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: erythromycin base / haldol attending: chief complaint: acute mitral valve regurgitation major surgical or invasive procedure: mitral valve repair with 26mm annuloplasty ring history of present illness: 51 year old female w/ history significant for dyslipidemia who presented to w/ increased dyspnea x 5day- unable to do adl's, pnd, unable to sleep w/ new onset acute shortness of breath. she had been in ususal good health until 6 weeks ago when she developed cough- was treated with mdi's and abx for pneumonia vs. copd at hospital. echo revealed severe mr and the patient was referred for cardiac surgery. past medical history: chronic abd pain w/+ black stool for several months hyperlipidemia bipolar hypothyroid gerd endometriosis past surgical history hip replacement in left rotator cuff repair chole social history: lives with her boyfriend. no children. works showing apartments. -tobacco history: smoker x36 years, former 1ppd, now 1/2ppd -etoh: quit , hx of heavy prior use -illicit drugs: denies family history: mother died of chf at 64. father committed suicide. 1 brother and 1 sister who are both healthy. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t=98.2 bp=92/59 hr=81 rr=19 o2 sat= 97% on 5l general: wdwn female in mild distress. oriented x3. sl. anxious heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, mmm neck: supple with jvp of 10 cm. nc in place cardiac: pmi not palpable, rrr, normal s1, s2. soft holosystolic murmur heard best at llsb (not heard at apex breast tissue) lungs: no chest wall deformities, scoliosis or kyphosis. respirations mildly labored but no accessory muscle use. mild crackles heard best at rll, otherwise ctab but patient taking poor inspirations. abdomen: soft, normoactive bs. non-distended mildly ttp in ruq, rlq, llq. no hsm. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: 04:25am blood wbc-11.7* rbc-2.88* hgb-9.2* hct-27.4* mcv-95 mch-32.1* mchc-33.7 rdw-13.7 plt ct-180 04:30am blood wbc-11.5* rbc-2.90* hgb-9.4* hct-27.9* mcv-96 mch-32.5* mchc-33.8 rdw-13.3 plt ct-164 04:25am blood na-140 k-4.1 cl-105 04:30am blood glucose-109* urean-22* creat-0.8 na-141 k-3.9 cl-106 hco3-25 angap-14 02:00am blood glucose-117* urean-23* creat-0.9 na-140 k-3.8 cl-105 hco3-27 angap-12 imaging: cxr: findings: moderate cardiac enlargement is present; however, precise heart size is difficult to assess because of high positioned diaphragms and bilateral pleural effusions blunting the lateral and posterior pleural sinuses. there are bilateral extensive confluenting parenchymal infiltrates predominantly in the central portions of the lungs and thus compatible with acute chf and pulmonary edema. question concerning fluid overload cannot be answered. as we have no previous chest examinations available in our records for comparison. also observed is the presence of a bipolar metallic prosthesis in the left shoulder. impression: cardiac enlargement, pulmonary edema and bilateral pleural effusions. further followup and evaluation recommended. echo: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded (inferior wall appears borderline hypokinetic in some suboptimal views). overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels 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. there is no mitral valve prolapse. at least moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: significant mr (unclear etiology). tee: pre-cpb:1. the left atrium is mildly dilated. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size and free wall motion are normal. 4. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. there is no aortic valve stenosis. no aortic regurgitation is seen. 6. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the mitral regurgitation vena contracta is >=0.7cm. the degree of regurgitation was made worse with trendelenberg and phenylephrine infusion. dr. was notified in person of the results. post-cpb: on infusion of phenylephrinbe briefly. a pacing. well-seated valvuloplasty ring in the mitral position with trace mr. lvef remains normal. the aortic contour is normal post decannulation. brief hospital course: medicine course: patient is a 51 yo female with no cardiac history who presents with cough x 6 weeks, fatigue and several days of dyspnea found to have mitral regurgitation and signs and symptoms of chf. . # pump: patient has history of mitral valve prolape and diet controlled dyslipidemia. she was admitted with cough, fatigue, dyspnea for the past several weeks with acute worsening of her dyspnea over the days prior to admission. echo showed severe mitral regurgutation with ef 65-70%. mitral regurgitation was the most likely cause of her chf. the etiology of her mitral regurgitation is unknown. blood cultures were obtained to evaluated for endocarditis and were negative to date (**********please check final micro prior to d/c***********). patient responded well to lasix and was negative 6 l in the ccu but was still quite dyspneic and requiring o2 via nasal cannula and/or non-rebreather. she was taken for mitral valve repair on . # coronaries: patient has no known coronary disease. ekg showed no ischemic changes and cardiac biomarkers were negative. # rhythm: patient is in sinus rhythm. she was monitored on telemetry