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: no known allergies / adverse drug reactions attending: chief complaint: chest pain major surgical or invasive procedure: - left heart catheterization - placement of intra-aortic balloon pump coronary artery bypass grafting x3,(lima-lad,svg-om,svg-pda),left atrial appendage resection, mitral valve repair(26mm annuloplasty ring) history of present illness: this 64 year old male who has not seen a physician for over 5 years presented with chest pain that started 2 days prior ( ) , lasted for "several hours" and resolved spontaneously. this was associated with mild dyspnea. he denies fevers, chills, nausea, vomiting, diaphoresis, pnd, orthopnea, palpitations, syncope, presyncope, weight change, lower extremity swelling. his symptoms seemed to be worsened with exertion and relieved by rest. ecg in the ed was consistent with recent an inferolateral stemi with q waves and prominent r waves in v1-3 and was admitted. a cardiac cath found 3 vessel disease (90% lad, lcx was 100% occluded at its origin, rca with long 70% mid-vessel stenosis). he was also found to have moderate-to-severe mr noted on echo and confirmed with his rhc tracings and ventriculogram. a cardiac surgery consult was requested for evaluation for cabg and possibly mv repair. past medical history: paroxysmal atrial fibrillation left atrium thrombus s/p tonsillectomy social history: medical assistant. lives alone. no children. not married. - tobacco history: 50 pack year history, stopped 2 weeks ago. - etoh: sparing social consumption. - illicit drugs: denies. family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - mother: denies. - father: denies. - brother who passed from a ruptured aaa in his 60s physical exam: vs: 98.5, 101/68, 78, 14, 99%ra. general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. faint bibasilar crackles (l>r). no egophony appreciated. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 1+ bilateral pitting edema skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: aaox3, cnii-xii intact, 5/5 strength in all extremities. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: . - echo () conclusions the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the left ventricle is not well seen. the left ventricular cavity size is normal.there is mild regional left ventricular systolic dysfunction with mid to distal inferior and inferolateral hypokinesis. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. impression; regional left ventricular systolic dysfunction consistent with inferior infarction/ischemia. moderate to severe mitral regurgitation which is likely due to leaflet tethering. severe pulmonary artery systolic hypertension. - chest radiograph () comparison: none. clinical history: chest pain and shortness of breath, assess for pneumonia. findings: portable ap upright chest radiograph was obtained. consolidation is noted at the left lung base with associated effusion concerning for pneumonia. right lung is clear. cardiomediastinal silhouette is normal. bony structures intact. impression: left lower lung pneumonia with associated effusion. - carotid series () study: carotid series complete reason: 64 year old man pre/op cabg. findings: duplex evaluation was performed of bilateral carotid arteries. on the right there is no plaque seen in the ica . on the left there is mild heterogeneous plaque seen in the ica. on the right systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 72/25, 68/28, 63/27, cm/sec. cca peak systolic velocity is 71 cm/sec. eca peak systolic velocity is 81 cm/sec. the ica/cca ratio is 1.0. these findings are consistent with <40% stenosis. on the left systolic/end diastolic velocities of the ica proximal, mid and distal respectively are 79/26, 61/20, 69/34, cm/sec. cca peak systolic velocity is 84 cm/sec. eca peak systolic velocity is 95 cm/sec. the ica/cca ratio is .94 . these findings are consistent with no stenosis. there is antegrade right vertebral artery flow. there is antegrade left vertebral artery flow. impression: right ica no stenosis. left ica <40% stenosis. . 04:45am blood wbc-7.6 rbc-3.26* hgb-10.2* hct-30.8* mcv-95 mch-31.4 mchc-33.2 rdw-14.4 plt ct-139* 03:27am blood wbc-9.7 rbc-3.67* hgb-11.3* hct-33.8*# mcv-92 mch-30.9 mchc-33.5 rdw-14.4 plt ct-166 05:15am blood pt-16.5* inr(pt)-1.6* 04:45am blood pt-14.3* ptt-27.2 inr(pt)-1.3* 03:27am blood pt-13.0* ptt-21.9* inr(pt)-1.2* 04:35am blood pt-13.7* ptt-23.9* inr(pt)-1.3* 02:02am blood pt-16.7* inr(pt)-1.6* 12:11pm blood pt-17.8* inr(pt)-1.7* 01:56am blood pt-20.8* ptt-31.6 inr(pt)-2.0* 03:08pm blood pt-20.4* ptt-43.9* inr(pt)-1.9* 04:45am blood glucose-145* urean-14 creat-0.9 na-135 k-3.9 cl-97 hco3-31 angap-11 03:27am blood glucose-120* urean-14 creat-0.8 na-135 k-3.8 cl-97 hco3-31 angap-11 04:35am blood glucose-113* urean-17 creat-0.8 na-134 k-3.8 cl-96 hco3-31 angap-11 06:44pm blood wbc-10.4 rbc-3.36* hgb-10.9* hct-30.7* mcv-91 mch-32.5* mchc-35.6* rdw-12.8 plt ct-257 06:25am blood pt-21.4* inr(pt)-2.0* 