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: cardiac catheterization placement of an iabp aortic valve replacement(19mm st. porcine) and three vessel coronary artery bypass grafting(lima to lad, svg to om, svg to pda) on iabp history of present illness: mrs. is a 88 year old female with a history of aortic stenosis who presented to an outside hospital on with acute shorteness of breath. she was found to have acute pulmonary edema thought to be secondary to dietary indiscretion, aortic stenosis, and uri. she was found initially to have hypertension treated with bipap and lasix with improvement of her breathing. while admitted the patient did have cardiac enzyme elevation that was thought to be secondary to lv strain rather than acute coronary syndrome. upon arrival to the , the patient is asymptomatic. she had no shortness of breath, chest pain, nausea or vomiting. she reported that she has had no dyspnea in 12 hours and has been off 02 since arrival to . she confirms that she had high salt intake prior to the admission to the osh but otherwise has had no change in her medications or symptoms including no preceeding chest pain, nausea or palpitations. ros + for increasing cough without sputum prior to admission negative except as above including no bleeding, syncope, fatigue, fever, chills, nausea, vomiting past medical history: chronic diastolic cardiac dysfunction hypertension aortic stenosis dyslipidemia glaucoma s/p appendectomy, left knee surgery, cataract surgery and hysterectomy social history: distant smoking history, occ etoh, no illicits, lives alone in rye, has daughter who is hcp or family history: no family history of early cardiac events or sudden death. physical exam: admission vs 97.7 139/68 66 18 96% ra gen: nad, a/ox3, cooperative heent: anicteric sclera, mmm, op clear neck: jvp ~ 10, no lad lungs: ctab, no wheezes, ronchi appreciated cv: rrr, normal s1 + s2, systolic cres/decres murmur loudest at lusbabd: sntnd, no tenderness or guarding, liver edge not palpable ext: warm, well perfused, 2+ pulses pt, dp, radial, no clubbing, trace edema discharge vs 98.8 146/72 62 18 95% ra gen pleasant to speak with, answers questions appropriately neuro: intact pulm: decreased breath sounds @right base, otherwise clear to auscultation cv: nl s1s2. i/vi systolic murmur heard best at base abdm: soft, nontender ext: warm with 1+ pitting edema to ankles bilaterally pertinent results: 05:40am blood wbc-6.8 rbc-4.32 hgb-12.8 hct-36.6 mcv-85 mch-29.7 mchc-35.1* rdw-13.2 plt ct-244 05:40am blood pt-13.0 ptt-22.9 inr(pt)-1.1 05:40am blood glucose-100 urean-34* creat-0.9 na-142 k-3.7 cl-99 hco3-36* angap-11 05:40am blood ck-mb-notdone ctropnt-0.04* 11:30am blood albumin-3.7 11:30am blood %hba1c-5.8 05:45am blood triglyc-82 hdl-56 chol/hd-3.3 ldlcalc-114 cardiac cath: 1. selective coronary angiography of this right dominant system demonstrated 3-vessel coronary artery disease. the lmca was heavily calcified with an ostial stenosis of 40-50% and a distal stenosis of 30-40%. the lad was heavily calcified with a proximal 30% stenosis and a mid 70% after the take off of a modest d1. the lad had diffuse disease in the mid to distal portion of the vessel. the lcx was heavily calcified with diffuse disease to 50% proximally with a mid stenosis of 60-70% before an aneurysmal segment from which small om3 and a large om4 arose. the om5/lpl had a proximal tubular stenosis of 60%. a small high om1 has a moderate stenosis at its origin. the rca was heavily calcified with diffuse disease throughout to 60% mid vessel. the rpda had a proximal 70% stenosis. 2. resting hemodynamics revealed mildly elevated left ventricuhg. there was mild systolic pulmonary artery pressures with 32 mmhg. the cardiac index was normal at 2.3 l/min/m2. there was mild systolic arterial blood pressure at 140 mmhg with a systemic vascular resistance of 1897 dynes/s-1/cm-5. there was severe aortic stenosis with a mean gradient of 67 mmhg and a calculated valve area of 0.5 cm2 (based on an assumed vo2 and an underestimate in the setting of aortic regurgitation). 3. left ventriculography showed a preserved ejection fraction at 71% with normal regional wall motion and a stroke volume index of 49 ml/m2. carotid ultrasound: less than 40% right ica stenosis. 40-59% left ica stenosis. chest ct scan: 1. moderate cardiomegaly with coronary artery and aortic calcifications, as well as calcification of the aortic valve and milder calcification of the mitral annulus. no evidence of acute pulmonary infection or pulmonary edema. small right greater than left pleural effusions with associated compressive atelectasis in the lower lobes. 2. incidentally noted small pulmonary nodules measuring up to 4 mm. in a patient without strong risk factors for intrathoracic malignancy, no followup is recommended per the guidelines. radiology report chest (pa & lat) study date of 10:38 am , fa6a sched chest (pa & lat) clip # medical condition: 88 year old woman s/p avr/cabg reason for this examination: eval for pleural effusions provisional findings impression: lcpc fri 1:10 pm pfi: bilateral pleural effusion increased, still small with adjacent atelectasis. left apical pneumothorax decreased, now down to 1 mm at the apex. pfi: bilateral pleural effusion increased, still small with adjacent atelectasis. left apical pneumothorax decreased, now down to 1 mm at the apex. dr. dr. dr. echocardiography report , (complete) done at 3:10:33 pm final referring physician , dob: age (years): 88 f hgt (in): 60 bp (mm hg): 139/47 wgt (lb): 125 hr (bpm): 78 bsa (m2): 1.53 m2 indication: intra-op tee for cabg, avr icd-9 codes: 440.0, 413.9, 414.8, 424.1, 424.0 test information date/time: at 15:10 interpret md: , md, md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2008aw01-: machine: echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.2 cm <= 4.0 cm left ventricle - septal wall thickness: *1.3 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.3 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.4 cm <= 5.6 cm left ventricle - ejection fraction: 55% >= 55% aorta - annulus: 2.0 cm <= 3.0 cm aorta - sinus level: 2.5 cm <= 3.6 cm aorta - sinotubular ridge: 2.1 cm <= 3.0 cm aorta - ascending: 2.1 cm <= 3.4 cm aorta - arch: 2.1 cm <= 3.0 cm aorta - descending thoracic: 1.9 cm <= 2.5 cm aortic valve - peak velocity: *4.7 m/sec <= 2.0 m/sec aortic valve - peak gradient: *87 mm hg < 20 mm hg aortic valve - mean gradient: 60 mm hg aortic valve - valve area: *0.5 cm2 >= 3.0 cm2 findings left atrium: moderate la enlargement. right atrium/interatrial septum: normal ra size. lipomatous hypertrophy of the interatrial septum. no asd by 2d or color doppler. left ventricle: wall thickness and cavity dimensions were obtained from 2d images. mild symmetric lvh. normal lv cavity size. