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: codeine / dilaudid attending: chief complaint: chest pressure, syncope, mobile echodensity on anterior mitral leaflet on echo major surgical or invasive procedure: avr ( porcine valve) history of present illness: pt is an 86 yo woman with pmh htn, hyperlipidemia, aortic stenosis, h/o chest pain and syncope, who presents after having echo on that demonstrates mitral valve mass. patient has been seeing dr. in cardiology clinic for a 2nd opinion (she is generally followed in , initially saw dr. in ) for c/o two- to three-year history of exertional and one-year history of rest chest discomfort, as well as episodes of syncope. due to these complaints, a cardiac cath was perfomed here in that showed normal coronary arteries along with moderate mitral regurgitation and mild-to-moderate aortic stenosis with a mean gradient of 20 mmhg (aortic valve area = 0.6cm2). she also had mildly elevated wedge pressures to 19 and her overall ejection fraction was 53%. it was thought, therefore, that the patient did not have a cardiac cause for her chest discomfort. however, the patient had some continued episodes of chest discomfort over the next 4-5 months, worsening over the past month to the point where the episodes were accompanied by shortness of breath that severely limited her functional capacity (she could hardly walk a block without stopping to catch her breath), and substantial weakness. she also had a couple episodes of syncope during this time. these complaints were evaluated in where the patient had a repeat echo and was told that she would need to have an aortic valve replacement. she again returned to dr. for a 2nd opinion, and her follow up appointment with him was . preceeding the appointment, the patient had a repeat echo () that demonstrated a new mitral valve (anterior leaflet) mobile mass, aortic stenosis unchanged. per dr. note from the visit that day, he believed her symptoms were unlikely due to critical aortic stenosis and were instead likely due to a combination of poorly controlled hypertension, diastolic dysfunction, mild anemia, mild-moderate mitral regurgitation, and mild-moderate aortic stenosis. she was treated with increasing the hctz from 12.5mg daily to 25mg daily and adding back nifedipine for improved blood pressure control. he also stated that he would carefully review the echo and the mass that it demonstrated, as well as the prior cardiac catheterization to determine whether or not the patient should get a repeat catheterization. upon review, demonstrates 1.5 x 1.5cm mobile mass/vegetation. the mass prolapses into the lvot without evidence of obstruction. the patient was sent to the hospital for admission for further w/u of the mitral valve mobile mass, and repeat cardiac catheterization in am. past medical history: syncope , prior + tilt table aortic stenosis - mean gradient of 20 mmhg (aortic valve area = 0.6cm2 pacemaker approximately 5-6 years ago for ?sss vs vagal reaction diastolic dysfunction hypertension hyperlipidemia mild anemia, ?early mds osteoporosis urinary urgency cosmetic surgery many years ago social history: patient lives alone in . she is currently staying with her daughter and son in law in . her son in law, dr. did his training at nedh many years ago. family history: mother had multiple at a young age. father had sudden death in his 50's-unclear source. physical exam: vitals - 98.4 120/70 60 18 97% ra general - pleasant younger than stated age, nad, full sentences heent - nc, at, anicteric, clear op neck - jvp @ 5 cm, no carotid bruits, radiation of the as b/l. cvs - rrr, loud ejection murmur at rusb with clear s2. lungs - ctab/l no w/r/r abd - + bs, snt/nd ext - no edema, no cyanosis, + 2 femoral + 2 dp pulses b/l, no femoral bruits b/l pertinent results: 06:50am blood wbc-8.2 rbc-3.17* hgb-9.9* hct-28.5* mcv-90 mch-31.3 mchc-34.9 rdw-15.0 plt ct-187 09:00am blood pt-23.1* inr(pt)-2.3* 09:00am blood glucose-138* urean-56* creat-2.1* na-135 k-4.0 cl-99 hco3-25 angap-15 chest (portable ap) reason: r/o ptx medical condition: 86 year old woman s/p avr and ct removal reason for this examination: r/o ptx portable chest, 9:40 a.m., . indication: status post avr with chest tube removal. findings: compared with , multiple tubes and catheters have been removed. no pneumothorax is seen. there are small bilateral pleural effusions and patchy atelectasis at the left base medially. the lungs are otherwise grossly clear. no chf. impression: no pneumothorax seen. dr. radiology final report unilat up ext veins us left 9:41 am unilat up ext veins us left reason: evaluate for clot in lue medical condition: 86 year old woman s/p avr reason for this examination: evaluate for clot in lue indication: status post aortic valve repair, evaluate for upper extremity clot. comparison: none. left upper extremity ultrasound: -scale, color, and pulse doppler evaluation of the left internal jugular, left subclavian, left axillary, left brachial veins were performed. eccentric nonocclusive thrombus is demonstrated within the left axillary and one of the left brachial veins containing a punctate focus of echogenicity suggestive of calcification. these findings are likely representative chronic nonocclusive thrombus. left