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: melena, chest pain major surgical or invasive procedure: egd bare metal stenting of proximal lad w/ 2.75x15 vision. history of present illness: mr. is a 64 year old male with medical history including hypertension and gerd who was in his usual state of health until 2 days ago. he reports sunday night that he feeled some sensation of increasing restlessness and difficulty sleeping although this is not that atypical for him. monday afternoon he had decreased appetitie but attempted to eat some pineapple and strawberries. he felt nauseous later in the afternoon and vomited this food up, denies identifiying blood in his vomitus at that time. the following morning he again felt increasingly fatigued but went to work per usual. that morning he felt lightheaded and then had a sense of a need to pass stool. he reports a sensation of diarrhea but saw that he had passd what is described as black stool with halo of maroon around it. he had two additional episodes of passing black stool that same day with decreased volume. the patient sought care with his pcp who confirmed guaiac positive stool and sent the patient to hospital for further evaluation. on arrival he reports sensation at the bottom of his sternal of burning/pressure that was similar to episodes of what he thought was reflux, but much more intense. he denies radiation, nausea/diaphoresis or dyspnea with these symptoms. the patient reports that at baseline his functional activity is limited secondary to arthritis and obesity although he recently had an exercise stress test with imaging that was normal per his verbal report. for his symptoms the patient was evaluated at an osh with hct of 29. ng lavage at the outside hospital was negative for bright blood. at he was treated with sl nitro and morphine and subsequently developed hypotension which resolved wiht fluid bolus. an ecg at the outside hospital was concerning for lateral st depressions although enzymes at that time were flat. the patient was transferred to for further care. . ed course: in the ed the patient had vitals of 98.9 132/59 70 16 97% ra. the patient had repeat hct which was 28 compared to 29 at osh. received 2u prbcs in ed. he was given protonix iv. repeat cardiac enzymes now reveal elevated ck and troponin 312/.30. the patient was seen by cardiology with impression that he likely has a fixed circ lesion and his current nstemi is secondary to demand ischemia in setting of gi bleed. the patient reports he does not take asa daily. he has been taking ibuprofen 400mg daily for couple weeks for left shoulder discomfort. he does not actively smoke or drink. . micu course: . pt is a 64 y/o m w/ hx of gerd, htn, peripheral edema, obstructive sleep apnea, copd, w/ 20 pack year history, quit smoking 30 years ago, who was transferred to micu for melena/brbpr which began on . at osh patient had "chest pressure" , epigastric, w/ reported st depressions on lateral leads, but flat troponins. osh hct 29. in micu patient received 3 units of packed rbcs, hct 28=>32=>30 with the 3 units of blood. gi has been consulted. egd is planned for am. . no more episodes of cp while in the unit. pt is not on asa, plavix or heparin. ecg, concerning for v3-v6 st depressions and twi, 1mm v1 st elevation, i/avl st 1mm st depressions and twi. . patient now ruled in for an nstemi. see below. 9pm ck: 312 mb: 57 mbi: 18.3 trop-t: 0.30 8am ck: 581 mb: 108 mbi: 18.6 trop-t: 0.61 430pm ck: 678 mb: 142 mbi: 20.9 trop-t: 0.98 . patients vitals in micu were t 97.9, hr 102 (68-107), bp 140/92(131/71-140/94), rr 12, 99% on 3l. . patient arrived on the floor, and developed sscp, nonradiating, ecg w/ and w/o pain were done, patient was given sl ntg 0.4mg x3 relieved pain down to zero. hr 60 and bp 150/70 w/ cp. cp developed after patient had repeat melanotic stool. past medical history: #. hypertension #. sleep apnea #. reactive airway disease #. gerd #. oa social history: the patient is employed in the security department providing computer passwords bank. he currently lives with his wife and 27 year old son in . tobacco: 50 pk-yr, quit > 30 years ago etoh: beer/month illict: none family history: mother: passed from breast ca father: died age 70 from likely cad physical exam: vitals: 97.8 132/77 70 12 98% 2l general: patient is a pleasant male, obese, in nad heent: ncat, eomi, sclera anicteric, conjunctiva pale. op: mmm, no lesions neck: obese, jvp not easily visualzied chest: fair air movement, no rhonchi, wheezes or rales cor: rrr, normal s1/s2. no m/r/g abd: obese, distended, soft, non-tender. + bs ext: trace pitting edema at ankles bilaterally pertinent results: admission labs: . 