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: shellfish derived attending: chief complaint: shortness of breath major surgical or invasive procedure: s/p cabg x1(svg->rca)/mvrepair (#30mm st. annuloplasty ring)- history of present illness: 64year old male presented to an outside hospital for increasing shortness of breath. further cardiac work up revealed severe mitral regurg with a decreased left ventricular ejection fraction of % consistent with systolic heart failure. mr. was transferred to for cardiac surgical consultation with dr.. past medical history: hypothyroidism diverticulosis polyp removal ' newly diagnosed systolic heart failure, ef=10-15% newly diagnosed atrial flutter s/p right inguinal herniorraphy' social history: auto mechanic tobacco- quit 9 months ago- 42 pk yr etoh- denies lives alone. family history: non- contributory physical exam: admission: general: nad skin: rigth forearm w/ erythematous, tender old iv site and left antecubital erythema- non-tender. heent: emoi, perrla neck: no lad, no jvd. chest: cta bilat. heart: rrr abd: soft, nt, nd, +bs, no palp masses exterm: le: warm w/ trace edema. superficial varicosities left foot. neuro: intact. pertinent results: 06:38am blood wbc-9.1 rbc-3.30* hgb-10.2* hct-31.0* mcv-94 mch-31.1 mchc-33.1 rdw-13.7 plt ct-444*# 06:38am blood glucose-97 urean-22* creat-1.1 na-137 k-4.6 cl-98 hco3-31 angap-13 06:35am blood urean-23* creat-1.3* k-4.4 01:55pm blood glucose-167* urean-40* creat-1.8* na-134 k-4.8 cl-97 hco3-27 angap-15 06:35am blood mg-2.1 pre-op echo: , portable tte (complete) done at 9:15:00 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 64 m hgt (in): 70 bp (mm hg): 102/60 wgt (lb): 195 hr (bpm): 78 bsa (m2): 2.07 m2 indication: left ventricular function. right ventricular function. new aflutter. icd-9 codes: 410.92, 427.32, 424.0, 424.2 test information date/time: at 09:15 interpret md: , md test type: portable tte (complete) 3d imaging. son: , rdcs doppler: full doppler and color doppler test location: / 6 contrast: none tech quality: adequate tape #: 2009w006-0:00 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.2 cm <= 4.0 cm left atrium - four chamber length: *6.7 cm <= 5.2 cm right atrium - four chamber length: *5.1 cm <= 5.0 cm 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: *6.8 cm <= 5.6 cm left ventricle - ejection fraction: 40% to 45% >= 55% left ventricle - stroke volume: 38 ml/beat left ventricle - cardiac output: 2.94 l/min left ventricle - cardiac index: *1.42 >= 2.0 l/min/m2 left ventricle - lateral peak e': 0.10 m/s > 0.08 m/s left ventricle - septal peak e': *0.06 m/s > 0.08 m/s left ventricle - ratio e/e': *17 < 15 aorta - sinus level: 3.4 cm <= 3.6 cm aorta - ascending: *3.5 cm <= 3.4 cm aorta - arch: 2.6 cm <= 3.0 cm aortic valve - peak velocity: 0.8 m/sec <= 2.0 m/sec aortic valve - lvot vti: 12 aortic valve - lvot diam: 2.0 cm mitral valve - e wave: 1.4 m/sec mitral valve - a wave: 0.4 m/sec mitral valve - e/a ratio: 3.50 mitral valve - e wave deceleration time: *278 ms 140-250 ms tr gradient (+ ra = pasp): *34 mm hg <= 25 mm hg pulmonic valve - peak velocity: 0.8 m/sec <= 1.5 m/sec findings multiplanar reconstructions were generated and confirmed on an independent workstation. right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. moderately dilated lv cavity. mild regional lv systolic dysfunction. no lv mass/thrombus. no resting lvot gradient. no vsd. right ventricle: mildly dilated rv cavity. mild global rv free wall hypokinesis. abnormal septal motion/position. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. mild thickening of mitral valve chordae. severe (4+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: no ps. pericardium: no pericardial effusion. conclusions 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 mild regional left ventricular systolic dysfunction with infero-lateral hypokinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. there is abnormal septal motion/position. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. severe (4+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. electronically signed by , md, interpreting physician 11:18 post op echo: echocardiography report , (complete) done at 12:02:20 pm final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 64 m hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: intraoperative tee for cabg, mitral valve repair icd-9 codes: 428.0, 440.0, 424.0 test information date/time: at 12:02 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 #: 2009aw2-: machine: ie33 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *7.0 cm <= 4.0 cm left atrium - four chamber length: *7.0 cm <= 5.2 cm left ventricle - inferolateral thickness: 0.6 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.5 cm <= 5.6 cm left ventricle - ejection fraction: 30% >= 55% aorta - ascending: 3.2 cm <= 3.4 cm aorta - descending thoracic: *3.0 cm <= 2.5 cm aortic valve - lvot diam: 2.5 cm mitral valve - mean gradient: 3 mm hg mitral valve - mva (p t): 2.7 cm2 findings left atrium: marked la enlargement. elongated la. mild spontaneous echo contrast in the body of the la. no mass/thrombus in the laa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness. moderately dilated lv cavity. moderate global lv hypokinesis. right ventricle: focal apical hypokinesis of rv free wall. aorta: focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. mildly dilated descending aorta. simple atheroma in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: moderately thickened mitral valve leaflets. mild mitral annular calcification. moderate thickening of mitral valve chordae. no ms. vena contracta is >=0.7cm severe (4+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. physiologic tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. mild pr. 