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: angina, palpitations and dyspnea on exertion major surgical or invasive procedure: aortic valve replacement(19mm st. mechanical valve) and mitral valve replacement(25mm st. mechanical valve) history of present illness: ms. is a 37 year old female with history of rheumatic heart disease who presented with worsening shortness of breath, chest pain and palpitations. she has been followed with serial echocardiograms for aortic and mitral valve stenoses/regurgitation. given congestive heart failure symptoms, she was admitted for elective aortic and mitral valve replacements. past medical history: 1. rheumatic valvular heart disease with: - moderate-to-severe aortic stenosis - mild-to-moderate aortic regurgitation - moderate mitral stenosis - mild mitral regurgitation. 2. mild secondary pulmonary hypertension 3. breast fibroma 4. childhood asthma 5. s/p cesarean section social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. the patient is originally from , republic. she immigrated to the united states in . she currently works nights as a cleaning lady at a bar. she lives with her sister and her two children and also the patient's 5-year-old daughter. the patient's 5-year-old daughter has difficulty speaking and is currently in special education classes. the patient denies smoking, drinking, or using illegal drugs. family history: noncontributory. physical exam: pulse:61 reg. resp: o2 sat: b/p right: 120/77 left: 132/73 height: 62" weight: 142# general:nad, well-nourished skin: dry intact heent: perrla eomi anicteric sclera, op remarkable neck: supple full rom no jvd noted chest: lungs clear bilaterally heart: rrr irregular murmur: 4/6 sem radiates loudly to carotids, diastolic murmur abdomen: soft non-distended non-tender bowel sounds + no hsm/cva tenderness extremities: warm , well-perfused edema-none varicosities: none mild superficial spider veins bilat. neuro: grossly intact, mae strengths, nonfocal exam pulses: femoral right: 2+ left: 2+ dp right: 2+ left: 2+ pt : 2+ left: 2+ radial right: 1+ left: 1+ carotid bruit : murmur radiates to bil. carotids pertinent results: wbc-26.4*# rbc-3.08*# hgb-9.7*# hct-28.6*# mcv-93 mch-31.4 mchc-33.8 rdw-12.7 plt ct-179 wbc-19.1* rbc-2.90* hgb-9.2* hct-27.0* mcv-93 mch-31.8 mchc-34.2 rdw-13.2 plt ct-198 wbc-14.1* rbc-2.86* hgb-9.2* hct-26.6* mcv-93 mch-32.1* mchc-34.5 rdw-13.2 plt ct-213 wbc-9.8 rbc-2.68* hgb-8.3* hct-25.2* mcv-94 mch-31.0 mchc-32.9 rdw-13.4 plt ct-266 glucose-131* urean-11 creat-0.6 na-137 k-4.7 cl-109* hco3-21* glucose-96 urean-9 creat-0.7 na-135 k-4.2 cl-103 hco3-24 glucose-137* urean-10 creat-0.7 na-138 k-4.0 cl-102 hco3-27 pt-15.5* ptt-28.9 inr(pt)-1.4* pt-27.8* ptt-52.5* inr(pt)-2.7* pt-28.0* ptt-31.0 inr(pt)-2.7* pt-30.9* ptt-33.2 inr(pt)-3.1* brief hospital course: ms. was admitted to on and taken to the operating room for aortic and mitral valve replacements with st. mechanical valves. see operative note for details. immediately post-operatively she remained intubated and was admitted to the icu for intensive care. she was extubated on pod#1 and started on betablockade and diuretics. her chest tubes and temporary pacing wires were removed per protocol on pod#2 without complication. anticoagulation was started with iv heparin and po coumadin. once her inr was therapeutic, the heparin drip was discontinued. over several days, she maintained stable hemodynamics and continued to make clinical improvements with diuresis. she was evaluated by physical therapy and claered for discharge to home on pod#4. her inr will be followed by dr. in coumadin clinic. her first inr check will be on . medications on admission: toprol xl 50 qd, lasix 20 qd, penicillin vk 250 mg discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). :*60 capsule(s)* refills:*0* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). :*60 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). :*100 tablet, delayed release (e.c.)(s)* refills:*2* 4. hydromorphone 2 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain. :*50 tablet(s)* refills:*0* 5. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. :*30 tablet sustained release 24 hr(s)* refills:*2* 6. lasix 20 mg tablet sig: one (1) tablet po twice a day for 7 days: take twice daily for seven days, then drop to once daily until follow up with cardiologist or pcp. :*30 tablet(s)* refills:*0* 7. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day: please do not take without lasix. :*30 tab sust.rel. particle/crystal(s)* refills:*0* 8. warfarin 2.5 mg tablet sig: one (1) tablet po once a day: warfarin should be titrated for goal inr between 2.5 - 3.5. :*60 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: rheumatic heart disease - aortic and mitral valve stenosis secondary pulmulmonary hypertension chronic diastolic congestive heart failure discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks from date of surgery. 6) no driving for 1 month or while taking narcotics for pain. 7) take warfarin as directed by md/ clinic. daily dose may vary according to inr. warfarin should be titrated for goal inr between 2.5 - 3.5. 8) please call cardiac with any questions or concerns. followup instructions: - dr. in 4 weeks - dr. (pcp) in weeks - dr. (cardiologist) in 2 weeks - wound check on 6 as scheduled by 6 nurses - first inr check should be on . vna should fax results to coumadin clinic @ . clinic office number is . procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve cardioplegia open and other replacement of mitral valve diagnoses: mitral valve disorders congestive heart failure, unspecified aortic valve disorders other chronic pulmonary heart diseases rheumatic heart disease, unspecified chronic diastolic heart failure 

Answer: The patient is high likely exposed to