and potassium was kept above 4 and magnesium was kept above 2. #leukocytosis: patient has leukocytosis to 14.7 on admission which was as high as 20 at osh. leukocytosis was thought to be related to recent use of steroids and trended down. there was no sign of infection and all culture data was negative. # chronic pain: patient has chronic pain from multiple surgeries (hip/ shoulder) as well as chronic abdominal pain. she continued to have abdominal pain during her hospitalization which is unchanged from prior. she was continued on her home oyxcodone and neurontin. # bipolar disorder/ depression: patient has significant pyschiatric comorbidity. prior to her cardiac catherization, she was very anxious which was contributing to her shortness of breath. she required extra doses of iv lorazepam. she was continued on her home citalopram, lorazepam, trazodone. her lithium level had to be intermittently held for high levels of lithium. she was discharged on _________ (***** new dose of lithium). she was seen by social work. # hypothyroidism: stable with tsh within normal limits. she was continued on her home dose of levothyroxine. # tobacco use: patient has a 30 + pack year history of smoking. she was planning on quitting. she was given a nicotine patch. she had recently been started on advair inhalers in the setting of ?copd/asthma. these inhalers were discontinued on discharge (*****please confirm******) as her dyspnea and cough was thought to be more likely caused by her chf. # gerd: stable. continued on home protonix. # fen: cardiac heart healthy diet # code: confirmed full code (but does not want prolonged life support) # communication: patient and boyfriend and hcp surgical course: the patient was brought to the operating room on where the patient underwent mitral valve repair with dr. . overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. she did demonstrate some post-op delerium. psychiatry was consulted given the patient's history and medication regimen. adjustments were made, and the patient would return to her baseline mental status. additionally, dobhoff tube was placed for feeding/medication administration. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. the patient was transferred to the telemetry floor for further recovery. chest tubes, dobhoff tube 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 5, the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged to home in good condition with appropriate follow up instructions. medications on admission: -lithium 300mg qam, 600mg qpm -trazadone 100mg qhs -neurontin 600 mg qid -lorazepam 1mg qday tid -levoxyl 50mcg qday -premarin 0.625mg po qday -protonix 40 mg po bid (not refilled since ) -oxycodone 5 mg po q6h prn - per pharmacy(getting 120/month). pt states she takes 20 mg in am only. -celexa 60 mg qday -colace 100 mg daily -pro-air (recently started at osh) -advair (recently started at osh) -clonidine 0.1 po tid (was prescribed to help patient decrease oxycodone but not taking recently) -avelox (moxifloxacin) started ( avalox x5 days) -prednisone 50 mg started ( script for 10 mg taper) discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for temperature >38.0. 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 4. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 6. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q 8h (every 8 hours). disp:*15 tablet(s)* refills:*0* 9. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 10. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 11. lithium carbonate 300 mg capsule sig: one (1) capsule po bid (). 12. furosemide 40 mg tablet sig: one (1) tablet po daily (daily) for 1 weeks. disp:*7 tablet(s)* refills:*0* 13. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day for 1 weeks. disp:*7 tablet, er particles/crystals(s)* refills:*0* 14. esomeprazole magnesium 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po once a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: mitral regurgitation, acute diastolic heart failure pmh: chronic abd pain w/+ black stool for several months hyperlipidemia bipolar hypothyroid gerd endometriosis discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 with any questions or concerns **please cardiac surgery office with any questions or concerns . answering service will contact on person during off hours** females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: wound check at dr. office wed. , 10am surgeon dr. , thursday, 1:15pm please to schedule the following: cardiologist dr. , r in 3 weeks primary care dr. , a. in weeks **please cardiac surgery office with any questions or concerns . answering service will contact on person during off hours** procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures insertion of endotracheal tube enteral infusion of concentrated nutritional substances annuloplasty diagnoses: other chronic pain esophageal reflux tobacco use disorder mitral valve disorders congestive heart failure, unspecified unspecified acquired hypothyroidism other and unspecified hyperlipidemia acute diastolic heart failure other alteration of consciousness hip joint replacement other specified retention of urine bipolar i disorder, most recent episode (or current) depressed, unspecified 

Answer: The patient is high likely exposed to