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. focal calcifications in ascending aorta. normal aortic arch diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: severely thickened/deformed aortic valve leaflets. severe as (aova <0.8cm2). mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. moderate mitral annular calcification. mild (1+) mr. tricuspid valve: physiologic tr. pulmonic valve/pulmonary artery: physiologic (normal) 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. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. see conclusions for post-bypass data the post-bypass study was performed while the patient was receiving vasoactive infusions conclusions pre-bypass: 1. the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. 2. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the descending thoracic aorta. 5. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 7. there is no pericardial effusion. dr. was notified in person of the results. post-bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine and is being av paced. 1. a well-seated bioprosthetic valve is seen in the aortic position with normal leaflet motion and gradients (peak gradient = 15 mmhg). a trace perivalvular leak is seen. 2. bi ventricular function is preserved. 3. aorta is intact post decannulation. 4. after massive transfusion, biventricular function is preserved, but mr is now moderate and tr is now moderate i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, md, interpreting physician 07:54 brief hospital course: mrs. was admitted under the cardiology service and underwent cardiac catheterization which confirmed severe aortic stenosis and revealed three vessel coronary artery disease - see result section for further detail. based upon those results, cardiac surgery was consulted and further preoperative evaluation was performed. preoperative workup consisted of dental clearance, carotid ultraound and chest ct scan - see result section for results. the night before surgery, she became acutely short of breath and devleoped respiratory distress. she was concomitantly hypotensive at that time(attributed to nitro). she required intubation and was placed on neosynephrine to maintain stable hemodynamics. following intubation, she transferred to the ccu. shortly thereafter, she was brought to the cardiac cath lab for placement of an iabp. following successfull placement of the iabp, she was urgently brought to the operating room where dr. performed aortic valve replacement and coronary artery bypass grafting surgery. for surgical details, please see seperate dicatated operative note. following the operation, she was brought to the cvicu for invasive monitoring. within 24 hours, she awoke neurologically intact and was extubated without incident. the iabp was slowly weaned and removed without complication on postoperative day one. she maintained stable hemodynamics and transferred to the sdu on postoperative day two. once on the floors she had an uneventful post-operative course. her activity level progressed slowly and on pod5 she was discharged to rehabilitation. medications on admission: verapamil 180sr hctz 25 md 81 mg qod azopt qd travtan z qd brimonidine tid ou discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. disp:*60 tablet(s)* refills:*0* 3. simvastatin 40 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q8h (every 8 hours). disp:*qs * refills:*2* 5. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). disp:*qs * refills:*0* 6. brinzolamide 1 % drops, suspension sig: one (1) ophthalmic tid (3 times a day). disp:*qs * refills:*0* 7. tramadol 50 mg tablet sig: one (1) tablet po every 4-6 hours as needed. disp:*60 tablet(s)* refills:*0* 8. 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* 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po q12h (every 12 hours): 20meq x10 days then 20meq qd x10 days. 10. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): 400mg x5 days then 400mg qd x 1wk then 200mg qd. 11. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 12. lasix 20 mg tablet sig: one (1) tablet po twice a day: 20mg x10days then 20mg qd x10 days . discharge disposition: extended care facility: house nursing home - discharge diagnosis: aortic stenosis, coronary artery disease - s/p avr/cabg cardiogenic shock chronic diastolic congestive heart failure hypertension elevated cholesterol discharge condition: good discharge instructions: 1) monitor wounds for signs of infection. these include redness, drainage or increased pain. in the event that you have drainage from your sternal wound, please contact the at (. 2) report any fever greater then 100.5. 3) report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) no lotions, creams or powders to incision until it has healed. you may shower and wash incision. gently pat the wound dry. please shower daily. no bathing or swimming for 1 month. use sunscreen on incision if exposed to sun. 5) no lifting greater then 10 pounds for 10 weeks. 6) no driving for at least one month. 7) call with any questions or concerns. 8) take all medication as prescribed. followup instructions: dr. in 4 weeks, call for appt dr. in weeks, call for appt procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours 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 insertion of endotracheal tube open and other replacement of aortic valve with tissue graft implant of pulsation balloon diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute on chronic diastolic heart failure hematoma complicating a procedure aortic valve disorders other and unspecified hyperlipidemia acute respiratory failure cardiogenic shock cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure 

Answer: The patient is high likely exposed to