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: past medical history: 1. bilateral subdural hematomas in . 2. aortic mechanical valve replacement in . 3. hypertension. 4. ventricular pacer. 5. status post pda ligation. 6. copd secondary to tobacco use. 7. non-st elevation mi in . allergies: the patient has no known drug allergies. admission medications: 1. albuterol. 2. flovent. 3. lisinopril. 4. prevacid. 5. toprol xl. 6. coumadin 3 mg q.h.s. physical examination on admission: vital signs: temperature 98.3, blood pressure 107/60, heart rate 70, respiratory rate 18, saturating 97% on room air. general: this is a well-developed, well-nourished middle-aged female asleep in bed. heent: remarkable for pupils equal, round, and reactive to light without jugular venous distention. a dry oropharynx that was without other lesion. lungs: there was faint end-inspiratory stridor without wheezes. good air movement throughout all lung fields. cardiovascular: prominent s1, iii/vi systolic ejection murmur at the right upper sternal border and otherwise a regular rate and rhythm. abdomen: soft, nontender, nondistended, with positive bowel sounds. extremities: there were 2+ dorsalis pedis pulses, trace edema of the bilateral lower extremities. laboratory/radiologic data: the admission diagnostic studies revealed a white blood cell count of 11.2, hematocrit 40.2, platelets 368,000. sodium 141, potassium 4.7, chloride 100, bicarbonate 33, bun 30, creatinine 0.9, glucose 89. pt 16, ptt 23, inr 1.7. a ct of the chest revealed subglottic stenosis, mild intrathoracic tracheomalacia and multifocal air trapping consistent with a disease airway process such as asthma. hospital course: 1. partial airway obstruction: the initial ct scan demonstrated subglottic stenosis and potential tracheomalacia in the interthoracic trachea. the otolaryngology service and interventional pulmonology services were both consulted upon admission. endoscopic examination by the otolaryngology service on revealed poor vocal cord abduction and a concern for subglottic stenosis. the patient was scheduled for an elective tracheostomy on . the patient was taken to the or on by the otolaryngology service here at the and a surgical tracheostomy was placed without incident. following the operation, postoperative oozing was noted at the trachea site and a hematocrit was ordered revealing a drop from a preoperative level of 35 to the postoperative level of 28. the patient's heparin drip was held. the patient continued to have some oozing postoperatively and was transferred to the medical intensive care unit for hypotension in association with this hematocrit drop. she was then transferred back to the floor on but on began to have dyspnea and the sensation of partial airway obstruction. a bedside endoscopy revealed granulation tissue at the distal most aspect of the tracheostomy with bleeding within the lumen of the trachea. the patient was then taken to the operating room on the same day with clot removal and bronchoscopy per the interventional pulmonology team. postoperatively, she was taken to the medical intensive care unit, was stable from a respiratory standpoint, was transferred back to the floor and remained without respiratory complaint throughout the remainder of her hospital course. 2. aortic valve replacement: the patient's perioperative and postoperative courses were remarkable for continued oozing at the site of the tracheostomy. the continued risk for bleeding was balanced by the need for anticoagulation given her mechanical valve. the patient was maintained throughout her hospitalization on a heparin drip with fluctuating infusion rates given the need to maintain a goal ptt of 50-60 seconds. throughout her course, coumadin was held until the which was initiated in anticipation of discharge. 3. anemia: the patient's presenting hematocrit of 40 was likely due to a hemoconcentrated state since her baseline hematocrits since the previous year had been closer to 30-35. however, the patient was noted to have a guaiac positive stool on and a further laboratory examination of her anemia revealed likely hemolytic anemia secondary to her mechanical valve. the patient was transfused a total of 3 units of packed red blood cells and during the final week leading to her discharge had hematocrit stable above 35. 4. pulmonary: the patient had a history of copd and presented with respiratory distress with symptoms of partial airway obstruction. the patient remained asymptomatic from her asthma and copd throughout the hospitalization course and was provided with p.r.n. nebulized albuterol and atrovent as needed. 5. gastrointestinal: as noted above, the patient was discovered to have guaiac positive stools on during a period of time in which her ptt was supratherapeutic above the laboratories technical limit of 150 seconds. the remainder of her stools were guaiac negative. the patient was to arrange outpatient gi follow-up for a possible colonoscopy. condition on discharge: good. discharge status: to . discharge diagnosis: 1. partial airway obstruction. 2. anemia. 3. chronic obstructive pulmonary disease. 4. status post aortic valve replacement. 5. status post tracheostomy. discharge medications: 1. albuterol 1 unit inhalation q. 4-6 hours per nebulizer p.r.n. shortness of breath. 2. ipratropium unit inhalation q. 6 hours nebulized p.r.n. shortness of breath. 3. montelukast 10 mg tablet, one p.o. q.d. 4. darvocet one tablet p.o. q. six hours as needed. 5. prednisone 10 mg one tablet p.o. q.d. 6. pantoprazole 40 mg one tablet q. 12 hours. 7. zolpidem 5 mg one tablet p.o. q.h.s. as needed. 8. warfarin 5 mg one tablet p.o. q.d. with doses to be altered by primary care physician based on outpatient laboratory follow-up. follow-up plans: the patient is to call dr. at within one week for a follow-up appointment. the patient is also to contract dr. at within one week for a change of the tracheostomy and follow-up of the surgical site. disposition: the patient is being discharged to . , m.d. dictated by: medquist36 procedure: insertion of endotracheal tube other bronchoscopy other bronchoscopy other bronchoscopy temporary tracheostomy local excision or destruction of lesion or tissue of trachea diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute posthemorrhagic anemia hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified old myocardial infarction other tracheostomy complications other diseases of respiratory system, not elsewhere classified 

Answer: The patient is high likely exposed to