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: protamine attending: chief complaint: doe/chf major surgical or invasive procedure: - aortic valve replacement (19mm st. mechanical valve) history of present illness: the patient is an 80-year-old woman with diabetes and renal failure who presented with recurrent congestive heart failure. she was noted to have severe aortic stenosis. catheterization showed normal coronary arteries. it was elected to proceed with aortic valve replacement with mechanical valve. past medical history: 1)history of gib of unknown cause; numerous diverticula on c-scope 2) l colectomy with transverse colostomy for gib (d/c ) 3) diastolic chf (ef 65-75%) 4) s/p trach placement after prolonged intubation in icu (at time of colectomy) 5) severe as ( 0.7cm2, pk gradient 91mmhg, mean gradient 55mmhg on tte 6) htn 7) elevated cholesterol 8) diabetes type 2 9) ckd - baseline creat 2.5-3 10) bilat total knee replacment 11) multiple skin lesions removed by general and plastic surgery 12) hypothyroid social history: lives at home with husband, 3 sons and 1 daughter. is a non-smoker, no alcohol use, no history of illicit drug use. retired, former manager. no h/o ivdu. family history: no colon ca, otherwise unremarkable. has 3 sons and 1 dtr. physical exam: 63 sr 18 150/61 68" 222lbs gen: nad skin: unremarkable heent: unremarkable neck: supple, from lungs: cta heart: rrr, loud sem, nls1-s2 abd: soft, nt/nd, nabs ext: 2+ le edema, pulses palp except nonpalp dp. neuro: nonfocal, unsteady gait pertinent results: 08:15am blood wbc-4.5 rbc-3.25* hgb-10.1* hct-31.3* mcv-96 mch-30.9 mchc-32.1 rdw-16.3* plt ct-183 11:06am blood wbc-9.2# rbc-3.11*# hgb-9.8*# hct-29.3*# mcv-95 mch-31.4 mchc-33.2 rdw-17.1* plt ct-177 11:06am blood neuts-62.2 lymphs-36.5 monos-0.5* eos-0.7 baso-0.1 05:42am blood pt-16.1* ptt-70.5* inr(pt)-1.4* 08:15am blood pt-13.9* ptt-35.5* inr(pt)-1.2* 01:10pm blood pt-12.9 inr(pt)-1.1 06:38am blood pt-13.7* ptt-30.9 inr(pt)-1.2* 12:12pm blood pt-14.8* ptt-47.3* inr(pt)-1.3* 11:06am blood pt-15.7* ptt-48.0* inr(pt)-1.4* 08:15am blood glucose-109* urean-45* creat-5.0*# na-137 k-3.9 cl-101 hco3-27 angap-13 12:12pm blood urean-21* creat-2.9* cl-105 hco3-28 08:15am blood calcium-8.5 phos-3.5 mg-2.5 09:00am blood pth-290* cardiology report ecg study date of 7:58:44 am sinus rhythm. compared to previous tracing of no diagnostic change. read by: , intervals axes rate pr qrs qt/qtc p qrs t 79 124 104 422/455 57 20 71 radiology final report chest (portable ap) 2:59 pm chest (portable ap) reason: evaluate effusion - in hd please check with rn that pt on fl medical condition: 80 year old woman with s/p avr reason for this examination: evaluate effusion - in hd please check with rn that pt on floor indication: followup. findings: comparison to . the right-sided sheath in the jugular vein has been removed. all other invasive and monitoring devices are in unchanged position. the effusions are small and limited to the very area of the pleural sinuses. in unchanged manner, the silhouette of the heart is enlarged. slight aortic calcification. subtle signs of fluid overload. impression: cardiomegaly with signs of fluid overload, unchanged extent of bilateral pleural effusions. dr. dr. approved: mon 5:14 pm radiology preliminary report picc w/o port 12:01 pm reason: no iv access medical condition: 80 year old woman with s/p avr w/ chronic renal failure, on hd reason for this examination: no iv access picc line placement indication: iv access needed for antibiotics. the procedure was explained to the patient. a timeout was performed. radiologists: drs. and performed the procedure. dr. , the attending radiologist, was present and supervised the entire procedure. technique: using sterile technique and local anesthesia, the right brachial vein was punctured under direct ultrasound guidance using a micropuncture set. hard copies of ultrasound images were obtained before and immediately after establishing intravenous access. a peel-away sheath was then placed over a guidewire and a 5 french double-lumen picc line measuring 35 cm in length was then placed through the peel-away sheath with its tip positioned in the svc under fluoroscopic guidance. position of the catheter was confirmed by a fluoroscopic spot film of the chest. the peel-away sheath and guidewire were then removed. the catheter was secured to the skin, flushed, and a sterile dressing applied. the patient tolerated the procedure well. there were no immediate complications. impression: uncomplicated ultrasound and fluoroscopically guided 5 french double-lumen picc line placement via the right brachial venous approach. final internal length is 35 cm, with the tip positioned in svc. the line is ready to use. dr. dr. preliminaryapproved: mon 4:48 pm echocardiography report , (complete) done at 10:14:31 am final referring physician information , w. , status: inpatient dob: age (years): 80 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: abnormal ecg. aortic valve disease. congestive heart failure. dizziness. hypertension. left ventricular function. pulmonary hypertension. icd-9 codes: 428.0, 402.90, 786.05, 440.0, 424.1 test information date/time: at 10:14 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 #: 2007aw2-: machine: echocardiographic measurements results measurements normal range left ventricle - inferolateral thickness: *1.5 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 45% to 55% >= 55% aorta - ascending: 3.0 cm <= 3.4 cm aortic valve - peak velocity: *3.0 m/sec <= 2.0 m/sec aortic valve - peak gradient: *40 mm hg < 20 mm hg aortic valve - valve area: *0.8 cm2 >= 3.0 cm2 findings left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. no asd by 2d or color doppler. left ventricle: moderate symmetric lvh. normal lv cavity size. mildly depressed lvef. right ventricle: rv hypertrophy. mildly dilated rv cavity. borderline normal rv systolic function. