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: mitral valve regurgitation major surgical or invasive procedure: mitral valve repair (28mm st. annuloplasty ring) right hip hemi-arthroplasty history of present illness: this 73 year old female has severe mitral regurgitation, moderate tr and single vessel coronary artery disease who was admitted now for elective surgery. she has been followed preoperativley and underwent diuresis and some pulmonary rehabilitation. since a previous visit in , she has gained approximately pounds with increased appetite and nutritional supplements. when first seen by our service she weighed only 83 pounds. overall she remains mildly fatigued and continues to experience exertional dyspnea. it is difficult to get her to admit to much in the way of symptoms however her son is helpful in helping her to acknowledge the significance of her symptoms. overall, her symptoms have remained stable and have not significantly worsened with her current medical therapy. she is high risk due to her heavy smoking history and poor lung function. past medical history: severe mitral regurgitation pulmonary nodule coronary artery disease s/p stent peripheral vascular disease s/p stent mild pulmonary hypertension anxiety s/p total abdominal hysterectomy cataracts hypothyroidism chronic atrial fibrillation dyslipidemia social history: last dental exam: 1 year. edentulous. lives with: son occupation: homemaker (college educated) tobacco: smoked up until . 50pack yr. hx etoh: socially family history: father had coronary artery disease, passed away at the age of 73. mom had renal failure, and had peripheral vascular disease, passed away at the age of 84. no family history of dementia or diabetes. physical exam: pulse: 78 resp: 18 o2 sat: 99% ra b/p right: 131/83 left: 141/88 general: no acute distress, thin skin: dry intact small red non raised rash right forearm (states occurs when she is stressed) heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally anteriorly heart: rrr irregular murmur , loudest at apex abdomen: soft non-distended non-tender bowel sounds + extremities: warm edema- none varicosities: none spider veins bilaterally well-healed skip incisions of bilateral gsv stripping neuro: alert and oriented x3 non focal pulses: femoral right: sheaths left: +1 dp right: d left: d pt : d left: d radial right: +1 left: +1 carotid bruit right: - bruit left: + bruit pertinent results: echo : pre-bypass: the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. a patent foramen ovale with bidirectional flow is present. overall left ventricular systolic function is mildly depressed (lvef= 45 %). with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened. the study is inadequate to exclude significant aortic valve stenosis. mild (1+) aortic regurgitation is seen. there is partial posterior mitral leaflet flail (p2 closer to p1). severe (4+) mitral regurgitation is seen. no tricuspid prolapse or flail segments. moderate tricuspid regurgitation is seen. there is a small pericardial effusion. dr. was notified in person of the results before surgical incision. post_bypass: normal rv systolic function. patient is on epinephrine infusion. lvef 50%. intact thoracic aorta. mitral valve post repair is intact, stable, no mitral regurgitation and no mitral stenosis. tr looks mild and at worst possibly 2+. 09:20am blood wbc-11.8* rbc-3.14* hgb-9.5* hct-29.3* mcv-93 mch-30.2 mchc-32.4 rdw-15.3 plt ct-399 04:05pm blood wbc-6.0 rbc-3.72* hgb-12.1 hct-35.9* mcv-97 mch-32.6* mchc-33.8 rdw-13.9 plt ct-208# 09:20am blood pt-26.7* inr(pt)-2.6* 05:50am blood pt-21.2* inr(pt)-2.0* 05:06am blood pt-14.7* ptt-26.3 inr(pt)-1.3* 12:43pm blood pt-13.3 ptt-25.8 inr(pt)-1.1 03:55am blood pt-13.5* inr(pt)-1.1 08:20am blood pt-35.2* ptt-39.9* inr(pt)-3.5* 06:59am blood pt-40.3* ptt-39.7* inr(pt)-4.1* 01:15pm blood pt-36.8* inr(pt)-3.7* 06:13am blood pt-33.0* inr(pt)-3.3* 05:40am blood pt-20.8* inr(pt)-1.9* 03:11am blood pt-13.6* ptt-36.3* inr(pt)-1.2* 09:20am blood glucose-107* urean-22* creat-0.9 na-133 k-3.9 cl-94* hco3-32 angap-11 04:05pm blood glucose-84 urean-33* creat-1.1 na-140 k-4.2 cl-103 hco3-26 angap-15 04:05pm blood alt-10 ast-18 ld(ldh)-205 ck(cpk)-22* alkphos-66 amylase-92 totbili-0.5 brief hospital course: mrs. was admitted to the on for surgical management of her mitral valve disease. she was admitted one day prior to surgery for heparin administration (chronic af) and underwent usual pre-operative work-up. she was taken to the operating room where she underwent mitral valve repair. please see operative note for details. post-operatively she was taken to the intensive care unit for monitoring for invasive monitoring in stable condition. over the next 24 hours, she was weaned from sedation and pressors, awoke neurologically intact and was extubated. beta-blockers and diuretics were started and she was gently diuresed towards her pre-op weight. on post-op day two she was transferred to the step-down floor for further recovery. coumadin was restarted for chronic atrial fibrillation. the patient reported pain with ambulation while working with physical therapy. she then admitted that she sustained a fall pre-operatively, which was not reported and hence not worked up. hip x-ray revealed femoral neck fracture. orthopedic surgery was consulted. the inr was reversed with ffp and she was taken to the operating room with dr. for right hip hemiarthroplasty on . overall she tolerated this procedure well