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: the patient is a 74 year-old man with a history of ischemic cardiomyopathy with an ejection fraction of 10 to 15% who has a chronic gastrointestinal bleed and chronic renal failure with a baseline creatinine of 2. he is sent to the emergency department by his primary care physician on the day of admission for a hematocrit of 22.5 and for increased fatigue. in the emergency department his initial vital signs were a heart rate of 78 with a blood pressure of 88/49, sating 99% on room air. his initial hematocrit was 22.5. the patient was transfused with 2 units of packed red blood cells and volume resuscitated with 1.5 liters of normal saline. his blood pressure then improved to 100 systolic. the patient's blood pressure range in the emergency department over the first four hours were between 78 and 83 systolic. the patient continued to mentate. his urine output was approximately 300 cc. the patient complained of intermittent nausea. his oxygen saturations was 97% on 4 liters by nasal cannula. in the emergency room he had a chest x-ray that showed stable mild congestive heart failure. the patient denied an lightheadedness, dizziness, chest pain, shortness of breath, palpitations. he did have some abdominal discomfort across the upper abdomen. he reported chronic black stools, but denied bright red blood per rectum. he denies any recent syncope. he reported normally his blood pressure is in the low 100s. the patient refused nasogastric lavage in the emergency department. past medical history: 1. coronary artery disease status post myocardial infarction. 2. congestive heart failure with cardiomyopathy with an ejection fraction of 10 to 15%. 3. gastrointestinal bleed secondary to small bowel avms. 4. atrial fibrillation status post pacer. 5. hypercholesterolemia. 6. hypertension. 7. benign prostatic hypertrophy. 8. depression. 9. eczema. 10. anemia with a baseline hematocrit of 27 to 32. 11. chronic renal failure with a baseline creatinine of 2.0. 12. mrsa colonization. 13. status post stroke. 14. gastroesophageal reflux disease. 15. status post appendectomy. medications on admission: 1. amiodarone 200 mg po q.d. 2. digoxin 0.125 mg po q.d. 3. epogen 10,000 units subq q tuesday. 4. lasix 80 mg q.a.m. and 40 mg po q.p.m. 5. lisinopril 40 mg po q.d. 6. toprol xl 25 mg po q.d. 7. niferex 150 mg po b.i.d. 8. rabeprazole 20 mg po q.d. 9. simvastatin 40 mg po q.d. 10. aldactone 25 mg po q.d. 11. zoloft 150 mg po q.d. allergies: neosporin causes a rash. social history: the patient lives with his wife and his adopted son who is 7. he has a fifty pack year history of smoking, but quit many years ago. he drinks one to two glasses of alcohol per day. physical examination on admission: temperature 97.9. heart rate 108. blood pressure 99/42 lying down and 90/60 sitting up. respiratory rate 18. sating 98% on 4 liters. the patient is an elderly man who is pleasant and in no acute distress. pupils are equal, round and reactive to light bilaterally. there is no sclera icterus. the mucous membranes are dry. there is 10 cm of jvp on the neck. there are no carotid bruits. the heart is regular with soft heart sounds. s1 and s2 are normal. there is no s3 or s4. there are no murmurs. there is an enlarged sustained point of maximal impulse. the chest is clear to auscultation bilaterally. bowel sounds are presents. the abdomen is soft, nontender, nondistended. no masses are palpated. there is no hepatosplenomegaly. the extremities have purpuric patch on the right medial leg. the extremities are warm. the distal pulses are intact. there is no edema. the skin has normal turgor. there are no rashes. the patient is alert and oriented times three. speech is normal. laboratory: white blood cell count is 4.6, hematocrit 22.5, platelets 160, mcv 89, sodium 140, potassium 4.5, chloride 104, bicarb 26, bun 68, creatinine 2.6, glucose 100. an electrocardiogram shows mild stable congestive heart failure. electrocardiogram shows av paced at 71. esophagogastroduodenoscopy done on showed grade two esophagitis. a colonoscopy done in showed diverticulosis at the sigmoid colon. in iron studies revealed a ferritin of 49, reticulocyte count of 1.8, tibc of 130 and trf of 331. hospital course: the patient was admitted to the medicine service. 