09:45pm blood wbc-12.7* rbc-3.43* hgb-9.7* hct-28.0* mcv-82 mch-28.2 mchc-34.5 rdw-15.7* plt ct-207 09:45pm blood neuts-82.3* lymphs-14.7* monos-2.8 eos-0.1 baso-0.1 09:45pm blood pt-13.3 ptt-26.0 inr(pt)-1.1 09:45pm blood glucose-165* urean-54* creat-1.3* na-139 k-4.3 cl-107 hco3-22 angap-14 09:45pm blood ck(cpk)-312* 07:53am blood alt-20 ast-98* ld(ldh)-318* ck(cpk)-581* alkphos-49 amylase-58 totbili-0.6 07:53am blood lipase-44 09:45pm blood calcium-8.4 phos-3.4 mg-1.9 08:20am blood type- temp-36.1 ph-7.42 08:20am blood lactate-1.3 08:20am blood freeca-1.12 cardiac enzymes: . 09:45pm blood ck-mb-57* mb indx-18.3* ctropnt-0.30* 07:53am blood ck-mb-108* mb indx-18.6* ctropnt-0.61* 04:36pm blood ck-mb-142* mb indx-20.9* ctropnt-0.98* 09:49pm blood ck-mb-129* mb indx-17.5* ctropnt-1.75* 05:35am blood ck-mb-92* mb indx-16.0* ctropnt-1.78* 03:20pm blood ck-mb-60* mb indx-11.0* ctropnt-2.62* 05:55pm blood ck-mb-6 ctropnt-2.27* 05:45pm blood ck-mb-4 ctropnt-1.46* 07:40am blood ck-mb-4 ctropnt-1.07* hcts: . 09:45pm hct-28.0* 12:59am hct-27.7* 07:53am hct-32.1* 12:17pm hct-32.1* 04:36pm hct-30.7* 09:49pm hct-31.5* 05:35am hct-32.9* 03:20pm hct-33.2* 09:50pm hct-31.8* 06:50am hct-32.6* 03:05pm hct-33.4* 06:34am hct-32.3* 05:55pm hct-35.6* 05:55pm hct-35.6* 05:45pm hct-35.0* 07:40am hct-33.0* cxr . findings: single frontal chest radiograph examination,showing an area of increased opacity seen projected over the right heart border. the pulmonary vasculature is mildly prominent. the heart size is mildly enlarged. no pleural effusion is seen. . impression: 1. a focal opacity is seen projected over the right heart border most likely in the right lung base secondary to either atelectasis and/or aspiration however pneumonia cannot be completely excluded since we do not have any prior studies.follow up exam in not less than three weeks with a dedicated pa and lateral chest radiographs. 2. the pulmonary vasculature is mildly prominent, indicating volume overload however no edema is noted. echo the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the mid to distal antero-septum, anterior wall and apex. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. cardiac cath comments: 1. selective coronary angiography of this right dominant system revealed single vessel coronary artery disease. the lmca had no angiographically apparent flow-limiting disease. the lad had a 90% proximal lesion and an 80% lesion of d1. the lcx and rca had no angiographically apparent flow-limiting stenoses. 2. limited resting hemodynamics revealed normal systemic arterial pressure of 136/78 mm hg. 3. successful ptca and stenting of the proximal lad with a 2.75 x 15 mm vision bms which was postdilated to 3.25 at high pressure. final angiography revealed no residual stenosis in the , no dissection and timi iii flow ( ptca comments) 4. right femoral arteriotomy site was closed with a 6 french angioseal device. final diagnosis: 1. single vessel coronary artery disease. 2. successful stenting of the proximal lad. egd (64 years) instrument: gif 180 id#: asa class: p2 medications: fentanyl 75 micrograms midazolam 2mg indications: melena gi bleed procedure: the procedure, indications, preparation and potential complications were explained to the patient, who indicated his understanding and signed the corresponding consent forms. the physical exam was performed. the patient was administered conscious sedation. the patient was placed in the left lateral decubitus position and an endoscope was introduced through the mouth and advanced under direct visualization until the second part of the duodenum was reached. careful visualization of the upper gi tract was performed. the procedure was not difficult. the patient tolerated the procedure well. there were no complications. findings: esophagus: other there were 2 sub-mucosal lesions noted in the lower third of the esophagus, each measuring 2cm in length and were bluish- cystic in appeareance( not classic for varices, did not extend from ge junction and did not flatten with inflation). stomach: excavated lesions multiple non-bleeding erosions were noted in the stomach body and antrum.there was no active bleeding noted. duodenum: excavated lesions multiple non-bleeding erosions were seen in the duodenal bulb. impression: there were 2 sub-mucosal lesions, each measuring 2cm in length and were bluish- cystic in appeareance( not classic for varices, did not extend from ge junction and did not flatten with inflation).these are located in the lower third of the esophagus. erosions in the stomach body and antrum erosions in the duodenal bulb otherwise normal egd to