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: weight gain, doe major surgical or invasive procedure: redo sternotomy/mvr923mm st. mechanical)/tv repair(28mm annuloplasty band) history of present illness: patient is a 41yo woman with h/o dm type in (congenital bicuspid valve) who presents for right heart catheterization in anticipation of mvr. . ms. was admitted 1 month ago to with acute diastolic heart failure. tte done during that admission demonstrated moderate to severe mitral and tricuspid regurgitation; increased from 2+ mr from . although echocardiogram showed evidence of possible former rheumatic heart disease, the underlying cause of her valvular dysfunction is unclear. was diuresed with lasix with improvement in her fluid status and dyspnea. she now presents for mvr. . patient reports that she has been "exhausted all the time" since her discharge. she is dyspneic with minimal exertion, such as walking down the . +orthopnea, uses 3 pillows at night. denies pnd or ankle edema. +8 pound weight loss in last month, which she attributes to poor appetite. she does admit to depression, and states she is not sleeping well, though she is optimistic about improving after surgery. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative except as noted in hpi. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. past medical history: type 1 dm--a1c 7.5% in ; c/b peripheral neuropathy and retinopathy; on insulin pump : st. 19 mm valve. prior to this found to have bicuspid valve, 0.6 with mean gradient 40. anemia with baseline hct 28-31 mitral regurg (3+ on tte ) and 3+ tr mitral stenosis (mild with rheumatic valvular deformities on ) depression anxiety dyslipidemia hypertension celiac disease . allergies: nkda . outpatient cardiologist: dr. pcp: in endocrinologist: dr. , psych: dr. () social history: social history is significant for the presence of current tobacco use; quit 1.5 years ago but still sometimes sneaks a cigarette. smoked x 10 years previously. there is history of alcohol abuse, but she has been sober x5 years. also with h/o percocet abuse, sober x5 years. she does not feel that narcotic pain control while in the hospital will trigger a relapse. she is a nurse, though is not currently working. she has a 10 year old daughter () and a life partner named ; live nearby. family history: there is no family history of premature coronary artery disease or sudden death. her mother has a h/o cervical ca, father died of prostate cancer. physical exam: vs - 98.9 138/80 68 16 98% ra. gen: wdwn woman in nad. oriented x3. mood, affect appropriate. slightly short of breath with conversation. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. mmm, old cavities with fillings. neck: supple with jvp of 5 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2 with loud click. iv/vi systolic murmur throughout precordium. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. + crackles at bases; no wheezes or rhonchi. abd: scar from prior c-section. +bs. soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: + hypopigmented macules on chest, arms, legs, and trunk, most prominent on chest and arms. occasional scabs are early stage of same process per patient. no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: cardiac cath performed on demonstrated: 1. coronary arteries are normal. 2. severe aortic stenosis. 3. normal ventricular function, lvef 66% 02:56am blood wbc-5.6# rbc-3.35* hgb-8.8* hct-27.4* mcv-82 mch-26.2* mchc-32.1 rdw-17.8* plt ct-336 02:56am blood pt-33.3* ptt-103.1* inr(pt)-3.5* 11:42am blood pt-23.0* ptt-51.7* inr(pt)-2.2* 05:45am blood pt-14.9* ptt-67.2* inr(pt)-1.3* 03:55pm blood pt-13.7* ptt-93.1* inr(pt)-1.2* 02:56am blood plt ct-336 02:56am blood glucose-56* urean-8 creat-0.8 na-132* k-4.1 cl-94* hco3-31 angap-11 chest (pa & lat) 8:42 am chest (pa & lat) reason: assess for effusions/infiltrates medical condition: 41 year old woman s/p mvr reason for this examination: assess for effusions/infiltrates history: status post mvr. findings: in comparison with the study of , the swan-ganz catheter has been removed. no definite pneumothorax is appreciated on the left. there is some residual atelectatic change at the left base. echocardiography report , m (complete) done at 1:53:55 pm final referring physician information , r. division of cardiothoracic , status: inpatient dob: age (years): 41 f hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: intraoperative tee for mvr/tvr icd-9 codes: 440.0, 424.1, 394.2, 424.2 test information date/time: at 13:53 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: suboptimal tape #: 2007aw4-: machine: 4 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 0.8 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.6 cm <= 5.6 cm left ventricle - ejection fraction: 40% to 45% >= 55% aorta - ascending: 2.4 cm <= 3.4 cm aorta - arch: 2.0 cm <= 3.0 cm aorta - descending thoracic: 1.5 cm <= 2.5 cm aortic valve - peak gradient: *20 mm hg < 20 mm hg aortic valve - mean gradient: 13 mm hg aortic valve - valve area: *1.1 cm2 >= 3.0 cm2 mitral valve - peak velocity: 2.3 m/sec mitral valve - mean gradient: 9 mm hg mitral valve - mva (p t): 1.1 cm2 findings left atrium: dilated la. no spontaneous contrast or thrombus in the body of the laa. good (>20 cm/s) laa ejection velocity. right atrium/interatrial septum: 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. normal lv wall thickness and cavity size. suboptimal technical quality, a focal lv wall motion abnormality cannot be fully excluded. mild-moderate global left ventricular hypokinesis. mildly depressed lvef. right ventricle: dilated rv cavity. moderate global rv free wall hypokinesis. abnormal septal motion/position. aorta: focal calcifications in aortic root. normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. simple atheroma in descending aorta. aortic valve: bileaflet aortic valve prosthesis (). increased gradient. trace ar. mitral valve: moderately thickened mitral valve leaflets. mild mitral annular calcification. moderate thickening of mitral valve chordae. moderate valvular ms (mva 1.0-1.5cm2) moderate to severe (3+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. moderate to severe 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. no tee related complications. suboptimal image quality. the patient appears to be in sinus rhythm. results were conclusions pre cpb the left atrium is dilated. no spontaneous contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is mild to moderate global left ventricular hypokinesis (lvef = 40 %). the right ventricular cavity is dilated. there is moderate to severe global right ventricular free wall hypokinesis. there is abnormal septal motion/position consistent with prior cardiac surgery. