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: patient recorded as having no known allergies to drugs attending: chief complaint: admission for elective cardiac catheterization and workup towards possible avr and tvr. major surgical or invasive procedure: cardiac catheterization history of present illness: 48-year-old immigrant from who has been troubled by shortness of breath. in , she underwent mvr in . she has been medically managed and troubled by shortness of breath with exertion that has been increasing. she has pnd, often waking up in the middle of the night short of breath. she has lower extremity swelling as well. she also describes some chest discomfort with exertion which is pain at its worst but more often experienced as a chest pressure. she has not noted palpitations and denies syncope or presyncope except for one episode of syncope in when she hit her head but did not seek medical attention. review of systems is otherwise negative in detail. . in mid , she underwent exercise testing. she exercised for 3 minutes and 25 seconds on a standard protocol stopping secondary to severe dyspnea and dizziness. she had rare isolated vpds. the nuclear imaging demonstrated no perfusion abnormalities and preserved lv function with an estimated ejection fraction of 68%. her peak heart rate was 112, and her peak blood pressure 118/78. she underwent echocardiography in . this demonstrated massive left and right atrial enlargement with the left atrium measuring 7.7 cm and a right atrium measuring 8.9 cm. she had left ventricular hypertrophy with a septal wall thickness of 1.3 and an inferolateral wall thickness of 1.2 cm. left ventricular systolic function was preserved. she had a bioprosthetic mitral valve prosthesis that was well seated with normal disk motion and normal gradients. her aortic valve was mildly thickened with moderate-to-severe aortic insufficiency. she also had moderate-to-severe tricuspid insufficiency. the rv size and function was normal. . she then underwent echocardiogram on , which demonstrated severe biatrial enlargement, left ventricular hypertrophy with an estimated ejection fraction of 80%. most notable was that she had a trileaflet aortic valve with moderate thickening of the aortic valve leaflets, systolic doming of the aortic valve leaflets, moderate aortic stenosis, and moderate-to-severe aortic insufficiency. her estimated valve area was 0.8 cm2, although given her severe aortic stenosis this may be an overestimate of the degree of her stenosis. her mitral valve prosthesis was well seated with normal appearance. she has severe tricuspid regurgitation with moderately thickened tricuspid valve leaflets and rheumatic deformity of the tricuspid valve. her right ventricle was markedly dilated with depressed rv function. . she is being admitted today for elective catheterization to further delineate her valve disorders in anticipation of aortic valve replacement past medical history: hypertension afib s/p mv repair in av stenosis and regurg tr social history: she does not smoke, does not drink, has lived in this country for approximately 16 months, has a son and is married. family history: her family history is notable for a mother who had high blood pressure in her 80's. physical exam: gen: comfortable, well-appearing woman at rest. heent is unremarkable. jvp is 8 cm. neck: carotids are 2+ bilaterally without bruit. lungs: clear to auscultation, bilat. cv: cardiac exam is irregularly irregular with mechanical heart sounds, soft s2, a holosystolic murmur at the left upper sternal border and left lower sternal border, as well as a diastolic murmur at the left upper sternal border. abd: nt, nd, nabs, no hsm, no masses ext: she has trace bilateral lower extremity edema and intact distal pulses (2+ pt and dp) pertinent results: 10:52pm ptt-150* 03:50pm glucose-88 urea n-21* creat-0.8 sodium-141 potassium-3.8 chloride-110* total co2-24 anion gap-11 11:46am glucose-99 urea n-21* creat-0.9 sodium-139 potassium-5.9* chloride-111* total co2-23 anion gap-11 11:46am calcium-8.0* phosphate-2.7 magnesium-2.0 11:46am digoxin-0.2* 11:46am wbc-5.4 rbc-3.83* hgb-11.5* hct-34.0* mcv-89 mch-30.0 mchc-33.8 rdw-14.3 11:46am plt count-237 11:46am pt-18.6* ptt-33.1 inr(pt)-1.7* . chest pa and lateral. the cardiac silhouette is enlarged with a mitral disease configuration. prosthetic mitral valve is again noted. the lung fields are clear. no pleural effusions or pneumothorax. no interval change compared to the prior radiograph of . cxr: dense linear structures appear within the region of the aortic valve, mitral valve, and tricuspid valve consistent with history of repair. endotracheal tube is seen at the thoracic inlet. a nasogastric tube is seen extending into the stomach. right internal jugular catheter sheath in place with catheter tip extending to the distal svc. the mediastinal contours appear slightly ill-defined likely secondary to post-surgical change. cardiomegaly appears grossly similar in size to prior study from one week prior. lung volumes are low with no gross evidence of focal opacities. no effusion on the right with chest tube in place on the right, chest tube also in place on the left. cannot rule out effusion secondary to cardiac silhouette. no evidence of pneumothorax. cxr: there is marked widening of the cardiac silhouette, without change since the recent study and with a similar appearance to the earlier radiographs dating back to , . the patient is status post replacement of the aortic, mitral, and tricuspid valves. there is some crowding of the pulmonary vascularity related to low lung volumes, but there is no overt evidence of chf allowing for this factor. it is difficult to exclude tiny small effusions on the lateral view. . cardiac cath comments: 1. selective coronary angiography showed a right dominant system with lmca, large wrap around lad, lcx and rca that were free of angiographically apparent disease. 