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: cardiac catherization redo sternotomy, s/p aortic valve replacemetn with 21mm regent mechanical, tricuspid valve replacement with 31mm epic tissue valve, removal of pacemaker leads with placement of epicardial left ventricular leads and new pacemaker generator history of present illness: 81 year old female with increasing dyspnea that has had serial echocardiograms to monitor valvular disease. most recent echocardiogram revealed severe aortic stenosis and tricuspid regurgitation. past medical history: cad ' cabg ' s/p mechanical mitral valve replacement () atrial fibrillation tachybrady syndrome s/p pacemaker mitral stenosis aortic stenosis prior cva??????s urinary frequency, hyperactive bladder cataracts s/p surgery ' right hip replacement appendectomy anemia osteoporosis social history: retired mill worker lives with spouse 50 pack year history quit in etoh denies family history: non-contributory physical exam: admission general elderly appearing female in no acute distress, mild speech impairment skin warm dry heent ncat perrla anicteric sclera, op benign neck supple full rom no jvd chest cta mildly diminished at bases heart murmur retrograde 2/6 sem irregular rhythm, 3/6 systolic murmur abdomen soft, nondistended, nontender, +bowel sounds no hepatosplenomegally ext warm well perfused no edema neuro a/o x3 strength on right, gait slow and slightly unsteady pertinent results: 05:31am blood wbc-9.9 rbc-3.05* hgb-8.8* hct-25.7* mcv-84 mch-28.9 mchc-34.2 rdw-16.8* plt ct-182# 05:42pm blood wbc-5.6 rbc-4.59 hgb-13.4 hct-39.6 mcv-86 mch-29.1 mchc-33.7 rdw-15.6* plt ct-150 05:31am blood plt ct-182# 05:31am blood pt-15.3* ptt-78.2* inr(pt)-1.3* 05:42pm blood plt ct-150 05:42pm blood pt-24.6* ptt-37.0* inr(pt)-2.4* 02:25am blood fibrino-588* 05:31am blood glucose-85 urean-29* creat-1.0 na-138 k-4.4 cl-103 hco3-30 angap-9 05:42pm blood glucose-100 urean-43* creat-1.3* na-136 k-4.7 cl-101 hco3-26 angap-14 06:30am blood alt-30 ast-41* alkphos-123* totbili-0.8 05:31am blood calcium-8.0* phos-2.9 mg-2.5 05:42pm blood calcium-9.1 phos-3.5 mg-2.4 11:15am blood %hba1c-5.6 , f 81 radiology report chest (portable ap) study date of 12:09 pm , csru sched chest (portable ap) clip # reason: r/o ptx s/p ct d/c medical condition: 81 year old woman with reason for this examination: r/o ptx s/p ct d/c final report history: 81-year-old woman status post chest tube removal. comparison: comparison is made to chest radiograph from at 11:15 a.m. findings: there has been interval removal of the chest tubes bilaterally as well as of the right internal jugular central venous line. there is no pneumothorax. the nasogastric tube, epicardial pacing wires, sternotomy wires, aortic and mitral valve replacements and multiple abandoned cardiac pacer leads are all unchanged from previous examination. small bilateral pleural effusions are unchanged. bibasilar opacities, likely atelectatic are unchanged. there are no new consolidations. mild cardiomegaly is unchanged. mediastinal and hilar contours are normal. visualized soft tissue structures and bony thorax are unremarkable. impression: 1. interval removal of chest tubes and right ij central line. no pneumothorax. 2. multiple support lines/tubes, small bilateral effusions and bibasilar atelectasis, all of which are unchanged from previous radiograph. the study and the report were reviewed by the staff radiologist. dr. dr. approved: tue 9:27 am , (complete) done at 9:00:24 am preliminary referring physician information , c. , status: inpatient dob: age (years): 81 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: aortic valve disease. left ventricular function. preoperative assessment. prosthetic valve function. shortness of breath. icd-9 codes: 440.0, 395.2, 424.2 test information date/time: at 09:00 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2008aw5-: machine: echocardiographic measurements results measurements normal range left atrium - four chamber length: 4.1 cm <= 5.2 cm left ventricle - septal wall thickness: 0.7 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.8 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.0 cm <= 5.6 cm aorta - annulus: 2.0 cm <= 3.0 cm aorta - sinus level: 2.8 cm <= 3.6 cm aorta - sinotubular ridge: 2.6 cm <= 3.0 cm aorta - ascending: 2.9 cm <= 3.4 cm aorta - arch: 1.9 cm <= 3.0 cm aorta - descending thoracic: 1.7 cm <= 2.5 cm aortic valve - peak velocity: *3.9 m/sec <= 2.0 m/sec aortic valve - peak gradient: *60 mm hg < 20 mm hg aortic valve - mean gradient: 43 mm hg aortic valve - lvot diam: 2.0 cm aortic valve - valve area: *0.6 cm2 >= 3.0 cm2 mitral valve - peak velocity: 1.2 m/sec mitral valve - mean gradient: 5 mm hg mitral valve - pressure half time: 48 ms mitral valve - mva (p t): 4.6 cm2 findings left atrium: normal la size. no spontaneous echo contrast is seen in the laa. right atrium/interatrial septum: no asd by 2d or color doppler. left ventricle: normal lv wall thickness and cavity size. right ventricle: moderately dilated rv cavity. mild global rv free wall hypokinesis. aorta: normal diameter of aorta at the sinus, ascending and arch levels. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: moderately thickened aortic valve leaflets. severe as (aova <0.8cm2). moderate (2+) ar. mitral valve: mechanical mitral valve prosthesis (mvr). normal mvr leaflet motion. normal mvr gradient. tricuspid valve: rhematic deformity of tricuspid valve. severe tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) pr. pericardium: no pericardial effusion. 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. results were conclusions prebypass 1. the left atrium is normal in size. no spontaneous echo contrast is seen in the left atrial appendage. no atrial septal defect of pfo is seen by 2d or color doppler. 2. left ventricular wall thicknesses and cavity size are normal. 