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: chest tightness and fatigue major surgical or invasive procedure: aortic valve replacement (19mm mechanical) and coronary artery bypass graft x1 (left internal mammary artery > left anterior descending) history of present illness: 61 year old female with aortic stenosis which was originally diagnosed 5 years ago and has been followed with serial echocardiograms since that time. her most recent echocardiogram showed worsening aortic gradients with left ventricle hypertrophy. in preparation for surgery, a cardiac catheterization revealed left anterior descending artery disease. she was subsequently referred for surgical evaluation. past medical history: aortic stenosis hypertension bladder suspension hysterectomy social history: lives with: daughter and inlaw in , ma occupation: cna tobacco: quit 40 pyh etoh: 1-2 drinks per month family history: mom died of mi at age 80 physical exam: pulse: 72 sr resp: 18 o2 sat: 99% b/p right: 168/94 left: 164/100 ****pt states that her home bp 150/70 but when she comes to hospital it is much higher height: 67" weight: 159 general: wdwn in nad skin: dry, warm and intact heent: ncat, perrla, eomi, sclera anicteric, op benign. upper full dentures and lower partials. neck: supple full rom no jvd chest: lungs clear bilaterally heart: rrr, nl s1-s2, iii/vi systolic murmur abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused no edema varicosities: none neuro: grossly intact pulses: femoral right:2 left:2 dp right:2 left:2 pt :2 left:2 radial right:2 left:2 carotid bruit faint right. aortic murmur transmitted bilaterally. pertinent results: 02:05pm blood wbc-10.9# rbc-2.48*# hgb-8.2*# hct-23.7*# mcv-96 mch-33.0* mchc-34.6 rdw-13.0 plt ct-121* 02:05pm blood pt-14.7* ptt-35.9* inr(pt)-1.3* 02:05pm blood plt ct-121* 03:39pm blood urean-12 creat-0.5 na-142 k-4.1 cl-112* hco3-24 angap-10 echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.2 cm <= 4.0 cm left ventricle - inferolateral thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.0 cm <= 5.6 cm left ventricle - ejection fraction: >= 70% >= 55% aorta - annulus: 2.1 cm <= 3.0 cm aorta - ascending: 3.1 cm <= 3.4 cm aorta - descending thoracic: 1.9 cm <= 2.5 cm aortic valve - peak gradient: *82 mm hg < 20 mm hg aortic valve - mean gradient: 68 mm hg aortic valve - lvot diam: 2.0 cm aortic valve - valve area: *0.7 cm2 >= 3.0 cm2 mitral valve - mva (p t): 2.4 cm2 mitral valve - e wave: 0.8 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 0.80 findings left atrium: dilated la. mild spontaneous echo contrast in the body of the la. no mass/thrombus in the laa. depressed laa emptying velocity (<0.2m/s) all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: lipomatous hypertrophy of the interatrial septum. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness, cavity size, and global systolic function (lvef>55%). overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. simple atheroma in aortic arch. normal descending aorta diameter. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. critical as (area <0.8cm2). no ar. mitral valve: moderately thickened mitral valve leaflets. characteristic rheumatic deformity of the mitral valve leaflets with fused commissures and tethering of leaflet motion. minimally increased gradient consistent with trivial ms. mild to moderate (+) mr. lv inflow pattern c/w impaired relaxation. tricuspid valve: tricuspid valve not well visualized. physiologic tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions pre bypass the left atrium is dilated. mild spontaneous echo contrast is seen in the body of the left atrium. no mass/thrombus is seen in the left atrium or left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple 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 with fusion of the right and left coronary cusps. there is critical aortic valve stenosis (valve area <0.8cm2). no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the mitral valve shows some characteristics consistent with rheumatic deformity. there is a minimally increased gradient consistent with borderline mitral stenosis. mild to moderate (+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. dr. was notified in person of the results in the operating room at the time of the study. post bypass there is normal biventricular systolic function. there is a bileaflet prosthesis located in the aortic position. it appears well seated. the leaflets can not be seen well but in limited views do appear to be moving normally. there is a small jet of trivial aortic regurgitation seen. it emanates from the area of the native right coronary cusp. it does not appear to represent a washing jet and may be paravalvular in origin. the washing jets are not clearly seen. the peak gradient across the aortic valve was 16mmhg with a mean pressure of 7 mmhg. the mitral regurgitation is worsened from the pre-bypass exam. it now appears to be at least moderate and at times moderate to severe. it is centrally directed. no mitral leaflet systolic anterior motion is seen. the thoracic aorta appears intact after decannulation. dr. was notified in the operating room of these findings. brief hospital course: admitted same day surgery and was brought to the operating room for aortic valve replacement and coronary artery bypass graft surgery. see operative report for further details. she received cefazolin for perioperative antibiotics and was transferred for the intensive care unit for post operative management. that evening she was weaned from sedation, awoke neurologically intact and was extubated without complications. on post operative day one she was started on betablockers and duiuretics. additionally she was started on coumadin for mechanical aortic valve and transferred to the floor. chest tubes and epicardial wires removed per protocol and physical therapy worked with her on strength and mobility. her inr was therapeutic at discharge. she was ready for discharge to home with vna on pod # 5 all follow-up appointments were advised. medications on admission: mvi daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 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:*2* 3. warfarin 1 mg tablet sig: as directed for mech avr tablet po daily (daily): indication mech avr goal inr 2.5-3.0. disp:*60 tablet* refills:*2* 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*65 tablet(s)* refills:*0* 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 6. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever/pain. 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 8. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. lasix 40 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* 10. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po once a day for 7 days. disp:*14 tablet extended release(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: aortic stenosis s/p avr #19 mechanical valve coronary artery disease s/p cabg lima-lad hypertension discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage edema trace 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 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 on at 1:30pm in the medical office building wound check cardiac surgery office tues at 10 am () cardiologist: dr on at 2:00pm 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 mechanical aortic valve goal inr 2.5-3.0 first draw on results to dr phone fax procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute posthemorrhagic anemia aortic valve disorders other and unspecified hyperlipidemia 

Answer: The patient is high likely exposed to