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: morphine / hydromorphone / nitroglycerin / reglan attending: chief complaint: nausea, vomiting and diarrhea - transfer from major surgical or invasive procedure: transesophageal echocardiography electrical cardioversion history of present illness: 57 year old male with pmhx significant for cad s/p cabg and lad stent, porcine tricuspid valve, complete heart block s/p pacemaker, hypertension, gerd, biliary stricture s/p ccy and mva s/p multiple abdominal surgeries including partial liver resection who is transferred from with nausea, vomiting and diarrhea for further gi evaluation. . patient initially presented to on with right-sided rib pain, nausea, vomiting (x 1 day) and loose stools (4-5 per day x 1 month, non-bloody). he was found to have a total bilirubin of 1.9, ast 71 and alt of 76; also with elevated white blood cell count of 18.6. patient had an abdominal ct scan on admission which showed fluid in the colon consistent with enteritis vs colitis. he was started on iv ciprofloxacin and metronidazole. stool was negative for c.difficile. gi (dr. was consulted, reviewed the ct scan with radiology - stable dilation of the cbd compared to and with dilation all the way to the ampulla and no intraluminal abnormality/stone seen; also with stable segmental intrahepatic dilation that appears to be related to previous liver surgery. dr. was concerned for biliary obstruction however patient unable to have mrcp due to pacemaker. per patient's request was transferred to for further evaluation. of note total bilirubin decreased to 1.1 but alt increased from 76 to 102. . regarding patient's right-sided rib pain - described as constant, starts under right axilla and radiates to right shoulder and right upper quadrant, worse with inspiration. no recent falls. an x-ray was done at which showed healing fractures of the right 8th and 9th ribs (patient had presented to the ed on after falling out of a broken chair and elbow pushing into right chest wall - pa/lat cxr at the time did not reveal any rib fractures; rib pain had resided two weeks ago). given patient's significant cardiac history he was monitored on telemetry at without any significant events and ruled out for ami with 4 sets of negative troponins. cta of chest was done which was negative for pulmonary embolism (had a positive d-dimer). . currently patient continues to have right-sided rib pain with inspiration that is at maximum. denies any chest pain or sob. endorses several episodes of palpitations over the past week. currently denies any abdominal pain. endorses nausea and dry heaves. no po intake since hospitalization and no further bowel movements. . ros: - constitutional: no fevers, chills, sweats, + 2 lbs weight loss, decreased appetite with early satiety x 1 month - heent: no changes in vision or hearing, no rhinorrhea, nasal congestion, sore throat, + chronic headaches - respiratory: no cough, shortness of breath, dyspnea on exertion - cardiac: + palpitations (several episodes in past week), orthopnea, pnd - gi: no brbpr, melena - gu: no dysuria, hematuria, urgency, frequncey - hematologic/lymphatic: no bleeding, bruising or lymphadenopathy - msk: no arthralgias or myalgias - neuro: no weakness, numbness, seizures, difficulty speaking, changes in memory. - skin: no rash or pruritis - psychiatry: no depression or suicidal ideation all other systems negative past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: a)cabg: with svg to pda b)percutaneous coronary interventions: - : cypher placed in the mid lad - : ptca with stent to proximal lad - : angiograph w/o stenting - : des to proximal lad overlapping with prior stent and poba to d1 c)pacing/icd: chb after cabg, s/p dual chamber pacemaker 3. other past medical history: - tricuspid valve replacement, porcine - s/p pericardial window - hypertension - hypercholesterolemia - mva , 3 month icu stay at with multiple abdominal surgeries including splenectomy, partial liver resection, partial gastrectomy, and left diaphragm rupture and repair. - gerd - anxiety - history of migraines - bph social history: married with three children, independent not currently working, on disability no current tobacco (distant past hx) no alcohol or illicits family history: father - ami age 40 with hx of rheumatic fever mother - hypertension known fhx of cancer or diabetes physical exam: 97 84p 20rr 116/60 98%ra appearance: alert, pale appearing, dry heaving eyes: eomi, perrl, anicteric ent: op clear s lesions, mm very dry, no jvd, neck supple cv: +s1, s2 -m/r/g, no peripheral edema, 1+ dp/pt bilaterally pulm: decreased bs at bases abd: multiple old surgical scars, soft, nt, nd, +bs msk: tenderness right side over ribs 8 and 9; 5/5 strength throughout, no joint swelling, no cyanosis or clubbing neuro: cn 2-12 grossly intact, no focal deficits skin: no rashes psych: appropriate, pleasant heme: no cervical pertinent results: osh labs : labs from admission note, awaiting labs to be faxed from wbc 18.6 -> 16 hct 44 plts 212 . 