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: history of present illness: mr. is a 75 year old male with a history of coronary artery disease, ischemic cardiomyopathy, and atrial fibrillation, who presented to hospital on , complaining of five days of melena and diffuse abdominal discomfort. his initial hematocrit was 33 and on upper endoscopy he was found to have barrett's grade i erosion. there were plans to do colonoscopy for further evaluation of sources for gastrointestinal bleeding and the patient was given a golytely bowel prep at hospital. however, the patient developed emesis and ten out of ten abdominal pain during this time, with an episode bradycardia to 30 to 50s range and decrease in blood pressure to systolic blood pressure in the 90s in the setting of having had a bowel movement and getting up from the commode. an arterial blood gas was done after this event and the patient was found to have a serum ph of 7.24, pco2 of 27 and pao2 of 100 on two liters nasal cannula. there was initial concern for a possible colonic acute mesenteric ischemia given the abdominal pain and hypotension and history of melena, but abdominal ct scan done at the outside hospital did not show any evidence of such. a temporary pacer was placed secondary to the bradycardic event. the patient was started on intravenous heparin given concern for acute mesenteric ischemia with a history of atrial fibrillation. the patient was transferred from the outside hospital for further gi work-up and evaluation. past medical history: 1. duodenal ulcer treated with pepcid; history of h. pylori, treated. 2. history of colonic polyps/avms. 3. history of atrial fibrillation on coumadin. 4. history of coronary artery disease with a history of myocardial infarction in ; status post coronary artery bypass graft, left ventricular ejection fraction of 45%; moderate mitral regurgitation and severe pulmonary hypertension. 5. spinal degenerative joint disease with right shoulder contraction. 6. type 2 diabetes mellitus, diet controlled. 7. peripheral vascular disease. 8. question of chronic obstructive pulmonary disease. allergies: no known drug allergies. medications on transfer: 1. protonix 40 mg p.o. q. day. 2. heparin 1000 units per hour. 3. zocor 40 mg p.o. q. day. 4. levofloxacin 500 mg p.o. q. day. 5. flagyl 500 mg intravenous q. six. 6. regular insulin sliding scale. 7. isordil 40 mg p.o. three times a day. 8. avapro 300 mg p.o. q. day. 9. neurontin 100 mg p.o. three times a day. outpatient medications: 1. zocor 40 mg p.o. q. day. 2. isordil. 3. neurontin 100 mg p.o. three times a day. 4. lasix 60 mg p.o. q. a.m. 5. avapro. 6. . 7. atenolol 50 mg p.o. twice a day. social history: former smoker, quit since . former alcohol, quit . lives in facility. daughter is in open care. physical examination: in general, a pleasant male in no acute distress. vital signs with temperature 99.3 f.; heart rate 75; blood pressure 128/88; respiratory rate 23; saturation o2 98%. heent: normocephalic, atraumatic. dry mucous membranes. pupils are equal, round and reactive to light. extraocular movements intact. neck: left cordis in place. cardiac examination: regular rate and rhythm, no murmurs, rubs or gallops. lung examination: clear to auscultation bilaterally. abdomen soft, with suprapubic and bilateral lower quadrant tenderness but no rebound. extremities with no cyanosis, clubbing or edema. chronic venous stasis changes. neurological: alert and oriented times three. cranial nerves intact, grossly non-focal. laboratory: from in the morning, white blood cell count 6.0, hematocrit 28.0, platelets 98 down from 134, mcv 98 to 103. chemistry panel with sodium 143, potasium 4.1, chloride 109, bicarbonate 22, bun 31, creatinine 1.8, glucose 104. pt 22.8, ptt 42.3, fibrin 233, negative d-dimer and negative fibrin degradation products. ck 142, mb fraction 2.2, troponin 0.5. chest x-ray showed cardiomegaly, no infiltrates, no effusion. ct scan of the abdomen showed gallstones but no evidence of cholecystitis. right intestinal opacity/adhesions. open celiac supra-mesenteric and common iliac arteries. summary of hospital course: the patient was initially admitted to the medical intensive care unit for close monitoring given history of bradycardia, placement of temporary pacemaker and history of recent gastrointestinal bleeding. hospital course was notable for the following: 1. gastrointestinal bleeding: the patient had a known history of arteriovenous malformations and polyps with gastrointestinal bleeding in . egd done at the outside hospital showed grade i esophagitis and ct scan of the abdomen had already patent mesenteric vessels; no valve thickening or obstruction. the patient had had hematocrits checked after blood transfusion at the outside hospital (at least one unit of packed red blood cells and two units of fresh frozen plasma). the gi consultation service was consulted for help in managing the patient's history of gastrointestinal bleeding. the patient was placed on intravenous protonix, fluids and initially n.p.o. with serial abdominal examinations. after review of the data, history and ct scan, it was felt that acute mesenteric ischemia was unlikely to have been responsible and heparin was discontinued. on , the patient underwent a colonoscopy and esophagogastroduodenoscopy. the egd showed medium hiatal hernia; otherwise a normal egd to second part of duodenum. erosions were seen inside the hernia. these erosions were thought to have been the cause for patient's melena and the gi consult service advised keeping patient on protonix 40 mg p.o. twice a day times one week, then 40 mg p.o. q. day for 60 days. the patient's colonoscopy on , showed polyps in the transverse colon, otherwise normal colonoscopy to the cecum. polypectomy was recommended at a future date and follow-up when gastrointestinal bleeding and cardiac issues resolved. the patient was subsequently monitored with serial checks with hematocrit which were stable with an initial trend downward. he did have hematocrit of around 27 to 28 when transferred from the medical intensive care unit to the regular medical and given his history of coronary artery disease, it was felt that he would benefit from blood transfusion. he received one unit of packed red blood cells and his subsequent hematocrits rose from 29 to 31 range and have remained stable there since. 