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 / keflex / amoxicillin / sulfa (sulfonamide antibiotics) / iodine-iodine containing attending: chief complaint: shortness of breath major surgical or invasive procedure: mitral valve repair with a 26-mm annuloplasty ring (physio ii). history of present illness: 78f with history of atrial fibrillation/flutter and hypothyroidism who presented to the ed with complaint of shortness of breath and low grade fever, associated with cough. patient states that she has been short of breath for the few weeks since her recent admission on at for a. fib with rvr. prior to that admission, paf was well controlled for 3 years. during that admission, rythmol dose was doubled. she subsequently followed up with her cardiologist, dr. , last week at which time her rythmol dose was decreased back to her normal dose of 225 mg of sr formulation and her pacemaker setting was decreased to 100. the next 24 hours she became so short of breath that she was unable to carry out any activities, barely able to walk a few steps. she returned to his office the next day and pacemaker was re-set to 110, with some improvement in symptoms. she then developed worsening shortness of breath over last weekend with another visit to her cardiologist 2 days prior to presentation. she reports a cxr showed fluid on her lungs, she declined lasix at that time. since then, has had worsening shortness of breath, non-productive cough and fever x 1 to 100.4 last night. overnight, she noted worsening shortness of breath, unable to sleep and necessitating sitting up in a chair all night. also noted belching, nausea, and substernal chest pain x 24 hours, worse with coughing, non-radiating. of note, has had 3 pound weight gain over past week. denies syncope, peripheral edema. . in the ed, initial vs were: 98.4 142/72 82 24 97%ra patient was given zofran 4 mg for nausea, asa 325 mg and ntg 0.4mg sl x 3 for chest discomfort. after chest x-ray, due to concern for chf vs. pna, was given lasix 20 mg iv x 1 and cefepime 2g iv x 1. . on the floor, patient is in no acute distress. she continues to complain of some shortness of breath and occasional cough. echo was done revealing severe mitral regurg and moderate aortic stenosis past medical history: atrial fibrillation- with multiples episode of palpitations in the past s/p pacemaker : s/p generator change at gerd . diverticulosis hypertension cataract surgery s/p tah/bso d/t bleeding endometriosis bilateral hip replacement benign positional vertigo urinary retention cyctocele/rectocele allergic rhinitis esophageal strictures s/p dilation s/p bladder suspension chest pain with normal coronaries by cath at , pt reports being "shocked" at the end of the case- osteoarthritis tonsillectomy appendectomy cholecystectomy hypothyroidism/partial thyroidectomy social history: does not drink, no history of tobacco or drug use. divorced/retired, living alone in . independent in all adls. family history: mother died of "tachycardia". father died of bladder/kidney cancer. brother died of hodgkins lymphoma at 21. physical exam: pulse:63 resp:18 o2 sat: 92/ra b/p 136/84 height: 66" weight: 87kgs general: nad, alert, cooperative skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally few wheezes and scattered rhonchi heart: rrr irregular murmur - i/vi systolic murmur 4th lics abdomen: soft non-distended non-tender x bowel sounds + extremities: warm , well-perfused edema varicosities: none neuro: grossly intact pulses: femoral right: left: dp right:+2 left:+2 pt :+2 left:+2 radial right: +2 left:+2 carotid bruit right: no bruit left: soft bruit pertinent results: discharge 04:45am blood wbc-10.5 rbc-3.81* hgb-10.5* hct-31.5* mcv-83 mch-27.5 mchc-33.4 rdw-17.1* plt ct-353 04:25am blood pt-16.6* inr(pt)-1.5* 04:25am blood na-132* k-4.9 cl-89* 04:45am blood glucose-118* urean-29* creat-1.2* na-132* k-4.0 cl-91* hco3-30 angap-15 inr 2.2 na 133 bun 23 crea 1.0 k 3.8 wbc 7.0 hct 29.8 echo - the left atrium is mildly dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size is mildly increased with preserved free wall motion. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. severe (4+) mitral regurgitation is seen. there is severe pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: mildly thickened mitral valve leaflets with severe mitral regurgitation. severe pulmlonary artery systolic hypertension. right ventricular cavity enlargement with preserved systolic function. normal left ventricular cavity size with preserved regional and global systolic function. mild-moderate aortic regurgitation. tee - no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). (intrinisic lv function may be depressed given the presence of significant mitral regurgitation). there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. there is no frank mitral valve prolapse but there is some leaflet redundancy. moderate to severe (3+) central mitral regurgitation is seen. no reversal of flow is identified in the pulmonary veins (4 seen entering the left atrium). there is at least