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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea major surgical or invasive procedure: aortic valve replacement utilizing a 25mm st. porcine valve history of present illness: this is a 78 year old male with severe aortic stenosis and a history significant for atrial fibrillation on coumadin, hypertension, dyslipidemia, history of dvt/phlebitis s/p filter placement & removal, copd and a history of respiratory failure. an echo by dr on demonstrated progressive aortic stenosis with 0.9, peak gradient 80/mean 45, mild mr/ tr. lvef 65%. he reports shortness of breath on exertion only, such as climbing one flight of stairs, carrying a bag from car, or walking up an incline. this has been getting worse over the past 6 months. he also reports bilateral ankle edema. he was referred for right and left heart catheterization. he is now being referred to cardiac surgery for an aortic valve replacement. past medical history: severe aortic stenosis atrial fibrillation, on coumadin hypertension dyslipidemia history of dvt/phlebitis in post -op state, s/p filter placement & removal copd history of respiratory failure osa, uses cpap history of pneumonia, remote obesity hypothyroidism history of prostate cancer, s/p turp radiation proctitis ed diverticular disease osteoarthritis with bilateral knee pain gerd renal insufficiency, per patient hernia rhematoid arthritis s/p cataract surgery, bilateral s/p turp s/p arthroscopic knee surgery s/p 3 hernia repairs social history: lives with: wife occupation:retired cigarettes: quit 40 years ago, smoked for 15 years 2 packs/day etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use: denies family history: no premature coronary artery disease physical exam: preop exam pulse:50 resp:16 o2 sat:100/ra bp right:119/57 left:132/59 height: 6' weight: 238 lbs general: wdwn elderly male in nad skin: dry intact heent: perrla eomi cataract surgery x 2 neck: supple full rom chest: lungs clear bilaterally distant lung sounds heart: rrr irregular murmur grade _2/6 systolic _ abdomen: soft non-distended non-tender bowel sounds+ , obese, diastasis extremities: warm , well-perfused edema ___1+__ varicosities: none neuro: grossly intact pulses: femoral right: 2 left: 2 dp right: 1 left: 1 pt : 1 left: 1 radial right: 2 left: 2 carotid bruit right: no left: no discharge: gen nad neuro a&o x3, mae, nonfocal exam pulm cta diminished bases bilat cv irreg-irreg, sternum stable, incision-cdi abdm soft, nt/nd/nabs ext warm, well perfused. 2+ edema bilat pertinent results: echo pre bypass: the left atrium is mildly dilated. mild spontaneous echo contrast is present in the left atrial appendage. a probable thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. the right atrium is markedly enlarged. there are complex (>4mm) atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. trivial mitral regurgitation is seen. there is no pericardial effusion. post bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylepherine. a well-seated bioprosthetic valve is seen in the aortic position with normal leaflet motion and gradients (mean gradient = 14 mmhg). no aortic regurgitation is seen. regional and global left ventricular systolic function are normal. mitral valve anterior leflet with increased mobility mva 3.24 cm2 by pressure half time. mr remains trace. remaining exam is unchanged. all findings discussed with surgeons at the time of the exam. admission labs: 05:25pm pt-12.4 ptt-29.5 inr(pt)-1.1 05:25pm plt count-153 05:25pm wbc-5.7 rbc-3.90* hgb-10.7* hct-35.6* mcv-91 mch-27.4 mchc-30.1* rdw-18.6* 05:25pm %hba1c-5.9 eag-123 05:25pm albumin-4.1 magnesium-2.3 05:25pm lipase-32 05:25pm alt(sgpt)-18 ast(sgot)-19 alk phos-63 amylase-72 tot bili-0.5 05:25pm glucose-139* urea n-27* creat-1.5* sodium-142 potassium-4.5 chloride-104 total co2-30 anion gap-13 discharge labs: 04:32am blood wbc-6.9 rbc-3.06* hgb-8.4* hct-27.8* mcv-91 mch-27.3 mchc-30.0* rdw-18.5* plt ct-118* 04:32am blood plt ct-118* 04:32am blood glucose-107* urean-26* creat-1.1 na-141 k-3.9 cl-104 hco3-27 angap-14 04:32am blood calcium-8.3* phos-2.1* mg-2.6 04:43am blood pt-14.0* ptt-54.5* inr(pt)-1.3* 04:49am blood pt-12.7* ptt-42.4* inr(pt)-1.2* radiology report chest (pa & lat) study date of 8:30 am final report : there is mild improvement of bilateral interstitial markings and hilar prominence compared with prior exam. no focal opacities are seen in the right, while the left lung demonstrates improved aeration although with persistent lower lobe atelectasis with concurrent small pleural effusion. the mediastinum is widened secondary to mediastinotomy, but unchanged compared with prior exam. there is no evidence of pneumothorax. old right-sided sixth rib fracture is again noted. a right ij line is seen ending in the mid svc. sternotomy wires are intact. impression: interval improvement of pulmonary vascular congestion, left lower lobe atelectasis and left sided pleural effusion. brief hospital course: mr. was admitted for intravenous heparin and routine preoperative evaluation prior to aortic valve replacement. workup was unremarkable and he was cleared to proceed with surgery. on dr. performed a bioprosthetic aortic valve replacement - for surgical details, please see operative note. in summary he had: aortic valve replacement with . medical biocor epic tissue valve. his bypass time was 77 minutes with a crossclamp time of 58 minutes. he tolerated the operation well and post-operatively was brought to the cvicu for invasive monitoring. on the day of surgery he woke neurologically intact, was weaned from the ventilator