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: bactrim ds attending: chief complaint: shortness of breath major surgical or invasive procedure: avr ( 23 mm ce magna pericardial)/resect. laa history of present illness: mrs. is an 85 year old female with a pmh significant for severe as, recently diagnosed af, htn, hld, and possible copd who presents with progressive shortness of breath. the patient presented to her pcp, on complaining of days of palpitations and was found to be in af with rvr. at that time, her atenolol was increased and she was started on coumadin. she then presented to her pcp today complaining of progressively increasing shortness of breath and was sent to the ed for further evaluation. of note, the patient has had chronic shortness of breath that is likely multifactorial in the setting of deconditioning, possible mild copd, and severe as. she states that at baseline, she can walk only from her bed to her bathroom (15 feet) before developing dyspnea, and that this is worse in the past few days. she also reports having gained approximately 2 lbs/month for the past year. . on initial presentation to the bimdc ed, vs 98.3 124 127/88 20 94%ra. the patient had an ecg that demonstrated af with rvr, a cta that was negative for pe or dissection, and a cxr that did not demonstrate an acute cardiopulmonary process. she received 10 mg iv diltiazem and 30 mg po diltiazem, and was admitted to for further management. . currently, the patient is resting comfortably without complaints. denies any cp/sob, f/c/s, n/v/d, abd pain, ha, palpitations, orthopnea, pnd, diaphoresis, or pain radiating to her jaw or shoulder or back. . ros: patient reports 3 months of expiratory wheezing. as above, otherwise negative. cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: past medical history: - breast cancer s/p left mastectomy . treated with tamoxifen for five years. negative nodes.no evidence of recurrence or metastases. - htn - hld - possible mild copd - osteoporosis - glaucoma . past surgical history: -tah/bso (irregular bleeding) right hip fracture, pinned. -diverticulitis-resected with temporary colostomy, reanastomosis -left mastectomy. -abdominal hernia repair. right hip replacement. -pelvic fracture. -right arm fracture, open reduction, internal fixation. -periprosthetic right hip fracture . cardiac risk factors: hypertension and hyperlipidemia . cardiac history: 1. aortic stenosis - last <0.8 cm2 (; mild ar), prior in 0.8-1 cm2. 2. atrial fibrillation - newly diagnosed on . social history: widowed, moved from to , the gables, in . supportive children. daughter is her healthcare proxy. she prefers not to have any invasive treatment. tobacco: ex-smoker, 22 years- 1/2 packs per day. etoh: one drink of scotch nightly. exercise: senior exercise class. family history: + cva (mgm age 78) physical exam: vs: 97.9 134/89 105 22 92%ra gen: age appropriate female in nad heent: perrl, eomi, sclerae anicteric. mmm, op clear without lesions, exudate, or erythema. neck supple without lad. cv: irregular s1+s2, iii/vi late peaking crescendo-descrescendo systolic murmur throughout the precordium radiating to the carotids. no pre-cordial heave. pmi not palpable. unable to assess jvp. pulm: bibasilar crackles (l>r) abd: s/nd/nd +bs gu: guaiac ob brown negative ext: no c/c/e. 1+ dp/pt bilaterally neuro: aox3, cn ii-xii intact. pertinent results: 11:50am pt-16.7* inr(pt)-1.5* 03:20pm pt-17.8* ptt-27.6 inr(pt)-1.6* 03:20pm plt count-218 03:20pm wbc-7.9 rbc-4.64 hgb-12.5 hct-38.9 mcv-84 mch-27.0 mchc-32.2 rdw-15.6* 03:20pm ctropnt-<0.01 03:20pm ck(cpk)-73 03:20pm glucose-152* urea n-15 creat-0.7 sodium-136 potassium-4.6 chloride-95* total co2-29 anion gap-1 06:15am blood wbc-11.3* rbc-3.48* hgb-9.5* hct-29.5* mcv-85 mch-27.2 mchc-32.1 rdw-15.6* plt ct-317 06:15am blood plt ct-317 06:15am blood pt-14.0* inr(pt)-1.2* 06:15am blood glucose-83 urean-12 creat-0.5 na-131* k-4.2 cl-91* hco3-31 angap-13 04:50am blood alt-14 ast-21 alkphos-92 totbili-0.7 04:50am blood %hba1c-5.7 eag-117 12:50pm blood tsh-4.5* radiology report chest (portable ap) study date of 1:40 pm final report indication: 85-year-old woman status post av replacement. evaluate for pneumothorax status post line change over a wire. comparison: multiple priors, most recent portable ap chest radiograph at 11:19 