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 attending: chief complaint: palpitations, increasing fatigue major surgical or invasive procedure: aortic valve replacement utilizing a 21mm onyx mechanical valve. replacement of ascending aorta utilizing a 24mm gelweave graft. history of present illness: this is an 44 year old female with a known aortic aneurysm for the last several years. over the last several months, she has been complaining of increasing dyspnea on exertion and fatigue. an echocardiogram in showed a bicuspid aortic valve with an ascending aorta measuring 5.0 centimeters. the lvef was estimated at 60%. chest mra revealed confirmed 5.0 centimeter ascending aorta. in preparation for surgery, she underwent cardiac catheterization which revealed normal lv function and normal coronary arteries. she was admitted for cardiac surgical intervention. past medical history: ascending aortic aneurysm, bicuspid aortic valve, hypertension, s/p tubal ligation, s/p appendectomy social history: active smoker, currently admits to ppd. already has at least 10 pack year history. admits to glasses of wine per week. family history: grandfather died of an mi at age 42 physical exam: vitals: bp 110/80, hr 70, rr 20 general: well developed, healthy female in no acute distress heent: oropharynx benign, neck: supple, no jvd, no carotid bruits heart: regular rate, normal s1s2, faint systolic murmur lungs: clear bilaterally abdomen: soft, nontender, normoactive bowel sounds ext: warm, no edema, no varicosities pulses: 2+ distally neuro: nonfocal pertinent results: 06:00am blood hct-26.2* 06:00am blood pt-25.8* inr(pt)-2.6* 04:21pm blood pt-49.5* inr(pt)-5.8* 06:20am blood pt-47.6* ptt-57.6* inr(pt)-5.6* 11:10am blood pt-47.9* ptt-46.1* inr(pt)-5.6* 05:50am blood pt-40.0* ptt-54.5* inr(pt)-4.5* 04:10am blood pt-21.5* ptt-107.7* inr(pt)-2.1* 05:50am blood urean-6 creat-0.7 k-5.1 03:45am blood urean-10 creat-0.6 k-4.1 03:45am blood mg-1.9 chest x-ray: there has been prior median sternotomy and aortic valve replacement. the heart size and mediastinal contours are within normal limits and stable during the postoperative period. bibasilar atelectasis, worse on the left and new on the right, is present, as well as new bilateral small pleural effusions. brief hospital course: on the day of admission, dr. performed a mechanical aortic valve replacement with replacement of her ascending aorta. for further surgical details, please see separate dictated operative note. following the operation, she was brought to the csru for invasive monitoring. within 24 hours, she awoke neurologically intact and was extubated without incident. she maintained stable hemodynamics and transferred to the sdu on postoperative day two. warfarin was started on for mechanical valve coverage. she transiently required intravenous heparin for a subtherapeutic prothrombin time. inrs were monitored daily and warfarin dosing was adjusted for a target inr between 2.5 - 3.0. brief episodes of paroxysmal atrial fibrillation were noted. beta blockade was advanced as tolerated with improvement in rhythm. she remained mostly in a normal sinus rhythm. last episode of paf was noted on postoperative day six. her postop course was otherwise unremarkable and she was eventually cleared for discharge to home with vna services on postoperative day eight. dr. will adjust her warfarin as an outpatient. medications on admission: atenolol 25 qd, imipramine 25 qd, flexeril, xanax 1 tid, prn verapamil and ibuprofen discharge medications: 1. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily): take ofr 1 month then stop. disp:*30 tablet(s)* refills:*0* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): you may stop taking this when you are no longer taking narcotic pain medicine. disp:*60 capsule(s)* refills:*0* 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day): take for 1 month then stop. disp:*60 tablet(s)* refills:*0* 4. imipramine hcl 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day): take for 1 month then stop. disp:*60 tablet(s)* refills:*0* 6. nicotine 21 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). disp:*30 patch 24hr(s)* refills:*0* 7. 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* 8. hydromorphone 2 mg tablet sig: 1-2 tablets po q3-4h (every 3 to 4 hours) as needed. disp:*50 tablet(s)* refills:*0* 9. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 1 weeks. disp:*21 tablet(s)* refills:*0* 10. lasix 20 mg tablet sig: one (1) tablet po once a day for 5 days: take for 5 days with potassium and then stop. disp:*5 tablet(s)* refills:*0* 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 5 days: take for 5 days with lasix and then stop. disp:*5 tab sust.rel. particle/crystal(s)* refills:*0* 12. atenolol 25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*1* 13. warfarin 2 mg tablet sig: three (3) tablet po at bedtime for 1 days: take as directed by dr. for inr goal of 2.5-3.5. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: hospice and vna discharge diagnosis: bicuspid aortic valve, ascending aortic aneurysm - s/p avr and replacement of ascending aorta, postop atrial fibrillation pmh: hypertension, s/p appendectomy, s/p tubal ligation discharge condition: good discharge instructions: shower, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns take warfarin as directed. dr. will monitor and adjust your warfarin as an outpatient. warfarin should be adjusted for a goal around 2.5-3.0. inr should be checked on thursaday go directly to office for blood draw or have vna fax results to . please call clinic office on thursday to inform them either that you will be coming in for blood draw or that vna will draw blood. clinic number is . followup instructions: dr. in weeks, call for appt dr. in weeks, call for appt dr. in weeks for routine follow-up appointment and as instructed for coumadin management. call for appt clinic appt as per scheduled by you. the visiting nurse may draw your blood and send it to the clinic initially. procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels diagnoses: tobacco use disorder unspecified essential hypertension thoracic aneurysm without mention of rupture atrial fibrillation long-term (current) use of anticoagulants congenital insufficiency of aortic valve other malaise and fatigue 

Answer: The patient is high likely exposed to