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: erythromycin base / codeine / iv dye, iodine containing contrast media attending: chief complaint: shortness of breath major surgical or invasive procedure: 1. aortic valve replacement with a 19-mm st. regent mechanical valve. 2. root enlargement with pericardial patch closure. history of present illness: 58 year old female with hypertension, type 2 diabetes, and obesity, who developed acute shortness of breath at rest in and was diagnosed and treated for pna. since that time she has continued with significant dyspnea on exertion. further work up included an echo which revealed severe as. with regards to symptoms she reports significant shortness of breath with walking as little as 5 to 6 steps. she denies chest pain but reports this is often accompanied by chest "soreness" and lung "ache". this resolves immediately with rest. she denies any lightheadedness or dizziness. she denies any presyncope or syncope. she reports mild bilateral ankle edema, left greater than right that is usually resolved by morning after her feet are elevated. she does report rare occasional palpitations with exertion but states these are not bothersome. she was referred for a cardiac catheterization for further evaluation. she was found to have no coronary artery disease and is now being referred to cardiac surgery for an aortic valve replacment. past medical history: aortic stenosis pneumonia hypertension type 2 diabetis mellitus past surgical history: s/p tonsillectomy s/p cholecystectomy social history: lives with:alone, sister and mother live close by occupation:previously worked as a manufacturing line but has is now disabled due to her medical condition. tobacco:very infrequent cigarette smoker and has not had a cigarette in over 15 years etoh:denies family history: father with mi in his 40's and lived into his 70's, mother with bilateral cea physical exam: pulse:61 resp:18 o2 sat:96/ra b/p right:124/52 left:150/80 height:5'1" weight:244 lbs general: skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally very diminished heart: rrr irregular murmur iv/vi abdomen: soft non-distended non-tender bowel sounds + obese extremities: warm , well-perfused edema varicosities: none , (b)le mild erythematous rash neuro: grossly intact pulses: femoral right: left: dp right:2+ left:2+ pt : left: radial right: left: carotid bruit (l)thrill-(b) bruits vs transmission of as-pulses=right: 2+ left:2+ pertinent results: tee conclusions pre bypass no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. a mass is present on the right coronary cuep of the aortic valve. there is critical aortic valve stenosis (valve area <0.8cm2). no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. a likely torn mitral chord associated with the posterior mitral leaflet is present. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results in the operating room at the time of the study. post bypass the patient is av paced. normal biventricular systolic function, though left ventricle is underfilled. there is a bileaflet prosthesis in the aortic position. it appears well seated and both leaflets can be seen moving normally. there is a mobile, loop like echodensity seen in some views of the left ventricular outflow tract (lvot) that probably represents some mitral annular tissue that was mobilized during the surgical procedure. it may be causing some amount of obstruction to flow through the lvot although this can not be clearly established due to limited views. the maximum gradient through the lvot/aortic valve is 16 mmhg with a mean pressure of 7 mmhg at a cardiac output of 3.5 liters/minute. there is trace aortic regurgitation seen which is likely the normal washing jets associated with this valve but this can not be completely established. the mitral regurgitation may be slightly worse than pre-bypass. the tricuspid regurgitation is now mild to moderate. the thoracic aorta is intact s/p decannulation. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 12:10 ?????? caregroup is. all rights reserved. 