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: mvr (25/33 on-x mechanical valve) history of present illness: 55 yo m with long history of myxomatous mv and chronic mr. serial echos showed increased la/lv dimensions and and severe mr and normal ef. referred for surgery. past medical history: mr/mvp, migraines, ankylosing spondylitis, gi bleed (10 years ago), hyperlipidemia, htn, b hernia repair social history: works as architect quit tobacco 27 years ago no etoh family history: mother with mvr @ age 70 father with mi/cva @ age 87 physical exam: nad hr 70 rr 12 bp 118/70 nad lungs ctab heart rrr 3/6 systolic abdomen benign extrem no edema, warm superficial ble aricosities pertinent results: 08:20am blood wbc-10.4 rbc-4.26* hgb-13.0* hct-36.3* mcv-85 mch-30.4 mchc-35.7* rdw-14.0 plt ct-385 08:05am blood wbc-13.8* rbc-4.31* hgb-13.0* hct-37.5* mcv-87 mch-30.1 mchc-34.6 rdw-13.9 plt ct-327# 08:20am blood plt ct-385 08:20am blood pt-30.7* ptt-52.6* inr(pt)-3.2* 07:35am blood pt-21.9* inr(pt)-2.1* 08:05am blood pt-20.8* ptt-33.7 inr(pt)-2.0* 07:10am blood pt-19.4* inr(pt)-1.9* 09:03am blood pt-14.4* ptt-27.8 inr(pt)-1.3* 08:20am blood glucose-102 urean-25* creat-0.7 na-134 k-4.3 cl-96 hco3-30 angap-12 chest (pa & lat) 9:16 am chest (pa & lat) reason: r/o inf, eff medical condition: 56 year old man s/p mvr reason for this examination: r/o inf, eff history: 56-year-old male status post mitral valve replacement. evaluate for infection, effusion. comparison: . chest, pa and lateral: retrosternal gas and a small air-fluid level are seen on the lateral view, probably related to recent sternotomy. the left basilar atelectasis has improved. however, there is a persistent small left pleural effusion. there is also a probable small right pleural effusion. the lung fields are clear. cardiomediastinal contours are normal. sternotomy wires and artificial mitral valve are unchanged. impression: 1. retrosternal gas and air-fluid level, probably related to recent sternotomy. 2. persistent small left pleural effusion and probable small right pleural effusion. echocardiography report , tte (complete) done at 4:01:56 pm preliminary referring physician information , , status: outpatient dob: age (years): 56 m hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: left ventricular function. mitral valve disease. mitral valve prolapse. preoperative assessment. icd-9 codes: 424.1, 424.0 test information date/time: at 16:01 interpret md: , md test type: tte (complete) son: doppler: full doppler and color doppler test location: echo lab contrast: none tech quality: adequate tape #: machine: echocardiographic measurements results measurements normal range findings right atrium/interatrial septum: no asd or pfo by 2d, color doppler or saline contrast with maneuvers. left ventricle: moderately dilated lv cavity. right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending, transverse and descending thoracic aorta with no atherosclerotic plaque. aortic valve: mildly thickened aortic valve leaflets (3). mild to moderate (+) ar. eccentric ar jet directed toward the anterior mitral leaflet. mitral valve: mildly thickened mitral valve leaflets. moderate/severe mvp. severe (4+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets. 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. brief hospital course: he was taken to the operating room on where he underwent a mechanical mvr. he was transferred to the icu in stable condition. he was extubated later that day. he was transferred to the floor on pod #1. he was started on coumadin for his mechanical mitral valve. he had some atrial fibrillation for which his beta blocker was increased and he converted to sinus rhythm. he did well postoperatively. he awaited a therapeutic inr and was ready for discharge on pod #5. dr. (spoke to at his office) will follow his coumadin. medications on admission: remicade q6w, folate 1mg qd, methotrexate 10mg qw, univasc 15mg qd, zantac 150 qd, lipitor 10mg , 81 qd, mvi 1 qd vit e 1000 iu qd, fish oil 1000mg qd, fioricet 50-325-40 1-2prn, celebrex 100mg qd discharge medications: 1. 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* 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. disp:*60 tablet(s)* refills:*0* 6. coumadin 5 mg tablet sig: one (1) tablet po once a day: check inr with results to dr. . disp:*30 tablet(s)* refills:*0* 7. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. moexipril 7.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 9. multi-vitamin hp/minerals capsule sig: one (1) capsule po once a day. 10. vitamin e 1,000 unit capsule sig: one (1) capsule po once a day. 11. fish oil 1,000 mg capsule sig: one (1) capsule po once a day. 12. propoxyphene n-acetaminophen 100-650 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. disp:*50 tablet(s)* refills:*0* 13. potassium chloride 20 meq packet sig: one (1) packet po q12h (every 12 hours) for 5 days. disp:*10 packet(s)* refills:*0* 14. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day) for 5 days. disp:*10 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: mr/mvp, migraines, ankylosing spondylitis, gi bleed (10 years ago), hyperlipidemia, htn, b hernia repair discharge condition: good. discharge instructions: call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. shower, no baths, no lotions, creams or powders to incisions. no lifting more than 10 pounds or driving until follow up with surgeon. coumadin to be followed by dr. . have inr checked with results called to dr. . goal inr 2.5-3.5 for mechanical mitral valve. followup instructions: dr. 2 weeks dr. 4 weeks dr. 2 weeks already scheduled appointments: , md (rheumatologist) phone: date/time: 5:00 procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of mitral valve diagnoses: mitral valve disorders unspecified essential hypertension atrial fibrillation other and unspecified hyperlipidemia migraine, unspecified, without mention of intractable migraine without mention of status migrainosus ankylosing spondylitis 

Answer: The patient is high likely exposed to