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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath major surgical or invasive procedure: coronary artery bypass graft x 4, aortic valve replacement (25mm tissue) history of present illness: 74 year old male with moderate aortic stenosis and recent echocardiogram demonstrating 1.4 cm2 and reports shortness of breath associated with chest tightness after climbing one flight of stairs and when walking up an incline. he was referred for right and left heart catheterization. he was found to have coronary artery disease and is now being referred to cardiac surgery for revascularization. past medical history: aortic stenosis, moderate, calculated 1.4 cm2 atrial fibrillation on pradaxa since hypertension hyperlipidemia gout (pt not aware, noted in records) arthritis cataract, bilateral s/p left knee replacement s/p appendectomy s/p carpal tunnel surgery social history: race:caucasian last dental exam:3 months ago, will call dentist to have dental clearance faxed to office lives with:wife contact: (wife) phone# occupation: retired elevator mechanic cigarettes: smoked no yes hx:quit 40 years ago other tobacco use:denies etoh: quit one month ago, former daily etoh 2-3 beers illicit drug use:denies family history: premature coronary artery disease - non contributory physical exam: pulse:68 resp:18 o2 sat:98/ra b/p right:87/52 left:83/54 height:5'" weight:190 lbs general: skin: dry intact heent: eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr murmur grade 2 systolic abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema _____ varicosities: none neuro: grossly intact pulses: femoral right: p left: p radial right: p left: p carotid bruit right: - left: - pertinent results: tee: left atrium: no spontaneous echo contrast in the body of the la. moderate to severe spontaneous echo contrast in the laa. depressed laa emptying velocity (<0.2m/s) cannot exclude laa thrombus. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: mild spontaneous echo contrast in the body of the ra. a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. mild symmetric lvh with normal cavity size and global systolic function (lvef>55%). right ventricle: normal rv systolic function. aorta: focal calcifications in aortic root. mildly dilated ascending aorta. simple atheroma in ascending aorta. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. moderately thickened aortic valve leaflets. mild as (area 1.2-1.9cm2). moderate as (area 1.0-1.2cm2) mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. no ms. mild to moderate (+) mr. tricuspid valve: tricuspid valve not well visualized. physiologic tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) pr. pericardium: no pericardial effusion. general comments: written informed consent was obtained from the patient. 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. the patient appears to be in sinus the patient. conclusions pre bypass no spontaneous echo contrast is seen in the body of the left atrium. moderate to severe spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). a left atrial appendage thrombus cannot be excluded. mild spontaneous echo contrast is seen in the body of the right atrium. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). the right ventricle displays normal free wall contractility. the ascending aorta is mildly dilated. there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. the left coronary cusp is essentially immobilized. there is mild to moderate aortic valve stenosis (valve area 1.4 cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. 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 thetime of the study. post bypass the patient is atrially paced. there is normal biventricular systolic function. there is a bioprosthesis located in the aortic position. it is well seated and the leaflets appear to be moving normally. there may be very trace aortic insufficiency though it was seen only after initial separation from bypass and its source could not be determined. the maximum gradient through the valve was 11 mmhg with a mean gradient of 5 mmhg at at cardiac output of 4.6 liters/minute. the mitral regurgitation appears to be slightly improved -now mild. the left atrial appendage has been resected. the thoracic aorta appears intact after decannulation. no other significant change from the pre-bypass period. 