moderate pulmonary artery systolic hypertension. there is no pericardial effusion. tee (complete) at 14:49 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: 0.9 cm 0.6 - 1.1 cm left ventricle - ejection fraction: 55% >= 55% conclusions prebypass the left atrium is dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. there is no structural abnormality seen with the mitral valve. the mitral regurgitation is central with an annulus size of 3.8 cm. moderate tricuspid regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results on at 1330pm. post bypass patient is av paced and receiving an infusion of phenylephrine and epinephrine. biventricular systolic function is unchanged. annuloplasty ring seen in the mitral position. it appears well seated and there is no residual mitral regurgitation. mean gradient across the mitral valve is 4 mm hg. moderate aortic insufficiency persists. there is also moderate tricuspid regurgiation. aorta appears intact post decannulation. radiology report chest (pa & lat) study date of 3:35 pm medical condition: 78 year old woman s/p mv repair final report in comparison with the study of , there are continued bilateral pleural effusions with cardiomegaly and some probable elevation of pulmonary venous pressure. mild bibasilar atelectasis persists. head ct there is no evidence for intracranial hemorrhage or large territorial infarct. there is no large mass, mass effect, edema, or hydrocephalus. there is mild cortical atrophy, which is likely secondary to patient's age. white matter hypodensity is likely secondary to chronic small vessel ischemic disease. visualized bony structures are grossly unremarkable. the visualized portions of the paranasal sinuses and mastoid air cells are well aerated. impression: no evidence for acute intracranial process. however, mr would be more sensitive for acute ischemia. head ct findings: there is no evidence of acute intracranial hemorrhage or acute major vascular territory infarction. there is no evidence of large mass, mass effect, edema or hydrocephalus. ventricles and sulci are mildly prominent, consistent with age-related involutional changes. periventricular and subcortical white matter low-attenuating lesions are likely sequelae of chronic small vessel ischemic disease. visualized osseous structures are grossly unremarkable. the visualized portions of the paranasal and mastoid air cells are well aerated. impression: no acute intracranial process. although mri would be more sensitive for acute ischemia, the patient has a pacemaker and therefore mri is contraindicated. since the patient is also allergic to ct contrast, repeat ct head without contrast is recommended if clinical concern persists. head ct no evidence for acute intracranial process. brief hospital course: 78 female with history of paroxysmal atrial fibrillation and hypertension admitted with hypoxia, low-grade fever, and cough. transthoracic echo showed severe mr (normal echo at osh one year ago). transesophogeal echo confirmed findings. symptoms were controlled with diuresis and afterload reduction. ct surgery was consulted and recommended mitral valve repair. on mrs. was taken to the operating room for mitral valve repair, please see operative report for details. in summary she had: mitral valve repair with a 26-mm annuloplasty ring (physio ii). her bypass time was 54 minutes with a crossclamp time of 40 minutes. she tolerated the surgery well and upon completion of the procedure she was transferred to the cardiac surgery icu. she awoke neurologically intact and was weaned from the ventilator and extubated. on pod#1 she was started on betablockers and she was aggressively diuresed toward her preoperative weight. she was followed by the electrophysiology department to assist with rhythm management when she was in rapid atrial fibrillation. she was changed to amiodarone from propafenone and lopressor dose was adjusted. she was rate controlled in sinus rhythm at the time of discharge with occasional pacing from her permanent pacemaker. her coumadin therapy was resumed for afib. her chest tubes and epicardial pacing wires were removed per cardiac surgery protocol. on pod#3 she was transferred from the icu to the step down unit for continued post-operative care. on pod#7 she developed serosanguinous drainage from her sternal incision, it subsequently resolved. at that time she was prophylactically started on levaquin which produced some diarrhea, but c. diff was negative. at the time of discharge she was afebrile and wbc was wnl. on she developed a sudden onset of vertigo while walking the hallway. she described the feeling of nausea and thought she was going to fall to the left. vertigo has persisted and worsens with any head movement, especially looking to the left. she also complained of some slurred speech and left facial paraesthesia. the neurology stroke team was consulted. on exam, awake, alert and oriented. speech is fluent with normal language functions. no obvious dysarthria. head ct showed no hemorrhage or early signs of infarction on . repeat