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: exertional chest pain major surgical or invasive procedure: 1. redo sternotomy. 2. coronary artery bypass graft x3: saphenous vein grafts to posterior descending artery, obtuse marginal and diagonal arteries. 3. aortic valve replacement with a size 23 st. epic tissue valve. 4. endoscopic harvesting of the long saphenous vein. history of present illness: 89 year old man referred for cardiac catheterization after recent hospitalization() for exertional chest pain. ruled out for mi but nuclear stress revealed rca infarct and peri-infarct ischemia. prior to this hospitalization had admission for orthostatic lightheadedness, felt to be d/t hypotension. at that time his lopressor and hytrin were dicontinued. since then had been having increased exertional angina. past medical history: coronary artery disease hypercholesterolemia hypertension aortic stenosis benign prostatic hypertrophy carotid stenosis s/p transient ischemic attack() syncope anemia aspestos exposure cabg x2(lima-lad,svg-rpda) appendectomy social history: 2 brothers died from/cad, one had cabg premature coronary artery disease: states one had mi in 20's parents no cad race: caucasian last dental exam: 6 months ago lives with: wife in contact: wife phone # tion: retired plumber cigarettes: smoked yes last cigarette hx: other tobacco use: none etoh: none illicit drug use: none family history: 2 brothers died from/cad, one had cabg states one had mi in 20's physical exam: pulse:61 resp:20 o2 sat: 94% b/p right: 187/80 left: height: 72 in weight: 160 lbs general: skin: dry intact heent: perrla eomi mmm, normal oropharynx neck: supple full rom no jvd chest: lungs clear bilaterally heart: rrr irregular murmur grade 3/6 sem abdomen: soft non-distended non-tender + bowel sounds extremities: warm , well-perfused edema: none varicosities: none neuro: grossly intact nonfocal exam pulses: femoral right: 2+ left: 2+ dp right: 1+ left: pt : 1+ left: radial right: 1+/cath site left: 2+ carotid bruit not appreciated pertinent results: admission labs: 07:05pm pt-13.0 ptt-28.9 inr(pt)-1.1 07:05pm plt count-93* 07:05pm wbc-7.7 rbc-4.64 hgb-16.4 hct-45.4 mcv-98 mch-35.3* mchc-36.0* rdw-13.2 07:05pm %hba1c-5.5 eag-111 07:05pm albumin-4.6 calcium-9.6 phosphate-3.0 magnesium-2.3 07:05pm ck-mb-2 ctropnt-<0.01 07:05pm lipase-40 07:05pm alt(sgpt)-19 ast(sgot)-19 alk phos-122 amylase-87 tot bili-0.5 07:05pm glucose-120* urea n-14 creat-0.9 sodium-142 potassium-3.8 chloride-102 total co2-28 anion gap-16 discharge labs: 08:05am blood plt ct-122*# 04:40pm blood ptt-26.3 08:05am blood glucose-168* urean-30* creat-0.9 na-151* k-4.0 cl-115* hco3-31 angap-9 04:40pm blood na-148* k-3.6 cl-110* echocardiogram: left atrium: mild la enlargement. no spontaneous echo contrast or thrombus in the body of the laa. all four pulmonary veins not identified. right atrium/interatrial septum: normal ra size. a catheter or pacing wire is seen in the ra. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. normal lv wall thickness and cavity size. moderate-severe regional left ventricular systolic dysfunction. lv wall motion: regional left ventricular wall motion findings as shown below; remaining lv segments contract normally. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. mildly dilated descending aorta. aortic valve: moderately thickened aortic valve leaflets. moderate as (area 1.0-1.2cm2) mild (1+) ar. mitral valve: moderately thickened mitral valve leaflets. mild mitral annular calcification. mild thickening of mitral valve chordae. trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. regional left ventricular wall motion: conclusions pre-bypass: the left atrium is mildly dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. there is moderate to severe regional left ventricular systolic dysfunction with akinesis of the basal and mid inferior walls. the remaining left ventricular segments contract normally. right ventricular chamber size and free wall motion are normal. the descending thoracic aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. trivial mitral regurgitation is seen. there is no pericardial effusion. post cpb: 1. unchanged lv and rv systoliv function with persistent inferior wall motion abnormality 2. trileaflet bioprosthtic valve is identified in aortic posiition. well seated and stable with good leaflet excursion. there is no ai. 3, pg= 22 mm hg mg = 12 mm hg. radiology report chest (pa & lat) study date of 11:48 am final report in comparison with study of , the right ij sheath has been removed. the dobbhoff tube has been extended to the distal portion of the stomach, where it coils upon itself so that the tip lies near the cardioesophageal junction. residual but decreased opacification in the retrocardiac region is again consistent with atelectasis. in the appropriate clinical setting, supervening pneumonia could be considered. small bilateral effusions persist. dr. oropharyngeal videofluoroscopic swallowing evaluation signed by , ccc-slp on @11:15 am affiliation: evaluation: an oral and pharyngeal swallowing videofluoroscopy was performed today in collaboration with radiology. nectar-thick liquid and pureed consistency barium were administered. results follow: oral phase: bolus formation, bolus control and oral transit times were wfl. base of tongue retraction was very slightly reduced, bit otherwise the oral phase was wfl without oral cavity residue. pharyngeal phase: swallow initiation was timely with complete palatal elevation. laryngeal elevation was moderately reduced, noted with better superior than anterior movement. laryngeal valve closure was also moderately reduced with absent epiglottic deflection. pharyngeal transit was timely but with moderately reduced pharyngeal constriction, a mild amount of residue remained in the valleculae after purees. moderate to severe residue remained throughout the pharynx after nectar and puree boluses, especially along the aryepiglottic folds and posterior pharyngeal wall. of note, no liquid passed through the ues on the initial tsp