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 major surgical or invasive procedure: - aortic valve replacement w/ regent mechanical valve - cardiac catheterization history of present illness: ms. is a 61 y/o f with pmh notable for severe as presenting as transfer from for further management of worsening dyspnea on exertion. the patient presented to sturdy with a 3 week history of worsening dyspnea, especially with exertion. the patient was feeling more and more short of breath with minimal activity (such as folding laundry); of note, she has been quite inactive for some time due to her mvc in with resultant multiple orthopedic injuries. she required a long rehab stay and has just recently increased her activity level. on , she contact ems due to worsening dyspnea; en route to the hospital, she received lasix but was ultimately intubated in the sturdy ed due to respiratory distress. cxr at that time demonstrated pulmonary edema and ? of pneumonia; she was treated with levofloxacin and vancomycin and briefly required pressors. swan-ganz catheter was placed which demonstrated pcwp of 20; she was diuresed and ultimately extubated on without complication. . during this time, she ruled in by enzymes for nstemi (trop i 14.2) but denied ever having chest pain. echocardiogram on demonstrated severe as with mean gradient 44 mmhg and valve area 0.6 cm2. lvef was slightly depressed at 45%. she requested transfer to for further care; on arrival, she denies any difficulty breathing. in fact, she is irritated by the nasal cannulae at the present time. she denies any chest pain. she has residual pain in her left clavicle and occasionally in her sternum due to her numerous prior fractures. past medical history: severe aortic stenosis prior cva () dm 2 (diagnosed ) carotid endarterectomy () mvc with multiple injuries including fractured hip s/p repair, sternal fracture, rib fractures gout psoriasis osteoarthritis myocardial infarction social history: the patient lives alone and has two sons in the area who visit her often. she is a prior smoker but quit following her mvc last . she does not use alcohol; previously drank only occasionally. she has been on disability due to back pain since the . family history: her mother and father both had heart disease with mis in their 70s. physical exam: t 97, bp 127/91, hr 101, rr 25, o2 99 % on 3l nc, 95% on ra gen: elderly female in nad, comfortable, and speaking in full sentences heent: ncat. sclera anicteric. perrl, eomi. conjunctiva pink, no pallor or cyanosis of the oral mucosa. mmm. neck: supple with jvp of 8 cm. cv: pmi nondisplaced, midclavicular line. rr, normal s1, s2. systolic murmur at upper sternal borders radiating to carotids. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles evident bilaterally to apices. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits appreciated. ext: no peripheral edema. r femoral bruit but unclear if radiation from as murmur. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ no bruit; femoral 2+ with slight bruit; 2+ dp left: carotid 2+ with no bruit; femoral 2+ without bruit; 2+ dp pertinent results: cath: 1. coronary angiography of this right dominant circulation demonstrated non-obstructive coronary disease. the lmca had minimal disease. the lad had minimal disease. the lcx was large with 3 om branches and non-critical disease. the rca had a small 40% proximal lesion. 2. resting hemodynamics revealed normal left and right filling pressures. the mean ra pressure was 6 mm hg. the mean pcw pressure was 9 mm hg. fick ci was slightly low at 2.18 l/min/m2. there was no pulmonary hypertension. 3. interrogation of the aortic valve revealed a mean gradient of 40.03 mmhg with a calculated area of 0.70 cm2. 4. the patient experienced a likely vagal event with hypotension and bradycardia, treated and resolved following administration of atropine 1 mg and intravenous fluids. cnis: 1. occluded right ica. 2. hypoechoic left ica plaque, no significant associated stenosis however (graded as less than 40%). head ct: no evidence of hemorrhage or acute infarct. encephalomalacia changes consistent with chronic infarct of the left centrum semiovale. echo: pre-bypass: 1. the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. 2. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with apical hypokinesis. overall left ventricular systolic function is moderately depressed. 3. right ventricular chamber size is normal. there is mild global right ventricular free wall hypokinesis. 4. there are simple atheroma in the aortic arch. there are complex (>4mm)atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). trace aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. severe (4+)mitral regurgitation is seen. both leaflets are slightly restricted. annulus measures 3.6cm in the commisural axis. vena contracta is 0.6 -0.7 cm. systolic blunting is noted in the pulmonary veins. post-bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine andf epinephrine. 1. a well-seated bileaflet valve is seen in the aortic position with normal leaflet motion and gradients (mean gradient = 20 mmhg). washing jets are noted. leaflets appear to open well. 2. mr is significantly improved and now is mild in severity. 3. biventricular systolic function is improved 4. aorta and interatrial septum are intact post decannulation 5. other findings are unchanged cxr: improved left lower lobe atelectasis, small bilateral pleural effusions. 