05:15am blood pt-16.5* inr(pt)-1.6* 04:45am blood pt-14.3* ptt-27.2 inr(pt)-1.3* 03:27am blood pt-13.0* ptt-21.9* inr(pt)-1.2* 06:25am blood na-136 k-4.6 cl-100 03:08pm blood urean-16 creat-0.8 na-137 k-4.2 cl-105 hco3-25 angap-11 brief hospital course: mr. was admitted to the on for management of his chest pain and myocardial infarction. heparin and plavix were started. an echocardiogram showed an ef of 45-50% with moderate to severe mitral regurgitation, severe pulmonary artery systolic hypertension and inferior and inferiorlateral hypokinesis. a cardiac catheterization was performed which showed severe three vessel disease. given the severity of his disease, the cardiac surgical service was consulted. mr. was worked-up in the usual preoperative manner. a dental consult was obtained for oral clearance for surgery. plavix was allowed to washout. after obtaining a panorex film, multiple extractions were recommended prior to surgery. on , mr. developed chest pain. he was returned to the cardiac catheterization lab where an intara-aortic balloon pump was placed. his pain resolved. on he was taken to the operating room where he underwent coronary artery bypass grafting to three vessels, a mitral valve repair and resection of his left atrial appendage. please see operative note for details. postoperatively he was taken to the intensive care unit for monitoring. on postoperative day one, he awoke neurologically intact and was extubated. his balloon pump was weaned and removed. pressors and inotropes were slowly weaned off. beta blocker was initiated and the patient was gently diuresed toward his preoperative weight. the patient was transferred to the telemetry floor for further recovery. he had a brief episode of post-op atrial fibrillation. he converted to sinus rhythm with titration of beta blocker. anti-coagulation was started with coumadin for left atrial thrombus noted on echo. 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 6 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to rehab in on in good condition with appropriate follow up instructions. medications on admission: none. no otc medications. discharge medications: 1. sodium chloride 0.65 % aerosol, spray sig: sprays nasal (2 times a day) as needed for rhinitis. 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q4h (every 4 hours) as needed for wheezing. 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever, pain. 9. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 10. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 11. furosemide 40 mg tablet sig: one (1) tablet po once a day for 10 days. 12. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day for 10 days. 13. coumadin 2.5 mg tablet sig: as directed tablet po once a day: inr goal . discharge disposition: extended care facility: - discharge diagnosis: coronary artery disease mitral valve regurgitaion paroxysmal atrial fibrillation left atrium thrombus s/p tonsillectomy discharge condition: alert and oriented x3 nonfocal ambulating, deconditioned incisional pain managed with oral analgesics incisions: sternal - healing well, no erythema or drainage leg left - healing well, no erythema or drainage. edema 1+ discharge instructions: 1) 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. 2) please no lotions, cream, powder, or ointments to incisions. 3) each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) no driving for approximately one month and while taking narcotics. driving will be discussed at follow up appointment with surgeon when you will likely be cleared to drive. 5) no lifting more than 10 pounds for 10 weeks 6) 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** followup instructions: you are scheduled for the following appointments clinic in 2a () on at 10:45am surgeon: dr. () on at 2:15pm cardiologist: dr. () on at 9:00 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** labs: pt/inr for coumadin ?????? indication - atrial thrombus( for three months) goal inr first draw **please arrange for coumadin follow-up prior to discharge from rehab** procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries angiocardiography of left heart structures implant of pulsation balloon pericardiotomy open heart valvuloplasty of mitral valve without replacement excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: pneumonia, organism unspecified other iatrogenic hypotension coronary atherosclerosis of native coronary artery tobacco use disorder mitral valve disorders congestive heart failure, unspecified hyposmolality and/or hyponatremia cardiac complications, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases long-term (current) use of anticoagulants acute myocardial infarction of inferolateral wall, initial episode of care obesity, unspecified acute on chronic combined systolic and diastolic heart failure certain sequelae of myocardial infarction, not elsewhere classified, other adhesive pericarditis chronic periodontitis, unspecified 

Answer: The patient is high likely exposed to