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: cipro attending: chief complaint: dyspnea major surgical or invasive procedure: left heart and right heart cardiac catheterization, coronary abgiography extraction of 6 teeth coronary artery bypass graft x2(left internal mammary artery to left anterior descending artery and saphenous vein graft to obtuse marginal artery), aortic valve replacement(19mm st. mechanical valve),mitral valve repair(26mm cg future mitral band). endoscopic harvesting of the long saphenous vein. tracheostomy/percutaneous gastrostomy tube placement history of present illness: this 69 year old female with dilated cardiomyopathy with lvef 20-25%, moderate mitral regurgitation, moderate tricuspid regurgitation and moderate aortic stenosis presented for right and left heart cardiac cath in the setting of prorressively worsening dyspnea and fatigue. she initially presented in of to dr. in , nh for evalution of her progressive sob. the plan was medical treatment at the time and to have cardiac cath. she did not want to have cardiac cath and she was lost of follow-up. her dyspnea has progressively worsened over the last few weeks. she can walk yards on the flat at her own pace, and up 1 flight of stairs at home, but has to sit down then. she occasionally gets associated pressure in the upper chest. she was referred for a right and left side heart cath. her cardiac catheterization showed left main disease w/70-80% occlusion, lad 50% and circ 99%. her recent echo also showed dilated left ventricle with severe global systolic dysfunction, probable aortic stenosis w/ mild to moderate aortic regurgitation, moderate to severe mitral regurgitation. past medical history: hodgkins lymphoma with radiotherapy, splenectomy. hypothyroidism anxiety social history: social history: pt lives with husband lives with:husband occupation: owned a shoe business with her husband. retired teacher cigarettes: smoked no other tobacco use:denies etoh: < 1 drink/week illicit drug use:denies family history: mother with hypertension physical exam: vs: t= 98 bp= 107/68 hr= 100 rr= 16 o2 sat= 98% 2l general: nad, mildly tachpneic with accessory work of breathing. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm above sternal angle. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 3/6 systolic murmur heard throughout precordium. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp with decreased volumes. crackles at bases with intermittent wheezes as well. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. no femoral bruits. skin: right leg wound with superficial ulceration. pulses: faint, 1+ pertinent results: tte left atrium: moderate la enlargement. no thrombus in the laa. right atrium/interatrial septum: a catheter or pacing wire is seen in the ra and extending into the rv. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. moderately dilated lv cavity. severely depressed lvef. false lv tendon (normal variant). right ventricle: mildly dilated rv cavity. mild global rv free wall hypokinesis. aorta: focal calcifications in aortic root. normal ascending aorta diameter. normal descending aorta diameter. simple atheroma in descending aorta. no thoracic aortic dissection. aortic valve: moderately thickened aortic valve leaflets. mechanical aortic valve prosthesis (avr). avr leaflets move normally. moderate as (area 1.0-1.2cm2) moderate (2+) ar. mitral valve: mildly thickened mitral valve leaflets. mitral valve annuloplasty ring. mild mitral annular calcification. torn mitral chordae. severe (4+) mr. tricuspid valve: normal tricuspid valve leaflets. moderate tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. mild pr. general comments: a tee was performed in the location listed above. i conclusions pre-cpb: the left atrium is moderately dilated. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 20-25 %). the basal inferoseptal wall appears diskinetic. all mid-papillary segments except for the anterior and anterolateral segments appear severely hypokinetic. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. there are simple atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. the aortic valve leaflets (3) are moderately thickened. there is moderate aortic valve stenosis (valve area 1.0-1.2cm2). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. torn mitral chordae are present. the mitral leaflets fail to coapt, leading to severe (4+) mitral regurgitation. this is likely due to lv dilation. moderate tricuspid regurgitation is seen. post-cpb: a mechanical valve is seen in the aortic position. the valve appears to be well-seated with normally mobile leaflets. there are no paravalvular leaks. there is no ai. the peak gradient across the aortic valve is 27mmhg, the mean gradient is 11mmhg with co of 4.7. a mitral valve annuloplasty ring is present. there is mild mitral stenosis with mean gradient of 4mmhg across the mitral valve. the mitral regurgitation is now mild. the patient is on milrinone, vasopressin, norepinephrine and epinephrine infusions. the lv systolic function remains severely depressed, estimated ef=25%. the rv systolic function appears mildly improved from pre-bypass. the tricuspid regurgitation remains moderate. brief hospital course: following admission she was diuresed with a lasix drip at 10-15 mg/min which was then switched to torsemide. more than 5l were diuresed with weight loss of about 3 kg. her jvd returned to near normal, breathing much easier, and she was no longer tachypneic. additionally she underwent cardiac catheterization for preoperative evaluation and was found to have coronary artery disease, she had no chest pain preoperatively. she had a dental consult and subsequently had teeth extracted on in preparation for valve surgery. she had a right leg ulcer on her shin from traumatic injury over one month ago. dermatology performed a biopsy with cultures growing out pan-sensitive pseudomonas. the wound does not appear infected with clean base and edges. she was treated with cefepime as recommended by infectious disease for 3 days peri operatively. additionally surgery was delayed due to increased creatinine which peaked at 2.1 on with bun 39, the diuretic was held over the next few days and creatinine decreased to 1.6 on and she was taken to the operating room. she underwent aortic valve replacement, mitral valve repair, and coronary artery bypass graft. see operative report for further details. she was taken to the intensive care unit on vasopressin, milrinone, norepinephrine and propofol. she remained intubated overnight due to hemodynamic instability and was able to be weaned and extubated on post operative day