a.m. findings: right internal jugular line tip projects over the cavoatrial junction. there is no pneumothorax. no focal parenchymal opacity suggesting pneumonia. there is no overt pulmonary edema. minimal atelectasis is once again noted in the retrocardiac region, unchanged from radiograph obtained earlier on the same day. borderline cardiomegaly is once again noted, unchanged from the radiograph obtained earlier today. impression: right ij tip is at the cavoatrial junction with no evidence of pneumothorax. otherwise, no interval change since chest radiograph obtained earlier today. the study and the report were reviewed by the staff radiologist. dr. dr. echocardiography report echocardiographic measurements results measurements normal range left atrium - long axis dimension: *5.7 cm <= 4.0 cm left atrium - four chamber length: 4.7 cm <= 5.2 cm 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: 3.7 cm <= 5.6 cm left ventricle - ejection fraction: 50% to 55% >= 55% aorta - sinus level: 2.1 cm <= 3.6 cm aorta - ascending: 3.2 cm <= 3.4 cm aortic valve - peak velocity: *4.6 m/sec <= 2.0 m/sec aortic valve - peak gradient: *85 mm hg < 20 mm hg aortic valve - mean gradient: 60 mm hg aortic valve - lvot diam: 1.8 cm aortic valve - valve area: *0.5 cm2 >= 3.0 cm2 findings left atrium: moderate la enlargement. depressed laa emptying velocity (<0.2m/s) probable thrombus in the laa. right atrium/interatrial septum: normal ra size. normal interatrial septum. pfo is present. left ventricle: mild symmetric lvh. normal lv cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: severely thickened/deformed aortic valve leaflets. critical as (area <0.8cm2). mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. no ms. mild to moderate (+) mr. tricuspid valve: normal tricuspid valve leaflets. mild tr. pulmonic valve/pulmonary artery: pulmonic valve not visualized. no ps. physiologic pr. pericardium: no pericardial effusion. 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 rhythm appears to be atrial fibrillation. see conclusions for post-bypass data conclusions pre-bypass: the left atrium is moderately dilated. the left atrial appendage emptying velocity is depressed (<0.2m/s). a probable thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. there are complex atheromas in the descending thoracic aorta. the aortic valve leaflets are severely thickened/deformed. there is critical aortic valve stenosis (valve area <0.8cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. there is no pericardial effusion. post-bypass: the patient is not receiving inotropic support post-cpb. there is a bioprothestic valve well-seated in the aortic position with good leaflet excursion. there is no paravalvular or transvalvular regurgitation. there is a mean pressure gradient of 5 mm hg across the valve. the left atrial appendage has been resected. biventricular systolic function is preserved. all other findings are consistent with the pre-bypass findings except an easy detection of left to right pfo by color doppler at rest. this was not seen in the preoperative period. there is evidence of laa ligation. all findings were communicated to the surgeon. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 14:14 radiology report carotid series complete study date of 9:03 am final report history: an 85-year-old lady with critical as, awaiting avr. technique: evaluation of the bilateral extracranial carotid arteries was performed with b-mode, color and spectral doppler ultrasound. mild-to-moderate amount of plaque was seen in the left internal carotid artery and a mild amount of plaque was seen in the right internal carotid artery, with b-mode ultrasound. on the right side, peak systolic velocities were 55 cm/sec for the internal carotid artery and 60 cm/sec for the common carotid artery. the right ica/cca ratio was 1.0. on the left side, peak systolic velocities were 112 cm/sec for the ica and 49 cm/sec for the cca. the left ica/cca ratio was 2.3. the right vertebral artery presented antegrade flow and the left vertebral artery could not be visualized. comparison: none available. impression: 1. less than 40% stenosis of the right internal carotid artery. 2. 