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: history of present illness: this is a 76-year-old gentleman with history of aortic valve replacement, mitral valve replacement both bioprosthetic valve, status post 1 vessel cabg for 3 vessel coronary artery disease back in , who presents to for further evaluation and treatment of his coronary artery disease, severe mitral regurgitation. the patient recently presented to his cardiologist, dr. , with gradually worsening shortness of breath with exertion over the last 12 months, more significantly over the last 2 to 3 months. the patient previously has been able to walk "three telephone poles " distance before dyspnea. now, the patient reports that he gets dyspneic with less than one-half of that distance. the patient also reports that he feels winded after 1 to 5 stairs. he denies history of chest pain, paroxysmal nocturnal dyspnea, orthopnea, lower extremity edema, palpitations, syncope or lightheadedness. review of systems: on further review of systems, he denies recent illness, injury, no recent fevers, chills, nausea, vomiting, diarrhea, melena, hematochezia, dysuria, hematuria, rash or headache. cardiac catheterization at on , showed three-vessel coronary artery disease, distal lad with tapered occlusion, (left circumflex 90 percent, av groove, occluded om, om-svg, 85 percent at proximal rca). in addition, a cardiac catheterization showed left ventricular dysfunction at 25 percent with global hypokinesis and apical akinesis, dysfunctional bioprosthetic mitral valve replacement with moderate to severe regurgitation and moderate mitral stenosis. the catheterization did reveal that the aortic valve replacement was functional and there was trace aortic insufficiency. the patient was referred to for further treatment. on the day of admission, , the patient had cardiac catheterization done here, which showed svg to om totally occluded, rca with severe disease, right atrial pressure of 17, pulmonary catheter wedge pressure 36/65/37; pulmonary artery pressure 85/32; cardiac index 2.54; peripheral vascular distance at 346. a pulmonary artery catheter was placed in the cardiac cath lab after the patient had two stents deployed in his right coronary artery. postcatheterization on arrival to the coronary intensive care unit, the patient was feeling well without complaints. past medical history: ischemic coronary artery disease. mitral stenosis, status post mitral valve replacement in . aortic stenosis, status post aortic valve replacement, both bioprosthetic valves. paroxysmal atrial fibrillation. hypertension. pneumonia. status post right hip replacement. allergies: no known drug allergies. social history: the patient lives with his wife. is a retired truck driver. he worked with budweiser horses. a korean war veteran. he was stationed in during the war. he never smoked. he has never drunken a beer in his life, no other alcohol use. no history of illicit drug use. his cardiologist is dr. . family history: no early coronary artery disease. outpatient medications: 1. aldactone 25 q.d. 2. lasix 20 mg p.o. b.i.d. 3. coumadin 3 mg q.d., except wednesday, the patient takes 4 mg p.o. q.d. 4. plavix 75 mg p.o. q.d. 5. atenolol 50 mg q.a.m., 25 mg q.p.m. 6. zantac 150 mg b.i.d. 7. kcl 10 meq q.d. physical examination: on admission, temperature 97.4, heart rate 62, blood pressure 116/47, respiratory rate 20, oxygen saturation 98 percent on room air, weight 88.3 kg. in general, he is in no apparent distress, calm. heent: sclerae anicteric. pupils equal, round, and reactive to light and accommodation. extraocular muscles intact bilaterally. mucous membranes moist. oropharynx: clear. neck: supple. jvd approximately 10 to 11 cm at 45 degree angle. cardiovascular: regular rate and rhythm. normal s1, loud s2, 2/6 systolic ejection murmur, audible throughout, loudest at apex. no rubs or gallops noted. chest: clear to auscultation bilaterally, anteriorly good aeration. abdomen: obese, soft, nontender, and nondistended. normoactive bowel sounds. no pulsatile masses or hepatosplenomegaly. extremities: cool, dry, 1 plus pedal pulses bilaterally. no clubbing, cyanosis or edema. left groin site clean, dry, and intact without hematoma, oozing or bruit. laboratory data: labs on admission, cbc, white count 9.3, hematocrit 