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: codeine / ibuprofen / aspirin / nsaids (non-steroidal anti-inflammatory drug) attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: 1. coronary artery bypass grafting x 1 with a saphenous vein graft to the right coronary artery. 2. aortic valve replacement with a . tissue valve, serial #, reference number . 3. mitral valve replacement with a . epic tissue valve, reference number . history of present illness: mrs. is a 75-year old with dyspnea on exertion which has been gradually progressive over the last 5 years. she becomes dyspneic performing adl's and ambulating down the hallway at home. a year ago she could do aquatic exercises but now becomes dyspnic. she denies chest pain, syncope, lightheadedness, wheezing, and coughing. she reports stable pillow orthopnea and mild lower extremity edema. sometimes she awakes at night with breathlessness that resolves after sitting up for a few minutes. her husband noted that she does snore. she has tried albuterol in the past but states this did not help. a recent chest ct and spirometry with dr. suggested her symptoms are more than expected for primary lung disease. she subsequently underwent a cardiac cath and echocardiogram which revealed moderate aortic stenosis and regurgitation, along with one vessel coronary artery disease. she presents today for surgical consulatation. cardiac catheterization: date: place: 1. selective coronary angiography of this right dominant system revealed single vessel coronary artery disease. the lmca had mid 25% stenosis. the lad had slightly slow flow consistent with microvascular dysfunction, a large d1 and a distal lad which wraps around the apex. there was a ramus intermedius. the lcx had slightly slow flow consistent with microvascular dysfunction. there were twin high om1 with a modest caliber medial high pole and a large lateral pole, a tiny om2, a large patent lpl1 with a small lpl2. there were minimal luminal irregularities. the rca had proximal catheter induced spasm/kinking (improved with ic tng and withdrawal of the catheter.) there was a proximal-mid 50% stenosis, a distal 44%stenosis between am1 and rpda, both lesions persisting after ic tng. there was slow flow consistent with microvascular dysfunction. past medical history: - coronary artery disease - mitral valve stenosis/ regurgitation - aortic valve stenosis - dmii - htn - stage iv ckd - complicated by anemia - asthma - gout - hyperparathyroidism - obesity - hypothyroidism social history: unable to exercise due to sob while walking several feet. non-smoker, quit 7 years ago after 40 years of 1ppd = 40 pack-year history. no alcohol use. family history: mother/father - both had mitral valve replacements paternal side - 4 of 5 brothers died of sudden cardiac death in their 50s. father also had aaa. mother had rheumatic fever and an allergy to iodine and sulfa. physical exam: admission exam: vital signs: bp: 137/55. heart rate: 83. resp. rate: 18. o2 saturation%: 97. height: 66" weight: 267lbs general: wdwn in nad skin: warm dry intact heent: ncat perrla eomi sclera anicteric, op benign. neck: supple full rom chest: lungs clear bilaterally heart: rrr, harsh iii/vi sem abdomen: soft non-distended non-tender bowel sounds + obese extremities: warm , well-perfused 1+ le edema varicosities: some superficial but otherwise seems suitable neuro: grossly intact pulses: femoral right:2 left:2 dp right:1 left:1 pt :1 left:1 radial right:2 left:2 carotid bruit: transmitted vs. bruit discharge exam: vs 98.8 89 sr 114/61 18 95% ra gen: nad neuro: a&ox3, mae. nonfocal exam pulm: bs diminsihed in bases bilat cv: rrr-paced, sternal incision cdi-no erythema, ppm site left chest-cdi abdm: soft, nt/nd/+bs ext: warm, well perfused, + lower ext edema cxr-small bilat effusions w/atelectasis. mod pulm congestion pertinent results: tee prebypass: the left atrium is normal in size. no spontaneous echo contrast is seen in the left atrial appendage. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). mild (1+) aortic regurgitation is seen. due to eccentric jet (coanda effect), the severity of aortic regurgitation may be significantly underestimated. aortic annulus is approximately 19mm and concern over possible patient prosthesis mismatch was discussed. there is mild valvular mitral stenosis (area 1.5-2.0cm2). mild (1+) mitral regurgitation is seen. there is no pericardial effusion. postbypass: initial imaging postbypass showed moderate to severe mitral regurgitation that was significantly worse than prebypass. second attempt to come off bypass shows a well seated prosthetic valve in the mitral position. the mean gradient is 8 mm hg across the mitral valve. the aortic valve continues to be well positioned. the mean gradient is 15 mm hg across the aortic valve. neither valve has a significant perivalvular leak. left ventricular function is preserved and unchanged from prebypass. there is no evidence of an aortic dissection. tte the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is small. overall left ventricular systolic function is normal-to-hyperdynamic (lvef 75%). an apical intracavitary gradient is identified. right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position with a prominent septal bounce. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. a bioprosthetic mitral valve prosthesis is present. the gradients are higher than expected for this type of prosthesis. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. aortic and mitral valves have been replaced; severe pulmonary hypertension is now present. 