3. the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. 4. there are simple atheroma in the descending thoracic aorta. 5. the aortic valve leaflets are moderately thickened. there is severe aortic valve stenosis (area <0.8cm2). moderate (2+) aortic regurgitation is seen. 6. a mechanical mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. the transmitral gradient is normal for this prosthesis. 7. there is a rhematic deformity of the tricuspid valve. severe tricuspid regurgitation is seen. 8. there is no pericardial effusion. 9. dr. was notified in person of the results on at 803. postbypass 1. patient is on phenylephrine infusion 2. left ventricle wall motion is difficult to assess, the walls that are seen are moving well. in the short axis view all walls are moving well. right ventricular function is difficult to assess, but appears to be moderately reduced in function compared to prebypass. 3. a well seated, well functioning prostetic valve is noted in the tricuspid position. no perivalvular leak. 4. a well seated, well functioning prostetic valve is noted in the aortic position. no perivalvular leak. 5. mitral st jude valve continues to function well. 6. the aortic contour is smooth after decannulation. 7. i certify that i was present for this procedure in compliance with hcfa regulations. interpretation assigned to , md, interpreting physician brief hospital course: admitted for intravenous heparin prior to cardiac catherization to bridge off coumadin due to mechanical mitral valve. underwent preoperative workup including cardiac catherization, carotid ultrasound, and head ct, was brought to the operating for aortic and tricuspid valve replacement and epicardial leads with new pacemaker generator. see operative report for further details. she was transferred to the intensive care unit for hemodynamic monitoring. in the first twenty foru hours she was weaned from sedation, awoke neurologically intact, and was extubated without complications. she was started on coumadin for mechanical valves and lasix for diuresis. on pod 2 she was started on heparin drip and remained in the intensive care unit for monitoring. dobhoff tube was placed due to absent gag and swallow evaluation ordered. pod 4 she was cleared for thin liquids, dobhoff removed, and started on supplements with meals. she was ready for discharge to acute rehab on heparin drip for mechanical valve until inr > 2.5 via picc line. medications on admission: lasix 20 mg daily toprol xl 50 daily coumadin 2 or 5mg as directed iron 325mg daily forteo 750mcg/3ml inj every other day folic acid 1 mg daily vitamin d 400 units discharge medications: 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 tablet sig: one (1) tablet po bid (2 times a day) for 1 months. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 5. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 6. warfarin 5 mg tablet sig: one (1) tablet po once (once): dose to change daily md, goal inr 2.5-3.5. 7. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: six y (650) units/hour intravenous continuous gtt : adjust dose for goal ptt 60-80 - check daily if no dose adjustment, if adjusting drip check 6 hours after change in rate. d/c when inr >2.5. 8. furosemide 20 mg tablet sig: one (1) tablet po once a day. 9. forteo 750 mcg/3 ml pen injector sig: one (1) subcutaneous every other day. 10. folic acid 1 mg tablet sig: one (1) tablet po once a day. 11. vitamin d 400 unit tablet sig: one (1) tablet po twice a day. 12. metoprolol tartrate 25 mg tablet sig: tablet po bid (2 times a day). 13. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. 14. outpatient work : pt/inr daily until off heparin drip then mon-wed-fri for coumadin dosing, goal inr 3.0-3.5 for mechanical mitral valve 15. outpatient work lft in 1 month - started on statin discharge disposition: extended care facility: - discharge diagnosis: aortic stenosis s/p avr tricuspid regurgitation s/p tvr hypertension tachy-brady syndrome s/p ppm anemia osteoporosis hyperactive bladder cva chronic atrial fibrillation coronary artery disease rheumatic heart disease discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns : pt/inr daily until off heparin drip then mon-wed-fri for coumadin dosing, goal inr 3.0-3.5 for mechanical mitral valve ptt for heparin dosing daily if no change, if change in drip - 6 hours after change in drip - goal ptt 60-80 until inr 2.5 or greater than heparin can be discontinued followup instructions: please call to schedule appointments dr in 4 weeks dr after discharge from rehab dr after discharge from rehab : pt/inr daily until off heparin drip then mon-wed-fri for coumadin dosing, goal inr 3.0-3.5 for mechanical mitral valve ptt for heparin dosing daily if no change, if change in drip - 6 hours after change in drip - goal ptt 60-80 until inr 2.5 or greater than heparin can be discontinued procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters open and other replacement of aortic valve angiocardiography of right heart structures suture of vein insertion or replacement of epicardial lead [electrode] into epicardium open and other replacement of tricuspid valve with tissue graft replacement of any type of pacemaker device with single-chamber device, rate responsive diagnoses: hyperpotassemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation aortocoronary bypass status accidental puncture or laceration during a procedure, not elsewhere classified heart valve replaced by other means atrioventricular block, complete osteoporosis, unspecified long-term (current) use of anticoagulants mitral valve insufficiency and aortic valve stenosis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation hypovolemia diseases of tricuspid valve chronic diastolic heart failure hip joint replacement 

Answer: The patient is high likely exposed to