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: this is a 62 year old white male with an extensive past medical history significant for coronary artery disease requiring coronary artery bypass graft, history of inferior myocardial infarction, status post st. jude valve for mitral valve prolapse in , aicd for ventricular tachycardia, chf with ef of 25%, history of cva, history of ulcerative colitis, diverticulitis, abdominal aortic aneurysm, chronic renal insufficiency, occluded left ra, peripheral vascular disease, history of recent lower gi bleed. lower gi bleed occurred in when during colonoscopy it was found that he had a cecal arteriovenous malformation. he had been recently admitted to for interrogation of his aicd. he most recently had a lower gi bleed treated at . he was readmitted to on for pulmonary edema. he was diuresed and his symptoms resolved. however, during that admission he developed dark diarrhea with a slow drop in his hematocrit. there he had two negative cks and troponins, but he was sent to for further workup of his gi bleed and further treatment. at the patient initially had no complaints. he was given two units of ffp and then was given a bowel prep with golytely. while receiving golytely, he developed chest pain on his way to the bedside commode. chest pain resolved with two sublingual nitroglycerin and iv metoprolol. he also had brown reddish appearance to his bowel movements. he had another episode of chest pain without radiation to his neck. it did not resolve initially with two sublingual nitroglycerin. however, he ruled out for coronary ischemia. he received 81 mg of aspirin and 5 mg of iv metoprolol. he also complained of headache and flushing. past medical history: coronary artery disease status post inferior mi in , status post coronary artery bypass graft times two in . cabg involved lima to lad and saphenous vein graft to posterior descending artery. mitral valve replacement with st. jude valve in . ventricular tachycardia status post dual chamber aicd in for ventricular tachycardia and bradycardia. history of inducible vt with old inferior scars. status post multiple admissions. chf with ef of 25%. epilepsy. stroke involving left middle cerebral artery. diverticulitis. benign prostatic hypertrophy status post turp. history of gastritis h.pylori positive. cholelithiasis. ulcerative colitis diagnosed in . abdominal aortic aneurysm which is 3 to 3.5 mm in diameter. status post appendectomy in . occluded left renal artery most likely with chronic renal insufficiency with creatinine of 2.5 to 3. peripheral vascular disease. lower gi bleed which last occurred in . at that time he was found to have cecal arteriovenous malformation. he had two polyps removed. he also had diverticulitis. allergies: ace inhibitor which causes angioedema. codeine and shellfish which cause hives. contrast dye and iodine to which he also has reactions. medications: hydralazine 75 mg p.o. t.i.d., amiodarone 200 mg p.o. q.d., lipitor 10 mg p.o. q.d., klonopin 0.5 mg p.o. b.i.d., protonix 40 mg p.o. q.d., folate 1 mg p.o. q.d., mysoline 250 mg p.o. q.d., colace 100 mg p.o. b.i.d., carvedilol 0.125 mg p.o. b.i.d., furosemide 80 mg p.o. b.i.d., multivitamin, norvasc 2.5 mg q.d., imdur 30 mg p.o. q.d. which had been discontinued because of headache, aldactone 25 mg p.o. q.d. which was also discontinued. physical examination: heart rate was 78, blood pressure 162/76, sating 97% on 2 liters, respiratory rate 20. in general, he was in moderate distress with chest pain, but alert and oriented. pupils were equal, round and reactive to light. extraocular movements were intact. moist mucous membranes. oropharynx was clear. tongue was midline. heart regular rate and rhythm, s1 mechanical sound above apex, 2/6 systolic murmur without radiation. lungs were limited to the anterior. he was found to have crackles. abdomen was soft, nontender, nondistended with positive bowel sounds. extremities had 2 to 3+ peripheral edema, warm, no cyanosis or clubbing. dorsalis pedis pulse was palpable. laboratory data: white count was 8.8, 82.5 neutrophils, 10 lymphocytes, 5 monocytes, 2 eosinophils, 5 basophils, hematocrit 24.9, platelets 127. sodium was 141, potassium 3.9, chloride 108, bicarb 24, bun 46, creatinine 2.2, glucose 99. ck was 54. inr was 2.7, ptt 26.2. ua was yellow, clear with specific gravity of 1.010, trace protein. ekg showed normal sinus rhythm at 93 beats per minute with normal axis, st depressions and t wave inversions in avl, 1, avf, 2, v4, v6. positive for left ventricular hypertrophy by voltage criteria. when he became chest pain free, he had less prominent t wave inversions. hospital course: the patient was a 62 year old white male with multiple medical problems who had a gi bleed complicated by ischemic changes on his ekg. 1. cardiac. his chest pain, along with the ekg changes, was thought to be secondary to his anemia. he has a history of chest pain with hematocrit decreases below 30. consequently the treatment in this situation was for blood transfusion. however, because of his congestive heart failure and clinical evidence of pulmonary edema, the blood transfusion would have to be closely monitored. he required furosemide between each unit. because of his anemic situation, his antihypertensives were held. his cardiac enzymes were cycled and were negative. troponin was 0.4. cks were 43, 45 and 102. no ckmb fractions were done on those cks. because of the setting of his acute gi bleed, aspirin was held. the goal was to keep his hematocrit above 