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: aortic regurgitation major surgical or invasive procedure: aortic valve replacement history of present illness: 32 year old male admitted directly from clinic found to have 4+ aortic regurgitation on exam and confirmed on echo. he has a past medical history significant for an unknown heart valve problem diagnosed as a child. he is from , non-english speaking, moved here 2 months ago to get married to his wife who translated this interview. he has experienced chest pain for many year and was told in that he had a problem with one of his heart valves though never had a specific diagnosis. he never had an ekg nor required treatment. these episodes of chest pain are described as squeezing on the left side of hi chest that radiated to hid left arm and shoulder. the pain is short-lived - only 3-5 minutes. he states he doesnt exert himself for more than 10 minutes at a time since he is fearful of bringing on these chest pain episodes. however, these episodes of chest pain are not temporally related to any exertion. he also reports palpitations and diaphoresis during these times. these episodes resolve if he turns off the light and breaths deeply. per online medical record note, when he was seen in clinic today, he became tearful during the interview and experience chest pain, diaphoresis and was ill-appearing. his blood pressure at that time was 220/90, heart rate 100. electrocardiogram at that time showed lateral st depression which was different than the ekg taken 30 minute prior when he was chest pain free. on admission to the floor, the patient denies chest pain, shortness of breath, n/v/d, change in vision or headache. he becames tearful when discussing possible surgery. his wife was present during the interview and translated. past medical history: broken arm, with metal plate repair unknown heart valve problem possible ulcer social history: from , moved here 2 months ago to get married to his wife who works as a nursing assistant at . he does not speak english, his wife does. tobacco, rare etoh, no drugs. used to work at a school in , currently unemployed. family history: cousin died at 14 years old of sudden cardiac death, thought to be related to his heart valve. physical exam: vs - 98.4 123/53 73 16 16 98% gen: nad, appears stated age, head moves with pulses heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp at pinna of ear, approximately 20cm above sternal notch cv: rr, s1, s2 heard. loud systolic murmur, low blowing diasolic murmur heard throughout precordium. pmi laterally displaced 3 cm, rounded. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. visible abdominal pulsation, no bruit. ext: no c/c/e, 3+ bounding dp pulse skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: echocardiography report , tte (complete) done at 4:12:32 pm final referring physician information , - cardiology , 7 , status: outpatient dob: age (years): 32 m hgt (in): 68 bp (mm hg): 160/80 wgt (lb): 180 hr (bpm): 74 bsa (m2): 1.96 m2 indication: chest pain. murmur. icd-9 codes: 786.51, 424.1, 424.0 test information date/time: at 16:12 interpret md: , md test type: tte (complete) son: , rdcs doppler: full doppler and color doppler test location: echo lab contrast: none tech quality: adequate tape #: 2008s000-0:00 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.3 cm <= 4.0 cm left atrium - four chamber length: 5.0 cm <= 5.2 cm left atrium - peak pulm vein s: 0.4 m/s left atrium - peak pulm vein d: 0.5 m/s right atrium - four chamber length: 4.4 cm <= 5.0 cm left ventricle - septal wall thickness: 0.7 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *8.2 cm <= 5.6 cm left ventricle - systolic dimension: 6.8 cm left ventricle - fractional shortening: *0.17 >= 0.29 left ventricle - ejection fraction: 35% to 40% >= 55% left ventricle - stroke volume: 118 ml/beat left ventricle - cardiac output: 8.72 l/min left ventricle - cardiac index: 4.45 >= 2.0 l/min/m2 left ventricle - lateral peak e': 0.09 m/s > 0.08 m/s left ventricle - septal peak e': 0.15 m/s > 0.08 m/s left ventricle - ratio e/e': 8 < 15 aorta - annulus: 2.5 cm <= 3.0 cm aorta - sinus level: 3.0 cm <= 3.6 cm aorta - ascending: 3.3 cm <= 3.4 cm aorta - arch: *3.2 cm <= 3.0 cm aortic valve - peak velocity: *2.5 m/sec <= 2.0 m/sec aortic valve - lvot pk vel: 1.50 m/sec aortic valve - lvot vti: 31 aortic valve - lvot diam: 2.2 cm aortic valve - pressure half time: 150 ms mitral valve - e wave: 1.0 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 1.43 mitral valve - e wave deceleration time: 165 ms 140-250 ms mitral valve - : 0.10 cm2 mitral valve - regurgitation volume: 29 ml findings left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. normal interatrial septum. no asd by 2d or color doppler. left ventricle: mild symmetric lvh. severely dilated lv cavity. no lv mass/thrombus. moderately depressed lvef. no resting lvot gradient. no vsd. right ventricle: mild global rv free wall hypokinesis. aortic valve: mildly thickened aortic valve leaflets (3). no masses or vegetations on aortic valve. no as. increased transaortic velocity related to increased stroke volume due to ar. severe (4+) ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. no mass or vegetation on mitral valve. no ms. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. indeterminate pa systolic pressure. pulmonic valve/pulmonary artery: no ps. pericardium: no pericardial effusion. conclusions the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is severely dilated. no masses or thrombi are seen in the left ventricle. overall left ventricular systolic function is moderately depressed (lvef= 35-40 %) with global hypokiinesis and regioanl akinesis of the basal inferior wall. there is no ventricular septal defect. the rv has mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened and do not coapt well. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to increased stroke volume due to aortic regurgitation. severe (4+) aortic regurgitation is seen (holodiastolic flow reversal in the descending thoracic aorta) . the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: severe aortic regurgitation with severely dilated lv and mild to moderate lv systolic dysfunction. electronically signed by , md, interpreting physician 16:56 cta coronary arteries w/quantitative calcium study date of 2:51 pm , fa5 sched cta coronary arteries w/quanti clip # reason: cat of chest - please do multi slice to look at coronary art medical condition: 32 year old man with severe aortic regurgitation - likely chronic, to go for valve replacement on monday, eval for coronary artery disease. reason for this examination: cat of chest - please do multi slice to look at coronary arteries and aorta. contraindications for iv contrast: none. provisional findings impression: mlkb fri 6:29 pm no significant stenosis or plaques. final report history: 32-year-old man with history of severe aortic regurgitation referred for evaluation of coronary artery disease prior to a planned aortic valve replacement. technique: prospectively cardiac gated (step and shoot) contrast enhanced 64- slice coronary cta was performed after administration of 100cc of optiray iv. prior to the acquicisition, 100 mg po metoprolol, 5 mg iv metoprolol and 0.4 mg sl nitroglycerin were given. 3d images were obtained and reviewed. findings: ct coronary angiography revealed a right dominant system with normal origins and orientations of the left main and right coronary arteries. the left main trifurcated normally into the lad, lcx and a large ramus branch, and was free of disease. the lad had one diagonal and was free of disease. the lcx had one om branch and was free of disease. although visualizatin of the rca was somewhat limited due to motion artifact, it appears dominant and free of disease. note is made that the coronary arteries are increased in caliber, which is compatible with his history of aortic regurgitation. at the level of main pulmonary trunk, the ascending aorta measures 27.4 mm and the descending aorta measures 23.4 mm, both normal in size. the aortic root also seems unremarkable. impression: 1. normal coronary artery origins with no evidence of anomalous coronary arteries, and normal signal characteristics of all visualized vessel segments. 2. visualized portion of the aorta is unremarkable, without evidence of dilatation or dissection. the study and the report were reviewed by the staff radiologist. dr. dr. . approved: fri 10:30 pm brief hospital course: patient was admitted to the cardiology service from cardiology clinic. echo revealed 4+ aortic insufficiency and cardiac surgery was consulted. he was worked up and evaluated in the usual manner. he was brought to the or with dr on for an uneventful mechanical aortic valve replacement. please see operative note for full details. post-operatively he was admitted to the cardiovascular intensive care unit for invasive hemodynamic monitoring. he was extubated on post-op day zero. his drips were weaned and he was transferred to the step down floor on post-operative day 2. physical therapy was consulted to work on strength and conditioning. he was gently diuresed towards his pre-operative weight. his chest tubes and epicardial wires were removed. coumadin was started on post-operative day one for mechanical aortic valve with goal inr 2.5-3. he continued to progress well and on post-operative day five he was discharged to home. medications on admission: none discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* 2. 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:*2* 3. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*45 tablet(s)* refills:*0* 4. erythromycin 5 mg/g ointment sig: one (1) gtt ophthalmic qid (4 times a day). disp:*120 gtt* refills:*2* 5. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 6. coumadin 5 mg tablet sig: 1.5 tablets po once a day: take 7.5 mg daily until directed otherwise by the office of to be followed by dr . phone(. disp:*45 tablet(s)* refills:*2* 7. outpatient lab work please check inr on monaday . to be followed by dr . phone(, and ask for triage nurse. fax: ( discharge disposition: home with service facility: homecare discharge diagnosis: acute on chronic systolic heart failure severe aortic regurgitation 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 no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr. in 4 weeks () please call for appointment dr. in 1 week () please call for appointment dr. in weeks please call for appointment wound check appointment 2 as instructed by nurse () labs: pt/inr monday/wednesday/friday, 1st draw monday for coumadin dosing, aortic mechanical valve, goal inr 2.5-3 to be followed by dr . phone(, and ask for triage nurse. spoke with office 12:21pm. fax: ( md procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified aortic valve disorders acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to