135 103 20 ------------< 3.8 25 0.9 . ast/alt 71/76 t bili 1.9 alk phos 57 albumin 4.4 lipase 27 amylase 38 . c.diff toxin/antigen negative labs: cardiac enzymes: 09:00pm blood ck-mb-2 ctropnt-<0.01 01:35pm blood ck-mb-2 ctropnt-<0.01 05:45am blood ck(cpk)-28* labs on discharge: 06:20am blood wbc-6.0 rbc-4.49* hgb-14.5 hct-42.1 mcv-94 mch-32.3* mchc-34.4 rdw-13.0 plt ct-256 06:20am blood pt-14.1* ptt-26.6 inr(pt)-1.2* 06:20am blood glucose-109* urean-19 creat-0.8 na-138 k-4.0 cl-108 hco3-24 angap-10 07:10am blood alt-102* ast-41* alkphos-68 totbili-0.7 06:20am blood calcium-8.7 phos-3.6 mg-2.1 01:35pm blood tsh-1.4 microbiology: : urine cx no growth : blood cx x 2: no growth to date : stool studies no enteric gram negative rods, salmonella, shigella, campylobacter found. clostridium difficile toxin a & b test (final ): negative osh images: ct abdomen with contrast: cbd 12mm, mild intrahepatic ductal dilatation in anterior segment of right lobe unchanged from ; fluid throughout the colon consistent with enteritis or colitis cta: no evidence of pulmonary emboli; mild cardiomegaly with right atrial enlargement increased compared with images: ekg: 77 nsr, nl axis, mix of native beats with rbb morphology and ventricular pacing with lbb morphology ekg: hr 150s svt vs aflutter with 2:1 block with rbb morphology ekg: atrial fibrillation with ventricular sensed qrs/ lbbb at 112 abdominal u/s: 10/11:11 the liver shows no focal or textural abnormalities. the patient is status post cholecystectomy. the common duct is not dilated. there is no intrahepatic ductal dilatation. both right and left kidneys are normal without hydronephrosis or stones. the pancreas is unremarkable. the patient is status post splenectomy. the aorta is of normal caliber throughout. the visualized portions of the inferior vena cava appear normal. no free fluid. impression: normal abdominal ultrasound. no intra or extrahepatic ductal dilatation. echo: mild spontaneous echo contrast is seen in the body of the left atrium and the descending aorta. no thrombus is seen in the left atrium or left atrial appendage. no spontaneous echo contrast or thrombus is seen in the body of the right atrium or the right atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is low normal (lvef 50%). there is borderline free wall hypokinesis of the right ventricle. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 35 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. impression: no thrombus identified. mildly depressed biventricular function. brief hospital course: 57 year old male with pmhx significant for cad s/p cabg and lad stent, porcine tricuspid valve, complete heart block s/p pacemaker, hypertension, gerd, biliary stricture s/p ccy and mva s/p multiple abdominal surgeries including partial liver resection who was transferred from with nausea, vomiting and diarrhea from likely infectious colitis. hospital course was complicated by the development of symptomatic atrial fibrillation/ atrial flutter requiring tee cardioversion. 1. presumed colitis: patient transferred from osh with nausea/ vomiting/ diarrhea from likely infectious colitis. ct scan at osh was compatible with diagnosis of acute colitis vs enteritis, although patient's complaint of diarrhea appears to be more chronic and may warrant further outpatient evaluation. abdominal ultrasound, stool studies were negative including repeat cdiff toxin although cdiff pcr was still pending at the time of discharge. symptoms improved with conservative management of initial bowel rest followed by brat diet, demerol for pain control (given multiple analgesic allergies) and cipro/flagyl. he was discharged to complete an 8 day course of antiobiotics to end on . clostridium difficile pcr will need to be followed as an outpatient. 2. atrial fibrillation/ atrial flutter: complained of symptomatic palpitations with dyspnea x 1 month prior to admission. on further investigation, patient was found to have intermittent afib/ flutter with hr up to 160s resulting in dyspnea and anxiety although otherwise hemodynamically stable. he was transferred to the icu for further evaluation. etiology of arrhythmia was unclear: cta negative for pe at osh, tsh within normal limitis, ruled out for cardiac ischemia although echo showed biventricular dysfunction. electrophysiology was consulted to interrogate pacemaker and found that mode switch off device was tracking atrial flutter with resultant ventricular rate of 120-130 bpm. pacer was readjusted with immediate releif of symptoms of palpitations and 'impending sense of doom.' however, remained in a-fib wih occasional bursts of tachycardia, despite increased b-blocker dosing, so cariology recommended cardioversion. he subsequently had an elective tee guided cardioversion and was started on dabigatran for anticoagulation. he was able to ambulate around the icu with stable heart rate and no significant symptoms. he was discharged home with increased metoprolol dose of 75mg , dabigatran and was placed on of hearts monitor x 2 weeks to assess for significant remaining arrhythmias. he will follow up with dr. to discuss further treatment and evaluation. 