12:27am blood wbc-7.1 rbc-4.13* hgb-12.2 hct-35.1* mcv-85 mch-29.4 mchc-34.7 rdw-17.6* plt ct-103*# 02:09pm blood wbc-7.8 rbc-3.11* hgb-9.0* hct-27.2* mcv-87 mch-28.8 mchc-32.9 rdw-16.6* plt ct-126* 06:35am blood hct-27.6* 08:50am blood wbc-5.8 rbc-3.24* hgb-9.4* hct-28.8* mcv-89 mch-28.9 mchc-32.6 rdw-16.5* plt ct-223 12:27am blood pt-12.6 ptt-27.3 inr(pt)-1.1 06:35am blood pt-21.4* ptt-92.1* inr(pt)-2.1* 12:27am blood glucose-118* urean-20 creat-1.0 na-145 k-3.9 cl-109* hco3-26 angap-14 05:45am blood glucose-116* urean-21* creat-0.8 na-144 k-3.9 cl-106 hco3-27 angap-15 10:25am blood glucose-74 urean-17 creat-0.9 na-142 k-3.9 cl-103 hco3-26 angap-17 06:35am blood k-4.2 05:45am blood alt-26 ast-46* ld(ldh)-345* alkphos-79 amylase-50 totbili-0.4 brief hospital course: ms. is a 61 year old female with known severe aortic stenosis transferred from osh after episode of respiratory distress leading to intubation due to pulmonary edema. she was extubated prior to transfer to . she underwent cardiac evaluation including cardiac catheterization which confirmed severe aortic stenosis and clean coronary arteries(see result section for further detail). further evaluation included carotid ultrasound and head ct scan. carotid ultrasound showed a complete occlusion of the right internal carotid artery, with some hypoechoic plaque/wall thickening involving the left internal carotid artery but no significant associated stenosis. given prior history of hemorrhagic stroke, she underwent head ct scan which revealed encephalomalacia changes consistent with chronic infarct of the left centrum semiovale. there was no evidence of hemorrhage or acute infarction. the neurology service was consulted to assess risk of perioperative stroke. it was concluded that a 2% risk was present but there was no contraindication to proceed. workup was otherwise unremarkable and she was cleared for surgery. on , dr. performed an aortic valve replacement utilizing a mechanical valve. for surgical details, please see separate dictated operative note. following the operation, she was brought to the csru for invasive monitoring. within 24 hours, she awoke neurologically intact and was extubated without incident. her csru course was otherwise unremarkable and she transferred to the sdu on postoperative day one. given her mechanical valve, she was started on warfarin. she transiently required intravenous heparin for a subtherapeutic prothrombin time. preoperative medications were resumed. over several days, she continued to make clinical improvements with diuresis and made steady progress with physical therapy. given her steady progress, she was medically cleared for discharge on postoperative day seven. prior to discharge, plan were made for inr to be followed by dr . medications on admission: on transfer): albuterol q2h prn duoneb glipizide 5 mg metformin 500 lisinopril 5 protonix 40 daily fluticasone 2 puffs lovenox 100 mg metoprolol 25 mg q8h simvastatin 40 mg qhs aspirin 325 mg daily lorazepam prn lasix 40 mg iv x 1 . meds prior to admission (unsure of doses): protonix 40 mg daily glucophage glipizide plaquenil allopurinol asa discharge medications: 1. 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:*0* 2. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 3. glipizide 5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 4. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. 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:*0* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 8. outpatient work pt/inr for coumadin dosing - please check mon/wed/fri with results to dr office phone # fax goal inr 2.5-3.0 for mechanical aortic valve 9. toprol xl oral 10. metoprolol succinate 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). disp:*90 tablet sustained release 24 hr(s)* refills:*2* 11. warfarin 2.5 mg tablet sig: three (3) tablet po once (once) for 1 doses: 7.5 mg today, inr to be drawn by vna on , and called to dr. for continued dosing. disp:*60 tablet(s)* refills:*0* 12. allopurinol 100 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 13. ibuprofen 600 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 14. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed. disp:*60 tablet(s)* refills:*0* 15. bupropion 75 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: community vna, discharge diagnosis: aortic stenosis s/p avr osteoarthritis hypertension hypercholesterolemia gout cva diabetes mellitus type 2 carotid endarectomy psoriasis discharge condition: good discharge instructions: shower daily and pat dry incisions no lotions, creams, powders on any incision no driving for one month no lifting greater than 10 pounds for 10 weeks call surgeon for redness, drainage, or fever greater than 100.5 followup instructions: dr in 4 weeks () please call for appointment dr in 1 week () please call for appointment dr in weeks () please call for appointment wound check appointment 2 as instructed by nurse () labs: pt/inr for coumadin dosing - please check mon/wed/fri with results to dr office phone # fax goal inr 2.5-3.0 for mechanical aortic valve procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures open and other replacement of aortic valve continuous intra-arterial blood gas monitoring diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified gout, unspecified aortic valve disorders peripheral vascular disease, unspecified personal history of tobacco use occlusion and stenosis of carotid artery without mention of cerebral infarction family history of ischemic heart disease 

Answer: The patient is high likely exposed to