and extubated. on postoperative day one, he was transferred to the stepdown floor for continued post-operative care. coumadin was resumed for atrial fibrillation. gentle diuresis was initiated. he worked with nursing and physical therapy to increase his postoperative strength and mobility. all tubes lines and epicardial pacing wires were discontinued without complication. on postoperative day three, he did have a temperature of 101.0. blood cultures were drawn and negative at the time of discharge, urine culture was negative and the the triple lumen catheter was discontinued. heparin intravenous was started for on intra-op echo and preoperative atrial fibrillation. he failed a voiding trial and the foley catherter was replaced. flomax therapy was initiated. the foley catheter was discontinued on the evening of postoperative day number 3 without further complication. he did have some serous midsternal drainage and was started on kefzol on pod3. this was resolved at the time of discharge. he was afebrile, wbc normal and was sent home on no antibiotics. he is to come to the wound clinic on for follow up. the remainder of his hospital course was uneventful and he was discharged home on pod 7. he is to follow-up with dr in 1 month-appointment already scheduled. medications on admission: amitriptyline 10 mg hs atenolol 50 mg daily clobetasol 0.05 % cream - as needed desonide 0.05 % cream - as needed advair diskus 250 mcg-50 mcg/dose disk with device - one puff inhaled twice a day folic acid 1 mg daily furosemide 20 mg daily levothyroxine 150 mcg daily methotrexate sodium 2.5 mg tablets, dose pack - three tablets once a week on friday omeprazole 20 mg daily prednisone 5 mg daily viagra 100 mg prn simvastatin 20 mg daily spiriva with handihaler 18 mcg capsule, w/inhalation device - two puffs inhaled once a day warfarin 2 mg daily calcium carbonate-vitamin d3 dosage uncertain vitamin d3 400 unit daily vitamin b-12 500 mcg daily methylcellulose 500 mg prn multivitamin dosage uncertain omega 3 fish oil dosage uncertain discharge medications: 1. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q4h (every 4 hours) as needed for wheezing, sob. disp:*1 * refills:*1* 3. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day). disp:*1 * refills:*2* 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*1* 5. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*1* 6. levothyroxine 50 mcg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*1* 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 8. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*60 disk with device(s)* refills:*2* 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*30 capsule(s)* refills:*1* 10. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 11. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*1* 13. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 14. methotrexate sodium 2.5 mg tablet sig: three (3) tablet po qfri (every friday). disp:*12 tablet(s)* refills:*1* 15. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). disp:*30 capsule, ext release 24 hr(s)* refills:*1* 16. amitriptyline 10 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. disp:*30 tablet(s)* refills:*0* 17. furosemide 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*1* 18. potassium chloride 20 meq packet sig: one (1) packet po once a day. disp:*30 packet(s)* refills:*1* 19. colchicine 0.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for pain. disp:*30 tablet(s)* refills:*0* 20. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*1* 21. warfarin 5 mg tablet sig: seven (7) mg po once a day: please check inr on . disp:*30 mg* refills:*1* 22. keflex 500 mg capsule sig: one (1) capsule po four times a day for 7 days. disp:*28 capsule(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: aortic stenosis - s/p avr atrial fibrillation with left atrial appendage thrombus hypertension discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with percocet incisions: sternal - healing well, no erythema or drainage edema 1+ 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 and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **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: wound care nurse phone: date/time: 10:30am in the medical office building, , surgeon: dr. , md phone: date/time: 1:30pm in the medical office building, , cardiologist: dr. at 11:30a please call to schedule appointments with your primary care 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 ?????? indication atrial fibrillation and thrombus in the left atrial appendage goal inr 2-2.5 first draw and then other day until stable results to phone fax atrius coumadin clinic procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve with tissue graft diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified essential hypertension long-term (current) use of steroids unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified gout, unspecified atrial fibrillation personal history of malignant neoplasm of prostate personal history of tobacco use other and unspecified hyperlipidemia long-term (current) use of anticoagulants mitral valve insufficiency and aortic valve stenosis rheumatoid arthritis personal history of venous thrombosis and embolism obesity, unspecified diseases of tricuspid valve personal history of irradiation, presenting hazards to health other ill-defined heart diseases osteoarthrosis, localized, not specified whether primary or secondary, lower leg personal history of thrombophlebitis postprocedural fever body mass index 34.0-34.9, adult 

Answer: The patient is high likely exposed to