one. additionally her inotropes and pressors were progressively weaned as tolerated and discontinued on day 3 with stable hemodynamics. she went into a rapid atrial fibrillation and given an amiodarone bolus and drip on pod#3. she converted to a sinus rhythm later in the day and was started on low dose beta blockers. hydralazine was started for afterload reduction as blood pressure tolerated (ace-i was not started due to increased creatinine.) on pod#4 pacing wires were pulled and she was started on heparin bridge later that day for mechanical avr. coumadin was initiated and she was anticoagulated to a goal of 2.5-3.5 for mechanical avr and afib. she was aggressively diuresed with a lasix drip due to cxr showing pulmonary edema and respiratory issues. she was taken off the lasix drip and started on spironolactone due to her heart failure. pleural chest tubes remained in place due to high serous drainage for several days post op. they were discontinued when protocol was met. her respiratory status slowly improved and she was transferred to the floor on pod 7. she had a poor oral intake and she was given glucerna for additional nutrition support. physical therapy was consulted for evaluation of her strength and mobility. for two days on the step down unit ms. worsening renal function and failure to thrive. on she was transferred back to the cvicu for further monitoring. she was ultimately reintubated secondary to pulmonary edema and requiring pressor support on . nephrology was consulted for acute renal failure with rising creatinine. a temporary hemodialysis line was placed for anticipation of possible dialysis. she responded to diuresis and never required dialysis. gi was consulted for c. diff colitis and gi bleed. vancomycin and flagyl were given for c.diff treatment.an egd revealed that the patient likely had oozing from the antral gastritis in the setting of high ptt. heparin, initiated for mechanical valve bridging, was held. a ppi drip was continued along with supportive care. electrophysiology was consulted for evaluation and management of heart failure and for possible biv pacemaker, which will be reevaluated as an outpatient. after several days of failure to wean on the ventilator, thoracic surgery was consulted for trach and peg. on she underwent a percutaneous tracheostomy tube and percutaneous endoscopic gastrostomy tube placement/bronchoscopy with bronchoalveolar lavage. nutrition was consulted for tube feed recommendations. she continued on antibiotics for c-diff and surveillance cultures were followed. she continued to very slowly progress. her amiodarone was increased for paroxysmal atrial fibrillation and ultimately on pod# 21 she converted back into normal sinus rhythm. she remained hemodynamically stable and was fully anticoagulated for mechanical avr/paf, without futher bleeding. three negative c. diff cultures were obtained after treatment was discontinued and precautions were stopped. she remains neurologically intact. she was cleared for discharge to on post-operative day 29 for further progression of her recovery. all follow up appointments were advised. she was tolerating one and a half hour trach collar trials at this time. medications on admission: furosemide 40 mg daily levothyroxine 100 mcg daily lisinopril 5 mg daily metoprolol succinate 25 mg daily cholecalciferol (vitamin d3) 400 unit daily omega-3 fatty acids-fish oil 300 mg-1,000 mg capsule - 1 capsule daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 3. chlorhexidine gluconate 0.12 % mouthwash sig: five (5) ml mucous membrane (2 times a day). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 5. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas pain. 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 7. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety . 8. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. 9. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily). 10. docusate sodium 50 mg/5 ml liquid sig: ml po bid (2 times a day). 11. warfarin 1 mg tablet sig: as ordered by inr tablet po once daily at 4 pm. 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 2-4 puffs inhalation q4h (every 4 hours) as needed for wheeze. 13. furosemide 10 mg/ml solution sig: four (4) ml(40mg) injection daily (daily). 14. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 15. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 16. levothyroxine 50 mcg tablet sig: two (2) tablet po daily (daily). 17. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). 18. prevacid 24hr 15 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 19. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: hospital discharge diagnosis: aortic stenosis s/p aortic valve replacement mitral regurgitation s/p mitral valve repair coronary artery disease s/p coronary artery bypass grafts postoperative renal failure s/p gastrointestinal bleeding acute on chronic systolic and diastolic heart failure hypothyroidism anxiety hodgkins lymphoma with radiotherapy s/p splenectomy discharge condition: alert and oriented x3, nonfocal unable to stand incisional pain managed with ultram incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema: trace 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: you are scheduled for the following appointments surgeon: dr. () on at 1:30 pm cardiologist: dr. () on at 1:40 pm 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 mechanical avr/atrial fibrillation goal inr 2.5-3.5 first draw coumadin follow up to be arranged upon discharge from rehab md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more 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 other endoscopy of small intestine enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] open and other replacement of aortic valve (aorto)coronary bypass of one coronary artery temporary tracheostomy closed [endoscopic] biopsy of bronchus right heart cardiac catheterization open heart valvuloplasty of mitral valve without replacement closed biopsy of skin and subcutaneous tissue other surgical extraction of tooth diagnoses: other primary cardiomyopathies other iatrogenic hypotension thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases chronic kidney disease, unspecified intestinal infection due to clostridium difficile dental caries, unspecified pseudomonas infection in conditions classified elsewhere and of unspecified site ulcer of other part of lower limb acute on chronic combined systolic and diastolic heart failure acute gastritis, with hemorrhage personal history of hodgkin's disease acute respiratory failure following trauma and surgery 

Answer: The patient is high likely exposed to