: quit in , prior to this, smoked ppd -etoh: denies -illicit drugs: denies retired manager at truck loading company where he was exposed to diesel and engine fumes. married without children. lives with wife in . family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t= 98.4 bp= 124/60 hr= 95 rr=16 o2 sat=97% on 2l nc general: nad. lying flat in bed without sob. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. no xanthalesma. neck: supple with jvp midneck. cardiac: irreg irreg, normal s1, s2. 3/6 systolic murmur heard best at apex. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were mildly labored, no accessory muscle use. fine crackles throughout. abdomen: soft, ntnd. +bs extremities: no c/c/e. 2+tp bilat skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: wbc-8.5 rbc-3.01* hgb-9.8* hct-28.8* mcv-96 mch-32.6* mchc-34.0 rdw-14.1 plt ct-169 pt-15.1* ptt-37.8* inr(pt)-1.3* glucose-131* urean-38* creat-1.3* na-139 k-4.3 cl-103 hco3-25 angap-15 ck-mb-notdone ctropnt-0.05* calcium-8.9 phos-3.8 mg-2.3 cardiac cath: 1. coronary angiography of this right dominant system revealed no angiographically apparent flow limiting epicardial disease of the lmca, lad, lcx, or rca. 2. resting hemodynamics revealed elevated biventricular filling pressures with rvedp of 12 mm hg and lvedp of 20 mm hg. pasp was elevated at 54 mm hg. mean pcwp was 25 mm hg; v waves were present up to 35 mm hg. systemic arterial pressures were decreased with aortic systolic pressure of 92 mm hg. cardiac index was 2.32 l/min/m2. 3. left ventriculography revealed + mitral regurgitation. lvef was 60%. echocardiogram: the left atrium is dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. there is partial mitral leaflet flail. severe (4+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is a small pericardial effusion. carotid ultrasound: widely patent common and internal carotid arteries bilaterally. single insignificant calcific focus of plaque involving the right internal carotid artery. blood wbc-11.0 rbc-2.87* hgb-8.9* hct-27.5* mcv-96 mch-30.8 mchc-32.2 rdw-15.0 plt ct-180# blood wbc-10.1 rbc-2.83* hgb-8.7* hct-27.0* mcv-95 mch-30.7 mchc-32.2 rdw-15.6* plt ct-106* blood wbc-9.2 rbc-2.55* hgb-7.8* hct-23.7* mcv-93 mch-30.7 mchc-32.9 rdw-15.7* plt ct-77* blood wbc-10.1 rbc-2.37* hgb-7.3* hct-22.5* mcv-95 mch-30.9 mchc-32.5 rdw-16.2* plt ct-67* blood pt-18.1* ptt-35.8* inr(pt)-1.7* blood pt-16.2* inr(pt)-1.4* blood pt-15.5* inr(pt)-1.4* blood pt-15.6* inr(pt)-1.4* blood glucose-108* urean-13 creat-1.1 na-136 k-4.2 cl-99 hco3-27 blood glucose-104 urean-14 creat-0.9 na-139 k-4.7 cl-101 hco3-31 blood urean-17 creat-0.9 k-4.5 blood glucose-105 urean-21* creat-0.9 na-137 k-4.1 cl-101 hco3-27 blood glucose-83 urean-25* creat-0.9 na-135 k-4.6 cl-103 hco3-23 blood glucose-90 urean-28* creat-1.1 na-135 k-4.5 cl-105 hco3-25 06:20am blood mg-1.9 05:35am blood mg-2.1 brief hospital course: mr. was admitted under cardiology with congestive heart failure. the following day, he underwent cardiac catheterization which confirmed to have severe mitral regurgitation. angiography showed normal coronary arteries, and right heart cath showed moderate pulmonary hypertension - see result section for additional details. he developed worsening hypoxia/dyspnea and required transfer to the ccu for closer observation and intravenous diuretics. given paroxsymal atrial fibrillation, he was anticoagulated with intravenous heparin. cardiac surgery was consulted and further preoperative evaluation was performed - see result section for details. prior to surgery, dental extractions were performed without complication. he otherwise remained stable on medical therapy and was eventually cleared for surgery. on , dr. performed mitral valve replacement and tricuspid valve repair. please see operative note for surgical detail. given inpatient stay was greater than 24 hours prior to surgery, vancomycin was used for perioperative antibiotic coverage. following the operation, he was brought to the cvicu for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated without incident. he was gradually weaned from pressor support and transferred to the telemetry floor on postoperative day two. beta blockade was resumed as he continued to experience paroxysmal atrial fibrillation/flutter. k and mg were monitored closely and repleted per protocol. low dose beta blockade was not advanced as he remained rate controlled and he intermittently experienced a junctional rhythm. given persistent atrial fibrillation with bioprosthetic mitral valve, warfarin anticoagulation was initiated and dosed for a goal inr between 2.0 - 2.5. he tolerated low dose beta blockade and at discharge