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: protonix / accupril / pravachol / mevacor attending: chief complaint: scheduled corevalve procedure major surgical or invasive procedure: corevalve aortic valve replacement history of present illness: 80yo male with h/o cabg x4, cva, 100% l carotid occlusion, known aortic stenosis now symptomatic. patient reports shortness of breath after walking 1 block, must rest after climbing 1 flightof stairs. he admits to 1 witnessed syncopal episode while havingiv's started in an upright position, 1 syncopal episode 6 months ago while getting into shower (also found to have pneumonia). he denies chest pain. cardiac cath showed three patent grafts.echocardiogram revealed 0.8cm2, mean gradient 36mmhg. noncontrast chest ct showed heavily calcified aorta prohibitive for conventional surgical avr. . he was consented for participation in the corevalve tavi study. he met all inclusion criteria and did not meet any exclusion criteria. he reported cold-like symptoms of head congestion, no fever. he saw his pcp and was initiated. his symptoms are improving, he remains fever free and he was cleared by his pcp. dose plavix . . he underwent succesful corevalve placement today. his transvenous pacing was placed through the femoral line and the valve was placed through subclavian access. he was sedated with fentanyl and versed and required neosynephrine for blood pressure supporet at the beginning of the procedure but was weaned off by the end. during balloon dilation he developed lbbb with a paced rhythm. he was given vancomycin and cefazolin during the procedure. he was extubated prior to arrival to the ccu. he is currently mildly sedated but appropriately responding to commands. . he does have a history of post op n/v from previous surgeries. he also has some residual sensory deficit from prior cva but no motor deficits. he has a history of esophageal stricture so can not get tee. . nyha class: ii past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: - cabg:coronary artery disease s/p coronary artery bypass graft x 4 - aortic stenosis - percutaneous coronary interventions: none - pacing/icd: 3. other past medical history: past medical history: - sepsis secondary to aspiration pneumonia - lumbar radiculopathy with l4-l5 disc herniation - aaa - carotid stenosis - cva from left common carotid occlusion - esophageal stricture s/p multiple dilatations - obstructive sleep apnea on cpap (doesn't use) - gerd - degenerative joint disease - pseudomonas bacteremia from uti - anxiety - spinal stenosis - benign prostatic hypertrophy - neurogenic pseudo-claudication past surgical history: - s/p left shoulder surgery - s/p back surgery - s/p tonsillectomy - s/p cataract surgery - s/p turp - s/p right elbow surgery - s/p right knee surgery social history: lives with wife on upper level of house, daughter lives on lower level (13 stairs). family history: father deceased secondary to trauma, mother deceased yo. physical exam: admission exam: bp=141/43 hr=61 rr=18 o2 sat= 96% general: nad. mildly sedated but responding appropriately to commands. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, trachea midline,bilat bruits vs referred murmer. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, no mrg. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. anterior exam ctab, posterior exam deferred. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: admission labs: 11:15am wbc-8.0 rbc-4.10* hgb-13.4* hct-37.0* mcv-90 mch-32.7* mchc-36.3* rdw-12.4 11:15am plt count-165 11:15am pt-13.7* ptt-28.0 inr(pt)-1.2* 11:15am glucose-96 urea n-10 creat-1.1 sodium-140 potassium-3.9 chloride-102 total co2-30 anion gap-12 11:15am estgfr-using this 11:15am alt(sgpt)-40 ast(sgot)-33 ck(cpk)-116 alk phos-80 tot bili-0.9 11:15am albumin-4.2 12:40pm urine color-yellow appear-clear sp -1.009 12:40pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg . pertinent labs: 11:15am ck-mb-2 probnp-173 01:00pm %hba1c-5.4 eag-108 07:11am blood triglyc-100 hdl-34 chol/hd-2.4 ldlcalc-26 05:01am blood ck(cpk)-303 01:00am blood ck-mb-5 . discharge labs: 06:44am blood glucose-103* urean-14 creat-1.0 na-138 k-3.8 cl-104 hco3-27 angap-11 06:44am blood wbc-7.5 rbc-3.59* hgb-11.4* hct-32.8* mcv-91 mch-31.7 mchc-34.7 rdw-12.5 plt ct-139* . echo due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. an aortic corevalve prosthesis is present. mild to moderate (+) aortic regurgitation is seen. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is no pericardial effusion. impression: corevalve aortic prosthesis in good position. posterior, mild to moderate paravalvular aortic regurgitation. . echo the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are focal calcifications in the aortic arch. an aortic corevalve prosthesis is present. the transaortic gradient is normal for this prosthesis. a mild (1+) paravalvular aortic valve leak is present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the aortic regurgitation is reduced. . # # # # # # # # ################################################################ please enter cta results # # # # # # # # ################################################################ brief hospital course: 80 yo male with history of cad s/p cabg x4, l mca cva with minimal residual r arm weakness, 100% l carotid occlusion, and previous symptomatic aortic stenosis now s/p corevalve procedure. . active issues: # severe symptomatic aortic stenosis: underwent succesful corevalve procedure. he was initially monitored in the ccu. his vitals were stable and he did not have any complications related to venous access or any conduction abnormalities. he was started on plavix and his aspirin was continued post procedure. . # possible tia: on he had a 20 minute epidose of expressive aphasia without any noted motor or sensory symptoms. md was made aware after episode resolved and there were no residual deficits on first evaluation. a cta of the head and neck was performed which showed complete occlusion of left cervical internal carotid artery with partial recanalization of