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: worsening shortness of breath at rest with chest tightness major surgical or invasive procedure: redo sternotomy avr ( mechanical) history of present illness: 65 year old male has a history of cad and aortic stenosis s/p cabg x 2 (svg to om, svg to pda) and porcine avr in of by dr. . he reports that over the past 2 months he has been bothered by fatigue and shortness of breath, at rest but more often with limited exertion including walking steps. when he becomes short of breath, he also notices mild tightness in the chest. he saw dr. who added furosemide to his medical regimen w/o any improvement in symptoms. he was referred for cardiac catheterization and per dr request, cardiac surgery consultation. past medical history: hypertension hyperlipidemia diabetes aortic stenosis cad sleep apnea, s/p surgical correction cva per patient report. patient reports it took 3 months to recover, no residual prior stomach ulcer with gib approximately 2-3 years ago, s/p multiple transfusions. no bleeding since then ? copd per discharge summary (patient denies history) tonsillectomy gerd post-op afib in mi : porcine avr, cabg x 2(svg to om, svg to pda), right vein graft social history: lives with:lives alone in occupation: security guard at tobacco: quit 12 years ago with a history of 2.5-3 packs a day for over 20 years etoh:denies family history: non-contributory physical exam: t 98 hr 90 bp 148/70 rr 20 sat 96%-ra physical exam- general: wdwn male in no acute distress cardiac: rrr irregular murmur 3/6 systolic murmur chest: lungs clear bilateral abdomen: soft nontender nondistended extremities: warm well perfused edema: none evh scar noted on right leg. left gsv without varicosities. pertinent results: 06:06am blood wbc-6.2 rbc-3.25* hgb-9.7* hct-28.7* mcv-88 mch-29.9 mchc-33.9 rdw-14.0 plt ct-335 06:06am blood pt-25.3* ptt-27.5 inr(pt)-2.4* 06:06am blood glucose-106* urean-34* creat-1.5* na-143 k-3.7 cl-101 hco3-35* angap-11 03:35pm blood alt-24 ast-22 ld(ldh)-230 ck(cpk)-116 alkphos-102 amylase-105* totbili-0.5 03:35pm blood lipase-89* 03:35pm blood %hba1c-6.4* eag-137* conclusions pre-bypass: the left atrium is dilated. mild spontaneous echo contrast is present in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. there are complex (>4mm) atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the prosthetic aortic valve leaflets are thickened. the transaortic gradient is higher than expected for this type of prosthesis. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). the mitral valve leaflets are mildly thickened. the mitral valve leaflets are moderately thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results on mr. before bypass.. post-bypass: preserved biventricular systolic function. lvef 55%. intact thoracic aorta. trace mr> the aortic prosthesis is stable and functioning well with a residual mean gradient of 12 mm of hg. i certify that i was present for this procedure in compliance with hcfa regulations. 04:40am blood wbc-7.9 rbc-3.33* hgb-9.9* hct-29.9* mcv-90 mch-29.6 mchc-33.1 rdw-14.0 plt ct-383 04:40am blood glucose-114* urean-37* creat-1.5* na-144 k-4.3 cl-103 hco3-34* angap-11 04:40am blood pt-22.3* ptt-28.1 inr(pt)-2.1* 06:06am blood pt-25.3* ptt-27.5 inr(pt)-2.4* 06:01am blood pt-33.2* ptt-94.7* inr(pt)-3.4* brief hospital course: admitted for heparin bridge from coumadin and preoperative workup for aortic valve replacement. on he was brought to the operating room for aortic valve replacement, see operative report for further details. he received cefazolin for perioperative antibiotics and was transferred to the intensive care unit in stable condition. extubated that evening and remained in icu for bp mgmt. coumadin started for mechanical valve. transferred to the floor on pod #2 to begin increasing his activity level. gently diuresed toward his preop weight. creatinine was at baseline at the time of discharge. lopressor was titrated up to 75 for hypertension and he was to resume his home dose of metformin for mildly elevated blood sugars. chest tubes and pacing wires removed per protocol. on pod 7 he continued to make good progress - his incisions were healing well, he was ambulating with assistance and he was tolerating an oral diet. his inr was 2.1 at the time of discharge. he was cleared for discharge to rehabilitation & nursing center - on pod #7. target inr 2.5-3.5 for mechanical valve - coumadin 5 mg to be given . all f/u appts were advised. medications on admission: atorvastatin - (prescribed by other provider) - 80 mg tablet - 1 tablet(s) by mouth at bedtime ezetimibe - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth at night furosemide - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth every morning lisinopril - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth every evening metformin - (prescribed by other provider) - 500 mg tablet - 2 tablet(s) by mouth at night metoprolol succinate - (prescribed by other provider) - 25 mg tablet sustained release 24 hr - 1 tablet(s) by mouth every morning warfarin - (prescribed by other provider) - 5 mg tablet - 1.5 tablet(s) by mouth every evening, last dose medications - otc lutein - (prescribed by other provider) - dosage uncertain multivitamin - (prescribed by other provider) - dosage uncertain omega-3 fatty acids - (prescribed by other provider) - 1,000 mg capsule - 1 capsule(s) by mouth twice a day discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily) for 2 weeks. 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 6. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 7. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 1 weeks: hold for k+ > 4.5. 8. furosemide 20 mg tablet sig: one (1) tablet po once a day for 1 weeks. 9. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 10. lisinopril 10 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp < 95. 11. hydralazine 10 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold for sbp < 120. 12. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 13. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 1 weeks: 400 mg for through ; then 400 mg daily , then 200 mg ongoing daily . 14. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 15. warfarin 1 mg tablet sig: daily dosing per rehab provider;target inr 2.5-3.5 for mechanical avr tablets po daily (daily): 5 mg dose today only; all further dosing per rehab provider. 16. metformin 1,000 mg tablet sig: one (1) tablet po at bedtime. 17. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for dyspnea. discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: aortic stenosis s/p redo avr hypertension hyperlipidemia diabetes mellitus coronary artery disease sleep apnea cva gastrointestinal bleed gastric esophageal reflux disease atrial fibrillation post op discharge condition: alert and oriented x3 nonfocal ambulating with steady gait with assistance incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema 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 **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 surgeon: , md phone: date/time: 1:30 cardiologist: appointment arranged on at 11:45am 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** labs: pt/inr for coumadin ?????? indication mechanical aortic valve goal inr 2.5-3.5 first draw tomorrow dose coumadin 5 mg on please set up coumadin f/u prior to discharge from rehab ***please call to inform service if inr level < 2 *** procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: anemia, unspecified esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified coronary atherosclerosis of autologous vein bypass graft atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia old myocardial infarction personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits other specified retention of urine 

Answer: The patient is high likely exposed to