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: dyspnea on exertion major surgical or invasive procedure: mitral valve repair (28mm st. ) history of present illness: 54 year old female with history of mitral regurgitation with recent echo revealing worsening cardiac parameters and 4+ mr. she is experiencing dyspnea on exertion currently and presents for surgical evaluation. past medical history: mitral regurgitation chronic obstructive pulmonary disease obesity hypertension past surgical history: s/p open cholecystectomy s/p appendectomy s/p tubal ligation social history: lives with: husband occupation: accountant tobacco: quit 12 yrs ago after 25 yrs of 2ppd etoh: several per week family history: grandmother died from mi at 55 physical exam: pulse: 90 resp: 16 o2 sat: 97% b/p right: 147/77 left: 157/115 height: 5'3" weight: 214 lbs general: well-developed, well-nourished obese female in no acute distress skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: regular-irregular rhythm with 2/6 holosystolic murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema/varicosities: none neuro: grossly intact pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 2+ left: 2+ carotid bruit right/left: none pertinent results: 05:11am blood wbc-11.9* rbc-3.73* hgb-10.7* hct-32.6* mcv-87 mch-28.8 mchc-33.0 rdw-14.4 plt ct-166 10:38am blood wbc-17.8*# rbc-2.99*# hgb-8.7*# hct-26.0*# mcv-87 mch-29.0 mchc-33.4 rdw-13.3 plt ct-193 05:11am blood plt ct-166 10:38am blood pt-13.8* ptt-27.9 inr(pt)-1.2* 10:38am blood fibrino-277 05:11am blood glucose-101* urean-35* creat-0.9 na-139 k-4.7 cl-106 hco3-26 angap-12 12:15pm blood urean-20 creat-0.9 cl-117* hco3-24 09:38pm blood alt-20 ast-47* ld(ldh)-314* alkphos-53 amylase-21 totbili-0.2 05:11am blood mg-2.7* pa and lateral chest radiograph: new mild pulmonary edema. the mild cardiomegaly is unchanged. the sternal wires are intact. a right ij terminates in the distal svc in appropriate position. linear atelectasis in the left lower lobe is unchanged. no pleural effusions are present. impression: new mild pulmonary edema. echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 40% to 45% >= 55% findings left atrium: moderate la enlargement. no spontaneous echo contrast is seen in the laa. good (>20 cm/s) laa ejection velocity. no thrombus in the laa. right atrium/interatrial septum: normal ra size. a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. top normal/borderline dilated lv cavity size. mildly depressed lvef. right ventricle: rv hypertrophy. normal rv chamber size. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. aortic valve: three aortic valve leaflets. mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: moderately thickened mitral valve leaflets. no mass or vegetation on mitral valve. mild mitral annular calcification. moderate thickening of mitral valve chordae. no ms. moderate to severe (3+) mr. tricuspid valve: mild tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: trivial/physiologic pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the patient received antibiotic prophylaxis. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. patient. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions pre-cpb: 1. the left atrium is moderately dilated. no spontaneous echo contrast is seen in the left atrial appendage. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is mildly depressed (lvef= 40 %). 3. the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. 4. there are three aortic valve leaflets. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. 5. the mitral valve leaflets are moderately thickened. no mass or vegetation is seen on the mitral valve. there is moderate thickening of the mitral valve chordae. moderate to severe (3+) mitral regurgitation is seen. there is a central jet. the annulus measures 3.8-3.9 cm. 6. there is a trivial/physiologic pericardial effusion. dr. was notified in person of the results. post-cpb: on infusion of epi briefly, phenylephrine. sinus rhythm. well-seated annuloplasty ring in the mitral position. mr is 1+. ms is 5 cm h2o. preserved biventricular systolic function with lvef now 50%. aortic contour is normal post decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 10:56 brief hospital course: same day admit after undergoing all pre-operative work-up as an outpatient. on she was brought directly to the operating room where she underwent a mitral valve repair. please see operative report for surgical details. within 24 hours she was weaned from sedation, awoke neurologically intact and extubated. she did have frequent ventricular ectopy and was placed on a lidocaine drip intraoperatively. this was stopped due to a junctional rhythm on postoperative night. she was started on oral amiodarone on postoperative day 1 once she was in sinus rhythm due to continued ventricular ectopy. she was weaned from all vasoactive medications on her postoperative night. swan-ganz catheter was removed with good cardiac output/index on postoperative day 1. a nasogastric tube was placed postoperative night due to nausea and vomiting. this was removed on post operative day 1 and reglan was started for hypoactive bowel sounds. she was changed from percocet to ultram due to nausea, which resolved. she was transferred to the step down unit on postoperative day 2 in stable condition. pacing wires and chest tubes were removed per cardiac surgery protocol. she continued to work with physical therapy to improve strength and endurance. she continued to progress, amiodarone was discontinued as ventricular ectopy resolved. she was ready for discharge home with services post operative day 4. medications on admission: actonel 35mg qwk aerobid 250mcg 2 puffs daily aspirin 81mg daily diltiazem 180mg daily diovan 80mg daily omeprazole 20mg daily serevent diskus 50mcg twice a day albuterol mdi discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 2. 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* 3. aerobid 250 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*120 puff* refills:*0* 4. salmeterol 50 mcg/dose disk with device sig: one (1) disk with device inhalation q12h (every 12 hours). 5. prevacid 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 6. diovan 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours) as needed for wheezing. disp:*qs qs* refills:*0* 9. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 10. lasix 40 mg tablet sig: one (1) tablet po twice a day: please take 40 mg twice a day for seven days then decrease to 400 mg daily for 7 days - please follow up with cardiologist prior to completion . disp:*21 tablet(s)* refills:*0* 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours): take 20 meq twice a day for 7 days, then decrease to 20 meq once a day for 7 days. disp:*21 tab sust.rel. particle/crystal(s)* refills:*0* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: mitral regurgitation s/p mitral valve repair chronic obstructive pulmonary disease obesity hypertension discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with ultram prn discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 approximately one month until follow up 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 followup instructions: , md phone: date/time: 1:15 please call to schedule appointments primary care dr. in weeks cardiologist dr. in weeks procedure: extracorporeal circulation auxiliary to open heart surgery open heart valvuloplasty of mitral valve without replacement operations on chordae tendineae diagnoses: esophageal reflux mitral valve disorders unspecified pleural effusion unspecified essential hypertension chronic airway obstruction, not elsewhere classified personal history of tobacco use other opiates and related narcotics causing adverse effects in therapeutic use paroxysmal ventricular tachycardia nausea with vomiting obesity, unspecified 

Answer: The patient is high likely exposed to