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: a 47-year-old woman with a possible history of rheumatic heart disease as a child, and an atrial septal defect repair in , had a history of palpitations and was diagnosed with atrial fibrillation. in , she underwent transesophageal echocardiogram cardioversion and was started on sotalol. in , she was admitted to an outside hospital with congestive heart failure, and the sotalol was discontinued at that time. the patient underwent cardiac catheterization which showed no significant coronary artery disease. an echocardiogram showed a normal ejection fraction with severe mitral regurgitation, moderate left atrial dilatation, and mild-to-moderate tricuspid regurgitation. she was started on lasix, a beta blocker, and a calcium channel blocker at that time. she was also seen by dr. from the cardiology service who suggested that she should undergo a mitral valve replacement. the patient was admitted preoperatively to discontinue her coumadin, to be started on heparin, and an amiodarone load. in addition, to a mitral valve replacement she has a possible tricuspid valve replacement as well as a maze procedure and plus or minus tieing off of a left atrial appendage. past medical history: (the patient's past medical history is significant for) 1. atrial septal defect repair in . 2. atrial fibrillation times four to five years, status post transesophageal echocardiogram cardioversion. 3. congestive heart failure. social history: she is married with adult children. rare alcohol use. smokes two to three cigarettes per day for tobacco use. family history: mother died at 32 of mps. medications on admission: medications prior to admission included verapamil 240 mg p.o. q.d., lasix 40 mg p.o. b.i.d., metoprolol 50 mg p.o. b.i.d., coumadin 5 mg p.o. q.d. (which was discontinued on , two days prior to admission). physical examination on presentation: examination at the time of admission revealed vital signs with temperature of 98.1, blood pressure of 103/67, heart rate of 70, respiratory rate of 18, oxygen saturation of 99% on room air. in general, alert and oriented, pleasant, well-appearing. head, eyes, ears, nose, and throat revealed pupils were equally round and reactive to light. extraocular movements were intact. mucous membranes were moist. neck revealed no jugular venous distention, no lymphadenopathy, supple. cardiovascular examination revealed irregularly irregular, a holosystolic murmur heard best at the apex. lungs were clear to auscultation bilaterally. the abdomen was soft, nontender, and nondistended, with positive bowel sounds. extremities were warm with no edema. radiology/imaging: echocardiogram from showed a normal ejection fraction with 4+ mitral regurgitation, mild left atrial dilatation, dilated right ventricle, hypokinetic right ventricular systolic dysfunction, 3+ tricuspid regurgitation, mild pulmonary hypertension. no atrial septal defect. electrocardiogram at the time of admission showed atrial fibrillation with a rate of 55, normal axis, t wave flipped in iii and f, t wave inversions in v1 through v3, and flipped in v4 and v5. pertinent laboratory data on presentation: laboratory data on admission revealed a sodium of 141, potassium of 3.6, chloride of 102, bicarbonate of 30, blood urea nitrogen of 20, creatinine of 0.6, glucose of 110. white blood cell count of 9.4, hematocrit of 33.2, platelets of 377. pt of 13.3, ptt of 69.4, inr of 1.2. hospital course: on , the patient was brought to the operating room at which time she underwent a mitral valve replacement and a tricuspid valve repair. please see the operative note for full details. in summary, she had a mitral valve replacement with #28 st. and a tricuspid valve repair with a #30 .................... ring. she tolerated the operation well and was transferred from the operating room to the cardiothoracic intensive care unit. the patient did well in the immediate postoperative period. her anesthesia was reversed, and she was weaned from the ventilator and successfully extubated. during the night of on postoperative day one, she was noted to be in first-degree atrioventricular heart block until about 2 in the morning when it was noted that she had a paced rhythm at 60. checking her underlying rhythm at that time showed only p waves with no ventricular escape. on the morning of postoperative one, in checking the patient's underlying rhythm it was noted that she was in complete heart block with a ventricular escape in the 30s. she remained hemodynamically stable with a paced rhythm. because she had no underlying rhythm, she remained in the intensive care unit. on the morning of postoperative two, the patient remained hemodynamically stable, in complete heart block. it was noted that her hematocrit was 22, and her urine output was somewhat diminished; and, therefore, she received 2 units of packed red blood cells. on postoperative day three, it was noted that the patient was in atrial fibrillation with