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: shellfish derived attending: chief complaint: dyspnea on exertion major surgical or invasive procedure: : 1. aortic valve replacement with a 21-mm magna ease aortic valve bioprosthesis, model #3300tfx, serial #. 2. mitral valve replacement with a 27-mm st. epic mitral bioprosthesis, reference #, serial #. 3. coronary bypass grafting x1 with reverse saphenous vein graft from aorta to distal right coronary artery. history of present illness: 77 year old female that presented to osh with worsening dyspnea on exertion x 3 days with known murmur. she was found to be in failure and echocardiogram revealed severe aortic stenosis with 0.5. she received lasix for diuresis and was transferred in for surgical evaluation and cardiac catheterization cardiac catheterization: date: place: revealed three vessel disease. the lmca was normal without stenosis. the lad has a 50% proximal stenosis. the lcx has a 40% proximal stenosis with a 40% distal stenosis. the rca has an 80% proximal stenosis. resting hemodynamics demonstrated elevated left and right sided filling pressures with rvedp of 13 mmhg and mean pcwp of 28 mmhg. there is moderate pulmonary arterial hypertension of 53/23 mmhg as well as persistent systemic arterial hypertension (151/61 with a mean of 101 mmhg). the cardiac index was preserved at 2.93 l/min/m2 (using an assumed oxygen consumption) past medical history: hypertension hyperlipidemia aortic stenosis 0.5 hodgkin's stage iiib s/p chemotherapy and radiation ( was from level of ears to pelvis done in ) breast cancer diverticulosis stage iii - found on colonscopy upper airway obstruction secondary to papillomas - although multiple areas note home oxygen - she states that she does not wear oxygen at home epitaxis every 2-3 months left nares only glaucoma s/p laser in left eye to reduce pressure past surgical history splenectomy hysterectomy laryngeal papillomas removal - last attempt left mastectomy social history: race: caucasian last dental exam: long time ago lives with: daughter occupation: health clinic in school tobacco: denies etoh: denies family history: grandfather deceased 65 mi brother deceased 74 mi grandmother stroke deceased 60 physical exam: pulse: 94 resp: 20 o2 sat: 100% 2 l nc b/p right: 132/49 left: not done due to mastectomy general: pleasant, no acute distress skin: dry intact right groin cath site, left subclavian surgical scar, left chest surgical scar heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur 3/6 systolic murmur abdomen: soft non-distended non-tender bowel sounds + non palpable masses extremities: warm , well-perfused edema none varicosities: multiple bilateral lower extremities neuro: grossly intact pulses: femoral right: +1 left: +1 dp right: +1 left: +1 pt : +1 left: +1 radial right: +2 left: +2 carotid bruit transmitted murmur pertinent results: admission: 06:35am blood wbc-10.4 rbc-3.90* hgb-10.9* hct-33.6* mcv-86 mch-27.9 mchc-32.4 rdw-14.5 plt ct-494* 06:35am blood plt ct-494* 06:35am blood glucose-98 urean-36* creat-1.3* na-142 k-4.2 cl-100 hco3-29 angap-17 03:11pm blood alt-24 ast-21 alkphos-110* totbili-0.3 06:35am blood ck(cpk)-154 03:11pm blood lipase-31 discharge: 11:32am blood vanco-26.0* 05:01am blood wbc-12.0* rbc-2.92* hgb-8.6* hct-26.3* mcv-90 mch-29.3 mchc-32.5 rdw-16.2* plt ct-349 05:01am blood plt ct-349 05:01am blood pt-22.3* ptt-30.3 inr(pt)-2.1* 05:01am blood urean-25* creat-1.0 na-132* k-4.8 cl-103 04:57am blood glucose-141* urean-23* creat-0.8 na-134 k-5.0 cl-104 hco3-25 angap-10 05:56am blood alt-66* ast-48* alkphos-209* totbili-0.7 radiology report video oropharyngeal swallow study date of medical condition: 77 year old woman with s/p avr, mvr, cabg reason for this examination: evaluate dysphagia final report findings: multiple consistencies of barium were administered. barium passed freely through the oropharynx without evidence of obstruction. mild penetration was seen with rapid swallows of thin barium; otherwise, there is no evidence of aspiration. for more information, please see the speech and swallow division note in the online medical record. radiology report chest (pa & lat) study date of 2:46 pm medical condition: 77 year old woman s/p avr/cabg/ex lap reason for this examination: assess for infiltrates there has been little interval change in bilateral pleural effusions, right greater than left, with marked retrocardiac opacity. upper lungs remain relatively well aerated without new focus of consolidation. there is no pneumothorax. the cardiomediastinal silhouette is grossly unchanged. impression: little change in bilateral pleural effusions with retrocardiac opacity. superimposed consolidation at the lung bases cannot be