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: sulfa(sulfonamide antibiotics) / torsemide attending: chief complaint: shortness of breath major surgical or invasive procedure: aortic balloon valvuloplasty history of present illness: mr. is an 80 year old male with a history of cad s/p 5 vessel cabg and aortic stenosis (s/p dilation x 2 , ) who presents with worsening dyspnea. his shortness of breath has gotten worse slowly over the course of two months. he now becomes dypneic when supine in bed. he endorses pnd and orthopnea, using pillows to sleep at night. however, most nights he ends up sleeping flat, very uncomfortably. he has not had chest pain, fevers or chills. he has a nonproductive cough that has persisted over the same time period. after the valvuloplasty in , he was able to walk for 15 mintues without stopping. he has not noticed swelling in his legs or ankles. on admission, vitals were notable for a hr 89, r18, bp 96/55, 100% 3lnc. acs was ruled out as the etiology of dyspnea and pt improved with diuresis. he underwent an uncomplicated valvoplasty today. during procedure, pawp was elevated to 35 w/ a /47. he is transferred to the ccu for further monitoring and diuresis. on arrival, patient only notes pain at sheath site. he denies sob, cp, fatigue, orthopnea,or weakness. past medical history: 1. cardiac risk factors: (-)diabetes, (+)dyslipidemia, (+)hypertension 2. cardiac history: aortic stenosis (dilation , at ); valve area 0.7cm2 with peak gradient 76mmhg cad s/p 5-vessel cabg congestive heart failure with ef 30% in by echo 3. other past medical history: social history: he lives with his wife. nonsmoker. rarely drinks etoh. he is retired and used to work as a manager at . family history: premature coronary artery disease- mother chf, died in 80s, father died from mi at 62 physical exam: admission vs: t=97.6 bp=106/55 hr=82 rr=21 o2 sat=100% general: wdwn ** in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of *** cm. cardiac: late peaking systolic murmur at r 2nd intercostal space. murmur 5 intercostal mid clavicular. rr, normal s1, s2. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. b/l basilar crackles, no wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge vs 97.4 99/56-110/65 78-96 18 95% ra weight 70.6 i/o yesterday: -660/ -480 general- nad, breathing comfortably when sitting upright at rest. oriented x3. mood, affect appropriate. heent- ncat. sclera anicteric. perrl, eomi. mmm neck- no elevation in jvp cardiac- pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. mid systolic high pitched murmur at the upper sternal border radiating to carotids with a preserved s2; more blowing sounding murmur at the apex, holosystolic, without an s2. parasternal heave. no s3 or s4. lungs- no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen- soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities- no c/c/e. no femoral bruits. skin- no stasis dermatitis or ulcers pulses- right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs: 04:50pm blood wbc-8.1 rbc-3.90* hgb-12.1* hct-37.6* mcv-97 mch-31.1 mchc-32.3 rdw-15.3 plt ct-148* 04:50pm blood neuts-79.1* lymphs-11.8* monos-5.4 eos-2.9 baso-0.8 04:50pm blood pt-14.8* ptt-33.4 inr(pt)-1.4* 04:50pm blood glucose-109* urean-51* creat-1.9* na-137 k-4.7 cl-102 hco3-22 angap-18 04:50pm blood probnp-8430* 04:50pm blood ctropnt-0.03* 07:00am blood ck-mb-4 ctropnt-0.02* 07:00am blood calcium-8.9 phos-3.7 mg-2.6 . discharge labs: 08:25am blood wbc-7.7 rbc-4.03* hgb-12.4* hct-38.6* mcv-96 mch-30.7 mchc-32.1 rdw-15.2 plt ct-173 08:25am blood pt-12.9* ptt-33.7 inr(pt)-1.2* 06:10am blood glucose-155* urean-34* creat-1.4* na-136 k-4.0 cl-101 hco3-24 angap-15 06:10am blood calcium-9.1 phos-3.3 mg-2.3 . cardiac cath with valvoplasty: : interventional details the indication for the procedure was refractory congestive heart failure due to severe aortic stenosis (aortic valve area 0.52 cm2), severe 4+ mitral regurgitation, and severe pulmonary hypertension. he is a non operative candidate due to his porcelain aorta. . heparin (5000u, 2000u) was used for anticoagulation to maintain an act > 250 seconds. . the procedure was performed using a pre-close technique with a 6 fr proglide. femoral access was obtained with vascular ultrasound guidance. . right and left heart pressures are listed above with severe pulmonary hypertension and a mixed venous saturation 51%. . balloon aortic valvuloplasty was performed using a single inflation using a 23 mm tyshak-ii balloon. the patient became profoundly hypotensive after the balloon inflation taking > 60 seconds to recovery his bp. . the mean aortic gradient decreased from 26.9 mmhg to 21.4 mmhg, the cardiac output increased from 2.89 l/min to 3.67 l/min, and the aortic valve area increased from 0.53 cm2 to 0.80 cm2. the mixed venous increased from 51% to 60%. . the right femoral artery sheath was removed without difficulty. assessment & recommendations 1. critical aortic stenosis 2. s/p successful balloon aortic valvuloplasty with an increase in the aortic valve area from 0.52 cm2 to 0.80 cm2 3. ccu monitoring overnight with diuresis . tte: : the left atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. overall left ventricular systolic function is severely depressed (lvef= 25-30%). the right ventricular cavity is moderately dilated with depressed free wall contractility. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the mitral valve leaflets do not fully coapt. an eccentric, posteriorly directed jet of severe mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: mild symmetric lvh with severe left ventricular systolic dysfunction. the inferior wall and distal septum are near-akinetic. the basal lateral wall has relatively preserved function. the other walls are moderately hypokinetic. there is severe mitral regurgitation likely due to leaflet tethering. severe calcific aortic stenosis with mild to moderate aortic regurgitation. dilated, hypokinetic and pressure-volume overloaded rv with severe pulmonary hypertension. . compared with the prior study (images reviewed) of , findings are similar. . tte: left ventricular systolic function is severely depressed. the aortic valve leaflets are severely thickened/deformed. there is significant aortic valve stenosis (probably severe). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is no significant pericardial effusion. . compared with the prior study (images reviewed) of , estimated pulmonary artery systolic pressure is now lower. the aortic valve gradient is now lower. . tte: overall left ventricular systolic function is moderately depressed (lvef= 30-35 %) secondary to moderate global hypokinesis and akinesis of the distal mid-anterior septum (suboptimal image quality, lv apex was not well visualized). there is severe aortic valve stenosis (valve area 0.8-1.0cm2). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. the mitral valve leaflets do not fully coapt. moderate to severe (3+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. . compared with the prior study dated (images reviewed), pulmonary pressures are worse. the degree of aortic stenosis remains severe based on visual assessment and continuity equation (low gradients may be secondary to poor forward flow and depressed lvef). aortic regurgitation and mitral regurgitation are similar. brief hospital course: mr. is an 80 year old male with a history of cad s/p 5 vessel cabg and aortic stenosis (s/p dilation x 2 , ) who presented with worsening dyspnea sedondary to his critical as and underwent valvuloplasty. . acute #) symptomatic, critical as/chf: patient initially presented to service with progressive dyspnea, poor activity tolerance and fatigue most likely from his critical aortic stenosis. he had valvoplasty on during which he was found to have pulmonary artery pressure of 103/77 with pulmonary wedge pressure of 35. follwing the procedure the mean aortic gradient decreased from 26.9 mmhg to 21.4 mmhg,the cardiac output increased from 2.89 l/min to 3.67 l/min, and the aortic valve area increased from 0.53 cm2 to 0.80 cm2. given his elevated pressures during the procedure he was transfered to ccu for further monitoring and aggressive diuresis. during his ccu stay he was made 4l negative with several rounds of iv lasix. his symptoms greatly improved following procedure and diuresis. he was discahrged on furosemide 250 po daily. he will follow up with dr. regarding possible av replacement if core valve trial permits in . . #) acute on chronic kidney injury: patient baseline cr is around 1.2. he repsented with acute on chronic with cr of 1.9 likely secondary to poor forward flow in setting of aortic stenosis. after aggressive diuresis his cr downtrended to 1.3, near his baseline. . #) cough: on presentation he complained ofcough likely to be related to as with some degree of pulmonary edema. findings on the recent ct chest showed left upper lobe nodularities, subcentimeter, that look infectious versus inflammatory with recommended interval f/u imaging in 3 months. there is also a 1.2cm subcarinal lymph node in addition to left base calcified granulomas. patient will follow up with pcp and potentially pulmonary for these findings. his cough had resolved by discharge. . chronic #) cad: continued aspirin, metoprolol, and simvastatin. started on low-dose lisinopril while in house. . #) hyperlipidemia: continued on home simvastatin . transitional #) patient will follow up with dr. regarding possible av replacement if core valve trial permits in #) follow up with pcp regarding ct chest findings medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. allopurinol 100 mg po daily 2. ascorbic acid 250 mg po daily 3. aspirin 162 mg po daily 4. bumetanide 1 mg po bid 5. metoprolol succinate xl 25 mg po daily 6. multivitamins 1 tab po daily 7. simvastatin 40 mg po daily 8. vitamin d 1000 unit po daily discharge medications: 1. allopurinol 100 mg po daily 2. ascorbic acid 250 mg po daily 3. aspirin 81 mg po daily rx *adult low dose aspirin 81 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 4. multivitamins 1 tab po daily 5. simvastatin 40 mg po daily 6. vitamin d 1000 unit po daily 7. metoprolol succinate xl 25 mg po daily 8. furosemide 240 mg po daily rx *furosemide 80 mg 3 tablet(s) by mouth daily in am disp #*120 tablet refills:*0 9. lisinopril 2.5 mg po daily rx *lisinopril 2.5 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 10. outpatient lab work please have chem 7 and magnesium drawn on at your pcp's office given you are on such a high dose of diuretics. thank you. discharge disposition: home discharge diagnosis: primary: heart failure, aortic stenosis secondary: hypertension, hyperlipidemia, coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr , it was a pleasure taking care of you during your recent admission to . you were admitted because you were having worsening shortness of breath. we believe that this was because of your aortic stenosis as well as fluid on your lungs. as a result, we diuresed you aggressively which improved your symptoms. you then went for aortic balloon valvuloplasty. this was accomplished without complication. you were discharged with followup to dr. and your pcp. should also call dr. for a f/u appointment. please have your electrolytes drawn on at you pcp's office (this includes a "chemistry 7 panel plus a magnesium level"). thank you the following changes were made to your medication: discontinue bumetanide start lasix 240 mg daily lisinopril 2.5 mg daily change aspirin to 81 mg daily followup instructions: please call pcp for appointment within 1 week of discharge: name: , location: primary care address: ste#441white , , phone: fax: please call dr. for f/u cardiology appointment within weeks: west cardiology , ( (office) department: cardiac services when: wednesday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage *dr. only sees patients at either 8am or 9am. procedure: combined right and left heart cardiac catheterization percutaneous balloon valvuloplasty diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders other chronic pulmonary heart diseases other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) dehydration acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to