a ventricular response in the 80s. she remained hemodynamically stable in that rhythm. however, it was noted that her respiratory status had diminished. she was begun on lasix, and an echocardiogram was done to check her valvular function. the echocardiogram showed normal valvular function with no evidence of pericardial effusion at that time. over the next two days, the patient remained hemodynamically stable. she continued to have difficulty with oxygenation, continued to be vigorously diuresed. her hematocrit was noted, on postoperative day five, to be 19.7. she was transfused with 2 additional units of packed red blood cells. the electrophysiology service was contact to evaluate for permanent pacemaker, and hematology was consulted to evaluate anemia without any obvious bleeding source. the electrophysiology service wanted to wait until the patient's respiratory and hematologic issues were resolved, and the hematology service felt that her anemia was possibly due to a delayed transfusion reaction. over the next several days, the patient remained in the cardiothoracic intensive care unit as she continued to have complete heart block while awaiting for evaluation for a permanent pacemaker. the patient was also noted to have a climb in a white blood cell count. on postoperative day eight, it had risen to 30,000. this was felt to be due to her delayed transfusion reaction; however, infectious disease was consulted. there was no obvious source of infection. the patient was pan-cultured at that time, but all cultures returned negative. on postoperative day 12, the patient lost capture from her epicardial pacing wires, and on postoperative day 13 she was brought to the electrophysiology laboratory where she underwent permanent pacemaker implantation. please see operative note for full details. in summary, the patient had a dual-mode, dual-pacing, dual-sensing pacemaker placed without complication. following pacemaker placement, she was transferred from the catheterization laboratory for six for continuing postoperative care and cardiac rehabilitation. she was restarted on her heparin and was also started on coumadin at that time. the patient remained on the cardiothoracic recovery floor for the next several days while awaiting for her inr to get into therapeutic range. over the course of that time, she continued working with physical therapy and with the nursing staff to increase her activity level. she had an uneventful recovery from her permanent pacemaker implantation. on postoperative day 18, it was felt that the patient was stable and ready for discharge to home as soon as her inr was therapeutic; at that time it was 1.9 with the cutoff being 2. an additional inr will be checked on the afternoon on postoperative day 18. if, at that time, it comes back greater than 2, she will be discharged to home on this day. otherwise, she will be discharged to home on postoperative day 19. physical examination at the time of discharge: vital signs revealed temperature of 97.9, heart rate of 83, blood pressure of 104/62, respiratory rate of 18, oxygen saturation of 95% on room air. weight preoperatively was 72.9 kg, at discharge weight was 66.9 kg. physical examination revealed alert and oriented times three, moved all extremities, conversant. respiratory was clear to auscultation bilaterally. heart sounds were regular in rate and rhythm. first heart sound and second heart sound with a loud click. the sternum was stable. the incision with steri-strips, open to air, clean and dry. left shoulder incision with steri-strips, open to air, clean and dry. the abdomen was soft, nontender, and nondistended, normal active bowel sounds. extremities were warm and well perfused with no clubbing, cyanosis or edema. laboratory data on discharge: white blood cell count of 10.9, hematocrit of 28.3, platelets of 575. sodium of 137, potassium of 4.6, chloride of 95, bicarbonate of 31, blood urea nitrogen of 31, creatinine of 0.8, glucose of 78. inr was pending. medications on discharge: (discharge medications include) 1. niferex 150 mg p.o. q.d. 2. folate 1 mg p.o. q.d. 3. lopressor 50 mg p.o. b.i.d. 4. amiodarone 400 mg p.o. t.i.d. times one then; and then every day. 5. coumadin 5 mg p.o. q.d. (to keep inr between 2.5 and 3). 6. percocet 5/325 one to two tablets p.o. q.4h. p.r.n. discharge status: the patient was to be discharged to home. die followup: a follow-up appointment in the electrophysiology clinic in one week. to follow up with dr. in one month. to follow up in the clinic in two weeks. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle open and other replacement of mitral valve annuloplasty diagnoses: urinary tract infection, site not specified cardiac complications, not elsewhere classified atrial fibrillation atrioventricular block, complete acquired hemolytic anemia, unspecified diseases of tricuspid valve other specified disease of white blood cells rheumatic mitral insufficiency 

Answer: The patient is high likely exposed to