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: penicillins / morphine / codeine / lipitor / erythromycin / clindamycin / chlorhexidine / iodine-iodine containing / adhesive tape / darvocet-n 100 attending: chief complaint: palpitations and syncope major surgical or invasive procedure: aortic valve replacement (19mm st. mechanical), mitral valve repair (30mm annuloplasty ring), excision of reveal device from left anterior chest history of present illness: this is a 54 year old female with significant medical history of mitral valve prolapse and moderate mitral regurgitation. this was initially diagnosed 20 years ago when it was picked up on an echocardiogram which was done in preparation for gynecologic surgery. since that time she has been followed with serial echocardiograms with her most recent showing moderate to severe mitral regurgitation with increasing lv dimensions. cardiac cath in showed clean coronaries. past medical history: -mitral valve (bileaflet) prolapse and moderate mitral regurgitation -longstanding history of palpitations, status post recent electrophysiology study with subsequent diagnosis of avnrt - ventricular tachycardia -pericarditis (small pericardial effusion) -hyperlipidemia (elevated total cholesterol and hdl) - endometriosis s/p total abdominal hysterectomy - vaginal cancer s/p radiation -frequent bowel obstruction d/t adhesions from xrt and abdominal surgeries. -recurrent stomach ulcers -gastroesophageal reflux disease and gastric ulcers -frequent bowel obstructions -atypical tuberculosis in the lung -dyslipidemia -mugs-abnormal low white blood cell count and low protein. followed by dr. (heme/onc) -complex migraines -syncopal episodes - lyme disease s/p 6 week treatment with doxycycline -glaucoma -seasonal allergies -bronchitis past surgical history: -tonsillectomy as a child -appendectomy as a child -right elbow surgery after a fall s/p three surgeries -s/p tah -s/p 7 gynecological surgeries -s/p bowel resection -reveal implant in left upper chest social history: lives with: mother and sister occupation: disability tobacco: never etoh: denies etoh or illicit drug use family history: non-contributory physical exam: pulse: 92 resp: 18 o2 sat: 100% b/p 146/77 height: 5'7" weight: 115 lbs general: wdwn in nad skin: warm, dry, intact. no lesions or rashes. well healed abdominal incisions. left upper chest reveal monitor noted subcutaneously. heent: ncat, perrla, eomi, sclera anicteric, op benign. teeth in good repair. neck: supple full rom no jvd chest: lungs clear bilaterally heart: rrr, ii/vi holosystolic murmur, nl s1-split s2 vs s3 abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused no edema varicosities: none neuro: grossly intact pulses: femoral right:2 left:2 dp right:2 left:2 pt :2 left:2 radial right:2 left:2 carotid bruit right: none left: none pertinent results: tee: pre cpb: no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. there is no aortic valve stenosis. moderate (2+) aortic regurgitation is seen. there is moderate bileaflet mitral valve prolapse. severe (4+) mitral regurgitation is seen. dr. was notified in person of the results. post cpb: the patient is in sinus rhythm with a cardiac output of 4.9l/min on a phenylephrine infusion. the biventricular systolic function is preserved. there is a mitral annuloplasty ring seen. there is trivial mr, the mean/peak gradient across the mitral valve are 4/8mmhg. there is a well seated mechanical valve in the aortic position. both leaflets are seen to move freely, washing jets are noted. the mean/peak gradients across the aortic valve are 16/30mmhg. the visible contours of the thoracic aorta are intact. 11:15am blood wbc-5.3# rbc-2.86*# hgb-8.8*# hct-25.7*# mcv-90 mch-30.7 mchc-34.2 rdw-13.5 plt ct-130* 09:58pm blood wbc-7.0 rbc-3.09* hgb-9.5* hct-27.1* mcv-88 mch-30.7 mchc-35.1* rdw-14.0 plt ct-113* 02:02am blood wbc-5.5 rbc-3.09* hgb-9.0* hct-27.5* mcv-89 mch-29.0 mchc-32.5 rdw-14.0 plt ct-396 11:15am blood pt-15.8* ptt-30.5 inr(pt)-1.4* 01:14pm blood pt-61.0* inr(pt)-6.7* 06:04pm blood pt-14.1* ptt-29.8 inr(pt)-1.2* 04:15am blood pt-19.2* ptt-69.0* inr(pt)-1.7* 02:02am blood pt-20.2* ptt-87.2* inr(pt)-1.8* 08:43am blood pt-20.3* ptt-64.5* inr(pt)-1.9* 12:55pm blood urean-10 creat-0.6 na-145 k-3.6 cl-117* hco3-23 angap-9 02:02am blood glucose-115* urean-11 creat-0.7 na-142 k-4.8 cl-104 hco3-32 angap-11 09:58pm blood alt-25 ast-36 ld(ldh)-333* alkphos-50 amylase-144* totbili-0.4 02:02am blood calcium-9.0 phos-3.9 mg-2.7* 03:03am blood pt-23.4* inr(pt)-2.2* brief hospital course: the patient was brought to the operating room on where he underwent an aortic valve replacement (mechanical), mitral valve repair and excision of reveal device from left chest. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. post-op day one he was weaned from sedation, extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. 