2. cardiovascular: the patient has a known history of coronary artery disease and atrial fibrillation. his serial cardiac enzymes were sent to rule out myocardial infarction given recent episode of hypotension and bradycardia. these returned negative. he did have a temporary pacer placed at the outside hospital for symptomatic bradycardia and cardiology consulted on this matter as well. after review of the patient's history and hematocrit, it was felt that his bradycardia was likely due to a combination of vasovagal episode in the setting of bowel movement during bowel preparation for colonoscopy and beta blockade with atenolol with the possibility of enhanced effects in the setting of acute renal insufficiency. his beta blockers were initially held and the patient had no further episodes of bradycardia. his blood pressure remained stable and his temporary pacemaker was discontinued. because he did have a history of atrial fibrillation and did need rate control, low dose beta blockers were restarted with metoprolol and have been titrated up with good rate control and no further episodes of bradycardia or hypotension. his history of atrial fibrillation had prompted use of anti-coagulants in the past, but given the acute episodes of gastrointestinal bleeding his coumadin was initially held, but when his hematocrit stabilized, his coumadin was restarted and should be continued with goal inr of 2.0 to 3.0. also, his anti-hypertensive medications were held in the setting of hypotensive event, however, when his blood pressure stabilized and his renal function improved, his angiotensin receptor blocker and lasix were restarted. 3. hypoxia: the patient developed an o2 requirement during the course of his hospital stay. this was in the setting of transfusion and intravenous fluid and holding of his lasix. his physical examination and chest x-ray findings were consistent with congestive heart failure and the patient has been restarted on his lasix and his angiotensin receptor blocker for treatment of this with subsequent improvement in his hypoxia. it is anticipated that with further therapy, his o2 requirements will resolve. he will need continued monitoring of his daily weights and intakes and outputs until his hypoxia resolved and his cardiovascular status becomes stable. 4. diabetes mellitus: the patient has a known history of type 2 diabetes mellitus that was formerly controlled on diet. he was started on regular insulin sliding scale and was on fingersticks while in the hospital and may benefit from started an oral if he continues to have periodic elevated blood sugars. 5. deconditioning: after a prolonged hospital stay, the patient was deconditioned and after physical therapy evaluation was felt to be someone who could benefit from physical therapy in a rehabilitation setting. disposition: the patient was subsequently stable fro discharge and is awaiting transfer to rehabilitation facility. discharge diagnoses: 1. gastrointestinal bleeding, likely secondary to esophageal erosions, barrett's type i esophagus. 2. bradycardic event; question vasovagal; question secondary to enhanced effects of beta blocker in the setting of acute renal insufficiency. 3. acute renal insufficiency; prerenal etiology with creatinine of 1.8 on presentation to and improvement to baseline creatinine of 0.9 after intravenous fluid hydration. 4. anemia secondary to gastrointestinal bleed. 5. history of coronary artery disease. 6. history of type 2 diabetes mellitus. 7. history of atrial fibrillation. 8. colon polyps; needs gi follow-up for polypectomy once gastrointestinal bleeding issues and cardiovascular status stabilize. 9. peripheral vascular disease. 10. history of spinal degenerative joint disease. 11. questionable history of chronic obstructive pulmonary disease. discharge medications: 1. protonix 40 mg p.o. twice a day times two weeks, then change to 40 mg p.o. q. day times 60 days. 2. metoprolol 25 mg p.o. twice a day; continue to monitor heart rate and blood pressure and adjust for rate control. 3. ibesartan 300 mg p.o. q. day. 4. atorvastatin 40 mg p.o. q. day. 5. warfarin 4 mg p.o. q. day; adjust to goal inr of 2.0 to 3.0. 6. lasix 60 mg p.o. q. a.m. 7. potassium chloride 10 meq p.o. q. day. 8. neurontin 100 mg p.o. three times a day. 9. isordil 10 mg p.o. three times a day. discharge instructions: 1. the patient will be discharged to rehabilitation. 2. he will need follow-up with his primary care physician on an ongoing basis. 3. he will inr checked two days following discharge and adjust coumadin to goal inr of 2.0 to 3.0. 4. the patient will also need to follow-up monitoring of his hematocrit to insure stability, given history of gastrointestinal bleeding. 5. the patient will also need follow-up colonoscopy for polypectomy given findings of transverse colon polyps during hospital stay. 6. discharge diet, cardiac, two gram salt. condition on discharge: stable. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine colonoscopy diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation aortocoronary bypass status other specified forms of chronic ischemic heart disease esophageal hemorrhage 

Answer: The patient is high likely exposed to