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: patient recorded as having no known allergies to drugs attending: chief complaint: abdominal pain major surgical or invasive procedure: aortic valve replacement(27mm epic tissue) and three vessel coronary artery bypass grafting with left internal mammary graft to the left anterior descending artery and reverse saphenous vein grafts to the posterior descending artery and margianl branch history of present illness: 63 y/o male with hx of diffuse atherosclerotic disease and aortic insufficiency (2+) transferred from osh after cardiac catheterization by dr. where patient was found to have multivessel disease: 99% stenosis rca, 70% lad, 70% left circumflex. transferred to to dr. service for evaluation of multivessel pci vs cabg/ avr. patient initially admitted to osh for evaluation and management of chronic abdominal pain x 2 months. describes pain as a constant burning pressure that radiates to back and up shoulder blades. occassional n/v with pain episodes. pain comes on about 1 hour after eating. relieved by vicodin only. patient notes prolonged constipation, especially since initiation of vicodin. egd on showed mild esophagitis and delayed gastric emptying. mrcp at osh showed no evidence of biliary or pancreatic obsrtuction. kub showed no signs of acute obstruction. patient has also complained of nonradiating substernal chest pressure with the abdominal pain for the 3 weeks. no associated sob, diaphoresis, cough, or other related symptoms. nitroglycerin does not relieve pain. evaluated by nuclear scan at hospital on which showed dilated rv, scar in the rv territory and ef of 49%. on transfer, vital signs were t= 98.1 hr = 66 bp = 131/75 rr = 18 sao2 = 99% ra. patient was comfortable without acute complaints although he was concerned that pain would return once morphine wore off. also citing concern that he has not had a bowel movement in 7 days. review of systems: pertinent positives: notes exertional calf pain, increased from common iliac stenting yeqars ago. denies any coldness, ulcers, or paralysis in his lower extremities. complains of orthopnea and paradoxical nocturnal dyspnea (uses pilliows at night). denies peripheral edema. pertinent negatives: he denies any prior history of stroke, black stools or red stools, recent fevers, chills or rigors or othersystemic symptoms. past medical history: 1. cardiac risk factors: htn, hyperlipidemia 2. cardiac history: cad with diffuse multivessel disease s/p mi (age unknown) followed by dr. 3. pvd s/p bilateral iliac stents: approx 4 years ago by dr. 4. abdominal aortic aneurysm stable at 3.9 cm by ct on 5. common iliac artery aneurysm at 2.5 cm by ct on 6. aortic insufficiency 7. bladder cancer s/p resection 8. hiatal hernia 9. chronic kidney disease followed by dr. 10. gerd: egd on showed mild esophagitis, gastritis, delayed gastric emptying social history: divorced 2 times, lives with sister. currently employed part-time in hotel laundry. multiple prior jobs in factories, mechanics, etc. -tobacco history: quit 3 months ago. heavy smoking history since the age of 14 -etoh: quit 22 years ago -illicit drugs: none family history: extensive family history of heart disease father: died of mi at age 59 mother: died of breast cancer sisters: cad physical exam: vs: t= 98.1 hr = 66 bp = 131/75 rr = 18 sao2 = 99% ra general: chronically ill, sallow gentleman, nad heent: ncat. sclera anicteric. eomi. conjunctiva were pink. dry oral mucosa neck: supple, no thyromegaly, normal jvp. b/l carotid bruits cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. grade iii/ vi diastolic blowing murmur heard best at rsb. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. decreased breath sounds at bases. abdomen: soft, mild distention. + tenderness to palpation in epigastrium. no guarding or rebound. no hsm. abd aorta not enlarged by palpation. extremities: no c/c/e. surgical dressing c/d/i on right groin. no fluctuence or pain to palpitation. + femoral bruits b/l skin: no rashes, ulcers or lesions pulses: +2 dp, pt pulses bilaterally pertinent results: carotid series: right ica stenosis <40%; left ica stenosis <40% echocardiogram: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior wall. the remaining segments contract normally and overall lvef is preserved (lvef = 60 %). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve is bicuspid (fused right and left raphe) with mildly thickened/restricted leaflets. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). an eccentric jet of moderate (2+) aortic regurgitation is seen, directed toward the anterior mitral leaflet. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. chest ct scan: the ascending aorta measures 4.4 cm and there is mild calcification of the posterior wall of the ascending aorta. diffuse paraseptal and centrilobular emphysematous changes of the lungs. asymmetric pulmonary fibrosis affecting the right lung in subpleural and basilar distribution. 5-mm right lower lobe pulmonary nodule for which followup is recommended in six months. right adrenal adenoma. abdominal ultrasound: unremarkable appearance of the visualized portions of the pancreas. abdominal aortic aneurysm, measuring up to 3.9 cm. bilateral renal cysts. the largest cyst on the right contains thin septations inferiorly. six-month followup study is recommended. intraop tee: prebypass no atrial septal defect is seen by 2d or color doppler. the left ventricular cavity is moderately dilated. there is mild global left ventricular hypokinesis (lvef = 40-45 %) with focal hypokinesis of the inferior base. the remaining left ventricular segments contract normally. right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level (4.6-4.8cm). the ascending aorta is mildly dilated. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. the aortic valve is bicuspid. there is systolic doming of the aortic valve leaflets. moderate to severe (3+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. postbypass there is a well seated, well functioning bioprostheis in the aortic position. no aortic insufficiency is visualized. biventricular systolic function remain unchanged compared to prebypass. chest x-ray(pa and lat): the right introducer sheath has been removed. there is no ptx. the chronic changes in the upper lung fields are no different. no new focal consolidations are seen. pulmonary vascular markings are within normal limits. the cardiac silhouette is enlarged but no different than prior. retrocardiac density has largely resolved. the left cp angle is cut of from view. impression: improved aeration in the retrocardiac area with no new consolidations and no features of chf. wbc/hgb/hct/plt ct 26.5* 7.7/7.9*/23.8*/293 8.1/9.2*/27.8*/303 25.3* glucose urean creat na k cl hco3 angap 31* 1.7* 4.3 26* 1.8* 133 4.6 98 25 15 27* 1.6* 4.4 28* 1.6* 133 4.6 97 27 14 27* 1.5* 132* 4.2 98 24 14 23* 1.4* 131* 4.3 93* 30 12 brief hospital course: 63 yo male with hx cad, aortic valve insufficiency transferred from osh after cardiac catheterization on showed native three vessel disease: 99% rca, 70% lad, 70% cx stenosis. cardiac surgery evaluated patient and felt he was an appropriate candidate for cabg/ avr. preoperative issues included: 1. abdominal discomfort: patient complaints of persistent abdominal pain prompted initial admission to osh. etiology remained unclear despite extensive prior workup: unimpressive ct abdoman (bilateral renal cysts), egd with only mild gastritis. patient found to have elevated lipase/ amylase but had negative mrcp for biliary/ pancreatic ductal dilitation, no evidence of pancreatic inflammation or masses. episode of abdominal pain recurred on , and pancreatic enzymes were found to be mildly elevated. gi consult felt presentation to be consistent with acute pancreatitis. 2. chronic kidney disease: according to outside records, patient's baseline creatinine ranged from 1.4 - 1.7. patient was found to have renal artery stenosis > 90% by cardiac catheterization, no acute intervention indicated. 3. focal right femoral artery dissection s/p cardiac catheterization on : noted to have femoral bruit on physical exam and found to have r cfa focal dissection by doppler. patient subjectively and clinically asymptomatic, distal pulses intact. follow up with vascular surgery following discharge from hospital. on patient brought to the operating room at which time he had aortic valve replacement and coronary bypass grafting x3...please see operative report for details. he tolerated the operation well and was transferred to the cardiac surgery icu in stable condition. he remained stable in the immediate post-op period and was extubated on the morning of pod 1. he stayed in the cardiac surgery icu for aggressive pulmonary toilet. on pod 3 he was transferred to the stepdown floor. his chest tubes, pacing wires and invasive monitoring lines were all discontinued according to cardiac surgery protocol. he developed urination retention after the foley was removed. he was started on flomax and had subsequent successful voiding trial. he was started on beta blockers and diuretics and these were titrated to response. on pod 6 he had a short burst of atrial fibrillation and was treated with increased beta blockade and amiodarone. within 24 hours, he converted to sinus rhythm and no further episodes of atrial fibrillation were noted. given chronic renal insufficiency, his creatinine was followed closely. creatinine ranged mostly between 1.4 to 1.6, peaking to 1.8 on pod 10. discharge creatinine was 1.7. he was also started on ciprofloxacin postoperatively for a positive urinalysis. urine culture revealed gram negative rods of greater than 100,000 organisms...final culture was pending at discharge. he continued to make clinical improvements and was eventually cleared for discharge to home on pod 11. medications on admission: pravastatin 80', isosorbide 20"', diltiazem 180', plavix 75', ranitidine 150", metoprolol 25', zetia 10', asa 81' discharge medications: 1. 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* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. hydromorphone 2 mg tablet sig: one (1) tablet po every hours as needed for pain. disp:*50 tablet(s)* refills:*0* 6. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*0* 7. amiodarone 200 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily) for 1 months. disp:*30 tablet(s)* refills:*0* 9. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily) for 1 months. disp:*30 tablet(s)* refills:*0* 10. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 11. ranitidine hcl 150 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*0* 12. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 13. megestrol 40 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 14. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*14 tablet(s)* refills:*0* 15. pravastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: tba discharge diagnosis: coronary artery disease s/p cabg aortic insufficiency s/p avr post operative atrial fibrillation hypertension peripheral vascular disease dyslipidemia chronic renal insufficiency postop urinary tract infection acute pancreatitis - preoperative femoral artery dissection - preoperative renal artery stenosis lung nodule discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month, and while taking narcotics no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: please call to schedule appointments dr. in 4 weeks () dr. in weeks dr. in weeks (needs 6 months followup of right renal cyst) dr (thoracic surgery) regarding lung nodule follow up. dr. for vascular surgery follow up appt procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery (aorto)coronary bypass of two coronary arteries open and other replacement of aortic valve with tissue graft diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortic valve disorders peripheral vascular disease, unspecified accidental puncture or laceration during a procedure, not elsewhere classified chronic kidney disease, unspecified other and unspecified hyperlipidemia atherosclerosis of renal artery cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure personal history of malignant neoplasm of bladder retention of urine, unspecified other constipation other diseases of lung, not elsewhere classified abdominal aneurysm without mention of rupture congenital insufficiency of aortic valve acute pancreatitis aneurysm of iliac artery dissection of other artery other specified cystic kidney disease 

Answer: The patient is high likely exposed to