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. normal ascending aorta diameter. simple atheroma in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. moderately thickened aortic valve leaflets. no masses or vegetations on aortic valve. moderate-severe as (area 0.8-1.0cm2). trace ar. mitral valve: moderately thickened mitral valve leaflets. moderate mitral annular calcification. calcified tips of papillary muscles. mild (1+) mr. tricuspid valve: mild tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. 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 mildly dilated. no atrial septal defect is seen by 2d or color doppler. 2. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 45-50%). 3. the right ventricular free wall is hypertrophied. the right ventricular cavity is mildly dilated. right ventricular systolic function is borderline normal. 4. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). trace aortic regurgitation is seen. the annulus is heavilyb calcified and measures 19 mm. 6. the mitral valve leaflets are moderately thickened. mild (1+) mitral regurgitation is seen. 7. there is a trivial/physiologic pericardial effusion. post-cpb: on infusions of epinephrine and levophed. well-seated mechanical valve in the aortic position. no ai. as gradient 20 peak, 13 mean at cardiac output of 7 l/min. preserved lv systolic function on inotropic support. mild inferior hypokinesis. lvef=50%. flow seen in lmca and rca. protamine reaction with hypotension and cco=8-9 l/min. rx'd epi boluses. lv sax shows underfilled lv with good systolic function. aorta intact post decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 16:50 brief hospital course: ms. was admitted to the on for surgical management of her aortic valve disease. she was taken directly to the operating room where she underwent an aortic valve replacement using a 19mm st. mechanical valve. please see operative note for details. postoperatively she was taken to the intensive care unit for monitoring. on postoperative day one, she underwent dialysis to remove volume. on postoperative day two, she awoke neurologically intact and was extubated. coumadin was started for anticoagulation. she was later transferred to the step down unit for further recovery. the physical therapy service was consulted for assistance with her postoperative strength and mobility. the renal service continued to follow her and she continued with hemodialysis as prior to surgery. she was started on heparin while her inr was subtherapeutic. the heparin should continue until her inr is 2. she is due for hd wednesday . medications on admission: lasix 100", fluticasone 50', diovan 160", levothyroxine 75', hydrazaline 50"', labetolol 400", procrit q mon, protonix 40', simvastatin 20', iron 325' discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: 1000 (1000) units/hr intravenous asdir (as directed): goal ptt 60-80 do not bolus discontinue when inr > 2.0 . 4. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 5. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 6. picc line picc line care per protocol 7. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. warfarin 1 mg tablet sig: goal inr 2.5-3.0 tablets po daily (daily) as needed for mech avr: please dose based on inr result - goal inr 2.5-3.0 with pt/inr checked daily until off heparin and then mon/wed/fri for continued dosing . she has received 3mg coumadin and 5mg coumadin and discharge disposition: extended care facility: hospital/radius discharge diagnosis: aortic stenosis s/p avr s/p aortic valvuloplasty chf (diastolic dysfunction lvef 65% diabetes mellitus cri baseline creatinine 3.0 hypothyroid gib obesity s/p vein stripping discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for 1 month. 7) call with any questions or concerns followup instructions: follow-up with dr. in 1 month. ( follow-up with dr. after discharge from rehab follow-up with pcp . after discharge from rehab follow up with dr please call all providers for appointments. scheduled appointments: provider: , m.d. phone: date/time: 10:40 dialysis - please refer back to when dc from rehab provider: , md phone: date/time: 9:20 procedure: extracorporeal circulation auxiliary to open heart surgery hemodialysis open and other replacement of aortic valve diagnoses: end stage renal disease pure hypercholesterolemia congestive heart failure, unspecified unspecified acquired hypothyroidism aortic valve disorders other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease knee joint replacement diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure 

Answer: The patient is high likely exposed to