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: dilaudid attending: chief complaint: shortness of breath major surgical or invasive procedure: cardiac catheterization mitral valve repair(28mm csgrove annuloplasty band) and four vessel coronary artery bypass grafting(left internal mammary artery to left anterior descending, saphenous vein grafts to diagonal, ramus, and posterior descending artery). history of present illness: this is a 74 year old male with a six month history of worsening dyspnea on exertion. several weeks prior to admission, he admitted to rapid decrease in exercise capacity. for several years, he had used two pillows for sleep. he has no history of chest pain or pnd. on , he presented to his cardiologist with the above complaints. office echocardiogram showed an lvef of 15-20%. he was subsequently admitted to with congestive heart failure. bnp on admission was 1400. he was diuresed with iv lasix with improvement in his shortness of breath. he was stabilized on medical therapy and transferred to the for further evaluation and treatment. past medical history: congestive heart failure, hypertension, hyperlipidemia, type ii diabetes mellitus, pulmonary hypertension, chronic renal insufficiency, history of atrial fibrillation, gerd, history of urinary sludge, prior tonsillectomy, hidradenitis suppurative s/p surgery social history: 15 pack year history of tobacco. quit smoking over 25 years ago. admits to 3 etoh drinks per month. married, lives with spouse. family history: denies premature coronary disease. physical exam: preop exam - vitals: 137/64, 79, 18, 95% ra general: wdwn male in no acute distress heent: oropharynx benign, eomi neck: supple, no jvd lungs: cta bilaterally heart: regular rate and rhythm, normal s1s2, soft systolic murmur abdomen: soft, nontender with normoactive bowel sounds ext: warm, no edema pulses: 2+ distally neuro: alert and oriented, cn 2- 12 grossly intact, no focal deficits noted pertinent results: 10:20am blood wbc-6.8 rbc-3.99* hgb-12.5* hct-36.9* mcv-93 mch-31.5 mchc-34.0 rdw-14.6 plt ct-264 10:20am blood pt-13.9* ptt-28.4 inr(pt)-1.2* 10:20am blood glucose-147* urean-20 creat-1.3* na-140 k-3.6 cl-105 hco3-23 angap-16 10:20am blood alt-18 ast-19 alkphos-84 totbili-0.9 10:20am blood albumin-4.3 cholest-133 10:20am blood %hba1c-6.2* 10:20am blood triglyc-115 hdl-31 chol/hd-4.3 ldlcalc-79 cardiac catheterization 1. coronary angiography in this right-dominant system revealed three-vessel disease: --the lmca had no angiographically apparent disease. --the lad had diffuse 80% stenosis in its mid-portion. d1 was a very large vessel wrapping around the lateral wall, with an ostial 80% stenosis. --the lcx had an 80% proximal stenosis --the rca was occluded in its mid-portion and fills by right-to-right and left-to-right collaterals. 2. resting hemodynamics revealed elevated right- and left-sided filling pressures with rvedp 10 mmhg and lvedp 26 mmhg. there was moderate pulmonary arterial hypertension with pasp 59 mmhg. the cardiac output was low-normal with ci 2.1 l/min/m2. the pcwp was elevated at 26 mmhg. there was mild systemic arterial systolic hypertension with sbp 145 mmhg. there was no gradient across the aortic valve upon pullback of the angled pigtail catheter from lv to ascending aorta. carotid ultrasound: bilateral less than 40% carotid stenosis. echocardiogram: left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe regional left ventricular systolic dysfunction with near-akinesis of the inferior/inferolateral walls. there is moderate-to-severe hypokinesis of the remaining segments (lvef = 20%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: mr. was admitted under cardiology and cardiac catheterization which revealed severe three vessel coronary artery disease with moderate to severe pulmonary hypertension(see result section). cardiac surgery was consulted and further evaluation was performed. carotid ultrasound found no significant disease of the internal carotid arteries. repeat echocardiogram was notable for an lvef of 20% with mild mitral regurgitation(see result section). post catheterization, he had a slight decline in renal function and his ace inhibitor was discontinued. his preoperative creatinine peaked to 1.7. creatinine just prior to surgery was 1.5. preoperative course was also notable for bouts of paroxysmal atrial fibrillation/flutter for which he was maintained on intravenous heparin. on , mr. coronary artery bypass grafting and a mitral valve repair by dr. . for surgical details, please see separate dictated operative note. following the operation, he was brought to the cvicu for invasive monitoring. on postoperative day one, sedation was weaned and he was extubated. however, due to severe agitation and confusion associated with atrial fibrillation and low mixed venous saturations, he