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: penicillins / shellfish / nafcillin attending: chief complaint: shortness of breath major surgical or invasive procedure: re-exploration of mediastinum for cardiac tamponade history of present illness: 34m with aortic insufficiency & aortic stenosis c/b recurrent endocarditis s/p multiple repeat aortic valve rreplacements, most recently on with a 19-mm onyx mechanical valve & replacement of ascending aorta/hemiarch with a 26-mm dacron graft. he presented ~two weeks post-op with pericardial tamponade secondary to hemopericardium requiring re-operation and evacuation of pericardial hematoma. he was doing relatively well since discharge with the exception of persistent mild anterior chest pain and r sub-scapular pain. last night was abruptly awakened from sleep with acute dyspnea and increase in his chest pain to , similar to his symptomatic pain during his episode of tamponade. he was evaluated in the ed at and cardiac surgery is being consulted for concerns about his r pleural effusion. past medical history: esrd on hd via l av fistula, aortic valve endocarditis with mssa s/p tissue avr , s/p redo sternotomy, homograft redo aortic valve and aortic root replacement with reimplantation of coronary arteries (); mssa bacteremia with recurrent endocarditis in , endocarditis following angioplasty of stenotic arteriovenous fistula; chf (systolic and diastolic dysfunction, ef55%); b subclavian vein, left ij and left brachiocephalic thromboses s/p brachiocephalic vein stent, htn, chronic low back pain, hyperlipidemia, chronic fatigue syndrome, pyloric stenosis social history: originally from . has 3 sons. drinks 2-3 drinks/month, continues to smoke 1ppd x10 years, no illicits. works part-time as a teacher. family history: mother - breast ca at 45, survivor, aunt - died of mi at 50, no other family hx of renal disease, no dm or other ca in the family physical exam: pulse:112 st resp:32 o2 sat: 100% on 2l b/p right: 115/75: general: skin: dry intact heent: perrla eomi neck: supple full rom chest: significantly diminished breath sounds @ r base with inspiratory crackles heart: rrr mechanical heart sounds; (-)murmur abdomen: soft, non-distended, non-tender extremities: warm , well-perfused edema none; l forearm fistula w/palpable thrill; varicosities: none neuro: grossly intact pulses: femoral right:2+ left:2+ dp right:2+ left:2+ pt :2+ left:2+ radial right:1+ left:1+ pertinent results: conclusions the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). the right ventricular cavity is unusually small. a mechanical aortic valve prosthesis is present. there is right atrial and right ventricular collapse which appears mechanical by nature -- a clot appears to be compressing on both . there is significant, accentuated respiratory variation in mitral valve inflow, consistent with impaired ventricular filling. impression: a mechanical compression by what appears to be a clot on right atrium ventricle with mitral inflow pattern compatible with tamponade physiology. dr. was notified in person of the results during the exam. electronically signed by , md, interpreting physician 08:48 07:20am blood wbc-4.2 rbc-2.69* hgb-8.5* hct-25.2* mcv-94 mch-31.6 mchc-33.8 rdw-18.4* plt ct-100* 04:38am blood wbc-3.8* rbc-2.78* hgb-8.2* hct-25.9* mcv-93 mch-29.4 mchc-31.5 rdw-17.7* plt ct-107* 05:30am blood wbc-3.7* rbc-2.71* hgb-8.3* hct-25.2* mcv-93 mch-30.7 mchc-33.0 rdw-17.9* plt ct-105* 07:00am blood pt-14.6* inr(pt)-1.3* 01:25pm blood pt-14.1* inr(pt)-1.2* 05:25am blood pt-15.6* inr(pt)-1.4* 12:10pm blood pt-17.2* ptt-22.9 inr(pt)-1.5* 07:20am blood glucose-108* urean-56* creat-10.2*# na-139 k-4.8 cl-98 hco3-31 angap-15 04:38am blood glucose-75 urean-36* creat-8.0*# na-140 k-4.6 cl-101 hco3-32 angap-12 05:30am blood glucose-72 urean-24* creat-5.9*# na-142 k-4.0 cl-99 hco3-33* angap-14 brief hospital course: admitted on for hypotension after dialysis. developed tamponade and was taken to the or for mediastinal exploration and evacuation of clot, and drainage of left plerural effusion by dr. on . transferred to the cvicu in stable condition. followed by nephrology. extubated later that day. transferred to the floor on pod # 2 to begin increasing his activity level. dr. does not want coumadin or heparin for his mechanical valve for one month. he is to remain on aspirin therapy. he had continuing chest tube output that delayed his discharge for several days. chest tubes were discontinued on . follow up chest x-rays revealed a stable hydropneumothorax on the right. the patient was discharged to home on pod 10, after dialysis, with appropriate follow-up instructions. dr. has ordered the patient to stay off of coumadin until . medications on admission: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. sevelamer hcl 400 mg tablet sig: six (6) tablet po tid w/meals (3 times a day with meals). disp:*200 tablet(s)* refills:*2* 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/temp. 9. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*14 patch 24 hr(s)* refills:*0* 10. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 11. tramadol 50 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. disp:*60 tablet(s)* refills:*0* 12. warfarin 1 mg tablet sig: one (1) tablet po once a day: dose to change for goal inr 1.8-2.5, coumadin clinic to manage. disp:*30 tablet(s)* refills:*2* 14. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. disp:*qs ml(s)* refills:*0* discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 2. 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* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily) for 2 weeks. disp:*14 tablet(s)* refills:*0* 4. hydromorphone 2 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. disp:*50 tablet(s)* refills:*0* 5. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 6. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 7. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily) for 2 weeks. disp:*14 patch 24 hr(s)* refills:*0* 8. nicotine 7 mg/24 hr patch 24 hr sig: one (1) transdermal once a day for 2 weeks. disp:*14 * refills:*0* 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. sevelamer hcl 400 mg tablet sig: four (4) tablet po tid w/meals (3 times a day with meals). 11. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 13. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 14. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. ***no coumadin for at least 1 month*** discharge disposition: home with service facility: homecare discharge diagnosis: s/p avr ( mechanical valve)/ replace. ascending and hemiarch aorta) on cardiac tamponade s/p re-exploration esrd on hd via l av fistula, aortic valve endocarditis with mssa s/p tissue avr , s/p redo sternotomy, homograft redo aortic valve and aortic root replacement with reimplantation of coronary arteries (); mssa bacteremia with recurrent endocarditis in , endocarditis following angioplasty of stenotic arteriovenous fistula; chf (systolic and diastolic dysfunction, ef55%); b subclavian vein, left ij and left brachiocephalic thromboses s/p brachiocephalic vein stent, htn, chronic low back pain, hyperlipidemia, chronic fatigue syndrome, pyloric stenosis discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with dilaudid and ultram incisions: sternal - healing well, no erythema or drainage discharge instructions: weigh yourself every morning, md if weight goes up more than 3 lbs. 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: dr. tuesday @ 2:00 pm please call to schedule appointments with your provider: , md phone: date/time: 10:00 provider: , md phone: date/time: 11:30 cardiologist dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** ?????? ****no coumadin or heparin for one month per dr. **** procedure: diagnostic ultrasound of heart hemodialysis arterial catheterization reopening of recent thoracotomy site other incision of pleura transfusion of packed cells transfusion of other serum diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status congestive heart failure, unspecified acute posthemorrhagic anemia hematoma complicating a procedure hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease heart valve replaced by other means surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation heart valve replaced by transplant combined systolic and diastolic heart failure, unspecified cardiac tamponade 

Answer: The patient is high likely exposed to