03:49am blood wbc-9.5 rbc-2.86* hgb-8.9* hct-25.6* mcv-90 mch-31.1 mchc-34.7 rdw-15.6* plt ct-115* 02:20pm blood hct-27.9* 02:17am blood wbc-9.4 rbc-2.62* hgb-8.2* hct-23.4* mcv-90 mch-31.5 mchc-35.2* rdw-15.3 plt ct-114* 12:29am blood hct-24.0* 03:49am blood glucose-103* urean-59* creat-1.8* na-131* k-4.5 cl-92* hco3-30 angap-14 02:15pm blood na-131* k-4.2 cl-92* 03:42am blood glucose-127* urean-58* creat-2.2* na-129* k-3.9 cl-93* hco3-26 angap-14 02:17am blood glucose-147* urean-57* creat-2.2* na-126* k-5.3* cl-91* hco3-24 angap-16 06:08pm blood glucose-99 urean-53* creat-2.2* na-129* k-3.8 cl-93* hco3-26 angap-14 05:12pm blood glucose-157* urean-49* creat-2.5* na-131* k-3.9 cl-94* hco3-25 angap-16 10:23am blood glucose-160* urean-50* creat-2.7* na-130* k-3.7 cl-93* 06:00am blood wbc-11.0 rbc-2.83* hgb-8.4* hct-25.6* mcv-91 mch-29.9 mchc-33.0 rdw-16.0* plt ct-131* 06:00am blood glucose-93 urean-60* creat-2.0* na-132* k-4.3 cl-90* hco3-33* angap-13 radiology report chest (pa & lat) study date of 1:48 pm comparisons: to . findings: dual-chamber pacemaker leads project over the appropriate positions in the right atrium and right ventricle in two planes. moderate to large bilateral pleural effusions are unchanged. the degree of pulmonary venous congestion has improved. there is no new consolidation or pneumothorax. a right-sided picc line terminates in the mid svc. median sternotomy wires are intact. impression: 1. appropriate dual-chamber pacing leads position. 2. moderate to large bilateral pleural effusions. brief hospital course: 75-year-old female who had dyspnea on exertion which has been getting progressively worse. she has a history of asthma and her asthma meds did not seem to help. she was seen by pulmonary where a workup suggested that her symptoms were from something other than lung disease. she subsequently underwent a cardiac workup which included an echocardiogram and a cardiac catheterization. the echocardiogram revealed that she had critical aortic valve stenosis with a mean gradient of 42 mmhg and an aortic valve area of 1.1 cm squared. there was mild functional mitral stenosis with mild-to-moderate mitral regurgitation. her left ventricular ejection fraction was more than 65%. the patient was brought to the operating room on where the patient underwent coronary artery bypass grafting x 1 with a saphenous vein graft to the right coronary artery, aortic valve replacement with a . tissue valve, mitral valve replacement with a . epic tissue valve. see operative note for full details. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. she had no underlying rhtyhm and had to be av paced. she had pain issues post operatively and pain meds were adjusted. on pod 4 night, her temporary pacer lost capture and ep was forced to place a temporary wire with plans to place a ppm the following morning. on a dual chamber ppm was placed by ep and she was v pacing with a stable blood pressure at the time of discharge. post op course was also complicated by acute kidney injury due to hypoperfusion with urine output improved once patient was started on dopamine. renal was consulted with peak creatinine 3.4. at the time of discharge, she was making adequate urine on low dose lasix and creatinine was at baseline. after ppm, beta blocker was initiated and she remained hemodynamically stable. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod #8 the patient was ambulating with assistance, the wound was healing and pain was controlled with oral analgesics. the patient was discharged hospital in in good condition with appropriate follow up instructions. medications on admission: 1. lisinopril 20 mg po bid 2. simvastatin 20 mg po daily 3. furosemide 20 mg po daily 4. levothyroxine sodium 50 mcg po daily 5. 70/30 17 units breakfast 70/30 21 units lunch 70/30 21 units bedtime insulin sc sliding scale using hum insulin 6. albuterol 7. flovent allergies: aspirin/advil - cp/n/v, codeine, ibuprofen-kidney dysfunction discharge medications: 1. albuterol-ipratropium 4 puff ih q4h 2. docusate sodium 100 mg po bid 3. fluticasone propionate 110mcg 2 puff ih 4. 70/30 17 units breakfast 70/30 21 units lunch 70/30 21 units bedtime insulin sc sliding scale using reg insulin 5. levothyroxine sodium 50 mcg po daily 6. metoprolol tartrate 12.5 mg po bid hold sbp<90; hr<55 7. simvastatin 20 mg po daily 8. tramadol (ultram) 50 mg po q6h:prn pain 9. ranitidine 150 mg po daily 10. bisacodyl 10 mg po daily:prn constipation 11. heparin 5000 unit sc tid 12. furosemide 40 mg po daily 13. cephalexin 500 mg po q8h duration: 5 days 14. potassium chloride 20 meq po daily duration: 10 days hold for k > 4.5 15. lactulose 30 ml po tid:prn constipation discharge disposition: extended care facility: discharge diagnosis: - coronary artery disease - mitral valve stenosis/regurgitation - aortic valve stenosis - diabetes mellitus ii - hypertension - stage iv ckd - creat 1.7 - complicated by anemia - asthma - gout - hyperparathyroidism - obesity - hypothyroidism - viral menigitis - bilateral knee arthroscopy - back surgery for ganglion growth - gall bladder surgery discharge condition: alert and oriented x3 nonfocal oob with assistance (used a scotter preop) incisional pain managed with ultram incisions: sternal - healing well, no erythema or drainage leg evh site- 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 females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **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: dr. on at 1:30pm cardiologist- dr. at 2:40pm device clinic on at 10:30a clinical ctr, 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** procedure: extracorporeal circulation auxiliary to open heart surgery initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle (aorto)coronary bypass of one coronary artery insertion of temporary transvenous pacemaker system open and other replacement of aortic valve with tissue graft open and other replacement of mitral valve with tissue graft diagnoses: hyperpotassemia other iatrogenic hypotension thrombocytopenia, unspecified anemia in chronic kidney disease coronary atherosclerosis of native coronary artery mitral valve disorders acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia unspecified acquired hypothyroidism chronic kidney disease, stage iv (severe) cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified asthma, unspecified type, unspecified aortic valve disorders other and unspecified hyperlipidemia atrioventricular block, complete long-term (current) use of insulin morbid obesity hyperparathyroidism, unspecified chronic diastolic heart failure body mass index 40.0-44.9, adult 

Answer: The patient is high likely exposed to