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. she briefly went into atrial fibrillation and converted to sinus rhythm. coumadin was started with a heparin bridge. she had quick increase in inr on to 6.7 which was treated with ffp and vitamin k. inr trended down and coumadin was titrated for goal inr for mechanical valve. titration of her coumadin for a goal inr took much longer than expected and she wasn't discharged until post-op day 11. the patient was discharged to home in in good condition with appropriate follow up instructions. follow up appointments scheduled in . target inr 2.5-3.0 for mechanical avr. first blood draw . coumadin to be managed through dr. office over weekend, then dr. will take over on monday, . medications on admission: butalbital-acetaminophen-caff - (prescribed by other provider) - 50 mg-325 mg-40 mg capsule - one capsule(s) by mouth twice a day to three times a day cyanocobalamin (vitamin b-12) - 1,000 mcg/ml solution - injection of 1000 ug once a month latanoprost - 0.005 % drops - one drop conjunctiva daily mom - (prescribed by other provider) - 50 mcg spray, non-aerosol - one spray(s) nasally daily - no substitution montelukast - 10 mg tablet - one tablet(s) by mouth daily ondansetron hcl - (prescribed by other provider) - 4 mg tablet - one tablet(s) by mouth three times a day breakfast, before dinner and at bed pantoprazole - (dose adjustment - no new rx) - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth at breakfast, one tablet before dinner and one before bed sucralfate - 1 gram tablet - one tablet(s) by mouth four times a day magnesium hydroxide - 2,400 mg/10 ml suspension - 3 tbs by mouth nightly multivitamin - tablet, chewable - one tablet(s) by mouth daily discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 2. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 3. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime): both eyes. disp:*2 bottles* refills:*1* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 5. 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:*1* 6. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours): may resume pre-op schedule of dosing. disp:*60 tablet, delayed release (e.c.)(s)* refills:*1* 8. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 9. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*1* 10. warfarin 2 mg tablet sig: one (1) tablet po once a day: dr. to manage for goal inr 2.5-3.0, dose may change daily. disp:*30 tablet(s)* refills:*2* 11. outpatient lab work labs: pt/inr coumadin for mechanical aortic valve goal inr 2.5-3.0 first draw (results to over weekend) then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by dr. /coumadin clinic results to phone 12. hydrocortisone 0.5 % cream sig: one (1) appl topical tid (3 times a day) as needed for rash: do not use on chest. disp:*qs * refills:*0* 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical q4h (every 4 hours) as needed for itching. disp:*qs * refills:*0* discharge disposition: home with service facility: health systems discharge diagnosis: aortic insufficiency s/p aortic valve replacement mitral regurgitation s/p mitral valve repair post-op a fib pmh: -mitral valve (bileaflet) prolapse and moderate mitral regurgitation -longstanding history of palpitations, status post recent electrophysiology study with subsequent diagnosis of avnrt - ventricular tachycardia -pericarditis (small pericardial effusion) -hyperlipidemia (elevated total cholesterol and hdl) - endometriosis s/p total abdominal hysterectomy - vaginal cancer s/p radiation -frequent bowel obstruction d/t adhesions from xrt and abdominal surgeries. -recurrent stomach ulcers -gastroesophageal reflux disease and gastric ulcers -frequent bowel obstructions -atypical tuberculosis in the lung -dyslipidemia -mugs-abnormal low white blood cell count and low protein. followed by dr. (heme/onc) -complex migraines -syncopal episodes - lyme disease s/p 6 week treatment with doxycycline -glaucoma -seasonal allergies -bronchitis past surgical history: -tonsillectomy as a child -appendectomy as a child -right elbow surgery after a fall s/p three surgeries -s/p tah -s/p 7 gynecological surgeries -s/p bowel resection -reveal implant in left upper chest discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage edema: none discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: you are scheduled for the following appointments: surgeon dr. phone: date/time:, 1:30 cardiologist dr. @ 12:30 primary care dr. , 9:25am **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr coumadin for mechanical aortic valve goal inr 2.5-3.0 first draw then please do inr checks monday, wednesday, and friday for 2 weeks then decrease as directed by dr. /coumadin clinic results to phone **please call inr results to dr. office over weekend *** procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve open heart valvuloplasty of mitral valve without replacement diagnoses: esophageal reflux mitral valve disorders atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia other specified cardiac dysrhythmias long-term (current) use of anticoagulants gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction personal history of irradiation, presenting hazards to health personal history of malignant neoplasm of other female genital organs other forms of migraine, without mention of intractable migraine without mention of status migrainosus personal history of tuberculosis encounter for therapeutic drug monitoring monoclonal paraproteinemia 

Answer: The patient is high likely exposed to