1. anemia: the patient's anemia was felt to be secondary to gastrointestinal blood loss as well as chronic renal failure. the patient had refused nasogastric lavage in the emergency department, but it was suspected that his gastrointestinal bleed was from a lower source. the patient was started on epogen shots 10,000 units q tuesday. he also refused a gastrointestinal consult. the gi service performed both an esophagogastroduodenoscopy and a colonoscopy. these did not reveal a source of the bleed. the patient was maintained on protonix b.i.d. with two large bore intravenous at all times. his hematocrit was checked b.i.d. the patient required several units of packed red blood cells during this admission to keep his hematocrit above 30. there have been plans to perform a small bowel capsule study to elucidate if the source of his bleeding was from the small bowel. however, given that the patient has a pacemaker we are unable to perform this study. at the time of discharge the patient's hematocrit has been stable at approximately 30 for three days. he has been guaiac negative for several days on the floor. it is hoped that the patient will be stable for discharge home. he will follow up with his primary care physician and have his hematocrit followed closely. the patient knows to return should he develop any black stools or feel lightheaded. initially the patient was admitted to the micu to monitor his gastrointestinal bleed. he received aggressive fluid hydration in the intensive care unit as well as a transfusion of 2 units of packed red blood cells. he then stabilized and was ready for transfer to the floor. 2. cardiovascular: the patient has a history of ischemic cardiomyopathy with an ejection fraction of 10 to 15%. the congestive heart failure service was consulted during this admission. given the patient's hypotension many of his medications were discontinued or the doses were lowered. during his stay in the hospital the patient has managed to tolerate toprol xl 12.5 mg po q.d. and lisinopril 5 mg po q.d. with systolic blood pressures running at approximately 100. the patient will follow up with the congestive heart failure clinic to have his medications titrated up as tolerated. please note that at the time of discharge the patient has not received lasix for approximately five days and has not had spironolactone at all during this admission. the patient remained asymptomatic from a cardiovascular point of view during his stay in the hospital and required lasix prn minimally. 3. chronic renal failure: the patient's creatinine was slightly elevated upon admission at 2.6. this was felt to be secondary to a prerenal state from his gastrointestinal bleed. the patient received aggressive hydration for his hypovolemia and upon discharge his creatinine is 1.3. 4. hypernatremia: patient received a colonoscopy on . during his prep for this he received golytely. he was also kept npo overnight prior to the procedure. on the following day the patient's sodium was noted to be 153. this was felt to be secondary to dehydration from the golytely prep as well as being npo. the patient was given approximately half a liter of d5w and was allowed to drink following his procedure and his sodium normalized. 5. atrial fibrillation: the patient has a pacemaker. he is not on anticoagulation secondary to his chronic gastrointestinal bleed. the patient was evaluated by the physiotherapy service and was felt to be safe for discharge home. the patient will have vna services at home both to monitor his blood pressure and his daily weights as well as to assist him with administration of his epogen on tuesdays. discharge diagnoses: 1. gastrointestinal bleed from presumed small bowel source. 2. blood loss anemia. 3. hypovolemia. 4. congestive heart failure with an ejection fraction of 10 to 15%. 5. ischemic cardiomyopathy. 6. atrial fibrillation. 7. hypernatremia. 8. atrial fibrillation. 9. hypertension. 10. hypercholesterolemia. 11. benign prostatic hypertrophy. 12. depression. 13. eczema. 14. chronic renal failure. 15. mrsa. 16. status post cerebrovascular accident. 17. gastroesophageal reflux disease. 18. status post appendectomy. discharge medications: 1. zoloft 150 mg po q.d. 2. simvastatin 40 mg po q.d. 3. epogen 10,000 units subq q tuesday. 4. digoxin 0.125 mg po q.d. 5. tylenol 325 to 650 mg po q 4 to 6 h prn. 6. amiodarone 200 mg po q.d. 7. toprol xl 12.5 mg po q.d. 8. protonix 40 mg po b.i.d. 9. lisinopril 5 mg po q.d. discharge follow up: the patient is being discharged to home with vna services. he will check his daily weights as well as a daily blood pressure. he will follow up with his primary care physician within one week to have his hematocrit checked. he will also follow up with the congestive heart failure service to have his medications titrated up as tolerated. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine colonoscopy diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified forms of chronic ischemic heart disease cardiac pacemaker in situ angiodysplasia of intestine with hemorrhage hyperosmolality and/or hypernatremia 

Answer: The patient is high likely exposed to