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: dyspnea on exertion major surgical or invasive procedure: aortic valve replacement (21mm ce magma tissue) cardiac cath history of present illness: ms. is a 68 year-old woman who was transferred from an outside hospital with dyspnea and a chronic obstructive pulmonary disease exacerbation. work-up for this complaint revealed moderate to severe aortic stenosis, moderate aortic regurgitation, moderate mitral regurgitation, severe pulmonary hypertension, and an ejection fraction of 55% by echocardiogram. she was referred to cardiac surgery for repair of her aortic valve pathology. past medical history: aortic stenosis, congestive heart failure hypertension, h/o breast cancer s/p left mastectomy and xrt, hyperthyroidism - multinodular goiter, noninsulin dependent diabetes mellitus, chronic obstructive pulmonary disease, hyperlipidemia, s/p non st elevation mycardial infarction social history: works in electronics company as tester. denies alcohol use. 20 pack year, quit 20 years ago. family history: no valvular disease, no sickle cell. physical exam: vs: 80 20 138/57 5'5" 69kg skin: left breast removed (well-healed), multiple bruises on arms heent: unremarkable neck: supple, full range of motion chest: decreased breath sounds bilat. bases heart: irregular rhythm with 3/6 systolic murmur radiating to carotids abd: soft, non-tender, non-distended, +bowel sounds ext: warm, well-perfused, 2+ edema neuro: alert and oriented x 3, grossly intact pertinent results: cath: 1. selective coronary angiography of this right dominant system revealed no angiographically apparent flow limiting disease. 2. resting hemodynamics demonstrated moderate pulmonary artery hypertension (pa 49/13 mm hg), elevated left sided filling pressures (lvedp 47 mm hg), and systemic arterial hypertension (central aortic pressure 147/42 mm hg. 3. aortic valve calculated at 0.9 cm2, with cardiac output/index 4.37 l/min and 2.39 l/min/m2, mean gradient 21.7 mm hg, systolic ejection period 23.8, valve flow 183.65 ml/sec. 4. wide pulse pressure indicative of significant aortic insufficiency. final diagnosis: 1. coronary arteries are normal. 2. moderate aortic mixed stenosis and regurgitation. 3. severe diastolic ventricular dysfunction. cnis: 1. no significant interval change and no evidence of significant ica stenosis on either side. 2. antegrade flow in both vertebral arteries. echo: pre-cpb:1. the left atrium is moderately dilated. no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no thrombus is seen in the left atrial appendage. no thrombus is seen in the right atrial appendage no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic root. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. the annulus measures 21 mm. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). mild (1+) aortic regurgitation is seen. 6. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate (2+) mitral regurgitation is seen at a systolic pressure of 130 that is 1+ at a systolic pressure of 100 mmhg. drs , and were in the or to discuss the findings with dr. . dr. was notified in person of the results. post-cpb: on infusions of epinephrine, phenylephrine. av pacing. well-seated bioprosthetic valve in the aortic position. no ai. gradient now 34 peak, 20 mean on inotropic support. mr is now trace. preserved biventricular systolic function. aortic contour is normal post decannulation. 04:27pm blood wbc-13.3*# rbc-3.20* hgb-10.1* hct-29.8* mcv-93 mch-31.5 mchc-33.8 rdw-17.1* plt ct-115*# 06:04am blood wbc-7.9 rbc-2.65* hgb-8.4* hct-26.3* mcv-99* mch-31.5 mchc-31.8 rdw-16.0* plt ct-167 06:01am blood wbc-10.7 rbc-2.84* hgb-9.1* hct-27.1* mcv-96 mch-31.9 mchc-33.4 rdw-16.9* plt ct-110* 04:27pm blood pt-13.6* ptt-28.0 inr(pt)-1.2* 06:04am blood pt-14.1* ptt-110.9* inr(pt)-1.2* 05:58am blood pt-29.1* ptt-33.4 inr(pt)-3.0* 04:27pm blood glucose-167* urean-76* creat-1.3* na-147* k-3.3 cl-103 hco3-34* angap-13 06:04am blood glucose-84 urean-37* creat-1.0 na-147* k-3.5 cl-105 hco3-37* angap-9 06:01am blood glucose-95 urean-50* creat-1.3* na-138 k-3.6 cl-99 hco3-32 angap-11 06:14am blood alt-47* ast-16 ld(ldh)-318* alkphos-42 totbili-1.0 brief hospital course: upon admission to the medicine service, ms. was treated with a solu-medrol taper for a resolving chronic obstructive pulmonary disease exacerbation. she was then transferred to cardiology for cardiac catheterization in preparation for an aortic valve repair. on she was intubated for respiratory distress and hypoxemia