3. r.sided rib pain: osh film with healing 8th and 9th rib fractures - no new trauma, ? healing from injury in and if so unclear why pain improved and is now worsening; pe ruled out by negative cta; no evidence of pna; romi negative at osh and at , making ischemia unlikely. pain was managed conservatively with demerol and lidocaine patch prn with resolution of symptoms through hospital course. 4. leukocytosis: likely due to infectious colitis as further infectious evaluation negative including blood, urine and stool cultures. downtrended throughout hospital course and was normal at the time of discharge. 5. cad/htn: as above, no signs of active ischemia per ekg and serial cardiac enzymes. maintained on home plavix and statin with addition of asa 81mg. bblocker was uptitrated for av nodal blockade. 6. anxiety: patient complained of significant anxiety relating to palpitations through hospital course which was managed by ativan prn. transitions of care: # afib/ flutter s/p d/c cardioversion: - koh monitor x 2 weeks - dabigatran for anticoagulation until cardiology follow up - bblocker uptitration - follow up with dr. # colitis: - complete antibiotic course - f/u cdiff pcr medications on admission: outpatient medications (per osh admission h and p): plavix 75mg daily ativan 1mg po prn metoprolol xl 50mg daily zantac 150mg crestor 40mg daily . medications on transfer: crestor 40mg qhs florastor 250mg po tid plavix 75mg po qam toprol xl 50mg qam ciprofloxacin 400mg iv q12h (started ) metonidzaole 500mg iv q8h (started ) ativan 1mg po daily prn demerol 50mg iv q6h prn motrin 600mg q6h prn roxicodone 5mg q4h prn tylenol 650mg q6h prn zofran 4mg iv q6h prn d5ns 100cc/hr discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. lorazepam 1 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 3. metoprolol tartrate 25 mg tablet sig: three (3) tablet po twice a day. disp:*180 tablet(s)* refills:*1* 4. rosuvastatin 20 mg tablet sig: two (2) tablet po daily (daily). 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. disp:*4 tablet(s)* refills:*0* 8. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 2 days. disp:*6 tablet(s)* refills:*0* 9. dabigatran etexilate 150 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*1* 10. acetaminophen 325 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for pain for 7 days. discharge disposition: home discharge diagnosis: primary: supraventricular tachycardia colitis chest wall pain secondary: coronary artery disease gastroesophageal reflux disease dyslipidemia hypertension pacemaker porcine tricuspid valve anxiety benign prostatic hypertrophy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr , you were transferred to the intensive care unit at for fast heart rates that required pacemaker adjustments and an electrical cardioversion. your heart rate was intermittently fast afterwards, and your metoprolol dose was increased. your abdominal symptoms improved while taking antibiotics for your colitis. . we have made the following adjustments to your medications: -continue ciprofloxacin 500 mg every 12 hours, through the end of (tomorrow) -continue metronidazole 500 mg every 8 hours, through end of (tomorrow) -start dabigatran 150 mg by mouth every morning and evening. this is a new blood thinner that may make you more likely to bleed. please see below for warning signs of increased bleeding. please continue taking this through your appointment with dr. (see below for information on how to schedule this appointment). -increase metoprolol tartrate to 75 mg by mouth, every 12 hours. please continue taking this regimen until your follow up with dr. . at that point, you may be able to switch to a once-daily pill. it is important to continue taking this every 12 hours to maintain your heart rate at a good level. -you can continue to take acetaminophen as needed for pain. please do not exceed the dosage as recommended on your discharge medication list. . it has a pleasure caring for you. followup instructions: you should follow up with the electrophysiologist dr within one month. please call his office to schedule an appointment. cardiology , 7 , phone: fax: . please also call dr. if you have any questions or concerns after your discharge. you can call him even on the weekends, when he should have coverage if he is not in the office. md procedure: diagnostic ultrasound of heart other electric countershock of heart diagnoses: esophageal reflux pure hypercholesterolemia unspecified essential hypertension atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other specified cardiac dysrhythmias other specified disorders of biliary tract cardiac pacemaker in situ heart valve replaced by transplant aftercare for healing traumatic fracture of other bone nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] colitis, enteritis, and gastroenteritis of presumed infectious origin 

Answer: The patient is high likely exposed to