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: history of present illness: this is a 74-year-old female patient who transferred to the from hospital on the night of , with a chief complaint of shortness of breath and chest pain. she was actually admitted to brochton history for right lower extremity cellulitis on . she was started on intravenous unasyn; however, she developed shortness of breath and substernal chest pain and desaturated to 80%. she had an electrocardiogram at that time which showed new onset atrial fibrillation with a left bundle branch block. the patient was placed on oxygen, and she was treated with morphine and intravenous diuretics at that time. her oxygen saturation improved, and her atrial fibrillation rate was controlled with metoprolol, and digoxin was started. she was placed on intravenous heparin. the patient was ultimately scheduled for cardiac catheterization; however, this was deferred secondary to bacteremia which was documented around at hospital. it was found to be coag-negative staph for which she was placed on unasyn. the patient has had some episodes at hospital of congestive heart failure, and she was ultimately transferred to the for cardiac catheterization. past medical history: atrial fibrillation of new onset during the admission at hospital. hypertension. aortic stenosis treated with an aortic valve replacement in with a mechanical valve. this was performed at , and the patient has been on coumadin therapy for her mechanical aortic valve. diabetes mellitus since . hypercholesterolemia. she is status post right carotid endarterectomy. she is status post cardiac catheterization in with an angioplasty to an unknown vessel at the time. she is also status post coronary artery bypass grafting. she also has a history of depression. medications on transfer: lopressor 100 mg b.i.d., aspirin 325 mg q.d., plavix 75 mg q.d., zocor 40 mg q.d., isosorbide dinitrate 20 mg t.i.d., digoxin 0.125 mg q.d., glipizide 5 mg p.o. b.i.d., vancomycin 1 g to be given p.r.n. dosing for a level of less than 15, unasyn 3 g iv q.8 hours. physical examination: general: she was anxious appearing. she was alert and oriented times three. vitals signs: temperature 98.1??????, heart rate 85-120 in atrial fibrillation, blood pressure 118/70, respirations 32, oxygen saturation on 4 l nasal cannula ranged from 88-95%. lungs: she had bibasilar crackles with expiratory wheezes. heart: irregular with no murmur noted. there was a mechanical s2. abdomen: soft, nontender, nondistended. positive bowel sounds. extremities: her right lower extremity did have notable erythema with 2+ edema. she had palpable dorsalis pedis pulse on the left, and doppler signal dorsalis pedis on the right. hospital course: the patient was managed on the medicine service and ultimately taken to the cardiac catheterization lab on . this revealed an 80% distal left main coronary artery occlusion, as well as two-vessel disease. she was also noted to have iliac artery atherosclerosis, marked systemic and pulmonary arterial desaturation, as well as elevated pulmonary artery wedge pressure. an intra-aortic balloon was deferred at that time due to significant history of peripheral vascular disease. cardiothoracic surgery consultation was obtained on , by dr. . it was recommended that the patient receive continued intravenous antibiotic therapy for the thrombophlebitis in her leg, as well as two reverse her anticoagulation from her coumadin usage with vitamin k. the patient was ultimately taken to the operating room on , where she underwent redo coronary artery bypass graft with a lima to the left anterior descending, saphenous vein to the diagonal, and saphenous vein to the posterior descending artery. she also had placement of an intra-aortic balloon pump. this was performed by dr. . postoperatively the patient was transported to the cardiac surgery recovery unit. she was continued to be followed by the infectious disease service, as well as pulmonary medicine. postoperatively she was on amiodarone, dobutamine, neo-synephrine, propofol, and insulin intravenous infusion. her cardiac index ranged from 1.5 to 2.3 during the first 24-48 hours, and this was treated with intravenous dobutamine. dobutamine was ultimately weaned off. she remained on amiodarone. nitroglycerin was added, and her balloon pump was weaned to , and she was started on diuretics on postoperative day #2. the patient remained on the ventilator but was weaning to cpap with pressure support mode at that time. she was awake, alert and oriented and following commands appropriately. later in the day on postoperative day #2, the patient was noted to have worsening ventilator parameters with periods of desaturation after extubation, and she was urgently reintubated. the patient also had some acidosis which was treated with sodium bicarbonate, and the patient was restarted on dobutamine at 5 mcg/kg/min. she was placed on a heparin infusion because of her mechanical aortic valve. she remained on neo-synephrine at this time, and propofol and amiodarone drips. over the next 24-48 hours, the patient continued to have increasing need for pressors and inotropes. she had en echocardiogram which showed a diminished ejection fraction postoperatively, as well as some signs of fluid overload. she was in atrial fibrillation on and 25, and unsuccessful attempts were made at cardioversion. the patient was ultimately