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: penicillins / erythromycin base / shellfish / percodan / eggs / trees,grass,and cats and dogs / omeprazole / latex attending: chief complaint: increasing doe and fatigue major surgical or invasive procedure: 1. redo sternotomy with aortic valve replacement with 19 mm - magna ease tissue valve. 2. mitral valve repair with a mitral valve annuloplasty with a 26 mm annuloplasty band. history of present illness: this is an 80 year old female who is status post coronary artery bypass grafting in . since that time she has been followed for aortic stenosis. an echo from showed severe aortic stenosis with a mildly diminshed left ventricular function. she also has known vein graft disease. prior to her redo operation, she underwent successful pci of the svg-rca graft with 3.0x15mm bare metal stent in . currently, her symptoms include dyspnea with minimal exertion along with a generalized fatigue. **she is on plavix at this time.** past medical history: - acute respiratory insufficiency, resolved - aortic stenosis - coronary artery disease, prior inferior myocardial infarction - hypertension - hyperlipidemia - diabetes mellitus type 2 - mild renal insufficiency, last cr 1.5 - hypothyroid - gerd - copd, asthma - obesity - kyphosis, chronic low back pain past surgical history: - cabg x4 - appenedectomy - ovarian resection - b hand surgeries x8 - bilateral knee arthroscopies (x2 each knee) - spine surgery c3-c6 fusion - cholecystectomy - carpal tunnel release - bso - lumbar disc ex-stop surgery ( has ble neuropathy) - b cataracts surgs social history: race: caucasian last dental exam: full dentures lives with: alone ( daughter nearby) occupation: retired cigarettes: smoked no yes hx: etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use: none family history: premature coronary artery disease - 2 brothers with cad physical exam: physical exam pulse: 90 resp: 18 o2 sat: 99% bp 130/48 height:5'0" weight: 164lbs general: elderly female in no acute distress, obese skin: dry intact heent: perrla eomi anicteric sclera; op unremarkable neck: supple decreased rom from cerv. disc ;no jvd appreciated chest: lungs clear bilaterally ; well-healed sternotomy scar heart: rrr irregular murmur grade 4/6 sem radiates throughout precordium abdomen: soft non-distended non-tender bowel sounds + ; no hsm extremities: warm , well-perfused edema: 1+ edema varicosities: spider veins on l: r leg saph harvest scars groin to ankle neuro: grossly intact ; nonfocal exam; mae strengths pulses: femoral right:2+ left:2+ dp right:2+ left:2+ pt :1+ left:1+ radial right:2+ left:2+ carotid bruit murmur radiates to b carotids pertinent results: echocardiography report , (complete) done at 10:13:43 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 80 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: aortic valve disease. left ventricular function. mitral valve disease. preoperative assessment. prosthetic valve function. icd-9 codes: 424.1, 424.0, 424.2 test information date/time: at 10:13 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2012aw3-: machine: echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.1 cm <= 5.6 cm left ventricle - ejection fraction: 30% to 35% >= 55% aortic valve - peak velocity: *4.3 m/sec <= 2.0 m/sec aortic valve - peak gradient: *74 mm hg < 20 mm hg aortic valve - mean gradient: 47 mm hg aortic valve - lvot diam: 1.9 cm aortic valve - valve area: *0.5 cm2 >= 3.0 cm2 findings right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: normal lv wall thickness. moderately dilated lv cavity. moderate regional lv systolic dysfunction. moderately depressed lvef. lv wall motion: regional left ventricular wall motion findings as shown below; remaining lv segments contract normally. right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. critical as (area <0.8cm2). trace ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. mild thickening of mitral valve chordae. moderate to severe (3+) mr. tricuspid valve: normal tricuspid valve leaflets. mild to moderate +] tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. physiologic (normal) pr. general comments: written informed consent was obtained from the patient. the patient was under general anesthesia throughout the procedure. no tee related complications. results were personally conclusions prebypass no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is moderate regional left ventricular systolic dysfunction with dyskinesis/aneurysm of inferior base and severe hypokinesis of the inferolateral wall and remaining inferior wall. overall left ventricular systolic function is moderately depressed (lvef= 30-35%). the remaining left ventricular segments contract normally. right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. dr. was notified in person of the results in the or. postbypass the patient is receiving epinephrine at 0.03 ucg/kg/min lv systolic function remains essentially unchanged in the setting of low dose inotropes (lvef~35%). rv systolic function remains preserved. there is a ring prosthesis in the mitral position. there is trace mr. there is a well seated, well functioning bioprosthesis in the aortic position. no ai is visualized. the remaining study is unchanged from prebypass. electronically signed by , md, interpreting physician 12:13 06:10am blood wbc-8.1 rbc-3.54* hgb-11.1* hct-32.7* mcv-92 mch-31.3 mchc-33.9 rdw-14.4 plt ct-159 06:10am blood pt-22.4* inr(pt)-2.1* 06:10am blood glucose-96 urean-45* creat-1.7* na-132* k-4.7 cl-95* hco3-26 angap-16 , f 80 radiology report chest port. line placement study date of 8:17 am , r. csurg csru 8:17 am chest port. line placement clip # reason: f/u effusions final report indication: evaluation of patient with history of aortic valve and mitral valve repair for interval change. comparison: multiple prior chest radiographs including the most recent from . findings: previously visualized swan-ganz catheter has since been removed. a left internal jugular central venous catheter is visualized with the catheter tip in the brachiocephalic