size bolus for nectar thick liquid but small amounts cleared to the esophagus on all other boluses given. residue was either aspirated or coughed back to the oral cavity over time. anterior to posterior position: bilateral vocal cord movement with symmetrical pharyngeal constriction, although it appears reduced bilaterally. there was question of increased residue on the right. aspiration/penetration: pt had deep penetration and aspiration of nectar thick liquids before the height of the swallow due to reduced valve closure. he was not immediately sensate to the aspiration but produced a delayed cough that brought up the majority of aspiration and pharyngeal residue. pt penetrated purees and would have aspirated them if not cued to cough prior to the purees reaching below the level of the vocal cords. treatment techniques: a chin tuck and effortful swallow were attempted with nectar thick liquids and pureed solids but did not significantly change the amount of aspiration or pharyngeal residue. summary: mr. presented with a moderate to severe pharyngeal dysphagia with reduced valve closure and pharyngeal constriction resulting in significant pharyngeal residue and aspiration of liquids and purees. boluses given today were limited for pt safety, but compensatory strategies did not seem effective at improving swallow function. as such, he should remain npo with continued alternate means of nutrition, hydration and medication. his level of dysphagia / residue / aspiration does not seem c/w his overall conditioning and etiology is unclear. pt does have a baseline history of a tia and perhaps possibility of a small cva should be considered. based on the current severity of pt's dysphagia, i do expect it will be some time before he can safely take enough by mouth to maintain his nutrition and would suggest consideration of a peg tube before d/c. we will continue to follow the pt during his admission and he will benefit from slp intervention for dysphagia therapy in rehab. recommendations: 1. suggest pt remain npo, including meds 2. continue with alternate means of nutrition, hydration and medication as you are doing. consider peg placement before d/c given severity of dysphagia 3. q4 oral care while npo 4. continued speech therapy services here and at rehab for his dysphagia. , m.s., ccc-slp pager # brief hospital course: transferred in from outside hospital for surgical evaluation after cardiac catheterization revealed multivessel coronary artery disease and aortic stenosis. he underwent preoperative workup, including dental clearance,and plavix was stopped in preparation for surgery. on mr. was taken to the operating room and underwent a redo sternotomy/coronary artery bypass graft x3 (saphenous vein grafts to posterior descending artery, obtuse marginal and diagonal arteries)/ and aortic valve replacement with a size 23 st. epic tissue valve. please refer to operative report for further surgical details. he transferred to the cvicu intubated, sedated requiring propofol and pressor support. he awoke neurologically intact and was extubated without difficulty during the postoperative night. on pod1 he weaned off pressors, remained hemodynamically stable and was started on beta-blocker/asa/statin and diuretics. plavix was resumed for his history of tia. narcotics were discontinued due to confusion. a speech and swallow evaluation was done, he was made npo and a dobhoff tube placed to give medications and provide nutrition support. he had a video swallow study to further evaluate for aspiration. this showed aspiration with all food groups, he continued to be npo and remained on tube feeds as recommended. the remainder of his hospital course was uneventful. chest tubes and pacing wires were discontinued per protocol. he remained in the cvicu until pod#3 when he was transferred to the step down unit for further monitoring and recovery. physical therapy was consulted to assist with strength and mobility. mr. continued to slowly progress and on pod 6 he was cleared for discharge to in . he is to have follow up with dr on at 1:30pm. medications on admission: asa 325 mg daily plavix 75 mg daily zocor 20 mg daily isorbide mononitrate 90 mg daily lisinopril 10 mg lasix 10 mg daily microk 8meq daily ntg-sl recently stopped metoprolol 75" and hytrin discharge medications: 1. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po once a day. 2. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 6. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 7. ranitidine hcl 15 mg/ml syrup sig: one y (150) mg po once a day. 8. furosemide 40 mg/5 ml solution sig: twenty (20) mg po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 11. terazosin 1 mg capsule sig: one (1) capsule po hs (at bedtime). 12. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 13. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day): hold for sbp<100 hr<60. discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease hypercholesterolemia hypertension aortic stenosis benign prostatic hypertrophy carotid stenosis transient ischemic attack syncope anemia aspestos exposure discharge condition: alert and oriented x3 nonfocal ambulating with assistance incisional pain managed with tylenol incisions: sternal - healing well, no erythema or drainage leg right - healing well, no erythema or drainage. edema trace bilat 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 **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.# date/time: at 1:30 cardiologist:dr on at 10:15 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** md procedure: (aorto)coronary bypass of three coronary arteries extracorporeal circulation auxiliary to open heart surgery enteral infusion of concentrated nutritional substances open and other replacement of aortic valve with tissue graft diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension coronary atherosclerosis of autologous vein bypass graft aortic valve disorders hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) dysphagia, oropharyngeal phase 

Answer: The patient is high likely exposed to