taken to the cardiac catheterization lab on due to continued need for pressors and inotropes and decreased left ventricular ejection fraction by echocardiogram. in the catheterization lab on , she had ptca with stent placement to the lima to the left anterior descending graft, and the patient was taken back to the cardiac surgery recovery unit. the patient remained somewhat tachycardiac on dobutamine with a cardiac index of approximately 2. the patient was placed on natrecor per the heart failure service, dr. . she was also placed on bumex with attempts to aggressively diurese her after her events over the previous two days, and she was changed from levophed to vasopressin. the patient remained in the intensive care unit on pressors and inotropes over the course of the next few days; however, on , she was taken to the cardiac catheterization lab for placement of an intra-aortic balloon pump due to continued need for support in the intensive care unit. the patient was maintained in the intensive care unit on levophed, milrinone, natrecor and propofol drips, as well as an intravenous heparin drip. she was begun on tube feeds. her creatinine had started to rise until she went into renal failure requiring cvvh treatment in the intensive care unit. renal consultation was obtained on . their recommendation initially was to discontinue the natrecor and the intra-aortic balloon pump which were both done without resolution of her renal failure. it was also their recommendation of the heart failure service to initiate cvvh at this time; however, the renal service felt that the patient required more diuretics and requested that the diuretics be increased prior to initiation of cvvh for fluid overload. on , an electrophysiology consult was requested due to history of paroxysmal ventricular tachycardia, as well as atrial fibrillation. it was their recommendation to continue amiodarone, as well as lidocaine, as the patient had previously on had ventricular tachycardia necessitating defibrillation. the electrophysiology service recommended continuing the amiodarone iv drip, as well as to continue lidocaine. on , the patient had recovered from her ventricular tachycardia arrest the previous day. she remained on amiodarone and dobutamine drips, as well as heparin, insulin, lidocaine, and neo-synephrine. she was also maintained on plavix. over the next few days, the patient's intra-aortic balloon pump was discontinued with manual pressure placement on the groin for 40 min; however, the patient was noted on to have developed a rectus sheath hematoma. at this time, her heparin was held for a short period. on , the patient was begun on cvvh due to the need to get fluid off of her, as well as continuing renal insufficiency. her neo-synephrine was ultimately weaned off over the next couple of days. she began to make progress from a hemodynamic standpoint. she was maintained on amiodarone; however, was not progressing with ventilator weaning. she developed bacteremia with gram-negative rods in her blood, as well as in her sputum. she also developed yeast in her urine for which she was placed on appropriate antibiotics. the patient was ultimately extubated and reintubated once again. she was reintubated on due to increased work of breathing and respiratory failure. the patient underwent bronchoscopy at the time of reintubation or shortly thereafter which was ultimately clear with minimal secretions. on , the patient was attempted on a wean from the ventilator with hopes of extubating her again, which she failed. the following day on the 13th, she was weaned again from the ventilator and ultimately extubated. she remained extubated for approximately 48 hours, when she required urgent reintubation due to oxygen saturation of 80% and tachypnea and respiratory distress. the patient underwent tracheostomy on , and she underwent feeding tube placement on . she had a picc line placed on . the patient continued, actually during the time of tracheostomy, with ventricular tachycardia which deteriorated to ventricular fibrillation requiring cardioversion. the electrophysiology service was reconsulted to assess whether it would be appropriate for the patient to have an aicd placed. the patient remained in the cardiac surgery recovery unit over the next few days on intravenous heparin drip, as well as intravenous neo-synephrine drip for some hypotension. the patient's renal function did recover and was able to maintain appropriate fluid balance with the use of diuretics, and cvvh was discontinued. the patient was started on caspofungin for blood cultures which were positive for yeast. the patient was taken to the electrophysiology lab where she underwent aicd placement on . the patient tolerated the procedure well. she remained on neo-synephrine drip at that time. she had successful placement of an defibrillator and was transported to the cardiac surgery recovery unit postprocedure, however, was hypotensive, having increasing neo-synephrine requirements and ultimately required transfusion of 2 u packed red blood cells postprocedure. the patient apparently had a significant intraoperative blood loss during her icd placement. the patient was fluid resuscitated at that time, and on the morning of the 26th, she began to have significant episodes of ventricular tachycardia progressing to ventricular fibrillation requiring multiple defibrillation over the next 24 hours, occurring