excluded. echocardiography report echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.5 cm <= 5.6 cm left ventricle - systolic dimension: 4.5 cm left ventricle - fractional shortening: *0.18 >= 0.29 left ventricle - ejection fraction: 50% to 55% >= 55% aorta - annulus: 2.3 cm <= 3.0 cm aorta - sinus level: 2.8 cm <= 3.6 cm aorta - sinotubular ridge: 2.1 cm <= 3.0 cm aorta - ascending: 2.6 cm <= 3.4 cm aorta - arch: 2.4 cm <= 3.0 cm aorta - descending thoracic: 2.0 cm <= 2.5 cm aortic valve - peak velocity: *3.6 m/sec <= 2.0 m/sec aortic valve - peak gradient: *52 mm hg < 20 mm hg aortic valve - mean gradient: 32 mm hg aortic valve - lvot diam: 1.9 cm aortic valve - valve area: *0.6 cm2 >= 3.0 cm2 mitral valve - mva (p t): 2.0 cm2 mitral valve - e wave: 0.5 m/sec mitral valve - a wave: 0.5 m/sec mitral valve - e/a ratio: 1.00 findings left atrium: no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. 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: wall thickness and cavity dimensions were obtained from 2d images. mild symmetric lvh. normal lv cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal ascending aorta diameter. focal calcifications in ascending aorta. normal aortic arch diameter. simple atheroma in aortic arch. normal descending aorta diameter. complex (>4mm) atheroma in the descending thoracic aorta. aortic valve: three aortic valve leaflets. severely thickened/deformed aortic valve leaflets. critical as (area <0.8cm2). mild to moderate (+) ar. mitral valve: moderately thickened mitral valve leaflets. severe mitral annular calcification. mild valvular ms (mva 1.5-2.0cm2). moderate to severe (3+) mr. tricuspid valve: moderately thickened tricuspid valve leaflets. moderate tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. physiologic (normal) pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. the patient appears to be in sinus rhythm. patient. conclusions pre bypass no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are complex (>4mm) atheroma in the descending thoracic aorta. there are three aortic valve leaflets. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is severe mitral annular calcification. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are moderately thickened. moderate tricuspid regurgitation is seen. dr. was notified in person of the results in the operating room at the time of the study. post bypass the patient is receiving epinephrine by infusion. biventricular systolic function appears normal. there is a bioprosthesis located in the mitral position. it appears well seated. the leaflets are seen to be moving normally. there is trace, central, valvular mitral regurgitation. the maximum gradient through the mitral valve was 16 mmhg with a mean gradient of 7 mmhg at a cardiac output around 3.5 liters/minute. there is a bioprosthesis located in the aortic position. it also appears well seated and displays normal leaflet movement. there is trace, central valvular aortic regurgitation. the maximum gradient through the aortic valve was 16 mmhg with a mean gradient of 8 mmhg at a cardiac ouput of 3.5 liters/minute. the thoracic aorta appears intact after decannulation. the tricuspid regurgitation may be slightly improved - now closer to mild to moderate. brief hospital course: patient was initially admitted to cardiology service after being seen at osh for chest pain and dyspnea. an echo showed aortic stenosis and she was referred to for cardiac catheterization. her catheterization revealed 3 vessel coronary disease. cardiac surgery was consulted. after the usual preoperative workup the patient was brought to the operating room on . please see operative report for details, in summmary she had: 1. aortic valve replacement with a 21-mm magna ease aortic valve bioprosthesis, model #3300tfx, serial #. 2. mitral valve replacement with a 27-mm st. epic mitral bioprosthesis, reference #, serial #. 3. coronary bypass grafting x1 with reverse saphenous vein graft from aorta to distal right coronary artery. 4. endoscopic left greater saphenous vein harvesting. 