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: rofecoxib attending: chief complaint: dyspnea on exertion, fatigue major surgical or invasive procedure: redo sternotomy/full left and right-sided maze procedure with resection of left atrial appendage using combination of atricure bipolar rf system and the cryo cath. cardiac catheterization history of present illness: 68 year old gentleman with past medical history of avr, mvr and septomyomectomy in who now has atrial fibrillation/flutter which is extremely symptomatic and has been very difficult to control. he underwent 2 cardoversions in and feels quite well when in normal sinus rhythm however reverts back to atrial tachycardia after a few days. despite aggressive medical therapy and cardioversions, mr. continues to suffer from atrial tachycardia. his symptoms are significant dyspnea with minimal activity and fatigue. he presents for admission today for cardiac catheterization, intravenous heparin to bridge from coumadin, and preoperative workup for maze. past medical history: past medical history hypertrophic cardiomyopathy with significant lvot gradient. complete heart block s/p dual chamber pacemaker () hypertension diastolic heart failure atrial tachycardia obesity aortic insufficiency gout af s/p successful electrical cardioversion of atrial fibrillation to sinus rhythm. depression foot cellulitis treated with antibiotics in past surgical history several ethanol ablations permanent pacemaker - aortic valve replacement with a . medical mechanical valve. mitral valve replacement with a . medical mechanical valve. septomyectomy() bilateral knee arthroscopies social history: -pt is widowed, lives with daughter in . currently on disability, previous occupation-mechanic. -quit tob 15 years ago, smoked 1.5 ppd x30years -social etoh use 1 drink per week. denies any other drug use. family history: family history: no premature heart disease -f: deceased at 87 from alzheimer's disease -m: alive, years of age, no known cad physical exam: physical exam pulse: 61 resp: 22 b/p right: 110/65 height: 5'6" weight: 280lb general: nad skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + obese extremities: warm , well-perfused edema trace ankle edema, early venous stasis changes varicosities none neuro: grossly intact pulses: femoral right: 1+ left: 1+ dp right: 1+ left: 1+ pt : np left: np radial right: 2+ left: 2+ carotid bruit no bruits appreciated pertinent results: admission: 05:10pm pt-25.5* ptt-32.4 inr(pt)-2.5* 05:10pm plt count-168 05:10pm wbc-7.6 rbc-4.71 hgb-13.9* hct-41.6 mcv-88 mch-29.5 mchc-33.4 rdw-15.2 05:10pm tsh-0.64 05:10pm %hba1c-5.5 eag-111 05:10pm albumin-4.3 calcium-9.0 phosphate-4.6*# magnesium-2.4 05:10pm ck-mb-4 ctropnt-<0.01 05:10pm lipase-70* 05:10pm alt(sgpt)-28 ast(sgot)-30 ld(ldh)-328* ck(cpk)-90 alk phos-131* amylase-80 tot bili-0.7 05:10pm glucose-85 urea n-27* creat-1.4* sodium-141 potassium-3.8 chloride-105 total co2-25 anion gap-15 06:22pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-0.2 ph-5.5 leuk-neg discharge: 04:55pm blood wbc-11.3* rbc-3.33* hgb-10.1* hct-29.0* mcv-87 mch-30.4 mchc-34.9 rdw-15.5 plt ct-118* 06:16am blood pt-29.0* inr(pt)-2.9* 04:55pm blood plt ct-118* 04:55pm blood glucose-99 urean-22* creat-1.0 na-137 k-4.4 cl-97 hco3-28 angap-16 06:29pm blood alt-23 ast-84* ld(ldh)-397* alkphos-59 totbili-1.0 echocardiography report echocardiographic measurements results measurements normal range left atrium - long axis dimension: *7.6 cm <= 4.0 cm left atrium - four chamber length: *6.8 cm <= 5.2 cm left ventricle - ejection fraction: 60% >= 55% aorta - sinus level: 3.1 cm <= 3.6 cm aorta - ascending: 3.4 cm <= 3.4 cm aorta - descending thoracic: 2.5 cm <= 2.5 cm mitral valve - mva (p t): 2.7 cm2 findings multiplanar reconstructions were generated and confirmed on an independent workstation. left atrium: marked la enlargement. moderate to severe spontaneous echo contrast in the body of the la. no spontaneous echo contrast is seen in the laa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: normal interatrial septum. right ventricle: normal rv systolic function. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: mechanical aortic valve prosthesis (avr). avr leaflets move normally. no ar. mitral valve: mechanical mitral valve prosthesis (mvr). normal mvr leaflets. mild mitral annular calcification. tricuspid valve: normal tricuspid valve leaflets. mild 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. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. the rhythm appears to be atrial fibrillation. patient. conclusions prebypass: the patient is v-paced at a rate of 80 bpm. the left atrium is markedly dilated. moderate to severe spontaneous echo contrast is seen in the body of the left atrium. no spontaneous echo contrast is seen in the left atrial appendage. it is difficult to evaluate the left ventricle due to reverberation artifact from the mechanical mitral valve and suboptimal transgastric views but function appears to be within normal limits. right ventricular systolic function appears normal with normal free wall contractility. there are simple atheroma in the descending thoracic aorta. a mechanical aortic valve prosthesis is present. the aortic valve prosthesis leaflets appear to move normally. no aortic regurgitation is seen. a mechanical mitral valve prosthesis is present. the prosthetic mitral leaflets appear normal. postbypass: the patient is on an infusion of phenylephrine and is still v-paced at a rate of 80 bpm. the