mostly of . she underwent an echocardiogram at that time which revealed fixed anterior leaflet of her prosthetic aortic valve which was immobile possibly due to thrombus, and this was a new finding since she had a transesophageal echocardiogram on . this was treated in the intensive care unit with tpa over the next 24 hours, and a repeat echocardiogram was performed on . this showed a significant improvement with a significant decrease in her aortic valve peak and mean gradient, and the valve was thought to be functioning much more appropriately after being treated with the tpa infusion. on , most likely as the result of her tpa infusion, the patient had an increasing hematoma in the pocket of the aicd in her left anterior chest for which she was taken to the operating room. after her valve was opened with the thrombolytics, her ventricular tachycardia abated. the patient remained in the cardiac surgery recovery unit with some decreased in ventilatory support. she was maintained on her goal of tube feeds, which she had been tolerating well. she was most of the time av paced with her device that had been recently placed. the patient had begun trials with a trach mask and a passy-muir valve, which she was tolerating for short periods at a time well. she remained hemodynamically stable. on and 7, the patient was noted to have an elevated white blood cell count which was felt to be pulmonary in origin, since she had a questionable new infiltrate on her chest x-ray. she required increased ventilatory support and increased fio2; however, over the next 48 hours, she was decreased back to her baseline ventilator settings. she remains hemodynamically stable today , and is ready to be discharged to a rehabilitation facility. condition on discharge: heart rate 90, and she is av paced. blood pressure 94/40. she remains afebrile. white blood cell count today is 12.6. her hematocrit is 27, and her platelet count is 216,000. the patient's prothrombin time is 14.6, inr 1.4, ptt 78.9 on intravenous heparin drip. her chem7 from today revealed a sodium of 140, potassium 3.9, chloride 96, co2 34, bun 63, creatinine 1.1, glucose 156. her physical exam revealed coarse breath sounds bilaterally. her incisions are clean, dry, and intact. her abdomen is soft, nontender, nondistended at this time. she remains on tube feeds, promote with fiber, at 55 cc/hr, which is her goal. discharge diagnosis: 1. redo coronary artery bypass graft times three on , with a lima to the left anterior descending, saphenous vein to the posterior descending artery, and saphenous vein to the diagonal. on , she underwent tracheostomy for respiratory failure and pneumonia. on , she underwent percutaneous endoscopically placed gastrostomy tube. on , she underwent automatic implantable cardiovascular defibrillator placement. on , she underwent surgical evacuation of an aicd hematoma. 2. atrial fibrillation, ventricular fibrillation. 3. hypertension. 4. diabetes mellitus, type 2. 5. right carotid endarterectomy. 6. hypercholesterolemia. 7. cellulitis. 8. peripheral vascular disease. 9. depression. 10. thrombosis of prosthetic heart valve and thrombolysis with tpa. discharge medications: aldactone 25 mg p.o. q.d., lasix 80 b.i.d., zaroxolyn 5 q.d., amiodarone 400 q.d., levothyroxine 25 q.d., this was started postoperatively and should be followed with appropriate lab values for continuing thyroid replacement therapy, vitamin c 500 mg q.d., multivitamin 1 q.d., zinc 220 q.d., aspirin 325 q.d., coumadin 3 mg q.d. with a target inr of 3.0, and this is anticoagulation for a mechanical aortic valve, she remains on a heparin iv infusion at 1050 u/hr with a target ptt of 60-80, until her inr is above 2.5, and then this heparin may be discontinued when her coumadin is dosed to give her an inr above 2.5, albuterol 2 puffs q.6 hours, lansoprazole 30 mg q.d., glipizide 10 mg b.i.d., santal ointment b.i.d. to her leg wound with saline wet-to-dry dressing to cleanse in between santal, percocet p.r.n., sliding scale regular insulin coverage for blood glucose of 150-200 she receives 3 u subcutaneous regular insulin, 201-250 6 u, 251-300 9 u. discharge instructions: the patient's tube feeding through her peg tube is promote with fiber at 55/hr which is her goal. she needs to have her coagulation parameters monitored very closely until she is on a stable coumadin dose. follow-up: the patient is to follow-up with dr. in electrophysiology here at upon discharge from rehabilitation. she is also to follow-up with dr. of the cardiothoracic surgery service upon discharge from rehabilitation. her cardiothoracic surgery office number is . in addition, she should follow up with her referring pcp . . , m.d. dictated by: medquist36 procedure: extracorporeal circulation auxiliary to open heart surgery insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries injection or infusion of platelet inhibitor enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis temporary tracheostomy implant of pulsation balloon implant of pulsation balloon implantation or replacement of automatic cardioverter/defibrillator, total system [aicd] diagnoses: acidosis subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery coronary atherosclerosis of autologous vein bypass graft hematoma complicating a procedure paroxysmal ventricular tachycardia acute respiratory failure cardiogenic shock 

Answer: The patient is high likely exposed to