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: heparin agents attending: chief complaint: chest pain when lying flat, dyspnea on exertion major surgical or invasive procedure: redo/redo sternotomy/coronary artery bypass graft x3 (left internal mammary artery to left anterior descending, saphenous vein graft to obtuse marginal, saphenous vein graft to posterior descending artery)/ aortic valve replacement (. mechanical)/mitral valve repair (28 mm cg future ring) mediastinal washout and closure history of present illness: 61 yof w/ a h/o aortic stenosis and cad s/p avr x 2 (initially bioprosthetic valve which was replaced with mechanical valve, on coumadin) and cabg x 2 (svg to om, svg to rca, re-do with svg to pda) was recently admitted to the with prosthetic valve endocarditis returns with dyspnea on exertion and chest pain. the patient states over the past 1 week he has noticed worsening dyspnea on exertion. he states that especially in the afternoon just ambulating across the room causes dyspnea. the dyspnea is associated with palpitations. he has non exertional chest pain also at night when he lies down to go to bed, it is a dull l chest sensation and radiates to his l arm. no orthopnea or pnd. minimal le swelling which is "baseline." he has a lb weight gain. he stopped taking his lasix 6 days ago as his le edema was improving. (although he states his symptoms preceeded his lasix discontinuation) . the patient had been on 6 weeks of antibiotics for his strep viridans bactermia / endocarditis which had finished on . no f/c, no sweats. minimal non productive cough. no other symptoms. referred for surgical eval. past medical history: hypertension dyslipidemia coronary artery disease s/p nstemi s/p 2.5x8mm cypher des to lcx proximally and four (4)overlapping 2.5x12mm promus rheumatic fever atrial fibrillation past surgical history: s/p aortic valve replacement (25 mm ce pericardial valve)/coronary artery bypass graft x 2 (svg->om, svg->rca)@ s/p aortic valve replacement (st. 21mm mechanical)/coronary artery bypass graft x 1 (svg->pda) with dr. s/p left elbow w/2 screws still in place s/p right ankle surgery social history: lives alone previously worked as a truck driver smoked 1+ ppd x 40 years no etoh or recreational drugs family history: cad and s/p cabg in mother and cva in father (died of cva at 49) physical exam: temp 98.0 pulse:116 resp:20 o2 sat:97%ra b/p 110/79 height: 6'1" weight: 210 (pre-op) general:nad, sitting up, appears comfortable skin: dry intact heent: perrla neck: supple full rom chest: lungs clear bilaterally crackles at bases heart: rrr tachycardic irregular i-ii/vi sem murmur valve abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema varicosities: none has endoscopic vein harvest sites on ble neuro: grossly normal pulses: femoral right: +2 left: +2 dp right: +2 left: +2 pt : +2 left: +2 radial right: +2 left: +2 carotid bruit right: ? soft bruit left: none pertinent results: echo: prebypass: very poor images of the ascending aorta. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). with mild global rv free wall hypokinesis. the aortic root is moderately dilated at the sinus level. a mechanical aortic valve prosthesis is present. motion of the aortic valve prosthesis leaflets/discs is abnormal. there is dehiscence noted of the prosthetic aortic valve.mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the leaflets are tethered. no obvious vegetatiion seen on the mitral valve. severe (4+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. dr. was notified in person of the results on at 930am. post bypass: patient is av paced and receiving an infusion of levophed, milrinone, vasopressin and epinephrine. lvef= 40%. rv mildly hypokinetic. mechanical valve seen in the aortic position. with limited views it appears well seated and the leaflets move well. annuloplasty ring seen in the mitral position. it appears well seated but there is 2+ mitral regurgitation. the moderate to severe tricuspid regurgitation persists. unable to visualize the aorta completely post decannulation. liver u/s: cholelithiasis without evidence of acute cholecystitis. small right pleural effusion. limited exam. abd mri: 1. gallstone within the gallbladder, without evidence of acute cholecystitis. 2. the common bile duct and intrahepatic bile ducts are of normal caliber with no evidence of obstruction. 3. significant subcutaneous emphysema (which has been present on recent chest radiographs. 