2. left ventriculography was deferred given hyperdynami state with ectopy and rtecent non-invasive assessment showing supranormal ef of 80% withoput wall motion abnormalities. 3. hemodynamic assessment showed normal left and right sided filling pressures with prominent v waves on the ra pressure tracings. the cardiac output calculated by fick method with measure o2 consumption showed depressed lv function with ci of 1.7. aortic valve gradient was initially 20 mm hg with aortic valve are of 0.5 cm2. however after administartion of 5 mcg/kg/min of dobutamin with increase in cardiac index to 1.9, the aortic valve gradient decreased to less than 6 mm hg and aortic valve area was 0.9 cm2. this was consistent with spurious pseudoaortic stenosis due to low output state. there was no significant mitral valve stenosis (3 mm hg as expected for a mitral valve mechanical prosthesis). final diagnosis: 1. coronary arteries are normal. 2. mild aortic stenosis. 3. moderate tricuspid regurgitation. 4. moderate systolic ventricular dysfunction with low output state. . carotid u/s impression: minimal plaque with bilateral less than 40% carotid stenosis tee: prebypass the left atrium is moderately dilated. no spontaneous echo contrast is seen in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). the right atrium is markedly dilated. the right atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the inferior vena cava is dilated (>2.5 cm). left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are simple atheroma in the aortic root. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. the aortic valve is abnormal. moderate (2+) aortic regurgitation is seen. a bileaflet mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are moderately thickened. there is a rheumatic deformity of the tricuspid valve. severe tricuspid regurgitation is seen. there is no pericardial effusion. post bypass lv and rv systolic function is preserved. mechanical valve seen in the aortic position. leaflets appear to move well and the valve appears well seated. mild aortic insufficiency is present. the views are limited due to presence of a mechanical mitral valve. there is an annuloplasty ring in the tricuspid position. however there is still moderate tricuspid regurgitation. mild mitral regurgitation persists. . ospital course: this is a 48-year-old chinese woman with history of htn and recent sob determined to have severe as, ar and tr admitted on for elective catheterization to further delineate her valve disorders in anticipation of avr and tvr. she underwent uncomplicated catheterization on (please see the report in 'results' section for more details). a pre-operative dental consult was obtained and 2 teeth were extracted on ; she was then cleared for valve repair surgery with perioperative vancomycin. she underwent mechanic aortic valve repair and tricuspid valve repair on (please see the operative note of dr. for full details). she had un unremarkable post-operative course. she was initially in the intensive care unit per routine post-operatively. she was extubated on post-operative day 1 after gentle diuresis. her chest tubes and pacer wires were then removed on post-operative day 2. she was tolerating a regular diet by post-operative day 2 and had adequate pain control with iv and oral narcotics. anticoagulation for her atrial fibrillation and mechanical valve was started on post-operative day 3 with heparin drip bridged to oral coumadin. she was then transferred to the step-down cardiac unit on post-operative day 3. physical therapy worked with the patient and she was deemed safe for home discharge. her coumadin levels were therapeutic by post-operative 6. shewas discharged to home on post-operative day 6 with planned follow-up with cardiac surgery. all questions were answered to her satisfaction upon discharge. medications on admission: chinese diuretic 25 mg daily, (unknown) sublingual nitroglycerin 0.4 mg as needed metoprolol 50 mg b.i.d. coumadin 0.125 mg daily, of some "heart" medication again the bottle was in chinese- could be digitalis discharge medications: 1. atenolol 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 4. 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:*2* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*50 tablet(s)* refills:*0* 6. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. potassium chloride 10 meq capsule, sustained release sig: two (2) capsule, sustained release po once a day. disp:*60 capsule, sustained release(s)* refills:*0* 8. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* 9. coumadin 2 mg tablet sig: one (1) tablet po once a day for 1 days: take as directed by dr. for inr goal of 3.5. disp:*30 tablet(s)* refills:*0* 10. motrin 600 mg tablet sig: one (1) tablet po four times a day as needed for pain: take with food. disp:*50 tablet(s)* refills:*0* 11. lasix 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: as/ar tr afib htn rheumatic heart disease discharge condition: good discharge instructions: follow medications on discharge instructions. do not drive for 4 weeks. do not lift more than 10 lbs. for 2 months. you should shower daily, let water flow over wounds, pat dry with a towel. call our office for sternal drainage, temp.>101.5 do not use creams, lotions, or powder on wounds. followup instructions: appt. with dr. on mon. @ 3:45pm. appt. with dr. on thurs. @ 1:30pm. procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters open and other replacement of aortic valve extraction of other tooth extraction of other tooth open heart valvuloplasty of tricuspid valve without replacement diagnoses: atrial fibrillation rheumatic heart failure (congestive) heart valve replaced by other means long-term (current) use of anticoagulants multiple involvement of mitral and aortic valves diseases of tricuspid valve dental caries, unspecified other acute rheumatic heart disease 

Answer: The patient is high likely exposed to