second part of the duodenum recommendations: 1. continue ppi po daily 2. if asa needs to be started for cardiac issues by tomorrow, would add 2 weeks of carafate 1gm po qid. 3. avoid nsaid's. ptca comments: initial angiography revealed a 90% proximal lad stenosis and an 80% ostial diagonal. we planned to treat the lad with ptca and stenting. a 6 french xb lad 3.5 guide provided good support for the procedure. angiomax was used as anticoagulation. a prowater wire crossed the lesion with minimal difficulty. the lesion was predilated with a 2.0 x 12 mm voyager balloon at 12 atms. a 2.75 x 15 mm vision bms was deployed in the proximal lad at 16 atms. the was post dilated with a 3.25 x 13 mm highsail balloon at 16 atm three times. final angiography revealed no residual stenosis in the , unchanged diagonal stenosis with improved flow, no dissection and timi iii flow. the right femoral arteriotomy site was closed with a 6 french angioseal device. brief hospital course: mr. is a 64 y/o m w/ a hx of gerd, osa, codp, who was transferred to micu from osh for melena, chest pain and ecg changes. felt that gi bleed was secondary to over use of nsaids (aleve). patient was admitted to the micu with a hct of 28. patient was noted to still be having melena on arrival, but normotensive through out hospital stay. patient was transfused 4 units of packed rbcs during his hospital stay. patients final hct at discharge was 33. patient was started on iv ppi, and high dose statin. he was transferred to general medical floor where he developed sscp, which resolved with sublingual ntg. patient ruled in for an mi during his hospital stay, felt to be a type 2 mi, mi in setting of demand ischemia. patients hct remained stable, he had egd which showed erosions in esophagus, stomach, and duodenum, no active bleeding. patient was started on aspirin and sucralfate 1gm qid. he was then taken for cardiac cath where he was found to have angiography revealing a 90% proximal lad stenosis and an 80% ostial diagonal. patient received dilation of the lad stenosis and placement of vision bms. diagonal lesion was not approached for intervention. . #gi bleed - patient was admitted with melena. on egd patient noted to have multiple erosion. hpylori was negative. felt that erosions were due to overzealous nsaid use. indicated to patient to minimize nsaid intake in the future. patient was given sulcralfate to take qid for 2 weeks to aid in the restoration of his gastric mucosal lining. patient was discharged on pantoprazole 40mg . patient informed that being on aspirin and plavix puts him at risk of repeat gi bleed. patient was warned of signs and symptoms that might indicate a gi bleed. . #anemia gi bleed: hct stable at 33 on day of dicharge. pt received 4 units of prbcs this admission. admission hct was 28. . #type 2 mi: (actually not acs, likely non-thrombotic, event rather, demand ischemia in setting of low hct, and probable cad) - trop 0.30=>0.61=>0.98=>1.75=>1.78, ck 312=>581=>678=>574, mbi 20=>17=>16. patient had lateral st depressions on ecg prior to cath. patient was continued on aspirin, plavix, toprol-xl 100mg daily and 80mg lipitor. . #angina: related to nstemi, timi score 2, patient had episode of sscp when he hit the floor. patient responded to 0.4mg slntg x3. no chest pain after cardiac intervention. patient discharged with sl ntg. . #acute systolic chf: depressed ef 40-45%, hypokinesis of ant wall and septum. new wall motion abnormalities in the setting of recent mi. patient will need follow up tte in months. discharged on toprol-xl 100mg daily, lisinopril 20mg daily, lasix 20mg daily. . #reactive airway disease.: patient was discharged on home advair. . #osteoarthritis: patient was given oxycodone for pain control. . #. communication: wife home: cell: medications on admission: atenolol 50mg daily lasix 20mg daily advair 250/50 albuterol prn flomax 0.4mg . allergies: nkda discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): you must continue to take this medicaton to keep your cardiac open. disp:*30 tablet(s)* refills:*2* 3. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. aspirin 81 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). disp:*60 tablet, chewable(s)* refills:*2* 7. nitroglycerin 0.4 mg tablet, sublingual sig: as directed for cp tablet, sublingual sublingual as directed below for 6 doses: please take one pill every 5 min for chest pain for a maximum of 3 pills. call 911 if you have chest pain. refill after 6 months. disp:*6 tablet, sublingual(s)* refills:*1* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 10. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 11. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day) for 14 days: please take for 2 weeks starting . disp:*56 tablet(s)* refills:*0* 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed: due not take more than 4gm per day. . disp:*50 tablet(s)* refills:*0* 13. oxycodone 5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for 20 doses. disp:*20 tablet(s)* refills:*0* 14. lasix 20 mg tablet sig: one (1) tablet po once a day: take daily. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: 1. upper gi bleed (gastro and duodenal lesions) 2. anemia 3. nstemi (in setting of demand ischemia) 4. coronary artery disease (lad 90% proximal, 80% origin of first diag. bare metal stenting of proximal lad w/ 2.75x15 vision, first diagnonal not approached done . secondary 1. hypertension 2. sleep apnea 3. reactive airway disease 4. gerd 5. osteoarthritis 6. hx of septic arthritis l knee. discharge condition: stable, hct 33, chest pain free. discharge instructions: mr. you were transferred to out of concern for your dropping red blood cell counts, gastrointestinal bleeding as well as for your chest pain and ecg changes. . you were monitored initially in the medical icu. during your hospital stay you received a blood transfusion of 4 units prbcs. your blood counts were stable at discharge. you were seen by the gastroenterologists, who completed an upper endoscopy on you. the endoscopy showed erosions, in your esophagus, stomach and duodenum. the gi doctors think that your lesions are from taking to much aleve. please do not take any more aleve or ibuprofen for pain control. we suggest you take tylenol for pain control, no more than 4gm per day. we have also written you for some oxycodone for pain control. you can not drive or operate heavy machinery if you take oxycodone. please take every 8 hours as needed. you were started on a protonix and 1gm of sucralfate 4 times a day for 2 weeks to help protect your stomach. . during your hospitalization you were noted to have an non-st elevation myocardial infarction. you had elevated cardiac markers or troponins that supported this diagnosis. you had a cardiac cath that showed to lesions in one of your cororonary arteries the lad had a 90% proximal stenosis and the first diagnonal had an 80% stenosis at the origin. . you had a bare metal vision placed in the lad. the cardiologists did not approach the other narrowing at this time. you need to follow up with cardiology as below. you will need to continue to take aspirin 162mg daily. you will also have to take your plavix 75mg daily for at least the next 3 months probably longer. it is essential that you continue to take this medication. if you stop taking this medication you could form a clot in your and have another heart attack. . you had an abnormal echocardiogram where your lv ejection fraction was reported to be 40-45%, this is abnormal but may recover in the future. you will need to follow up with your cardiologist for a repeat echocardiogram in the future. . you were started on some other medication during your hospitalization. you have several new medications that you should continue to take lisinopril 20mg daily, toprol-xl 100mg daily, and atorvastatin 80mg daily, plavix 75mg daily, aspirin 162mg daily, colace 100mg twice a day(for constipation), senna 1 tab twice daily (for constipation), 20mg po lasix daily. . you are on blood thinners aspirin and plavix, in the setting of a recent gi bleed, you are at high risk of bleeding again. it is important that you watch for signs of bleeding, meaning looking for black-tarry stools, bloody stools or any vomiting of blood. . you have been given nitroglycerin tablets. if you develop chest pain place one of the pills under your tongue. continue to do this for please call 911 or go to the emergency room if you develop any of the above symptoms, chest pain, shortness of breath or any other worsening of your overall condition. followup instructions: please follow up with your primary care physician . in the next two weeks. . please follow up with dr. from the department of cardiology at ph# you are scheduled for an appointment on at 11 am on the of the building. procedure: insertion of non-drug-eluting coronary artery stent(s) other endoscopy of small intestine injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures transfusion of packed cells cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension acute posthemorrhagic anemia chronic obstructive asthma, unspecified chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction other specified gastritis, with hemorrhage antirheumatics [antiphlogistics] causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to