40-59% stenosis of the left internal carotid artery. dr. cardiology report cardiac cath study date of brief history: mrs. is an 85 y/o woman with symptomatic critical aortic stenosis (mean gradient 55 mmhg, 0.5 cm2) who declined ohs and requested percutaneous valvuloplasty. hemodynamics results body surface area: 1.77 m2 hemoglobin: 11.9 gms % **pressures right atrium {a/v/m} -/23/20 right ventricle {s/ed} 70/15/24 aorta {s/d/m} 161/94/125 **cardiac output heart rate {beats/min} 105 rhythm atrial fibrillation **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca normal 2) mid rca normal 2a) acute marginal normal 3) distal rca normal 4) r-pda normal 4a) r-post-lat normal 4b) r-lv normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad normal 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 normal 10) diagonal-2 normal 12) proximal cx normal 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 normal comments: 1- arterial and venous access under us guided and placement of 8f sheaths in the r cfa and r cfv. 2- selective coronary angiography showed no angiographically-apparent coronary artery disease. the lmca, lad, lcx and rca were all patent. 3- limited resting hemodynamic assessment showed elevated right-sided filling pressure with (mean ra 20 mmhg, rvedp 24 mmhg). despite numerous atempts, including using a j wire, we were unable to advance the pa catheter to the pulmonary arteries. the systemic arterial bp was markedly elevated was 161/94 mmhg requiring iv ntg gtt. the rv systolic pressure was markedly elevated (70/15/24 mmhg). 4- heparin (4000 units) was administered. 5- despite prolonged attempts, using different catheters (including 5f pigtail, al1, jr2, al2, ar2, and mp) we were unable to cross the aortic valve. the tight as as well as extremely severe valve calcifications, as well as the dilated aortic root are potential reasons for this. notably, the femoral, iliac and distal aorta had moderate tortuousity making it a little difficult to torque the catheters. the al1 catheter was the one that appeared to provide best (although suboptimal) orientation. 6- given the radiation dose, we opted to abort further retrograde aortic valvuloplasty. 7- we will consider trans-septal antegrade approach or surgical avr. 8- medical therapy including continuing anticoagulation and cardioversion for af. 9- if no trans-septal antegrade valvuloplasty or avr is to be done next week, consider restarting warfarin. otherwise, continue heparin gtt. final diagnosis: 1. no significant coronary artery disease 2. severly elevated right-sided filling pressures (mean rap 20 mmhg) 3. unable to advance the pa catheter to the pulmonary arteries but rv pressure was elevated at 70/24 mmhg. 4. moderate systemic arterial hypertension. 5. dilated aortic root 6. atrial fibrillation with rapid ventricular response 7. moderately tortuous l cfa, l iliac and distal aorta 8. markedly calcific aortic valve and significant mitral annular calcifications 9- patient not a candidate for percutaneous retrograde aortic valvuloplasty. 10. consider percutaneous antegrade aortic valvuloplasty via trans-septal approach or surgical avr next week attending physician: , . referring physician: , . cardiology fellow: , attending staff: , j. brief hospital course: mrs. is an 85 year old female with a pmh significant for critical aortic stenosis, recently diagnosed atrial fibrillation, hypertension, hyperlipidemia, who initially presented with progressive shortness of breath consistent with acute on chronic congestive heart failure. etiology behind exacerbation was secondary to new atrial fibrillation significantly decreasing cardiac output causing florid heart failure. patient was gently diuresed with lasix. her blood pressures could not tolerate significant fluid removal and thus significant diuresis was terminated. volume status goal was net -500 cc to 0 cc per day prior to surgery. she remained comfortable on 2 liters oxygen. patient initially opted against surgery due and valvuloplasty was attempted. this was not successful as the catheter could not be passed safely through the aortic valve. this was felt to be due to the tight valve, the extremely severe valve calcifications, as well as the dilated aortic root. it was decided the definitive treatment for this patient was an aortic valve replacement. patient was taken to surgery . please see operative report for details in summary the patient had aortic valve replacement with a 