the petrous and cavernous ica. an mri was not obtained as the patient has a pacemaker. tte showed no ventricular thrombus. neurology consultation recommended starting him on coumadin with asa and rosuvastatin for about 6 months or so and then switch him back to plavix/asa/rosuvastatin. he was started on coumadin the day prior to discharge with goal inr of .5. plan is to stop plavix when inr is at goal with plan to re-initiate plavix therapy after coumadin discontinued. . # htn - blood pressure was initially managed with nitroglycerin gtt. his losartan was continued. the amlodipine and hydrochlorothiazide were stopped as his blood pressure remained normotensive off these meds. . # rhythm: ppm, interrogated as per study protocol prior to procedure. post procedure interogation showed normal function.the p waves without the qrs are part of the pm programming thatoccasionally does not pace to evaluate pr interval to reduce ventricular pacing . chronic issues: . # cad: s/p cabg x 4 ()- aspirin was continued and plavix 300mg post procedure and 75mg daily afterwards was started. . # chf - secondary to severe as, ef>55% . #respiratory illness: he completed 10 day course of levofloxacin per pcp, day . # hyperlipidemia: he was continued on home crestor/niacin . issues of transitions in care: # code status: full # contact: relationship: wife phone number: daughter's cell ( ruffini) . # follow up regarding tia: transition from coumadin to plavix in about 6 months (). continue asa and rosuvastatin throughout treatment. . #follow up hypertension: home amlodipine and hctz were discontinued in hospital. need to re-initiate as outpatient if suboptimal bp control. medications on admission: medications - prescription avalox 400mg daily x 10 days (start date ) amlodipine - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth daily ezetimibe - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth daily fexofenadine ] - (prescribed by other provider) - 60 mg tablet - 1 (one) tablet(s) by mouth twice a day prn allergies hydrochlorothiazide - (prescribed by other provider) - 12.5 mg tablet - 1 (one) tablet(s) by mouth once daily in the morning losartan - (prescribed by other provider) - 100 mg tablet - 1 tablet(s) by mouth once a day omeprazole - (prescribed by other provider) - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth twice a day ropinirole - (prescribed by other provider) - 0.25 mg tablet - 1.5 (one and a half) tablet(s) by mouth once a day rosuvastatin - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth once a day tamsulosin - (prescribed by other provider) - 0.4 mg capsule, ext release 24 hr - 1 capsule(s) by mouth once a day tramadol - (prescribed by other provider) - 50 mg tablet - 1 tablet(s) by mouth as needed for pain medications - otc aspirin - (otc) - 81 mg tablet, chewable - 1 (one) tablet(s) by mouth once daily in the evening cholecalciferol (vitamin d3) - (prescribed by other provider) - 1,000 unit capsule - 1 capsule(s) by mouth once a day glucosamine-chondroitin - (prescribed by other provider) - dosage uncertain lactobacillus acidophilus - (prescribed by other provider) - 460 mg (20 billion cell) capsule - 2 capsule(s) by mouth daily niacin - (prescribed by other provider) - 500 mg capsule, extended release - 1 capsule(s) by mouth once a day discharge medications: 1. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 2. ezetimibe 10 mg tablet sig: one (1) tablet po hs (at bedtime). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 4. ropinirole 0.25 mg tablet sig: 1.5 tablets po hs (at bedtime). 5. rosuvastatin 20 mg tablet sig: two (2) tablet po hs (at bedtime). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 8. losartan 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. niacin 500 mg capsule, extended release sig: one (1) capsule, extended release po hs (at bedtime). 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. warfarin 2 mg tablet sig: 2.5 tablets po q evening for 6 months: take as directed pending lab results. disp:*100 tablet(s)* refills:*5* 12. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): stop when inr>2.0. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: coronary artery disease aortic stenosis transient ischemic attack secondary diagnosis: carotid occlusion discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. discharge instructions: dear mr. , you were admitted for corevalve procedure. you tolerated the procedure well but you did experience a transient ischemic attack, which is a small stroke. because of this, you will need to take coumadin for 6 months. it is important that you follow up with your physicians regarding your coumadin and regarding your corevalve. please note the following changes to your medications: - start coumadin - start multivitamin - change losartan from 100mg daily to 50mg daily - stop avalox - stop amlodipine - stop - stop hydrochlorothiazide - stop tramadol - stop glucosamine-chondroitin - stop lactobacillus please be sure to follow up with your physicians. it was a pleasure taking care of you at and we wish you all the best. followup instructions: department: cardiac services when: friday at 11:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 10:30 am with: device clinic building: sc clinical ctr campus: east best parking: garage procedure: angiocardiography of left heart structures left heart cardiac catheterization aortography intracardiac echocardiography endovascular replacement of aortic valve diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux congestive heart failure, unspecified unspecified essential hypertension aortocoronary bypass status aortic valve disorders peripheral vascular disease, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia other left bundle branch block aphasia examination of participant in clinical trial fitting and adjustment of cardiac pacemaker chronic diastolic heart failure cerebral embolism without mention of cerebral infarction late effects of cerebrovascular disease, hemiplegia affecting dominant side 

Answer: The patient is high likely exposed to