was electively reintubated. while intubated and sedated, cardioversion was performed but unsuccessful. he was also given several units of prbcs. on postoperative day three, he self-extubated. he did not required reintubation but was initially maintained on 100% shovel mask. despite medical therapy and multiple cardioversions, he continued to experience atrial fibrillation. given atrial fibrillation, he was eventually started on amiodarone and warfarin. he temporarily required a heparin bridge. postoperative renal function remained relatively stable. his confusion and agitation gradually improved with use of haldol. on , mr. was transferred to the step down unit for further recovery. he continued to be gently diuresed towards his preoperative weight. the physical therapy service worked with him daily to increase his strength and mobility. keflex was started for mild incisional erythema. an ace inhibitor was started given his low preoperative ejection fraction. mr. continued to make steady progress and was discharged to baypoint of . dr. coumadin clinic will assume management of his coumadin dosing after discharge from rehabilitation. his goal inr is 2.0-2.5. he will also follow-up with dr. and dr. . amiodarone will be tapered to 200mg once daily. medications on admission: aspirin 325 qd, zestril 20 qd, toprol xl 50 qd, lasix, kcl, nexium 40 qd, plavix load of 600mg discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). 4. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 5. cephalexin 500 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 5 days. 6. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 9. warfarin 1 mg tablet sig: adjust for goal inr 2.0-2.5 tablets po daily (daily): adjust dose for goal inr of 2.0-2.5. 10. lasix 40 mg tablet sig: one (1) tablet po once a day for 10 days. 11. potassium chloride 10 meq capsule, sustained release sig: one (1) capsule, sustained release po once a day for 10 days: take with lasix and stop when/if lasix stopped. 12. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): take amiodarone 400mg twice daily for 2 more days. starting , take 400mg once daily for 7 days and then decrease to 200mg once daily therafter until seen by dr. . . 13. senna lax 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 14. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 15. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 16. lisinopril 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: baypointe - discharge diagnosis: primary: coronary artery disease, mitral regurgitation, acute on chronic systolic heart failure - s/p cabg and mv repair secondary: postoperative atrial fibrillation, postoperative agitation, hypertension, hyperlipidemia, type ii diabetes mellitus, pulmonary hypertension, chronic renal insufficiency discharge condition: stable 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 1 month. 7) you are taking coumadin (a blood thinner) for atrial fibrillation. you goal inr is 2.0-2.5. you coumadin dosing will be managed by dr. and you will need an appointment for blood draw (pt/inr) when discharged from rhab for coumadin management. 8) take amiodarone 400mg twice daily for 2 more days. starting , take 400mg once daily for 7 days and then (starting )decrease to 200mg once daily therafter until seen by dr. . 9) take lasix and potassium once daily for 10 days. monitor electrolytes and replete as needed. monitor daily weights. preop weight 150lbs. you may need continued treatment with lasix but will be determined per cardiologist or rehab physician. 10) take keflex for 5 days for sternal wound erythema. 11) monitor renal function (bun/creat)given history of chronic renal insufficieny and currently on ace and lasix. preop creat 1.3. creat 1.4. 12) call with any questions or concerns. followup instructions: dr. in weeks, call for appt dr. in weeks, call for appt dr. in weeks, call for appt ****coumadin management with dr. via his coumadin clinic. they are aware of patient (contact ). please contact his office when discharged from rehab to schedule pt/inr draw and appointment for coumadin management.**** procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours (aorto)coronary bypass of three coronary arteries 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 insertion of endotracheal tube arterial catheterization atrial cardioversion annuloplasty transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases personal history of tobacco use chronic kidney disease, unspecified paroxysmal ventricular tachycardia other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants accidents occurring in residential institution acute on chronic systolic heart failure delirium due to conditions classified elsewhere encounter for therapeutic drug monitoring hidradenitis 

Answer: The patient is high likely exposed to