vein. post-surgical changes are again noted with intact sternotomy wires as well as mediastinal clips. there have been an overall improvement in aeration of bilateral lungs; however, foci of band-like atelectasis persist at the left lung base. bilateral small pleural effusions also persist. cardiomediastinal silhouette appears enlarged but stable. mild pulmonary edema is again noted. impression: an overall improvement in lung aeration bilaterally but persistent small pleural effusions as well as areas of left basilar atelectasis. brief hospital course: on mrs. was taken to the operating room and underwent redo sternotomy with aortic valve replacement (#19 mm - magna ease tissue valve)/ mitral valve repair (mitral valve annuloplasty with a 26 mm annuloplasty band) with dr.. please see operative report for further surgical details. cross clamp time=69 minutes. cardiopulmonary bypass time=86 minutes. she tolerated the procedure well and was transferred to the cvicu intubated and sedated requiring pressor support. pod#1 she awoke neurologically intact and was weaned to extubation. her rhythm was bradycardic and she required dopamine in addition for rate support in the setting of failure of her epicardial wires. electrophysiology was consulted. av nodal blocking agents were held to allow for recovery and permanent pacemaker not required. she had acute on chronic pulmonary insufficiency requiring aggressive pulmonary hygiene and prolonged observation in the cvicu. pod#4 her rhythm went into atrial fibrillation. amiodarone was initiated. she was placed on heparin drip for anticoagulation bridge for afib. coumadin was started. all lines and drains were discontinued per protocol. postop renal insufficiency was noted with a creatnine peak to 2.3. no intervention required and by the time of discharge her creatnine was trending back down. she had postoperative thrombocytopenia. a hit panel was sent and resulted negative. by the time of discharge her platlets were increasing towards her baseline. pod#5 she was transferred to the step down unit for further recovery and monitoring. her epicardial wires were removed. she was placed on cipro for a positive u/a- urinary culture was negative cipro was d/c'd. foley was maintained for failure to void. she should have a repeat voiding trial at rehab. her problem at discharge was upper airway wheezing from asthma exaccerbation- she is on nebs. physical therapy was consulted for evaluation of strength and mobility. the remainder of her hospital course was essentially uneventful and she continued to slowly progress. on pod#9 she was cleared for discharge to . all follow up appointments were advised. medications on admission: plavix 75mg once a day aspirin 325mg once a day levothyroxine 75 mcg once a day lisinopril 40 mg once a day metoprolol succinate 50 mg once a day nitroglycerin 0.4 mg/hour patch 24 hr - 1 patch once a day nitroglycerin sublingual prn ranitidine 150mg once a day pioglitazone 30 mg once a day simvastatin 80 mg once a day acetaminophen 325 mg prn multivitamin once a day vitamin e 400 unit once a day vitamin d colace discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for dyspnea. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for dyspnea. 6. amiodarone 200 mg tablet sig: two (2) tablet po once a day: then decrease dose to 200mg daily on . 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 10. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours) for 7 days. 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 12. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 13. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 14. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 15. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 16. warfarin 1 mg tablet sig: dose per inr tablet po once a day: indication afib goal inr 2.0-2.5. 17. outpatient lab work please check inr daily until stable then 3x/week discharge disposition: extended care facility: for the aged - macu discharge diagnosis: s/p aortic valve replacement(#19 tissue)/mitral valve repair(#22 tissue) secondary: - aortic stenosis - coronary artery disease, prior inferior myocardial infarction - hypertension - hyperlipidemia - diabetes mellitus type 2 - mild renal insufficiency, last cr 1.5 - hypothyroid - gerd - copd, asthma - obesity - kyphosis, chronic low back pain -post-op afib discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 1+ lower extemity edema alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 1+ lower extemity edema alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 1+ lower extemity edema alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 1+ lower extemity edema 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 one month or while taking narcotics. driving will be discussed at follow up appointment with surgeon. 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** labs: pt/inr for coumadin ?????? indication afib goal inr 2.0-2.5 first draw results to: please arrange couamdin follow up upon discharge from rehab followup instructions: surgeon: , md phone: date/time: at 1:30 in the medical office building cardiologist: dr. @3:15pm please make an appointment with dr. for 4 weeks. please arrange coumadin follow upon discharge from rehab procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of aortic valve with tissue graft annuloplasty diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified anemia, unspecified esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia unspecified acquired hypothyroidism coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status other specified conduction disorders other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction chronic systolic heart failure mitral valve insufficiency and aortic valve stenosis obesity, unspecified chronic obstructive asthma with (acute) exacerbation lumbago kyphosis (acquired) (postural) chronic kidney disease, stage ii (mild) other pulmonary insufficiency, not elsewhere classified, following trauma and surgery 

Answer: The patient is high likely exposed to