head ct was unchanged. based on clinical findings it was suspected she had a new left inferior cerebellar infarction in the pica territory along with some lateral medullary involvement. she was continued on coumadin with heparin bridge until she was therapeutic with inr 2-2.5. she was ambulating in the halls with assistance with some gait instability and no other residual. on pod 20 she awoke with left facial numbness and dizziness. repeat head ct showed no evidence for acute intracranial process. she was again evaluated by the neurology stroke team with no recommended changes in management. she is to continue on coumadin and aspirin with a goal inr 2-2.5. she is scheduled for a follow up appointment with dr at 2 pm. she did have urinary retention x 2 after foley catheter removal. she had a 900 cc residual after voiding with a bladder scan on and foley was replaced at this time. she is to be discharged to rehab with a leg bag with plans for voiding trial in the next 1-2 days. an urinalysis done showed moderate bacteria and wbc and trace leukocytes and she was started on trimethaprime x 5 days. urine culture was pending at the time of discharge and needs to be followed up with discontinuation of antibiotics if culture is negative. if she fails voiding trial once more, urology follow up is recommended. she was evaluated by physical therapy for strength and conditioning and rehab was recommended upon discharge. she was discharged to rehabilitation at at on pod#20 in stable condition. inr was 2.2 at the time of discharge and she is to receive 5 mg of coumadin on for inr goal 2-2.5. coumadin follow up is be arranged upon discharge from rehab to at . all follow up appointments have been arranged. medications on admission: levothyroxine 137 mcg qday metoprol succinate 75 mg qday pantoprazole 40 mg qday propafenone 225 mg warfarin 2.5 mg mwf and 5mg t,th,, discharge medications: 1. meclizine 12.5 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for dizziness. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain, fever. 4. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dryness. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 7. lasix 40 mg tablet sig: one (1) tablet po once a day: continue until edema resolves. 8. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day: continue while on lasix. 9. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for reflux. 10. warfarin 1 mg tablet sig: as directed tablet po daily (daily): for afib dose based on inr 2.0-2.5. take 5 mg dose 12/7. tablet(s) 11. acetaminophen-codeine 300-30 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 12. synthroid 150 mcg tablet sig: one (1) tablet po once a day. 13. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day) for 4 weeks: 400 mg x 2 weeks then 400 mg daily x 2 weeks then dose to be determined by cardiologist. tablet(s) 14. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 15. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 16. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 17. trimethoprim 100 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. discharge disposition: extended care facility: at discharge diagnosis: s/p mitral valve repair(annuloplasty ring) pmh: severe mr hypothyroidism afib/flutter (dx: per pt.) s/p pacemaker s/p generator change / ( model #addr01p) gerd hypertension benign positional vertigo urinary retention cyctocele/rectocele allergic rhinitis esophageal strictures s/p dilation chest pain with normal coronaries by cath at (~), pt reports being "shocked" at the end of the case osteoarthritis psh: tonsillectomy appendectomy cholecystectomy s/p bladder suspension cataract surgery s/p tah/bso d/t bleeding endometriosis bilateral hip replacement discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with tylenol and ultram. sensitive to narcotics incisions: sternal - healing well, no erythema or drainage edema 1+ lower extremity edema discharge instructions: discharge instructions 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 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 females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: recommended follow-up: you are scheduled for the following appointments: surgeon: dr. 1:15, medical office building cardiologist: dr. 9:40 electrophysiologist: dr 10:00 neurologist: dr at 2 pm 5 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 afib goal inr 2-2.5 first draw coumadin dose 5 mg will need coumadin follow up established upon discharge from rehab procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open heart valvuloplasty of mitral valve without replacement diagnoses: pneumonia, organism unspecified esophageal reflux mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases constipation, unspecified cardiac pacemaker in situ diarrhea cerebral artery occlusion, unspecified with cerebral infarction benign paroxysmal positional vertigo hip joint replacement other specified retention of urine postsurgical hypothyroidism other speech disturbance 

Answer: The patient is high likely exposed to