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. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. bilateral pleural effusions. conclusions pre bypass the left atrium is markedly dilated. the left atrium is elongated. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. 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 global left ventricular hypokinesis (lvef = 30 %). the inferior and lateral walls are somewhat more hyponinetic than the other left ventricular wall segments. the right ventricle displays focal hypokinesis of the apical free wall. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the systolic excursion of the mitral leaflets is restricted, posterior leaflet greater than anterior leaflet, resulting in a failure to coapt and severe mitral regurgitation. there is moderate thickening of the mitral valve chordae. the mitral regurgitation vena contracta is >=0.7cm. the tricuspid valve leaflets are mildly thickened. there are bilateral pleural effusions. dr. was notified in person of the results in the operating room at the time of the study. post bypass the patient is receiving milrinone by infusion and is being atrially paced. there is normal right ventricular systolic function. the left ventricle displays overall mild improvement in systolic function with an ef of about 35%. the inferior and lateral walls still appear more hypokinetic than the other segments. a mitral valve annuloplasty ring is in situ. there is trace mitral regurgitation. the maximum pressure gradient across the mitral valve is 4 mm hg with a mean of 2 mm hg at a cardiac output of about 4.5 l/m. the thoracic aorta appears intact. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:22 cxr : chest two views on history: mvr, cabg. reference exam: . findings: there are small bilateral effusions, left greater than right. the patient is status post sternotomy and valve replacement. the heart is moderately enlarged. there is no focal infiltrate. compared to the recent study, there is no significant interval change. dr. approved: mon 12:57 pm ekg: , g m 64 cardiology report ecg study date of 11:07:58 pm atrial flutter with a controlled ventricular rate with 4:1 block. indeterminate axis. right bundle-branch block. non-specific st-t wave changes. compared to the previous tracing atrial flutter is new. brief hospital course: 64 yo male presented to osh for increasing sob. cath on revealed ef 10-15% w/ dilated left ventricle and global hypokinesis, 4+ mr and 50% rca. echo ef 30%. transferred to on for surgical eval of severe mitral regurg. in rate controlled afib/flutter treated with heparin gtt and aggressive diuresis while awaiting surgery. cleared for surgery by dental. tsh elevated-levothyroxine adjusted. repeat echo prior to surgery w/ ef 30%. taken to the operating room on for mv repair(#30 annuloplasty ring) and cabg x1 (svg to distal rca). admitted to the cvicu on milrinone and norepi for low ef. kept intubted overnoc then weaned and extubated easily on pod#1. weaned from milrinone and norepi on pod#2. required boluses of ivf, prbc and albumin for hypotension. once hemodyamically stable pt was transferred from the icu on pod# 4. pt was started on lopressor, statin and asa. chest tubes and wires were d/c'd per protocol. pt was started on coumadin for ongoing afib/flutter. pt progressed well and was evaluated by physical therapy and was thought to require rehab stay prior to returning home. pt was d/c'd to rehab on pod 8 w/ inr 2.2. medications on admission: : levothyroxine - dose uncertain admit meds: levothyoxine 50mcg, heparin gtt, asa 325, lipitor40, lasix 40 iv, amiodarone 400 tid, lopressor 25 mg tid discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. metoprolol tartrate 25 mg tablet sig: .5 tablet po twice a day. disp:*60 tablet(s)* refills:*2* 8. cephalexin 500 mg tablet sig: one (1) tablet po four times a day for 7 days. disp:*28 tablet(s)* refills:*0* 9. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: dose will change daily for inr goal . tablet(s) 10. furosemide 10 mg/ml solution sig: four (4) injection (2 times a day): 40mg iv bid. 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours). discharge disposition: extended care facility: hospital tcu - discharge diagnosis: s/p coronary artery bypass x1(svg->rca)/mitral valve repair (#30mm st. annuloplasty ring)- -new heart failure/atrial flutter -hypothyroidism -diverticulosis -polyp removal ' discharge condition: deconditioned discharge instructions: please shower daily including washing incisions and pat dry gently 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: will need a pa and lat cxr at 3-4 week follow-up appointment with your primary care doctor to follow nodule seen on pre-op cxr. please call and schedule the following appointments: dr in 4 weeks () dr in 1 week dr in weeks procedure: extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of one coronary artery annuloplasty diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified unspecified acquired hypothyroidism obstructive chronic bronchitis with (acute) exacerbation atrial flutter surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants phlebitis and thrombophlebitis of superficial veins of upper extremities acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to