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: ace inhibitors attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: aortic valve replacement with 23mm st. mechanical and mitral valve replacement . mechanical history of present illness: 62 y/o male with h/o rheumatic heart disease with aortic and mitral valve stenosis. he also has h/o cad with lad stenting in , complete heart block w/ ppm placed in and paf. recent echo showed severe aortic and mitral stenosis with increased gradients. past medical history: rheumatic heart disease, aortic stenosis, mitral stenosi, coronary artery disease s/p stent, hypertension, hypercholesterolemia, paf, complete heart block s/p pacemaker, pneumonia social history: married lives with his wife and children. he has a daughter who works at . quit smoking 20 years ago. social drinker. no other signficant drug use history. family history: not contributory physical exam: vs: 70 irregular 110/78 gen: nad skin: venous stasis changes in le heent: eomi, perrl, op benign neck: supple, from -jvd, -carotid bruit chest: ctab -w/r/r heart: rrr +murmur abd: soft, nt/nd +bs ext: warm -edema neuro: a&o x 3, non-focal pertinent results: cxr: in comparison with study of , the patient has taken a much poorer inspiration. the endotracheal tube and nasogastric tube have been removed. swan-ganz catheter has been removed and the right ij sheath remains in place. atelectatic changes persist at the left base with blunting of the right costophrenic angle suggesting pleural fluid in this region. echo: pre bypass: poor transgastric windows and significant artifact limit this study. the left atrium is moderately dilated. smoke is seen in the left atrial appendage. the right atrium is moderately dilated. the left ventricle is not well seen. with normal free wall contractility. estimated lvef 50%the ascending aorta is moderately dilated. there are simple atheroma in the aortic arch. the descending thoracic aorta is mildly dilated. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are severely thickened/deformed. the mitral valve shows characteristic rheumatic deformity. there is severe valvular mitral stenosis (area <1.0cm2). moderate tricuspid regurgitation is seen. there is no pericardial effusion. post bypass: patient is on epinepherine 0.4 mcg/kg/min, phenylepherine infusions, v paced. preserved biventricular function. lvef 50-55%. there is a mechanical aortic valve instu with normal bileaflet motion. it appears well seated with no perivalvular leaks and normal washing jets seen. peak gradient 5, mean gradient 1 mm hg. there is a mechanical mitral prosthesis insitu with a mean gradient 4 mm hg. bileaflet motion is normal. no perivalvular leaks seen. normal washing jets seen on the mitral prosthesis. aortic contours intact. tr remains 2+. remaining exam is unchanged. all findings discussed with surgeons at the time of the exam. cxr: moderate cardiomegaly is stable. lungs are clear and there is no pleural effusion. transvenous right atrial and right ventricular pacer leads follow their expected courses continuously from the left axillary pacemaker. 06:50pm blood wbc-6.7 rbc-4.57* hgb-13.8* hct-41.3 mcv-90 mch-30.2 mchc-33.4 rdw-12.6 plt ct-204 06:40am blood wbc-13.6* rbc-3.29* hgb-10.1* hct-29.6* mcv-90 mch-30.6 mchc-34.1 rdw-13.1 plt ct-168# 06:50pm blood pt-15.6* ptt-27.9 inr(pt)-1.4* 01:10pm blood pt-18.6* ptt-59.6* inr(pt)-1.7* 06:50pm blood glucose-166* urean-18 creat-1.0 na-141 k-4.4 cl-103 hco3-30 angap-12 06:40am blood glucose-103 urean-24* creat-1.1 na-136 k-4.3 cl-97 hco3-32 angap-11 brief hospital course: mr. was admitted pre-operatively secondary to being on coumadin. upon admission he was started on heparin and appropriately work-up prior to surgery. on he was brought to the operating room where he underwent a aortic and mitral valve replacement. please see operative report for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. later on op day he was weaned from sedation, awoke neurologically intact and extubated. on post-op day one he was started on diuretics and gently diuresed towards his pre-op weight. on post-op day to coumadin was initiated with a heparin bridge for his mechanical valves. chest tubes and epicardial pacing wires were removed on this day. on post-op day three he was transferred to the telemetry floor for further care. over the next several days he remained relatively stable while receiving coumadin and awaiting his inr to increase to therapeutic level. on post-op day seven he was discharged home with the appropriate medications and follow-up appointments. at dr. office will resume coumadin management. medications on admission: aspirin 325mg qd, zocor 80 mg qd, toprol 50mg qd, lasix 40mg qd, diovan 160mg qd, coumadin qd (last dose 2/19) discharge medications: 1. zocor 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 2. 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* 3. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*0* 4. 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* 5. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 8. warfarin 5 mg tablet sig: 1.5 tablets po once (once) for 1 doses: 7.5 mg; check inr with results to dr. office. . disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: rheumatic heart disease/aortic stenosis/mitral stenosis s/p aortic valve replacement and mitral valve replacement discharge condition: good discharge instructions: please shower daily including washing incisions, 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 dr. will be following your inr and adjusting your coumadin accordingly p instructions: 6 for wound check in 2 weeks dr. in 4 weeks dr. in weeks dr. in weeks procedure: extracorporeal circulation auxiliary to open heart surgery diagnostic ultrasound of heart open and other replacement of aortic valve cardioplegia open and other replacement of mitral valve diagnoses: other iatrogenic hypotension anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension atrial fibrillation personal history of tobacco use percutaneous transluminal coronary angioplasty status long-term (current) use of anticoagulants cardiac pacemaker in situ rheumatic heart disease, unspecified mitral valve stenosis and aortic valve stenosis long-term (current) use of aspirin 

Answer: The patient is high likely exposed to