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 attending: chief complaint: dizziness and dyspnea major surgical or invasive procedure: aortic valve replacement(23mm st. epic supra porcine) and single vessel coronary artery bypass grafting(vein graft to ramus intermedius). history of present illness: mr. is a 70 year old male with known aortic stenosis. he admits to a several month history of worsening dyspnea. he presented to outside hospital with several hours of dizziness. he ruled out for myocardial infarction. echocardiogram was notable for worsening aortic stenosis with of 0.6 cm2 with mild to moderate aortic insufficiency. his ejection fraction was normal at 65-70%. cardiac catheterization confirmed severe aortic stenosis while coronary angiography showed significant disease in the ramus branch and first obtuse marginal arteries. given the above findings, he was transferred to the for cardiac surgical intervention. past medical history: aortic stenosis, aortic insufficiency coronary artery disease history of myocardial infarction hypertension dyslipidemia atrial fibrillation diverticular disease interstitial lung disease prior colonic resection s/p appendectomy social history: retired mechanical engineer. quit tobacco over 18 years ago. admits to only social etoh. lives with wife. family history: two sons died of heart attacks. physical exam: vs - 114/74, 60, 24 gen: well developed well nourished elderly male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, no lad, no jvp appreciated cv: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: decreased breath sounds bilaterally abd: soft, nt, nd. no abdominial bruits appreciated. ext: warm. no edema or cyanosis. skin: multiple nevi on face and head pulses: 1+ bilaterally, no carotid or femoral bruits noted pertinent results: trans-thoracic echo: the left atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with thinning/akinesis of the inferolateral wall and hypokinesis of the inferior wall. the remaining segments contract well (lvef 45%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be quantified. there is an anterior space which most likely represents a fat pad. carotid us: 1. no significant stenosis of the right ica. 2. less than 40% stenosis of the left ica. : spirometry 12:43 pm pre drug post drug actual pred %pred actual %pred %chg fvc 4.37 4.23 103 4.30 102 -2 fev1 2.75 2.85 97 2.70 95 -2 mmf 1.11 2.61 42 1.23 47 +11 fev1/fvc 63 67 93 63 93 0 lung volumes 12:43 pm pre drug post drug actual pred %pred actual %pred tlc 6.55 6.71 98 frc 2.95 3.82 77 rv 2.17 2.48 88 vc 4.52 4.23 107 ic 3.60 2.89 125 erv 0.78 1.34 58 rv/tlc 33 37 90 he mix time 3.38 dlco 12:43 pm actual pred %pred dsb 15.16 24.79 61 va(sb) 6.22 6.71 93 hb 15.20 dsb(hb) 14.91 24.79 60 dl/va 2.40 3.70 65 intraop tee: pre bypass: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the aortic arch. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. post bypass: preserved biventricular function lvef 45%. mid inferior hypokinesis is unchanged. mr remains 1+. aortic bioprosthesis is insitu (#23 ) peak gradient 17, mean gradient 5 mm hg. no perivalvular leaks or insufficiency. aortic contours intact. remaining exam is unchanged. all findings discussed with surgeons at the time of the exam. , c m 70 radiology report chest (pa & lat) study date of 9:05 am , r. csurg fa6a sched chest (pa & lat) clip # reason: pleural effusions final report pa and lateral chest radiograph history: 70-year-old man status post avr and cabg. evaluate for pleural effusions. comparison: chest radiograph from dating back to . findings: small bilateral pleural effusions are present and unchanged. bilateral pleural densities may be due to subpleural adipose tissue or pleural thickening. in the right apex, there is an ill-defined spiculated nodule which is either in the lung parenchyma or abuts the pleura. this nodule is unchanged since . the patient is status post median sternotomy and cabg with appropriately positioned cerclage wires. the cardiac silhouette is normal in size. the aorta is mildly tortuous but unchanged. the hilar and mediastinal contours appear unremarkable. a swan-ganz catheter has been removed. impression: 1. unchanged bilateral pleural effusions with slight improvement in the left basilar atelectasis. 2. right apical spiculated nodule will require further investigation with chest ct when the patient is clinically stable. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 4:18 pm hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:15am 8.2 3.13* 9.6* 27.5* 88 30.8 35.0 14.3 182# chemistry renal & glucose glucose urean creat na k cl hco3 angap 06:05am 26* 1.4* 139 3.9 brief hospital course: mr. was admitted to the cardiac surgical service and underwent routine preoperative evaluation which included repeat echocardiogram, carotid ultrasound and pulmonary function testing - please see result section for details. he remained stable on medical therapy. prior to surgery, he was cleared by the dental service. his preoperative course was otherwise uneventful. given his hospital stay was greater than 24 hours prior to surgery, vancomycin was used for perioperative coverage. on , dr. performed an aortic valve replacement and coronary artery bypass grafting surgery. for surgical details, please see separate dictated operative note. following the operation, he was brought to the cvicu for invasive monitoring. within 24 hours, he awoke neurologically intact and was extubated without incident. his cvicu course was uneventful and he transferred to the step down floor on postoperative day two. chest tubes and pacing wires were discontinued without complication. the patient made excellent progress with physical therapy, showing good strength and balance prior to discharge. he did require meclizine for vertigo, which was diagnosed pre-operatively. the patient required supplemental oxygen throughout his post-operative course. a blood gas was drawn on room air on and reavealed a po2 of 49. he was diuresed aggressively and treated with inhalers and his oxygenation improved with room air saturations above 90% with ambulation. there was a right upper lobe nodule found on cxr and he had a chest ct which revealed bullous emphysema and a right upper lobe pleural based mass which could represent scarring, inflamation, or neoplasm. he was evaluated by dr. from thoracic surgery and will follow up with him. he should obtain a pet ct and head ct prior to that visit. he was discharged to home in stable condition on pod#7. medications on admission: aspirin 81 qd, zocor 20 qd, metoprolol 150 , cartia 120 qd, zestril 5 qd, tikosyn 0.5 , celebrex 200 qd, protonix 40 qd discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 3. dofetilide 250 mcg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*60 capsule(s)* refills:*0* 4. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. disp:*60 tablet(s)* refills:*0* 5. meclizine 12.5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for vertigo symptoms. disp:*90 tablet(s)* refills:*0* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 7. simvastatin 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 9. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation every six (6) hours. disp:*1 vial* refills:*2* 10. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 vial* refills:*2* 11. potassium chloride 20 meq packet sig: one (1) po bid (2 times a day) for 10 days. disp:*20 tabs* refills:*0* 12. lasix 20 mg tablet sig: one (1) tablet po three times a day for 10 days. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: hospice and vna discharge diagnosis: aortic stenosis emphysema paroxysmal atrial fibrillation hypertension hyperlipidemia discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: 1) dr. in 4 weeks () please call for appointment 2) dr. , n in 1 week () please call for appointment *follow up with dr. re: right apical nodule on cxr * 3) dr. in weeks please call for appointment 4) wound check appointment 2 as instructed by nurse () 5)make an appointment with dr. for 4 weeks. obtain pet ct and head ct prior to visit. procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart (aorto)coronary bypass of one coronary artery open and other replacement of aortic valve with tissue graft diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia old myocardial infarction postinflammatory pulmonary fibrosis hypoxemia diverticulosis of colon (without mention of hemorrhage) emphysematous bleb dizziness and giddiness swelling, mass, or lump in chest 

Answer: The patient is high likely exposed to