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: keflex / avelox / nifedipine / pulmicort / doxycycline attending: chief complaint: sob major surgical or invasive procedure: corevalve aortic valve replacement via ileofemoral approach history of present illness: this 74 year old woman has severe aortic stenosis with nyha class iii symptoms of chf. she describes exertional dyspnea after walking blocks or if she talks for an extended period of time. this improves when she stops to rest. she denies any chest pain or dizziness. she also has pulmonary hypertension which is secondary to hepatopulmonary syndrome r/t liver cirrhosis. she has been treated with sildenafil for several years, with subsequent pa systolic of 50. she is also on home oxygen 2l per nasal cannula continuously. she states that she has been on the oxygen for close to 20 years. she has esophageal varices grade 1 and was cleared for procedure by gastroenterology. she was seen by liver service and was deemed to be childs a with espophageal varices and prohibitive for surgical avr. she was referred for corevalve/tavr trial. she has met all inclusion criteria, with no exclusion criteria. she is here for elective tavr. she reports recent episode of bronchitis for which she was treated with 3 weeks of antibiotics and steroids (last dose 1/16) with improvement. . corevalve was successfully placed today in the or using an ileofemoral approach. she is currently intubated and sedated, stable. of note, pacemaker appearing to be firing inappropriately despite hr of 70s. also only seeing pacemaker spikes, not capturing, no qrs complexes. . unable to obtain review of systems since the patient is intubated. acknowledges some mild back pain, but no other pain. past medical history: 1. severe aortic stenosis 2. hepatic cirrhosis prior etoh use - esophageal varices- s/p bleed required tx -grade 1 varices - pulmonary hypertension hepatopulmonary syndrome 3. pulmonary nodules by chest ct stable since 4. arthritis of spine and hips 5. s/p basal cell cancer excision of lip 6. s/p hemorrhoidectomy hemorrhoid surgery social history: married and lives with her husband in , . worked as a secretary, now retired. has 6 children. tobacco: never smoked. etoh: no etoh x 22 years family history: father had emphysema. mother has alzheimer's and is 96 physical exam: admission physical exam: general: intubated and sedated, opens eyes spontaneously, responsive, appropriate. height: 63 inches weight: 73.8 kg skin: color pink, skin warm and dry. no decubiti. heent: normocephalic, anicteric, conjunctiva pink. oropharynx moist. partial dentition lower. neck: supple, trachea midline. chest: no obvious deformities/scarring. ctabl scatterred rhonchi. heart: rrr. no m/r/g abdomen: soft,nontender, nondistended. +bs. femoral venous sheath in place. extremities: no lower extremity edema at present. neuro: alert and oriented, responsive. perrla, eomi. cn ii-xii grossly intact, tone power, reflexes coordination sensation intact in all four extremities. pulses: palpable peripheral pulses. 2+ carotid/femoral/dp/pt bilaterally. . discharge physical exam: vitals: tm/tc: 98.6 hr:93 bp:110/61 rr:18 02 sat: 98 (ra) weight: 68.9 kg (yest 70.3kg) ) tele: sinus rythm general: pleasant, oob adlib, in no acute distress heent: perrla, no pharyngeal erythemia, mucous membs moist, no lymphadenopathy, jvp non elevated chest: ctabl no wheezes, no rales, no rhonchi cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. no rebound/guarding, neg hsm. neg sign. bm yesterday. lower abdominal echymosis stable. ext: wwp, no edema. dps, pts 2+. bilateral groin sites clean and dry. no erythema. no palpable hematomas. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. oob ad lib, gait steady. denies pain, showered yesterdy. skin: no rash psych: calm, pleasant, asking questions approp. pertinent results: admission labs: 12:40pm blood wbc-4.5 rbc-4.02* hgb-12.9 hct-37.0 mcv-92 mch-32.0 mchc-34.9 rdw-13.8 plt ct-83* 12:40pm blood pt-12.4 ptt-30.1 inr(pt)-1.1 12:40pm blood glucose-87 urean-21* creat-0.7 na-142 k-3.9 cl-106 hco3-29 angap-11 12:40pm blood albumin-3.5 12:40pm blood alt-27 ast-40 ck(cpk)-169 alkphos-117* totbili-0.9 12:40pm blood ck-mb-3 probnp-136 12:40pm blood %hba1c-6.1* eag-128* 12:40pm blood hemoglobin, free-4.6 . discharge labs: 06:10am blood wbc-4.2 rbc-3.24* hgb-10.5* hct-29.7* mcv-92 mch-32.3* mchc-35.3* rdw-15.5 plt ct-115* 06:10am blood glucose-153* urean-7 creat-0.8 na-137 k-3.7 cl-102 hco3-26 angap-13 06:10am blood alt-24 ast-43* ck(cpk)-60 alkphos-68 totbili-2.1* 06:10am blood ck-mb-2 probnp-156 06:10am blood albumin-3.6 mg-2.0 . chest x-ray (): the lung volumes are normal. borderline size of the cardiac silhouette and mild tortuosity of the thoracic aorta. there is a moderate enlargement of the right pulmonary artery, already documented on a ct examination from and since then unchanged. no acute changes. no pleural effusions. no pulmonary edema. . echo (): the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. an aortic corevalve prosthesis is present and appears well-seated. the aortic gradient was not assessed. mild (1+) aortic regurgitation is seen. trivial mitral regurgitation is seen. mild (1+) mitral regurgitation is seen. compared with the prior study (images reviewed) of , a corevalve is now in place. . chest x-ray (): as compared to the previous radiograph, a right internal jugular catheter has been inserted. inspiration is improved as compared to the pre-interventional radiograph. there is no evidence of pulmonary edema. known enlargement of the right hilus. normal size of the cardiac silhouette. no pleural effusions. . echo (): the left atrium is normal in size. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the right ventricular cavity is mildly dilated with borderline normal free wall function. an aortic corevalve prosthesis is present. the aortic valve prosthesis appears well seated, with normal transvalvular gradients. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normally functioning aortic corevalve with mild aortic regurgitation. preserved left ventricular function. moderate-severe tricuspid regurgitation with severe pulmonary artery systolic hypertension. compared with the post aortic corevalve implantation study dated , the corevalve continues to be well seated. transaortic gradients (not assessed on the prior study) are normal. . abdominal x-ray (): supine views of the abdomen demonstrate multiple air-filled loops of small and large bowel. a single loop of jejunum in the mid-abdomen is slightly dilated due to mild localized ileus. no evidence of obstruction. calcified splenic artery aneurysm is seen in the left upper quadrant. brief hospital course: 74 yo f with h/o severe as with nyha class iii chf admitted for corevalve/tavr. . #aortic stenosis s/p corevalve/tavr: procedure completed successfully without complication. post operatively she was monitored in the ccu for 48 hours, after which her pacer wires were pulled (she had no pacer requirement). she had one episode of chest pain post-operatively without ekg changes or enzyme leak. otherwise, her course was uncomplicated. she underwent tte which showed successful placement of corevalve. patient discharged on asa and plavix to complete 3 month course. . #rhythm: sinus throughout, without rhythm disturbance. pacer not required. . #hepatic cirrhosis: she has cirrhosis by both an abdominal ct scan and mri with esophageal varices. she has not had bleeding recently. she has a meld score = 10 and appears to be childs- class a prohibitive for surgery per liver service. was not active during this hospitalization. she was restarted on her home diuretics with good uop when she was stabilized. . #pulmonary hypertension secondary to hepatopulmonary syndrome: she has apparently responded to sildenafil 60 mg daily with a reduction in her pulmonary pressures from over 100 mmhg systolic to 65 mmhg systolic. this has appeared stable over the past several years. she was maintained on her home sildenafil and her home o2 requirement of 2l nc. medications on admission: furosemide - 40 mg tablet (noncompliant leg cramps) ipratropium bromide - 0.2 mg/ml (0.02 %) solution qid levalbuterol hcl dosage uncertain levalbuterol tartrate - 45 mcg/actuation hfa aerosol prn potassium chloride - 20 meq tablet, er sildenafil - 20 mg tid spironolactone - 50 mg tablet zolpidem - 10 mg tab qhs prn codeine-guaifenesin - 100 mg-10 mg/5 ml liquid q 4hrs multivitamin - daily discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. sildenafil 20 mg tablet sig: one (1) tablet po tid (3 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. spironolactone 25 mg tablet sig: two (2) tablet po bid (2 times a day). 5. codeine-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q4h (every 4 hours) as needed for cough. 6. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 7. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for insomnia. 8. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*2* 9. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 10. multivitamin tablet sig: one (1) tablet po once a day. 11. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po twice a day: while taking furosemide. discharge disposition: home with service facility: vna of and southern nh discharge diagnosis: 1. aortic stenosis s/p corevalve transcatheter aortic valve replacement 2. pulmonary hypertension 3. hepatic cirrhosis 4. esophageal varices discharge condition: alert and oriented x 3, calm, receptive, asking questions appropriately and verbalizing good understanding of instructions and plan. ambulatory with assist for supervision. mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mrs. , you were admitted on for and elective transcatheter aortic valve replacement with the corevalve device to treat your severe symptomatic aortic stenosis. your procedure was successful and your postoperative course was without complications. you are now ready for discharge. your discharge instructions include: 1.weigh yourself every morning, md if weight goes up more than 3 lbs. 2. shower daily with antibacterial soap 3. keep groin sites clean and dry, no powders or lotions. 5. no lifting > 10 lbs your medications will remain the same as those prior to your procedure with the following additions: 1. clopidrogel 75mg - take one tablet daily 2. aspirin 81mg - take one tablet daily 3. acetaminophen 325mg - take 1-2 tablets every 6 hours if needed for pain. 4. famotidine 20mg - take 1 tablet twice a day while on aspirin and clopidrogel. followup instructions: follow up appt with dr :20pm. follow up with dr in weeks. (pcp) follow up with dr in weeks. (pulmonologist) procedure: coronary arteriography using two catheters left heart cardiac catheterization aortography arteriography of other intra-abdominal arteries endovascular replacement of aortic valve diagnoses: anemia of other chronic disease congestive heart failure, unspecified alcoholic cirrhosis of liver other and unspecified alcohol dependence, in remission acute on chronic diastolic heart failure hematoma complicating a procedure aortic valve disorders other chronic pulmonary heart diseases other specified cardiac dysrhythmias cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other internal prosthetic device, implant, and graft diseases of tricuspid valve lumbosacral spondylosis without myelopathy other dependence on machines, supplemental oxygen esophageal varices without mention of bleeding personal history of malignant neoplasm of other and unspecified oral cavity and pharynx solitary pulmonary nodule arthropathy, unspecified, pelvic region and thigh precordial pain hepatopulmonary syndrome 

Answer: The patient is high likely exposed to