23-mm magna lifesciences pericardial tissue valve, model number 3000tfx, serial number . resection of left atrial appendage. her cardiopulmonary bypass time was 103 minutes with a crossclamp time of 80 minutes. she tolerated the operation well and was transferred from the operating room to the cardiac surgery icu in stable condition. she remained hemodynamically stable in the immediate post-op period and was weaned from sedation and extubated on the morning after surgery. she continued to be hemodynamically stable but remained in the icu for pulmonary hygiene. all tubes lines and drains were removed according to cardiac surgery protocols. she was transferred from the cardiac surgery icu to the stepdown floor on pod3. the remainder of her hospital course was uneventful. she was transferred to rehab at rehab in on pod6. followup with dr in 4 weeks medications on admission: albuterol mdi prn atenolol 50 mg po bid citalopram 20 mg daily fluticasone 50 mcg each nostril daily furosemide 10 mg/ml solution, 1 ml daily lisinopril 10 mg daily lorazepam 0.5 mg prn kcl 25 meq daily ranitidine 150 mg po daily risedronate 35 mg po qweek simvastatin 20 mg daily travatan 0.004% drops coumadin 2 mg daily asa 81 mg daily - on hold since calcium 1500 mg daily vitamin d 800 units daily simethicone 80 mg qid prn discharge medications: 1. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qac (). 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. furosemide 20 mg tablet sig: one (1) tablet po q12h (every 12 hours): 20mg x10 days then 20mg qd. 10. potassium chloride 10 meq tablet sustained release sig: one (1) tablet sustained release po once a day. 11. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 12. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 13. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous qac&hs. 14. amiodarone 200 mg tablet sig: two (2) tablet po bid (2 times a day): 400mg x 4days then 400mg qd x7 days then 200mg qd. 15. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 16. atenolol 50 mg tablet sig: one (1) tablet po bid (2 times a day). 17. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) tx inhalation q6h (every 6 hours) as needed for wheezing. 18. warfarin 1 mg tablet sig: as directed to keep inr 2-2.5 tablets po daily (daily) as needed for afib: target inr 2-2.5 home dose 2mg qd. discharge disposition: extended care facility: aberjona nursing center - discharge diagnosis: as s/p avr/resect. laa atrial fibrillation chronic diastolic heart failure chronic obstructive pulmonary disease hypertension hypercholesterolemia glaucoma gerd/hiatal hernia esophageal stricture osteoporosis osteoarthritis depression lumbar spinal stenosis discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair sternal wound healing well, no drainage or erythema 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 until follow up with surgeon 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 ****wheelchair only for 10 weeks- may not use her routine walker followup instructions: surgeon dr. on @1:15 please call to schedule appointments primary care dr. in weeks cardiologist dr. in weeks wound check appointment - 6 () - your nurse will schedule dental: f/u with your dentist to check vitality of tooth #30 with peri-apical xray after discharge. procedure: extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters excision or destruction of other lesion or tissue of heart, open approach open and other replacement of aortic valve with tissue graft diagnoses: anemia, unspecified esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders personal history of malignant neoplasm of breast personal history of tobacco use unspecified glaucoma diaphragmatic hernia without mention of obstruction or gangrene occlusion and stenosis of carotid artery without mention of cerebral infarction osteoporosis, unspecified long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation urinary complications, not elsewhere classified stricture and stenosis of esophagus oliguria and anuria hip joint replacement acquired absence of both cervix and uterus spinal stenosis, lumbar region, without neurogenic claudication acquired absence of breast and nipple other ill-defined heart diseases acquired absence of intestine (large) (small) 

Answer: The patient is high likely exposed to