5. epiaortic duplex scanning. her bypass time was 160 minutes with a crossclamp time of 136 minutes. she tolerated the operation well and was transferred post-operatively to the cardiac surgery icu in stable condition. the patient woke from anesthesia with tachycardia and hypertension and was resedated. on the morning of pod1 she was extubated. over the next few days she remained hemodynamically stable but had generalized complains aof pain with some localization to the abdomen. on pod2 her lactate rose from 1.2 to 2.1 and general surgery was consulted. she was brought to the operating room by general surgery on for exploratory laparotomy, cholecystectomy. please see operative report for details. she again was brought to the cardiac surgery icu in stable condition. she extubated the day after surgery but remained in the icu for hemodynamic monitoring. during this time she had several episodes of atrial fibrillation and was treated with beta blockers, amiodarone and anticoagulation. she was very deconditioned and her activity was minimal in this initial period, she failed a swallow evaluation and a feeding tube was placed. she slowly gained strength and on pod 9 and 6 she was transferred from the icu to the cardiac stepdown floor. once on the floor she was started on some oral nutrition and appeared to have aspirated, with a leukocytosis and chest xray the revealed a right lower lobe infiltrate. she was started on broad spectrum antibiotics and her leukocytosis gradually resolved. she worked with physical therapy and the nursing staff to regain strength and mobility, again the progress was slow. on pod 18 she was transferred to rehabilitation at life care center of for continued recovery. medications on admission: torsemide 20 mg daily - will increase to 40 mg if weight increased metoprolol 25 mg atorvastatin 10 mg daily aspirin 81 mg daily multivitamin 1 daily lumigan 0.03% 1 drop each hs klor-con 20 meq daily plavix - last dose: none allergies: shellfish - vomiting discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 4. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 5. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 6. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 7. tramadol 50 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) yx inhalation q6h (every 6 hours) as needed for wheezing. 9. acetaminophen 325 mg tablet sig: two (2) tablet po every hours as needed for fever, pain. 10. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 11. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 12. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day): 200mg x7 days then 200mg qd. 13. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea. 14. sodium chloride 0.9 % 0.9 % parenteral solution sig: three (3) ml intravenous qd and prn as needed for line flush. 15. vancomycin 750 mg recon soln sig: seven y (750) mg intravenous q 12h (every 12 hours) for 8 days: please check trough after 3rd dose. 16. heparin, porcine (pf) 10 unit/ml syringe sig: ten (10) ml intravenous prn (as needed) as needed for line flush: heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. . 17. cipro 500 mg tablet sig: one (1) tablet po twice a day for 8 days. 18. warfarin 1 mg tablet sig: as directed to keep inr 2-2.5 tablets po once daily at 4 pm: target inr 2-2.5(afib) dose 1mg. 19. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 20. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days. discharge disposition: extended care facility: discharge diagnosis: 1. aortic stenosis/aortic regurgitation. s/p avr 2. mitral stenosis/mitral regurgitation. s/p mvr 3. coronary artery disease. s/p cabg 4. s/p cholecystectomy pmh: hypertension, hyperlipidemia, as, ms, cvd, pvd, hodgkin's stage iiib s/p chemo and radiation,upper airway obstruction secondary to papillomas, on home o2 2 liters, splenectomy, hysterectomy, laryngeal papillomas, tubular adenoma, diverticulosis stage iii discharge condition: alert and oriented x3 nonfocal ambulating with asssistance incisional pain managed with ultram and tylenol incisions: sternal - healing well, no erythema or drainage leg right - healing well, no erythema or drainage. 1+ edema exploratory laporotomy wound- no eryhtema or drainage 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: , md phone: date/time: 2:45pm cardiologist: dr on at 2:15pm general surgeon: , md (abdominal surgeon)phone: date/time: 2:20 please call to schedule appointments with your primary care dr in weeks ****pulm nodules on chest ct needs f/u study in 6 mo** **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 atrial fibrillation goal inr 2.0-2.5 first draw procedure: venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters enteral infusion of concentrated nutritional substances (aorto)coronary bypass of one coronary artery cholecystectomy open and other replacement of aortic valve with tissue graft open and other replacement of mitral valve with tissue graft diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases personal history of malignant neoplasm of breast other and unspecified angina pectoris pneumonitis due to inhalation of food or vomitus hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites diverticulosis of colon (without mention of hemorrhage) mitral valve stenosis and aortic valve stenosis acute and chronic cholecystitis essential thrombocythemia 

Answer: The patient is high likely exposed to