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: shortness of breath major surgical or invasive procedure: redo sternotomy, aortic valve replacement utilizing a 23mm st. porcine valve, and three vessel coronary artery bypass grafting(left internal mammary to left anterior descending, vein grafts to obtuse marginal and posterior descending artery) history of present illness: the patient is a 58-year-old man who 7 years ago underwent repair of type a aortic dissection; however, it turned out to be a chronic dissection. the aneurysm was repaired, and the aortic valve was resuspended. he was lost to follow-up. he presented with congestive heart failure, moderate aortic insufficiency, ejection fraction of 30%, and severe 3-vessel coronary artery disease. he has elected to proceed with aortic valve replacement and coronary bypass grafting. past medical history: congestive heart failure, coronary artery disease, dilated ascending aorta, aortic insufficiency, anemia, prior aortic dissection repair (type a), hypertension, history of positive ppd, gerd, active smoker, etoh abuse social history: 50-60 pack year smoking hx, alcohol abuse glasses of scotch at night after son was killed in an automobile accident 8 yrs prior. pt currently lives in a studio apartment, does not work, sustained by family members, poor social support, reports in past very lucrative profession, but lost hope after death of only child. family history: father expired, unknown etiology cardiac disease in family physical exam: 98.2 180/90 60 98% ra gen: nad, anxious, talking rapidly heent: eomi, perrl< no jvd, mmm card: rrr, ii/vi systolic murmur, i/vi diastolic murmur lungs: clear abd: benign ext: warm, well perfused, no c/c/e pertinent results: 03:24am blood wbc-7.1 rbc-3.07*# hgb-9.5*# hct-26.1* mcv-85 mch-31.1 mchc-36.6* rdw-14.4 plt ct-202 03:24am blood glucose-116* urean-19 creat-1.0 na-138 k-4.2 cl-101 hco3-29 angap-12 radiology final report chest (pa & lat) 9:22 am chest (pa & lat) reason: eval effusions/atelectasis medical condition: 58 year old man s/p cabg reason for this examination: eval effusions/atelectasis indication: 50-year-old male status post cabg. evaluate for effusion/atelectasis. comparisons: comparison is made to . technique: pa and lateral views of the chest. findings: since the prior study, the endotracheal tube tube, swan-ganz catheter, and a nasogastric tube have been removed. the pulmonary vasculature is normal. there is no evidence of congestive heart failure. there are mild residual bilateral pleural effusions. there is no evidence of pneumothorax. the cardiac silhouette appears enlarged when compared to the preoperative radiograph and the possibility of pericardial effusion cannot be excluded. there is also an unusual contour of the right cardiac border, which could be postoperative, but the possibility of a mediastinal hematoma cannot be completely excluded. otherwise there is marked improvement of left bibasilar atelectasis. impression: 1. marked improvement of bilateral bibasilar atelectasis. 2. small bilateral pleural effusions. 3. large cardiac silhouette and prominence of the right cardiac border. although this could be all postoperative, the possibility of pericardial effusion or mediastinal hematoma cannot be excluded on the basis of this study. the study and the report were reviewed by the staff radiologist. dr. dr. d' otheecardiology report echo study date of *** report not finalized *** preliminary report patient/test information: indication: aortic valve disease. intra-op tee for avr height: (in) 67 weight (lb): 160 bsa (m2): 1.84 m2 status: inpatient date/time: at 10:10 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2006aw04-: test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. . measurements: left ventricle - septal wall thickness: *1.3 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.3 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: *6.4 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 5.3 cm left ventricle - fractional shortening: *0.17 (nl >= 0.29) left ventricle - ejection fraction: 25% to 30% (nl >=55%) aorta - valve level: 2.1 cm (nl <= 3.6 cm) aorta - ascending: *3.8 cm (nl <= 3.4 cm) aorta - arch: 2.7 cm (nl <= 3.0 cm) aorta - descending thoracic: *3.2 cm (nl <= 2.5 cm) interpretation: findings: poor echo windows in the upper esophageal and transgastirc probe position. cardiology consult left atrium: mild la enlargement. no spontaneous echo contrast or thrombus in the body of the laa. all four pulmonary veins identified and enter the left atrium. right atrium/interatrial septum: normal ra size. no spontaneous echo contrast in the body of the ra. a catheter or pacing wire is seen in the ra. the ivc is normal in diameter with appropriate phasic respirator variation. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. mild symmetric lvh. moderately dilated lv cavity. severely depressed lvef. lv wall motion: regional lv wall motion abnormalities include: basal anterior - hypo; mid anterior - hypo; basal anteroseptal - hypo; mid anteroseptal - hypo; basal inferoseptal - hypo; mid inferoseptal - hypo; basal inferior - hypo; mid inferior - hypo; basal inferolateral - hypo; mid inferolateral - hypo; basal anterolateral - hypo; mid anterolateral - hypo; anterior apex - hypo; septal apex - hypo; inferior apex - hypo; lateral apex - hypo; apex - hypo; right ventricle: moderate global rv free wall hypokinesis. aorta: moderately dilated aortic root. dilated sinuses of valsalva. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. aortic valve: three aortic valve leaflets. moderately thickened aortic valve leaflets. moderate to severe (3+) ar. mitral valve: mildly thickened mitral valve leaflets. no ms. trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the procedure. suboptimal image quality - poor echo windows. conclusions: pre-bypass: the left atrium is mildly dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no spontaneous echo contrast is seen in the body of the right atrium. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed. . there is moderate global right ventricular free wall hypokinesis. the aortic root is moderately dilated. the sinuses of valsalva are dilated. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. moderate to severe (3+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is no pericardial effusion. post cpb #1: bioprosthetic valve in aortic position. good leaflet mobility and excursion. mechanically stable. an anteriorly located perivalvular jet of moderate to severe intensity was visualized inaddition to a centrally located jet of mild intensity. this necessitated a return to full cpb to address the perivalvular leak. post cpb#2: bioprosthetic valve in aortic position, mecahnically stable and has good leaflet excursion. the perivalvular regurgitation is still present but of slightly resuced intensity. there is mild valvular regurgitation. right and left ventricular systolic function is slightly improved. ejection fraction 35-40% with inotropic support. brief hospital course: mr. was admitted to the on for further management of his valvular and coronary disease. mr. t extensive pre-operative work-up prior to surgery d/t his past surgical history. on he was brought to the operating room where he underwent a redo-sternotomy with a aortic valve replacement and coronary artery bypass graft x 3. please see operative report for surgical details. he tolerated the procedure well and was transferred to the csru in stable condition. post-operatively he required multiple transfusions and inotropic support. patient remained intubated for several days despite attempts to extubate secondary to agitation and being combative. he was medically managed and weaned off sedation and finally extubated on post-op day four. during this time epinephrine was weaned off and his chest tubes were removed. he was then started on diuretics and beta blockers. he was gently diuresed towards his pre-op weight. he was again transfused with 2 units of prbcs for low hct. epicardial pacing wires were removed and he was then transferred to 2 on post-op day five. over the next several days he improved his activity while being followed by physical therapy to assist with strength and mobility. his medications were adjusted for maximum hemodynamics and he was discharged home on post-op day 7 with vna services, medications, and the appropriate follow up appointments. medications on admission: aspirin 325mg qd, protonix 40mg qd, lisinopril 10mg qd, lipitor 40mg qd, ntg sl prn 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. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain. disp:*50 tablet(s)* refills:*0* 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 9. nicotine 21 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). disp:*30 patch 24hr(s)* refills:*0* 10. furosemide 20 mg tablet sig: one (1) tablet po daily (daily) for 7 days. disp:*7 tablet(s)* refills:*0* 11. lisinopril 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: redo sternotomy, coronary artery bypass graft x3, aortic valve replacement with (23mm porcine valve) congestive heart failure aortic insuffiency coronary artery disease dilated ascending aorta anemia prior aortic dissection repair hypertension history of positive ppd gerd active smoker etoh abuse discharge condition: stable discharge instructions: patient may shower, no baths. no creams, lotions, powders, or ointments to incisions. no driving for at least one month. no lifting more than 10 lbs for 10 weeks. please call for temperature 101.5 or greater, drainage, redness, or swelling of incisions. please call with any concerns or questions. followup instructions: dr. in 4 weeks, () call for appt dr. in weeks, () call for appt dr (pcp) in 1 week, call for 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 transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified aortic valve disorders 

Answer: The patient is high likely exposed to