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: patient recorded as having no known allergies to drugs attending: chief complaint: orthopnea with new onset of atrial fibrillation, abnormal stress test major surgical or invasive procedure: - coronary artery bypass grafting x 4 (left internal thoracic artery to the first diagonal coronary artery, reverse saphenous vein graft to the left anterior descending artery, reversed saphenous vein single graft from the aorta to the posterolateral branch, and reversed saphenous vein single graft from the aorta to the obtuse marginal). resection of left atrial appendage. - cardiac catheterization history of present illness: mr. is a very nice 76 year-old gentleman with prior history of hypertension, s/p mi and coronary angioplasty in . he has been chest pain free but reports orthopnea that started 1-2 months ago. he now uses 2 pillows, has awakened in the middle of the night due to cough, but denies sob. a stress test was done for further evaluation. he had a positive result, was also noted to be in new onset atrial fibrillation, and his internist referred him for cardiac catheterization. dr. was consulted for coronary revascularization. past medical history: mi in coronary angioplasty newly diagnosed paroxysmal atrial fibrillation coronary artery disease diabetes dyslipidemia hypertension social history: he is married with two grown children. he does not smoke. he rarely drinks alcohol. he denies any illegal substance use. he is semi-retired in public relations. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. he is only son. physical exam: admission: general - well-appearing man in nad, oriented x3, comfortable, mood, affect appropriate. heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear, conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck - supple, no thyromegaly, jvd 12 cm, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. no r/g. no thrills, lifts. no s3 or s4. sem in apex, radiating towards the axila that worsens with handgrip. abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding. abd aorta not enlarged by palpation. no abdominial bruits. extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps), no c/c/e. no femoral bruits. skin - no rashes or lesions. no stasis dermatitis, ulcers, scars, or xanthomas. neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, cerebellar exam intact, steady gait. pertinent results: stress test : impression: poor exercise tolerance and marked drop in exercise tolerance from ett in . test terminated secondary to hypotensive blood pressure response to exercise low level exercise. ischemic ecg changes in the absence of typical anginal symptoms with nonspecific st segment changes. nuclear report sent separately. . cardiac perfusion : impression: new small, fixed, moderate apical and distal septal defect correlating with reversible abnormality on the prior study but with normal lv cavity size and preserved ejection fraction of 63%. . cardiac cath : comments: 1. coronary angiography of this right dominant system revealed diffuse three vessel coronary artery disease. the lmca had no lesions. the lad had a 40% stenosis in the proximal segment and 90-100% lesions in the mid segment. the lad recanalized in the distal portion which was diffusely diseased. the diagonal branch had a 90% origin stenosis. the lcx was diffusely diseased with a tubular and beaded 90% lesion leading to a large om2. the rca had a 50% stenosis in the mid segment and a 70% stenosis in the distal vessel. the pda was occluded, but appeared to have faint anterograde flow. the proximal rpl had a 70% stenosis. 2. resting hemodynamics demonstrated moderately elevated right and left sided filling pressures (rvedp 20 mm hg, lvedp 26 mm hg). the pcwp mean was moderately elevated at 31 mm hg. there was moderate pulmonary arterial hypertension (pasp 51 mm hg). the systemic arterial blood pressure was mildly elevated (sbp 140 mm hg). there was no gradient upon pullback of the catheter from the lv to the aorta. the cardiac index was low-normal at 2.4 l/min/m2. the systemic and pulmonary vascular resistances were normal (1433 and 83 dynes-sec/cm5, respectively). there was no evidence of restrictive or constrictive physiology. there was no evidence of intracardiac shunt by oximetry. 3. left ventriculography demonstrated low-normal lv function (ef 50%) and moderate (2+) mitral regurgitation. final diagnosis: 1. three vessel coronary artery disease. 2. moderate mitral regurgitation. 3. moderate biventricular diastolic dysfunction. . cxr pa/lat : impression: pa and lateral chest reviewed in the absence of prior chest radiographs: mild cardiomegaly is exaggerated by a pectus deformity. main and hilar pulmonary arteries are not enlarged and pulmonary vascularity generally is not engorged. there is a small volume of right pleural fluid. lungs are clear. the study and the report were reviewed by the staff radiologist. . carotid series : impression: right ica stenosis <40%. left ica stenosis <40%. . ct chest w/o contrast : impression: no evidence of recent infection, malignancy, or overhydration. numerically increased, but morphologically normal lymph nodes. aortic and coronary calcifications. uncharacteristic scars in the lung parenchyma, no recent infection. even pleural surfaces. moderate dilatation of the upper esophagus. echocardiography report , (complete) done at 10:31:41 am preliminary referring physician information , c. indication: aortic insufficiency, mitral stenosis, mitral regurgitation, shortness of breath. intraoperative management icd-9 codes: 786.05, 440.0, 395.2, 394.2 test information date/time: at 10:31 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2009aw2-: machine: 2 echocardiographic measurements results measurements normal range left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 3.7 cm <= 5.6 cm left ventricle - systolic dimension: 2.0 cm left ventricle - fractional shortening: 0.46 >= 0.29 left ventricle - ejection fraction: 60% to 65% >= 55% aorta - annulus: 2.7 cm <= 3.0 cm aorta - sinus level: *3.7 cm <= 3.6 cm aorta - sinotubular ridge: *3.1 cm <= 3.0 cm aorta - ascending: 3.1 cm <= 3.4 cm aorta - arch: 2.6 cm <= 3.0 cm aorta - descending thoracic: 2.4 cm <= 2.5 cm aortic valve - peak velocity: 1.5 m/sec <= 2.0 m/sec aortic valve - peak gradient: 9 mm hg < 20 mm hg aortic valve - lvot diam: 2.2 cm aortic valve - valve area: *1.7 cm2 >= 3.0 cm2 mitral valve - mean gradient: 4 mm hg mitral valve - mva (p t): 1.7 cm2 mitral valve - mva (2d): 1.3 cm2 findings 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 and cavity size. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: simple atheroma in aortic arch. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. moderately thickened aortic valve leaflets. mild as (area 1.2-1.9cm2). mild (1+) ar. mitral valve: severely thickened/deformed mitral valve leaflets. characteristic rheumatic deformity of the mitral valve leaflets with fused commissures and tethering of leaflet motion. moderate mitral annular calcification. moderate thickening of mitral valve chordae. mild valvular ms (mva 1.5-2.0cm2). mild to moderate (+) mr. tricuspid valve: tricuspid valve not well visualized. physiologic tr. pulmonic valve/pulmonary artery: pulmonic valve not well seen. no 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. no tee related complications. results were conclusions prebypass 1. no atrial septal defect or pfo is seen by 2d or color doppler. 2. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is normal (lvef>55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the aortic arch and descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2) along with mild (1+) aortic regurgitation. 6. the mitral valve leaflets are severely thickened/deformed. the mitral valve shows characteristic rheumatic deformity. there is moderate thickening of the mitral valve chordae. there is mild valvular mitral stenosis (area 1.5-2.0cm2). mild to moderate (+) mitral regurgitation is seen. 7. there is no pericardial effusion. 8. dr. was notified in person of the results during the surgery on at 940. postbypass 1. patient is on a phenylephrine infusion 2. lv ef is similar to prebypass 3. the left atrial appendage is no longer present 4. the mitral regurgitation is now reduced and graded +1. 5. the aortic contours are smooth post aortic decannulation i certify that i was present for this procedure in compliance with hcfa regulations. interpretation assigned to , md, interpreting physician brief hospital course: on mr. was taken to the operating room and underwent coronary artery bypass grafting x 4 (left internal mammary artery grafted to the diagnal/saphenous vein grafted to the distal left anterior descending artery/obtuse marginal/ and plb) with dr.. please refer to dr operative report for further details. cross clamp time=102 minutes, cardiopulmonary bypass time=126 minutes. he was intubated and sedated, requiring phenylephrine for blood pressure augmentation upon arrival to the cvicu. he awoke neurologically intact but was kept sedated and intubated until hemodynamic stability was maintained. pod#2 he was extubated. all lines and drains were discontinued in a timely fashion. anticoagulation with coumadin was started for atrial fibrillation. with improved cognition and progression, pod# 4 mr. was transferred to the stepdown unit for further monitoring. physical therapy was consulted. he continued to be gently diuresed towards his preoperative weight. keflex was started prophylactically for draiange from the distal pole of his sternotomy. on , mr. was ready for discharge to rehabilitation. his coumadin will be managed by dr. for a goal inr of 2.0. he will follow-up with dr. , dr. and dr. as an outpatient. medications on admission: atenolol 50 mg po daily aspirin 325 mg daily discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. warfarin 1 mg tablet sig: dose based on goal inr of 2.0 tablet po once a day: dose for goal inr of 1.5-2.0. discharge dose is 2mg. 5. pimecrolimus 1 % cream sig: one (1) topical daily (). 6. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical daily (daily). 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily) for 1 months. 8. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. acetaminophen 650 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 10. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 11. lasix 40 mg tablet sig: one (1) tablet po once a day for 5 days. disp:*7 tablet(s)* refills:*0* 12. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once (once) for 5 days. 13. amiodarone 200 mg tablet sig: two (2) tablet po once a day for 6 days: then starting switch to 200mg daily until otherwise instructed by cardiologist. . 14. keflex 500 mg capsule sig: one (1) capsule po four times a day for 7 days: start date . discharge disposition: extended care facility: baypointe - discharge diagnosis: -coronary artery bypass grafting x 4 - s/p coronary angioplasty newly diagnosed paroxysmal atrial fibrillation coronary artery disease non insulin dependent diabetes mellitus dyslipidemia hypertension discharge condition: good discharge instructions: 1) please shower daily including washing incisions. no baths or swimming for 6 weeks. 2) monitor wounds for infection - redness, drainage, or increased pain. contact surgeon at ( with any wound issues. 3) report any fever greater than 101. 4) report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week. 5) no creams, lotions, powders, or ointments to incisions. 6) no driving for approximately one month. 7) no lifting more than 10 pounds for 10 weeks from date of surgery. 8) you are taking coumadin for atrial fibrillation. your goal inr is 1.5-2.0. dr. will monitor your coumadin dosing as an outpatient. please be seen within 48 hours following discharge from rehabilitation for pt/inr blood draw and further follow-up for coumadin management. . please contact office prior to discharge from rehab to schedule appointment and follow-up care. the office is aware of him. discharge dose is 2mg daily. please check daily pt/inr. 9) take lasix and potassium for 5 days and then stop. 10) take amiodarone 200mg twice daily for 6 more days. then starting , take 200mg daily until otheriwse instructed. 11) please call with any questions or concerns followup instructions: dr. in 4 weeks () -please call for appointment dr. () in 1 week- please call for appointment dr. ) in weeks -please call for appointment wound check appointment 6 as instructed by nurse () procedure: (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 combined right and left heart angiocardiography excision, destruction, or exclusion of left atrial appendage (laa) diagnoses: coronary atherosclerosis of native coronary artery mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation mycosis fungoides, unspecified site, extranodal and solid organ sites other and unspecified hyperlipidemia old myocardial infarction staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus chronic diastolic heart failure 

Answer: The patient is high likely exposed to