was noted to be in a normal sinus rhythm with first degree av block, rate of 70 and blood pressure of 101/64. his postoperative course was also complicated by urinary retention and hematuria. urology was consulted and continous bladder irrigation(cbi) was initiated. at time of discharge, he continued to have hematuria. at discharge he will continue to require bladder irrigation via 2-way foley catheter. he will continue to require foley management while at rehab. a very detailed plan was outlined in the discharge instructions. he will eventually require an outpatient cystoscopy once he was fully recovered from his open heart operation. given his mitral valve, he should remain on antibiotics until his foley catheter is removed. the remainder of his postoperative course was uneventful. he continued to make clinical improvements with diuresis and was eventually cleared for discharge to rehab on postoperative day nine. at discharge, room air saturations were 94% and all surgical wounds were clean, dry and intact. he was noted to have a stage ii sacral ulcer which will require local wound care to prevent further skin breakdown. medications on admission: discharge medications from osh: digoxin 0.125 po daily diltiazem gtt titrate to hr<100, sbp>90 flomax 0.4 daily trazodone 50 qhs prn ultram 50 q 6 prn nitroquick 0.4 sl prn protonix 40 daily asa 325 daily xanax 0.25 q 6 prn xopenex nebs q 4prn discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 4. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). 9. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 10. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily): hold for k+ > 4.5 . 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 12. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 13. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): continue with foley in place. please stop when foley discontinued. 14. phenazopyridine 100 mg tablet sig: one (1) tablet po tid (3 times a day) for 3 days. 15. warfarin 2 mg tablet sig: one (1) tablet po once a day: daily dose may vary...adjust for goal inr between 2.0 - 2.5. discharge disposition: extended care facility: tcu - discharge diagnosis: chronic diastolic congestive heart failure mitral and triscupid valve regurgitation, s/p mvr/tv repair paroxysmal atrial fibrillation/flutter postop junctional rhythm - transient postop hematuria/urinary retention sacral ulcer hypertension monoclonal gammopathy chronic obstructive pulmonary disease discharge condition: good discharge instructions: - no driving for one month. - no lifting greater than 10 pounds for 10 weeks. - no lotions, creams or powders on any incision. - shower daily and pat incisions dry. - call for fever greater than 100.5, redness, drainage, weight gain of 2 pounds in 2 days or 5 pounds in 1 week. - local wound care for sacral ulcer - monitor pt/inr closely and adjust warfarin for goal inr between 2.0 - 2.5. warfarin dose may vary. - continue 2-way foley and irrigate with normal saline twice per shift and prn. once hematuria has resolved, change to 3-way foley catheter with continous bladder irrigation(cbi). would continue cbi until urine clear for 24 hours, this may take a few days given his history. after urine is clear off cbi for 24 hours, then remove foley. if hematuria restarts, start again with hand irrigation and cbi. if there any concerns regarding foley management, please call urology clinic at . patient will eventually require outpatient cystoscopy once fully recovered from cardiac surgery. patient should call the above number to schedule appt. - please continue antibiotics while foley in place. followup instructions: dr. in weeks, call for appt dr. in weeks, call for appt dr. in weeks, call for appt clinic in months for cystoscopy, procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures intraoperative cardiac pacemaker diagnostic ultrasound of heart open and other replacement of mitral valve with tissue graft open heart valvuloplasty of tricuspid valve without replacement other surgical extraction of tooth diagnoses: mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) personal history of other malignant neoplasm of skin osteoarthrosis, unspecified whether generalized or localized, site unspecified retention of urine, unspecified pressure ulcer, lower back 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 spinal stenosis, unspecified region hematuria, unspecified hip joint replacement tricuspid valve disorders, specified as nonrheumatic pressure ulcer, stage ii unspecified disorder of the teeth and supporting structures monoclonal paraproteinemia peyronie's disease 

Answer: The patient is high likely exposed to