05:07am blood wbc-10.5 rbc-3.94* hgb-11.2* hct-35.3* mcv-90 mch-28.3 mchc-31.6 rdw-16.9* plt ct-476* 03:00am blood wbc-8.1 rbc-3.59* hgb-10.4* hct-32.2* mcv-90 mch-28.9 mchc-32.2 rdw-16.5* plt ct-365 05:07am blood glucose-128* urean-45* creat-1.2* na-146* k-4.6 cl-105 hco3-32 angap-14 03:00am blood glucose-104* urean-48* creat-1.3* na-145 k-4.4 cl-105 hco3-36* angap-8 05:07am blood pt-26.9* inr(pt)-2.6* 03:00am blood pt-34.0* ptt-30.8 inr(pt)-3.4* 02:51am blood pt-25.9* ptt-70.5* inr(pt)-2.5* 03:18am blood pt-18.1* ptt-77.9* inr(pt)-1.6* 10:46pm blood pt-16.6* ptt-82.5* inr(pt)-1.5* 12:49am blood pt-15.6* ptt-66.2* inr(pt)-1.4* 12:59am blood pt-15.1* ptt-56.9* inr(pt)-1.3* 03:07pm blood pt-15.6* ptt-51.6* inr(pt)-1.4* 02:00am blood pt-14.8* ptt-53.3* inr(pt)-1.3* 02:02am blood pt-16.4* ptt-61.2* inr(pt)-1.4* 11:16pm blood pt-18.0* ptt-28.8 inr(pt)-1.6* 02:37am blood pt-17.6* ptt-32.8 inr(pt)-1.6* brief hospital course: the patient was brought to the operating room on where the patient underwent aortic valve replacement (19mm st. mechanical) with dr. . overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. urine output decreased, and she became hemodynamically unstable. the swan ganz catheter was re-placed. additionally, she developed pulmonary edema and respiratory distress and was re-intubted. she remained on neo and milrinone and was given volume. she was anti-coagulated with coumadin and a heparin bridge for the mechanical valve. the patient was extubated on pod 3. later in the day she developed atrial fibrillation. amiodarone was given for chemical cardioversion. she developed a junctional rhythm requiring pacing. pa pressures rose and pulmonary edema was shown on cxr. she was re-intubated again. amiodarone was held. dobhoff was placed for tube feeding purposes. she remained on a lasix drip. hemodynamics improved and the patient was weaned from pressors and extubated. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod 12 the patient was ambulating, yet deconditioned, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to house rehab in good condition with appropriate follow up instructions. medications on admission: atenolol - (prescribed by other provider) - 25 mg tablet - 1 (one) tablet(s) by mouth once a day hydrochlorothiazide - (prescribed by other provider) - 25 mg tablet - 1 (one) tablet(s) by mouth once a day lisinopril - (prescribed by other provider) - 10 mg tablet - 1 (one) tablet(s) by mouth once a day metformin - (prescribed by other provider) - 500 mg tablet - 1 (one) tablet(s) by mouth daily at dinner time medications - otc aspirin - (otc) - 81 mg tablet, chewable - 1 (one) tablet(s) by mouth once a day calcium carbonate-vitamin d3 - (otc) - dosage uncertain discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 4. warfarin 1 mg tablet sig: three (3) tablet po daily (daily): md to dose daily for goal inr 2.5-3.0, dx: mechanical avr. 5. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 7. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 8. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 9. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours). 10. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 12. metformin 500 mg tablet sig: one (1) tablet po once a day. 13. outpatient lab work labs: pt/inr coumadin for mechanical avr goal inr 2.5-3.0 first draw then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by md 14. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 15. furosemide 20 mg tablet sig: one (1) tablet po once a day for 10 days. 16. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po once a day for 10 days. 17. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 18. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain/fever. 19. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: aortic stenosis pneumonia hypertension type 2 diabetis mellitus past surgical history: s/p tonsillectomy s/p cholecystectomy discharge condition: alert and oriented x3 nonfocal ambulating, deconditioned sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage edema: trace discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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** females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: you are scheduled for the following appointments: surgeon , md phone: date/time: 1:30 cardiologist dr. phone: date/time: 9:40 please call to schedule the following: primary care dr. , jr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr coumadin for mechanical avr goal inr 2.5-3.0 first draw then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours extracorporeal circulation auxiliary to open heart surgery insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances open and other replacement of aortic valve pulmonary artery wedge monitoring operations on other structures adjacent to valves of heart diagnoses: other iatrogenic hypotension urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified aortic valve disorders atrial flutter long-term (current) use of insulin morbid obesity surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation congenital insufficiency of aortic valve acute edema of lung, unspecified physical restraints status body mass index 45.0-49.9, adult 

Answer: The patient is high likely exposed to