and returned to for post-op recovery. she did have low urine output which responded to lasix. her creatinine remained within normal limits. urinalysis was positive, and she was started empirically on cipro, pending culture. the culture was, however, negative and antibiotics were discontinued. coumadin was resumed for chronic atrial fibrillation. she was transferred to the telemetry floor for further recovery. the patient was evaluated by the physical therapy service for assistance with strength and mobility. she is to be weight bearing as tolerated and on anterior hip precautions per orthopedics. she will follow up in the clinic for staple removal 2 weeks post-op. by the time of discharge on pod the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to in good condition with appropriate follow up instructions. her coumadin will be managed at this time by the rehab center, with an inr goal of .5. medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 puffs inhaled every 6 hours as needed for shortness of breath or cough clonazepam - 0.5 mg tablet - 0.5 (one half) tablet(s) by mouth in am and 1 tab at night digoxin - (prescribed by other provider) - 125 mcg tablet - one tablet(s) by mouth once a day levothyroxine - (dose adjustment - no new rx; per home health report) - 100 mcg tablet - 1 tablet(s) by mouth once a day - no substitution metoprolol succinate - 100 mg tablet extended release 24 hr - 1 tablet(s) by mouth daily mirtazapine - 7.5 mg tablet - 2 tablet(s) by mouth at bedtime polyethylene glycol 3350 - (prescribed by other provider) - 17 gram/dose powder - 17 gm(s) by mouth once a day prn sertraline - 25 mg tablet - 1 tablet(s) by mouth daily per rehab discharge summary simvastatin - 10 mg tablet - 1 tablet(s) by mouth daily tiotropium bromide - 18 mcg capsule, w/inhalation device - capsule to be placed into device, then crushed and inhaled once a day. pharmacist to give further instructions. warfarin - (prescribed by other provider) - 2 mg tablet - one tablet(s) by mouth 2 days a week (tues and thurs), 3mg 5 days a week, last dose acetaminophen - (prescribed by other provider) - 325 mg tablet - 2 tablet(s) by mouth daily prn aspirin - (prescribed by other provider) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 6. sertraline 25 mg tablet sig: one (1) tablet po daily (daily). 7. rosuvastatin 20 mg tablet sig: 0.5 tablet po daily (daily). 8. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 9. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 10. furosemide 20 mg tablet sig: tablet po once a day. 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 12. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 13. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/temp. 14. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 15. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours) as needed for wheezing. 16. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for wheezing. 17. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 18. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. 19. warfarin 1 mg tablet sig: as directed tablet po once a day: inr 2-2.5. 20. metoprolol tartrate 50 mg tablet sig: one (1) tablet po three times a day. 21. outpatient lab work inr check on and then daily until inr stable. 22. fosamax 70 mg tablet sig: one (1) tablet po once a week: begin in 2 weeks from right orif- start on . 23. vitamin d-3 400 unit tablet sig: two (2) tablet po once a day. 24. calcium 500 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: severe regurgitation (mitral valve prolapse) s/p mitral valve repair right femoral neck fracture s/p right hip hemiarthroplasty coronary artery disease with old apical infarction atrial fibrillation dyslipidemia pulmonary hypertension vertebral fractures goiter (s/p rai ablation years ago) hypothyroidism discharge condition: alert and oriented x3, nonfocal ambulating incisional pain managed with percocet incisions: sternal - healing well, no erythema or drainage right hip- healing well, no erythema or drainage. staples in place edema - trace 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 surgeon:dr. () on at 2:00pm in the medical office building, . cardiologist:dr. on at 9:00am please call to schedule appointments with: orthopaedic trauma, in 2 wks. please call to schedule an appointment primary care dr. () in weeks provider: function lab phone: date/time: 1:10 **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 chronic atrial fibrillation goal inr 2.0-2.5 first draw , then monday, wednesday, friday until stabilized. md to dose daily. sensitive to coumadin. procedure: extracorporeal circulation auxiliary to open heart surgery partial hip replacement open heart valvuloplasty of mitral valve without replacement diagnoses: acidosis hyperpotassemia mitral valve disorders congestive heart failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of bronchus and lung other chronic pulmonary heart diseases personal history of tobacco use percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia anxiety state, unspecified chronic systolic heart failure other diseases of lung, not elsewhere classified atherosclerosis of native arteries of the extremities, unspecified fall from other slipping, tripping, or stumbling unspecified cataract acquired absence of both cervix and uterus tricuspid valve disorders, specified as nonrheumatic other closed transcervical fracture of neck of femur 

Answer: The patient is high likely exposed to