subclavian and left internal jugular veins demonstrate normal color flow and waveforms. normal compressibility is present within the left internal jugular vein. the left cephalic and basilic veins were not visualized. impression: non-occlusive thrombus within the left axillary and left brachial veins, likely chronic. the study and the report were reviewed by the staff radiologist. dr. dr. cardiology report echo study date of patient/test information: indication: aortic valve disease. intra-op tee for avr height: (in) 63 weight (lb): 130 bsa (m2): 1.61 m2 status: inpatient date/time: at 10:21 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw06-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. . measurements: left ventricle - ejection fraction: 50% to 55% (nl >=55%) aorta - valve level: 2.6 cm (nl <= 3.6 cm) aorta - ascending: 2.9 cm (nl <= 3.4 cm) aorta - arch: 2.5 cm (nl <= 3.0 cm) aorta - descending thoracic: 2.5 cm (nl <= 2.5 cm) aortic valve - peak velocity: *3.1 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 39 mm hg aortic valve - mean gradient: 29 mm hg aortic valve - lvot peak vel: 0.78 m/sec aortic valve - lvot vti: 18 aortic valve - lvot diam: 1.9 cm aortic valve - valve area: *0.6 cm2 (nl >= 3.0 cm2) mitral valve - peak velocity: 1.3 m/sec mitral valve - mean gradient: 5 mm hg mitral valve - pressure half time: 47 ms mitral valve - mva (p t): 4.7 cm2 mitral valve - e wave deceleration time: 162 msec interpretation: findings: right atrium/interatrial septum: normal interatrial septum. no asd by 2d or color doppler. left ventricle: moderate symmetric lvh. normal lv cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. severe as (aova <0.8cm2). mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. severe mitral annular calcification. calcified tips of papillary muscles. no ms. mild (1+) mr. tricuspid valve: mild to moderate +] tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. the patient appears to be in sinus rhythm. results were personally post-bypass data conclusions: pre-bypass: 1. no atrial septal defect is seen by 2d or color doppler. 2. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. there is severe mitral annular calcification. mild (1+) mitral regurgitation is seen. post-bypass: pt is being av paced and is on an infusion of phenylephrine 1. a bioprosthesis is well seated in the aortic position. trace central ai is seen. a mean gradient of 30mm of hg is seen. no evidence of a subvalvular gradient. 2. biventricular systolic function is preserved. 3. aorta is intact post decannulation 4. other findings are unchanged electronically signed by , md on 11:32. brief hospital course: she was taken to the operating room on where she underwent an avr with a #21 st. porcine valve. she was transferred to the icu in critical but stable condition. she was extubated later that same day. her vasoactive drips were weaned by pod #2. her pacer was interrogated by ep, they found no sensing or pacing from the a lead. she was transferred to the floor on pod#2. she continued to progress and was anticoagulated with coumadin. she was found to have a non-occlusive thrombus in the l axillary and brachial veins which are stable and likely chronic. ep felt that she did not need a revision of her atrial lead unless she becomes symptomatic. she had issues with constipation which were relieved with enemas. she also had urinary retention and had a foley catheter placed on the pm of for 775 cc of post void residual. she continued to improve and was discharged to rehab in stable condition on pod#8. medications on admission: asa 81 detrol la 4 mg toprol xl 50 lisinopril 40 trimaterine 37.5/hctz 25 qd nifedipine xl 30 lipitor 20 aricept 10 discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 4. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 6. tolterodine 1 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*0* 7. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. 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* 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*50 tablet(s)* refills:*0* 10. coumadin 1 mg tablet sig: one (1) tablet po once a day for 1 days: take as directed for inr goal of .5. discharge disposition: extended care facility: health care, discharge diagnosis: as lvot mass pmh: syncope with + tilt table ppm for ? sss vs. vagal rxn diastolic dysfunction htn hyperlipidemia anemia mild proctitis osteoporosis urinary urgency cosmetic surgery many years ago 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. no lifting more than 10 pounds or driving until follow up with surgeon. shower, no baths, no lotions, creams or powders to incisions. followup instructions: dr. 2 weeks dr. 2 weeks dr. 4 weeks procedure: extracorporeal circulation auxiliary to open heart surgery excision or destruction of other lesion or tissue of heart, endovascular approach open and other replacement of aortic valve with tissue graft diagnoses: pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation mitral valve insufficiency and aortic valve stenosis retention of urine, unspecified diastolic heart failure, unspecified mechanical complication due to cardiac pacemaker (electrode) heart disease, unspecified 

Answer: The patient is high likely exposed to