30. on the second day of admission he had chest pain after having hematochezia. he had st depressions on his ekg. at that time nitroglycerin drip was started. he also received metoprolol iv, morphine and aspirin. he was also diuresed with 40 mg of iv lasix. because of his cardiac issues, he was continued on nitroglycerin drip along with metoprolol 12.5 mg p.o. b.i.d. he was also started on hydralazine 50 mg p.o. t.i.d. for afterload reduction. his inr had initially been elevated at 2.6. consequently because of his gi bleed, it was decided to discontinue coumadin. heparin was then started. however, after he had hematochezia associated with chest pain, heparin was also discontinued. he had been actually hypertensive with blood pressure between 140s and 200s despite probable bleeding from the gi tract. hydralazine was continued and increased eventually to 75 mg p.o. b.i.d. he had colonoscopy done on . thereafter he was started on heparin and aspirin. metoprolol was increased to 25 mg p.o. b.i.d. because he had been placed on carvedilol as an outpatient, he was then switched over to carvedilol 12.5 mg p.o. b.i.d. it was then increased to 25 mg p.o. b.i.d. however, these events occurred after his colonoscopy. he was also started on amlodipine and imdur. imdur was started at 30 mg p.o. q.d. norvasc was started at 10 mg p.o. q.d. he continued to be diuresed because of his congestive heart failure. he required 80 mg iv b.i.d. this was transitioned to 80 mg p.o. b.i.d. which was his dose taken at home. daily weights were measured. his edema improved gradually over time. he was transferred to the floor on . he had some nonsustained v-tach. however, his aicd was interrogated and it was found to be working well. he was continued on heparin for his mitral valve replacement. it was debated whether to start low molecular weight heparin. however, it was decided that he would be started on coumadin. gi fellow was consulted about this. they felt that the risk of bleeding would be low after having intervention so subsequently he was started on coumadin 5 mg p.o. on . he will need to be continued on coumadin with a goal inr of 2 to 3. heparin will be continued until his inr is therapeutic. there was some discussion whether he needed cardiac catheterization. because of his gi bleed issues and his anemia, cardiac catheterization was deferred on this admission. it will need to be reconsidered as an outpatient. 2. gi. the patient had multiple episodes of hematochezia. gi service was consulted and recommended colonoscopy. because of his history of cecal avm, it was felt that his new bleed was also related to cecal avm. he had bowel movements on . at that time a nuclear medicine scan was determined to be most effective in localizing the bleed. it showed active bleeding at the cecum. because of his anemia he was transfused multiple units of blood. gi service recommended discontinuing anticoagulants that were on board. during the procedure he was found to have a single large angiectasia that was not bleeding in the cecum. bicap electrocautery was applied for hemostasis successfully. two nonbleeding polyps with benign appearance and ranging in size from 3 mm to 6 mm were found in the descending colon and rectum. nonbleeding grade 2 internal hemorrhoids were noted. diverticula was seen in the proximal sigmoid colon. however, none of the polyps were removed. anticoagulation was held for 24 hours after the procedure. thereafter heparin was started. the patient had a bowel movement on and . both bowel movements were guaiac negative. it was thought that his gi bleed was under control. consequently anticoagulation would be acceptable. 3. the patient has chronic renal insufficiency. his creatinine actually increased from 2.2 to 2.5 to 2.6. he may have a renal azotemia picture. however, he has been receiving large quantities of furosemide. his creatinine was monitored. magnesium and potassium were repleted as necessary. 4. heme. the patient was anemic and required multiple units of blood. however, once he no longer had hematochezia his hematocrit remained stable. followup: the patient was originally at . because of the proximity to his home, he can possibly be transferred back to the tcu at . physical therapy has seen him and recommended rehab for him. he will need followup with cardiology and his primary care physician. will most likely need followup in two weeks. discharge medications: 1. lasix or furosemide 80 mg p.o. b.i.d. 2. colace 100 mg p.o. b.i.d. 3. coumadin 5 mg p.o. q.d. (subject to change). 4. heparin adjusted to ptt. 5. aspirin 81 mg p.o. q.d. 6. carvedilol 25 mg p.o. b.i.d. 7. clonazepam 0.5 to 1 mg p.o. b.i.d. 8. serax 15 mg p.o. q.h.s. 9. tylenol 325 mg p.o. q.four to six hours. 10. imdur xr 30 mg p.o. q.d. 11. potassium chloride 40 meq p.o. q.d. 12. norvasc 10 mg p.o. q.d. 13. hydralazine 75 mg p.o. t.i.d. 14. levofloxacin 250 mg p.o. q.o.d. to be discontinued on . condition on discharge: guarded, but stable. discharge status: to be discharged to . discharge diagnoses: 1. demand ischemia. 2. arteriovenous malformation in the cecum. 3. chf. , m.d. dictated by: medquist36 procedure: colonoscopy endoscopic destruction of other lesion or tissue of large intestine transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified iron deficiency anemia secondary to blood loss (chronic) aortocoronary bypass status other and unspecified angina pectoris angiodysplasia of intestine with hemorrhage benign neoplasm of colon anal and rectal polyp 

Answer: The patient is high likely exposed to