and was transferred to the cardiac care unit. she was diuresed and extubated by the following day. she was seen in consultation by cardiac surgery to evaluate her for aortic valve replacement. her subsequent cardiac catheterization on revealed no significant coronary artery disease. she was diuresed with a lasix drip. she was also seen in consultation by endocrinology for a nodule on her thyroid. it was recommended that after her heart surgery, this nodule be ablated. on she was taken to the operating room and underwent an aortic valve replacement with a ce magna tissue valve. please see operative report for surgical details. following surgery she was transferred to the cvicu for invasive monitoring in stable condition. she did require blood transfusions due to low hct. within 24 hours she was weaned from sedation, awoke neurologically intact and extubated. but shortly after she had increased rhonchi with respiratory acidosis and need to be re-intubated. she was again weaned and extubated the following day. she remained int he cvicu for several mores days while receiving aggressive pulmonary toilet and diuresis. on post-op day three chest tubes were removed. post-operatively she continued to have arrhythmias which were also seen upon admission. therefore she was started on coumadin with heparin bridge. electrophysiology was eventually consulted. epicardial pacing wires were removed on post-op day four and she was then transferred to the telemetry floor for further care. she continued to slowly recover over the next several days while awaiting for her inr to be therapeutic (). she worked with physical therapy and appeared ready for discharge on post-op day five. medications on admission: imdur 60 mg, methimazole 5 mg mtwtfs, verapamil 240 mg daily, lasix 40 mg daily, guafenesin 600 mg , ecotrin 325 mg daily, levaquin 750 mg daily, dyazide 50/25mg? (patient unsure of dose) discharge medications: 1. warfarin 1 mg tablet sig: as instructed based on inr tablet po daily (daily): goal inr 2.0-3.0. dose coumadin accordingly. likely dose 1mg alternating with 2mg. 2. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po bid (2 times a day): take with lasix and stop when lasix stopped. 3. furosemide 40 mg iv tid 4. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 5. zocor 80 mg tablet sig: one (1) tablet po qhs. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months: or while taking narcotics. 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. methimazole 5 mg tablet sig: one (1) tablet po qmotuwethfrsa (). 9. ipratropium bromide 0.02 % solution sig: one (1) neb ih inhalation q6h (every 6 hours). 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day): 1 inh ih . 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb ih q6h inhalation q6h (every 6 hours): neb ih q6h . 12. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 13. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). discharge disposition: extended care facility: - discharge diagnosis: aortic stenosis s/p aortic valve replacement acute on chronic congestive heart failure acute renal failure atrial fibrillation pneumonia secondary: hypertension, h/o breast cancer s/p left mastectomy and xrt, hyperthyroidism - multinodular goiter, noninsulin dependent diabetes mellitus, chronic obstructive pulmonary disease, hyperlipidemia, s/p non st elevation mycardial infarction discharge condition: good discharge instructions: shower daily, no baths or swimming no lotions, creams or powders to incisions no driving for 4 weeks and off all narcotics no lifting more than 10 pounds for 10 weeks report any redness of, or drainage from incisions report any fever greater than 100.5 report any weight gain greater than 2 pounds a day or 5 pounds a week take all medications as directed followup instructions: dr. in 4 weeks () 6 wound clinic in 2 weeks dr. () in weeks dr. . () in 2 weeks please call for appointments md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube insertion of endotracheal tube open and other replacement of aortic valve with tissue graft angiocardiography of right heart structures diagnoses: pneumonia, organism unspecified acidosis congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure other chronic pulmonary heart diseases personal history of malignant neoplasm of breast other and unspecified hyperlipidemia acute respiratory failure old myocardial infarction multiple involvement of mitral and aortic valves nontoxic multinodular goiter 

Answer: The patient is high likely exposed to