41, platelets 196,000. chem-7, sodium 141, potassium 5.2, hemolyzed chloride 105, bun 26, bicarbonate 40, creatinine 1.6, calcium 10, inr 1.1. ekg on admission, sinus bradycardiac 53 beats per minute, normal axis, pr interval prolonged at 320 ms, qrs 166 ms, left bundle-branch block. old left atrial enlargement. spital course: this 76-year-old man status post bioprosthetic avr and mvr now status post catheter since the rca, three-vessel disease, elevated pulmonary artery pressure secondary to severe mitral regurgitation was admitted for trial of vasodilators and diuresis, in hopes of optimization of clinical status for consideration of mitral valve replacement by dr. . puy artery hypertension, mitral valve regurgitation: the patient was started on a trial of nipride, which the patient tolerated well with significant reduction of his pulmonary artery pressures. the initial upon readings for pulmonary artery pressure 85/32 with a mean of 48, which reduced to pulmonary artery pressure of 34/12 with a mean of 20 after nitroprusside. the patient's svr also decreased significantly from 1008 to 744 on the nipride. his pulmonary vascular resistance also decreased significantly from 346 to 160 on nipride. his pulmonary capillary wedge pressure decreased from 37 to 15 on nipride. the patient tolerated the trial of nipride well. however, the patient's systolic blood pressure did drop somewhat with the nipride drip, which was held secondary to hypotension after 12 hours of nipride therapy. after discussion with the patient, the decision was made to transition the patient from nipride to nesiritide for conservative afterload reduction until mitral valve replacement. the patient was diuresed significantly with nesiritide and lasix. the team felt that the patient was diuresed to euvolemia given that his creatinine increased from 1.4 to 1.9 on the day of discharge. discussion was held with the patient and his wife as well as with dr. regarding whether or not to keep the patient inpatient until mitral valve replacement could be done or readmit the patient to optimize his medical condition for possible surgery at a later date. the patient preferred to go home given that dr. cannot do his mitral valve replacement until next week. therefore, the patient was discharged home on his home medications with one change. the patient's atenolol was felt to be too high of a dose for the patient. he was noted to be hypotensive to a map of 55 to 60 and the heart rate in the 50s on this atenolol dose of 50 mg q.a.m. and 25 q.h.s. therefore, the atenolol dose was decreased to 25 mg b.i.d. the patient was advised that he felt dizzy or lightheaded that he should discontinue his p.m. atenolol dose after talking with his cardiologist, dr. . discharge diagnoses: congestive heart failure. severe mitral valve regurgitation. hypertension. paroxysmal atrial fibrillation. reversible pulmonary artery hypertension. discharge condition: stable. die medications: 1. plavix 75 mg p.o. q.d. 2. spironolactone 25 mg p.o. q.d. 3. aspirin buffered 325 mg p.o. q.d. 4. lipitor 40 mg p.o. q.d. 5. atenolol 25 mg p.o. b.i.d., hold if lightheaded. 6. valsartan 320 mg p.o. q.h.s. 7. zantac 150 p.o. b.i.d. 8. coumadin 3 mg p.o. q.h.s. the patient's was told to contact dr. regarding when to discontinue the coumadin prior to mitral valve replacement. 9. lasix 20 mg p.o. b.i.d. die follow up: the patient will be contact by dr. for mitral valve replacement surgery. he will be called to schedule a follow up appointment likely next week. he is advised if he has any chest pain, shortness of breath, lightheadedness or dizziness, he should call his primary care physician or his cardiologist, dr. , for further advise. he is advised that if he does not hear from dr. next tuesday that he should call dr. office to inquire about an appointment. , md procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor injection or infusion of nesiritide insertion of drug-eluting coronary artery stent(s) diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome unspecified essential hypertension atrial fibrillation aortocoronary bypass status other chronic pulmonary heart diseases rheumatic heart failure (congestive) heart valve replaced by transplant mitral stenosis with insufficiency 

Answer: The patient is high likely exposed to