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. a bileaflet aortic valve prosthesis is present. the transaortic gradient is higher than expected for this type of prosthesis. trace aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. the posterior mitral leafllet is, essentially, immobilized. there is moderate thickening of the mitral valve chordae. there is moderate valvular mitral stenosis (area 1.1 cm2). moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. post cpb the patient is receiving milrinone and epinephrine by infusion. exam limited by poor windows. right ventricular free wall function is much improved, now low normal to normal. left ventricular function, which can only be assessed from the transgastric windows, appears normal with an ejection fraction of about 60%. a bileaflet prosthesis is located in the mitral position. it appears well seated. both leaflets can be seen moving. there is normal mild valvular regurgitation. a perivalvular component can not be completely ruled out. the maximum gradient across the valve is about 18 mm hg with a mean pressure of 7 mm hg in the setting of a cardiac output of 6 l/m. a tricuspid valve annuloplasty ring is seen in situ. it also appears well seated. there is at least mild, eccentric tricuspid regurgitation. can not rule out a perivalvular component. the mean gradient across the tricuspid valve is 5 mm hg. the thoracic aorta is intact. brief hospital course: patient is a 41yo woman with iddm and from admitted for cardiac cath in anticipation of mvr. she was started on a heparin gtt. she was seen by nephrology for hyponatremia, and was fluid restricted and her doses of trileptal and celexa were reduced. cardiac cath on showed no cad, elevated right and left filling pressures and severe pulmonary hypertension. she was taken to the operating room on where she underwent a redo-sternotomy, mvr(mechanical) and tv repair. she was transferred to the icu in critical but stable condition on levophed, epinephrine, and milrinone. she awoke and was extubated on pod #1. she was weaned from her vasoactive drips by pod #2. she was found to be in complete heart block and was seen by ep. she was transfused 1 unit for hct 27 and sbp 80s. she was started on heparin for her mechanical valves. she was followed by . she was transferred to the floor on pod #5. her rhythm recovered, she was started on coumadin and her epicardial pacing wires were dc'd. by post-operative day 10 her inr was therapeutic, but it rose quickly from the previous day and it was recommended that she stay overnight to ensure that her inr does not rise even further. she expressed the desire to return home regardless. the risks of doing so were stressed to her, yet she continued to express the desire to leave against medical advice. her inr was scheduled to be checked by visiting nursing on the day after her discharge. medications on admission: insulin pump valsartan 120 mg po daily buspirone 20 mg po tid trazodone 300 mg qhs atenolol 25 mg po daily celexa 80 mg po daily wellbutrin sr 200 mg po bid atorvastatin 80 mg po daily oxcarbazepine 900 mg po qhs coumadin 7-8mg qhs furosemide 20 mg po daily --not taking her iron or asa 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. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*0* 7. valsartan 40 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*0* 8. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. bupropion 100 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). disp:*120 tablet sustained release(s)* refills:*0* 10. oxcarbazepine 300 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 11. buspirone 10 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*0* 12. warfarin 2 mg tablet sig: one (1) tablet po once (once) for 1 doses: check inr with results to coumadin clinic/ . disp:*60 tablet(s)* refills:*0* 13. lasix 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: mr, tr now s/p mvr/tvrepair htn, ^chol, dm i, neuropathy, anxiety, eye sx, shoulder sx, c sec, s/p (19mm st. ) c/b sternal dehiscence, retinopathy, anemia, depression, restless leg syndrome 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-check inr with results to coumadin clinic/ rn, . further checks and dosing rn . goal inr 3-3.5 for mechanical /mvr. spoke to ms. to confirm follow up. followup instructions: dr. 4 weeks dr. 2 weeks coumadin follow up with already scheduled appointments: , md phone: date/time: 1:40 procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of temporary transvenous pacemaker system open and other replacement of mitral valve annuloplasty transfusion of packed cells diagnoses: tobacco use disorder congestive heart failure, unspecified hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission other chronic pulmonary heart diseases polyneuropathy in diabetes hypopotassemia pulmonary collapse dysthymic disorder other and unspecified hyperlipidemia heart valve replaced by other means atrioventricular block, complete iron deficiency anemia, unspecified celiac disease diseases of tricuspid valve background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled rheumatic mitral insufficiency restless legs syndrome (rls) insulin pump status diabetes with other specified manifestations, type i [juvenile type], not stated as uncontrolled chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to