05:31am blood wbc-7.5 rbc-3.16* hgb-9.5* hct-29.4* mcv-93 mch-30.0 mchc-32.3 rdw-14.5 plt ct-142* 02:49pm blood wbc-11.8* rbc-2.83* hgb-8.7* hct-26.3* mcv-93 mch-30.8 mchc-33.1 rdw-13.1 plt ct-128* 04:40am blood pt-25.7* inr(pt)-2.5* 08:40am blood pt-13.7* ptt-23.5* inr(pt)-1.3* 05:31am blood glucose-95 urean-22* creat-0.8 na-141 k-4.0 cl-103 hco3-29 angap-13 04:04pm blood urean-12 creat-0.7 na-140 k-4.2 cl-111* hco3-23 angap-10 brief hospital course: mr. was a same day admit and brought to the operating room on where he underwent a coronary artery bypass graft x 4 (lima-lad, svg-diag, svg-plva-pda jump) aortic valve replacement tissue 25mm and laa ligation. please see operative note for surgical details. following surgery he was transferred to the cvicu for invasive monitoring. he was a-paced over sinus bradycardia and required neo and volume for hypotension and low cardiac index. he awoke neurologically intact and was extubated without incident. he required neo until pod#3. mr. has a history of afib/flutter and went back into it on post-op day two. he was mostly in atrial flutter which was rapid at times and his meds were adjusted. he was rapid atrial paced to sr for several hours but returned to a-flutter. he was started briefly on amio but due to hypotension this was discontinued and he was then started on digoxin with good effect. his pacing wires and chest tubes were removed per protocol, without difficulty. he had a slight drop in his platlet count but this has since resolved. on pod #4 he transferred to the floor in rate control atrial flutter and stable condition. he was evaluated by the physical therapy department for strength and mobility.the remainder of his hospital course was essentially uneventful. on post-op #6 he was discharged to home with vna services. dr., his pcp will follow coumadin dosing. all follow up appointments were advised. want to consider future ablation for atrial flutter. medications on admission: atenolol 25 mg daily dabigatran etexilate 150 mg indomethacin 50 mg tid prn simvastatin 20 mg daily triamterene-hydrochlorothiazid 37.5 mg-25 mg capsule - one capsule daily aspirin 81 mg daily discharge medications: 1. acetaminophen 325 mg sig: two (2) po q4h (every 4 hours) as needed for temperature >38.0. 2. aspirin 81 mg , delayed release (e.c.) sig: one (1) , delayed release (e.c.) po daily (daily). disp:*60 , delayed release (e.c.)(s)* refills:*2* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 5. simvastatin 10 mg sig: two (2) po daily (daily). disp:*60 (s)* refills:*2* 6. metoprolol tartrate 25 mg sig: three (3) po tid (3 times a day). disp:*270 (s)* refills:*2* 7. ranitidine hcl 150 mg sig: one (1) po daily (daily). disp:*60 (s)* refills:*2* 8. digoxin 250 mcg sig: one (1) po daily (daily). disp:*60 (s)* refills:*2* 9. hydromorphone 2 mg sig: one (1) po q6h (every 6 hours) as needed for pain. disp:*50 (s)* refills:*0* 10. potassium chloride 10 meq extended release sig: two (2) extended release po bid (2 times a day) for 10 days. disp:*40 extended release(s)* refills:*0* 11. warfarin 1 mg sig: md once (once). disp:*90 (s)* refills:*2* 12. warfarin 2.5 mg sig: one (1) po once (once) for 1 doses. disp:*1 (s)* refills:*0* 13. lasix 20 mg sig: one (1) po twice a day for 10 days. disp:*20 (s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: coronary artery disease s/p coronary artery bypass graft aortic stenosis s/p aortic valve replacement past medical history: atrial fibrillation on pradaxa since hypertension hyperlipidemia gout (pt not aware, noted in records) arthritis cataract, bilateral s/p left knee replacement s/p appendectomy s/p carpal tunnel surgery discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with oral analgesia incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 1+ 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 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 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: you are scheduled for the following appointments wound care phone: date/time: 11:00 surgeon: dr. , date/time: 1:00 cardiologist: dr. at 2:15p please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve with tissue graft excision, destruction, or exclusion of left atrial appendage (laa) central venous catheter placement with guidance diagnoses: other iatrogenic hypotension anemia, unspecified coronary atherosclerosis of native coronary artery unspecified essential hypertension gout, unspecified atrial fibrillation aortic valve disorders atrial flutter other and unspecified hyperlipidemia knee joint replacement unspecified cataract 

Answer: The patient is high likely exposed to