left atrial appendage has been ligated. a small pouch (at most several millimeters deep) remains without evidence of flow on color doppler. left ventricular function appears to be unchanged although the views of the left ventricle are limited. the mechanical mitral and aortic valves continue to appear normal without regurgitation. aortic contours are normal. electronically signed by , md, radiology report chest (portable ap) study date of 2:35 pm medical condition: 68 year old man s/p maze reason for this examination: eval for pneumothorax s/p chest tube removal final report reason for examination: followup of the patient after maze procedure. portable ap chest radiograph was compared to . the right internal jugular line tip is at the level of low svc. there is unchanged appearance of the cardiomediastinal silhouette, bibasal atelectasis and bilateral pleural effusions. note is made that the current study was obtained with suboptimal technique and repeat radiograph for precise evaluation of the chest is recommended. dr. brief hospital course: 68yom admitted to for heparin bridge prior to cardiac catheterization followed by redo sternotomy and full maze procedure. on he had a repeat cardiac echo, on he had cardiac catheterization. on he was brought to the operating room for: redo sternotomy. full left and right-sided maze procedure with resection of left atrial appendage using combination of atricure bipolar rf system and the cryo cath. his cardiopulmonary bypass time was 127 minutes, with a crossclamp time of 80 minutes. he tolerated the operation well and was transferred from the operating room to the cardiac surgery icu in stable condition. he remained hemodynamically stable in the immediate post-op period, woke neurologically intact and was extubated. all tubes, lines and drains were removed according to cardiac surgery protocol. he was ready to transfer to the stepdown floor on pod1 however there were no beds available and he therefore stayed in the icu until pod3. once on the floor he worked with the physical therapist to increase his activity level, generally the remainder of his stay was uneventful. on pod4 he was discharged to rehabilitation at of . he is to f/u with dr in one month. medications on admission: amiodarone 400mg daily lisinopril 2.5mg daily toprol-xl 100mg daily simvastatin 20mg daily aldactone 25 mg daily coumadin 2.5 mg monday thru saturday (last dose 8/6) furosemide 80 mg twice a day colace 100 mg daily multivitamin aspirin 81 mg daily trazadone 50 mg at bedtime colchicine 0.6 for gout flare up (1-2 doses a week) discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 2. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po q12h (every 12 hours). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous q ac&hs. 7. warfarin 1 mg tablet sig: as directed tablet po daily (daily): target inr 2.5-3.0 for aortic and mitral mechanical valves. 8. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: before surgery patient took 2.5mg qd on mon-sat. none on sunday. 9. acetaminophen 325 mg tablet sig: two (2) tablet po every six (6) hours as needed for pain. 10. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 11. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 12. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 13. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 14. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 15. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 16. furosemide 80 mg tablet sig: one (1) tablet po bid (2 times a day). 17. aldactone 25 mg tablet sig: one (1) tablet po once a day. 18. lorazepam 0.5 mg tablet sig: 0.5 tablet po every twelve (12) hours as needed for anxiety. discharge disposition: extended care facility: - discharge diagnosis: s/p redo sternotomy/full left and right-sided maze procedure with resection of left atrial appendage using combination of atricure bipolar rf system and the cryo cath. past medical history hypertrophic cardiomyopathy with significant lvot gradient. complete heart block s/p dual chamber pacemaker () hypertension diastolic heart failure atrial tachycardia obesity aortic insufficiency gout af s/p successful electrical cardioversion of atrial fibrillation to sinus rhythm. depression foot cellulitis treated with antibiotics in past surgical history several ethanol ablations permanent pacemaker - aortic valve replacement with a . medical mechanical valve. mitral valve replacement with a . medical mechanical valve. septomyectomy bilateral knee arthroscopies discharge condition: discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with incisions: sternal - healing well, no erythema or drainage edema- chronic bilat edema with venous stasis changes discharge instructions: 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 until follow up with surgeon 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: recommended follow-up: you are scheduled for the following appointments: surgeon: dr (on @1:45pm please call to schedule appointments with your primary care dr , () in weeks cardiologist dr , in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization excision or destruction of other lesion or tissue of heart, open approach excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: other iatrogenic hypotension congestive heart failure, unspecified atrial fibrillation atrial flutter heart valve replaced by other means atrioventricular block, complete morbid obesity cardiac pacemaker in situ diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to