04:39am blood wbc-8.2 rbc-3.74* hgb-10.7* hct-33.2* mcv-89 mch-28.5 mchc-32.1 rdw-17.4* plt ct-281 05:46am blood wbc-8.4 rbc-3.78* hgb-11.3* hct-34.1* mcv-90 mch-30.0 mchc-33.2 rdw-17.1* plt ct-275 05:23am blood wbc-10.4 rbc-4.11* hgb-11.2* hct-36.6* mcv-89 mch-27.3 mchc-30.7* rdw-17.2* plt ct-294 04:39am blood wbc-12.1* rbc-4.03* hgb-11.7* hct-36.1* mcv-90 mch-29.1 mchc-32.4 rdw-16.9* plt ct-264 04:39am blood pt-22.6* ptt-34.8 inr(pt)-2.1* 05:46am blood pt-25.3* ptt-35.6* inr(pt)-2.4* 05:23am blood pt-27.5* ptt-35.6* inr(pt)-2.7* 04:39am blood pt-21.9* ptt-33.1 inr(pt)-2.0* 05:40am blood pt-27.8* inr(pt)-2.7* 05:10am blood pt-34.0* ptt-37.3* inr(pt)-3.5* 05:53am blood pt-36.5* ptt-38.4* inr(pt)-3.8* 04:39am blood glucose-88 urean-30* creat-0.6 na-134 k-4.4 cl-98 hco3-28 angap-12 05:46am blood glucose-85 urean-29* creat-0.9 na-134 k-4.2 cl-98 hco3-29 angap-11 05:23am blood glucose-89 urean-28* creat-0.8 na-136 k-4.2 cl-99 hco3-29 angap-12 04:39am blood glucose-99 urean-31* creat-0.9 na-134 k-4.8 cl-98 hco3-27 angap-14 05:40am blood glucose-100 urean-37* creat-1.0 na-134 k-3.9 cl-99 hco3-28 angap-11 05:10am blood glucose-106* urean-36* creat-0.6 na-137 k-4.1 cl-101 hco3-27 angap-13 04:39am blood alt-68* ast-86* ld(ldh)-406* alkphos-165* amylase-65 totbili-14.4* 05:46am blood alt-70* ast-92* ld(ldh)-480* alkphos-179* amylase-70 totbili-16.0* dirbili-14.4* indbili-1.6 05:23am blood alt-62* ast-87* ld(ldh)-523* alkphos-178* totbili-17.7* 04:39am blood alt-66* ast-90* ld(ldh)-582* alkphos-186* amylase-78 totbili-21.5* 05:40am blood alt-70* ast-98* ld(ldh)-614* alkphos-188* amylase-104* totbili-21.1* 05:10am blood alt-72* ast-104* alkphos-167* amylase-123* totbili-21.2* dirbili-17.1* indbili-4.1 05:53am blood alt-72* ast-105* alkphos-159* amylase-154* totbili-20.2* 05:42am blood alt-77* ast-120* ld(ldh)-645* alkphos-165* amylase-233* totbili-19.4* dirbili-15.0* indbili-4.4 03:00am blood alt-84* ast-138* alkphos-152* amylase-246* totbili-19.3* 02:12am blood alt-89* ast-151* alkphos-136* amylase-198* totbili-18.1* 02:13am blood alt-93* ast-162* alkphos-119 amylase-137* totbili-17.6* 04:39am blood albumin-3.1* calcium-8.8 phos-3.4 mg-2.0 05:46am blood albumin-2.6* calcium-8.4 phos-3.0 mg-2.1 08:10am blood %hba1c-6.1* eag-128* 07:50am blood tsh-3.4 04:39am blood ama-negative 09:14pm blood ama-negative smooth-positive 04:39am blood -negative 04:39am blood igg-1270 igm-726* 04:39am blood vanco-13.8 brief hospital course: 61 yom w/ a h/o as s/p mechanical valve, cad s/p cabg and recent admission for prosthetic valve endocarditis presents with dyspnea on exertion and chest pain. . # ? of aortic valve dehiscence on echo. concern for persistent endocarditis with valve destruction. appreciate input: 1) csurg - cta chest + tee 2) id - vanc + ctx, tee 3) referred for surgery . # dyspnea on exertion: possibly from above.. nyha iii heart failure symptoms. given exam, weight gain, discontinuation of lasix most suggestive of heart failure, possibly triggered by cessation of lasix in setting of continued tachycardia (causing tachymyopathy). . # atrial arrhythmia: while inpatient , the patient had atrial fibrillation as well as possible atrial flutter vs. atrial tachycardia. he was never cardioverted and had no history of atrial arrhythmias prior to admission. he was initiated on amiodarone and has finished a load, currently on 200mg po daily. currently on physical exam and telemetry, has been atrial tachycardic. - patient has been intolerant of beta blockers in the past given his copd (significant bronchospasms) - continue diltiazem 30mg four times daily for now and uptitrate as hr and bp tolerates (patient unsure if taking, discharged on 120mg cr daily) . # chronic shoulder pain: continue oxycontin 10mg po qhs as patient still unsure of dose - will start low. pre-op workup completed and underwent surgery with dr. on . transferred to the cvicu in fair condition with a packed open chest on levophed, vasopressin, epinephrine, and milrinone drips. returned to or on for washout,closure and dccv and then back to icu on same 4 drips plus titrated propofol. id was further for abx mgmt. seen by gen. for elevated lfts. coumadin started for mechanical valve. extubated on pod #5. deep tissue injury noted to sacral area and treatment continued with recs from wound care nurse. for continuing elevated lfts.scan showed gallstones without obstruction of ducts. he was pan-cultured. transfered to the floor on pod #11 to begin increasing his activity level. also followed by clinical nutrition team. ep consult done for further a fib mgmt. digoxin and eplenerone started. vancomycin and cefepime started per for liver dz. abx will continue through . he is cleared for discharge to rehab by dr. on . appropriate follow up is advised. medications on admission: plavix 75mg daily asa 325mg daily lisniopril 5mg daily amiodarone 200mg po daily coumadin 2.5mg daily lipitor 40mg daily flexeril prn discharge medications: 1. dressing leg right groin with small 1 cm opening due to not well approximated when staples removed for mri - no drainage or odor, continue with wet to dry dressing changes tid 2. outpatient lab work labs cbc, sma 7, pt/ptt, lft with total and direct bilirubin on - please fax results to dr liver center fax 3. outpatient lab work daily inr until off antibiotics and lft normalized then three times a week for coumadin dosing goal inr 2.5-3.0 for coumadin dosing mechanical avr 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 6. picc line per protocol - heparin free due to allergy - flush with saline 7. warfarin 1 mg tablet sig: goal inr 2.5-3.0 tablets po once a 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 10. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 11. eplerenone 25 mg tablet sig: one (1) tablet po daily (daily). 12. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 13. temazepam 15 mg capsule sig: one (1) capsule po hs (at bedtime) as needed for insomnia. 14. cyclobenzaprine 10 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for pain. 15. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 16. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 17. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 18. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily). 19. lasix 40 mg tablet sig: one (1) tablet po once a day. 20. cefepime 2 gram recon soln sig: two (2) gram intravenous q12h (every 12 hours): 7 day course per liver attending completes after pm dose . 21. vancomycin 1,000 mg recon soln sig: 1250 (1250) mg intravenous q 12h (every 12 hours): 7 day course per liver attending completes after pm dose please check trough before am dose goal 15-20. 22. statin due to liver dysfunction - statin stopped - will need to resume when clears to restart - please re evaluate after labs draw in 1 week discharge disposition: extended care facility: of - , nh discharge diagnosis: endocarditis/?dehiscence of prior prosthetic aortic valve cholelithiasis past medical history: hypertension dyslipidemia coronary artery disease s/p nstemi s/p 2.5x8mm cypher des to lcx proximally and four (4)overlapping 2.5x12mm promus rheumatic fever atrial fibrillation past surgical history: s/p aortic valve replacement (25 mm ce pericardial valve)/coronary artery bypass graft x 2 (svg->om, svg->rca)@ s/p aortic valve replacement (st. 21mm mechanical)/coronary artery bypass graft x 1 (svg->pda) with dr. s/p left elbow w/2 screws still in place s/p right ankle surgery discharge condition: alert and oriented x3 nonfocal does not ambulate; requires 2 person assist deconditioned incisional pain managed with oxycodone/cyclobenzaprine incisions: sternal - healing well, no erythema or drainage leg right - healing well, no erythema or drainage, ecchymosis edema :2+ discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage 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 **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: , md phone: date/time: 1:45 pm liver: , md phone: date/time: 10:30 please call to schedule appointments with your primary care/cardiologist: dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? mechanical valve/atrial fibrillation goal inr : 2.5-3.0 (mechanical aortic valve and a fib) first draw please check inr daily and dose coumadin based on results due to changing liver function dosing is progressively going up - when lft stable and off antibiotics - please check three times a week inr coumadin 04:39 2.1* - 5 mg source: line-pic 05:46 2.4* - 2 mg source: line-picc 05:23 2.7* - 1 mg source: line-picc 04:39 2.0* - 2.5mg source: line-picc 05:40 2.7* - 2.5 mg source: line-right picc 05:10 3.5* - 1 mg source: line-right picc 05:53 3.8* - 1 mg source: line-picc 05:42 4.4* - none 03:00 5.7*1 - none 02:12 4.4* - none source: line-rij 02:13 5.7*2 - none source: line-arterial 11:54 5.7*3 - none source: line-aline 03:10 5.1*4 - none source: line-aline 02:42 3.6* - none source: line-a-line 03:10 2.3* - 2.5 mg source: line-aline 14:00 1.9* - 2 mg source: line-aline 05:16 1.8* ---- source: line-art 22:07 1.7*5 - 2 mg source: line-art; heparin dose: 700 01:40 1.6* - 2 mg source: line-a-line 10:06 1.6* source: line-a line 01:31 1.4* labs cbc, sma 7, pt/ptt, lft with total and direct bilirubin on - please fax results to dr liver center fax procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries left heart cardiac catheterization diagnostic ultrasound of heart other electric countershock of heart open and other replacement of aortic valve other repair of chest wall annuloplasty other conversion of cardiac rhythm diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified other chronic pain anemia, unspecified coronary atherosclerosis of native coronary artery toxic encephalopathy unspecified essential hypertension thoracic aneurysm without mention of rupture coronary atherosclerosis of autologous vein bypass graft atrial fibrillation atrial flutter percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia heart valve replaced by other means anxiety state, unspecified mechanical complication due to heart valve prosthesis ostium secundum type atrial septal defect pressure ulcer, buttock calculus of gallbladder without mention of cholecystitis, without mention of obstruction acute and subacute bacterial endocarditis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation chronic obstructive asthma, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus subendocardial infarction, subsequent episode of care diseases of tricuspid valve other abnormal glucose pain in joint, shoulder region rheumatic mitral insufficiency other specified disorders of liver infection and inflammatory reaction due to cardiac device, implant, and graft other ill-defined heart diseases encounter for planned post-operative wound closure pressure ulcer, unstageable 

Answer: The patient is high likely exposed to