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: no known allergies / adverse drug reactions attending: chief complaint: chest pain major surgical or invasive procedure: enteroscopy with -cap electrocaudery of avms history of present illness: east hospital medicine attending admission note 87 year-old man with prior gi bleeds from jejunal avms in past, cad and chf with ef of 30% s/p icd and ppm for complete heart block who presents from osh with gi bleed. he was in his usual state of health on until this am when he awoke from sleep with acute shortness of breath and sharp chest pain radiating across chest. was pleuritic in nature. no fevers, chills, or cough. pt was unclear if this was "heart burn" or cardiac related and tried omeprazole however did not have any relief. then tried sublingual nitroglycerin x 1 which relief however pain then returned. pt then tried omeprazole again without relief and then called ems for further assistance. ems gave patient nebulizer treatment which per patient provided good relief. at outside hospital ed, patient was noted to have a hct of 25 down. patient was then transferred to for further evaluation. of note, per patient, he has had several gi bleeds and has chronic anemia from gi loss requiring several blood transfusions. has long standing history dating back to 2 years ago. patient was last admitted at osh from to during which time an enteroscopy was completed revealing stable avms. however he required 3 units of prbcs. per report, if patietn were to bleed, "spiral enteroscopy" was to be completed. additionally, patient was also seen in ed on for severe right nare epistaxis. nasal packing was completed by ent and patient was sent home. since epistaxis, patient has had repeated episodes of melena however per patient, he has black stools regularly iron supplementation. he denies any bright red blood. no dizziness/lh. at ed, initial vs were 97.3 60 114/61 22 91% 4l. patient initially had chest pain and sob and was given 4mg of morphine. several attempts at pivs failed requiring rij placement. hct was 24 and patient was transfused 1 unit of prbcs. gi was consulted in ed. trop was also elevated to 0.25 however there were no ekg changes. cards was also consulted who did not feel this required any acute intervention. he had one episode of hypotension to 80s while positioning during cvl placement which prompted icu admission. he remained hemodynamically stable in the icu. on floor, he appeared well and had no complaints. he did endorse his usual congestion. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - coronary artery disease s/p mi x 3 - systolic heart failure with ef of 30% - diabetes mellitus, type ii - jejunal avms - chronic kidney disease - hypertension - hyperlipidemia social history: - tobacco: 55ppd, quit 5 years ago - alcohol: occ - illicits: denies family history: mother with ovarian ca, father with renal ca. physical exam: vitals: t: 96.0 bp: 126/49 p: 70 r: 22 o2: 93%1l general: well appearing nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: decreased breath sounds on left with crackles cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, +2 pitting edema to mid shins pertinent results: (from outside hospital): wbc 6.0, hct 33, plt 138 na 136, k 4.4, cl 104, hco2 32, bun 45, cr 1.5, ca 8.7 from : 08:48pm ck(cpk)-70 08:48pm ck-mb-7 ctropnt-0.22* 08:48pm iron-65 08:48pm caltibc-256* ferritin-194 trf-197* 08:48pm hct-26.3* 02:25pm pt-13.2 ptt-27.7 inr(pt)-1.1 02:05pm glucose-141* urea n-44* creat-1.7* sodium-139 potassium-4.3 chloride-99 total co2-28 anion gap-16 02:05pm estgfr-using this 02:05pm ck-mb-8 ctropnt-0.25* 01:45pm wbc-8.6 rbc-2.45* hgb-8.3* hct-24.8* mcv-101* mch-33.7* mchc-33.3 rdw-19.8* 01:45pm neuts-86* bands-0 lymphs-9* monos-5 eos-0 basos-0 atyps-0 metas-0 myelos-0 01:45pm hypochrom-2+ anisocyt-2+ poikilocy-occasional macrocyt-3+ microcyt-normal polychrom-occasional ovalocyt-occasional target-occasional 01:45pm plt smr-normal plt count-160 enteroscopy : - clotted blood on a background of dry oropharynx was noted. no active bleeding - diffuse friability, erythema and nodularity of the mucosa with contact bleeding were noted in the antrum and stomach body. cold forceps biopsies were performed for histology - at least 20 small avms were noted extending from d1 to distal jejunum. treated successfully with -cap electrocautery. - otherwise normal enteroscopy to distal jejunum pathology: stomach, antrum, biopsy : 1. chronic inactive gastritis with intestinal metaplasia. 2. h. pylori immunostain is negative with adequate controls. brief hospital course: 87 year-old man with history of cad, systolic hf (ef 30%), dm, recurrent gi bleeds presenting with chest pain, sob and drop in hct. the patient was taken to enteroscopy and found to have numerous avms. caudery was used to ablate the avms that were seen. hct was monitored post-procedure and hct was downtrending, but very slowly. it is very probable that the patient has other avms that were not visualized and may still be oozing blood. he had no frank blood in stool. his discharge hematocrit was 29.7. patient was not short of breath and did not have angina on the day of discharge. problem list: #. gastrointestinal bleeding from avms. the patient received a total of 4 units of prbc transfusion (2 on on , and 1 on ). he had push enteroscopy with electrocaudery of avms on . #. anemia secondary to blood loss s/p caudery of avms . #. chest pain/sob: with elevated troponin concerning for demand ischemia v. ongoing new ischemia. ekg unrevealing in setting of paced rhythm. could be related new ischemic event versus ischemia in setting of anema. cards was consulted in ed who did not feel he required acute intervention. cp did resolve after blood transfusion. sob improved after receiving lasix. ranexa continued to prevent anginal symptoms. nebulizer meds were effective in controlling cardiac wheeze. #. cad/chf: ef 30% per report. s/p icd/ppm placement for primary prevention. on ranexa for refractory angina. lisinopril not given because of low blood pressure. #. epistaxis: packed right nostril. packing removed after several days. epistaxis did not recur. #. hypotension secondary to hypovolemia from hemorrhage. resolved after transfusion. lisinopril held throughout hospitalization. #. dm: no a1c on file. insulin sliding scale given while in hospital. glipizide restarted at discharge. # dvt prophylaxis: pneumoboots # code: dnr/dni (confirmed) transitional issues: - recheck hct within 5-7 days; transfuse as indicated - titrate glipizide dose - restart lisinopril if bp can tolerate medications on admission: medications on transfer: - glipizide 5mg - lasix 120mg daily - lasix 40mg qhs - lipitor 10mg - ranexa 500mg - omeprazole 20mg daily - sublingual nitroglycerin prn - lisinopril 10mg daily (patient states that he does not take this when his bp is lower) discharge medications: 1. nebulizer provide a nebulizer machine for delivering nebulized medications. indication: reactive airway disease 2. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) unit dose inhalation every four (4) hours as needed for shortness of breath or wheezing. disp:*30 units* refills:*0* 3. glipizide 5 mg tablet sig: 0.5 tablet po twice a day. 4. furosemide 40 mg tablet sig: three (3) tablet po qam (once a day (in the morning)). 5. furosemide 40 mg tablet sig: two (2) tablet po every evening. 6. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. ranolazine 500 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po bid (2 times a day). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes as needed for chest pain: if you still have chest pain after 3 doses, seek immediate medical attention. discharge disposition: home with service facility: vna assoc. of discharge diagnosis: - arterio-venous malformations in jejunum - anemia, chronic gastrointestinal blood loss - coronary artery disease - systolic heart failure - diabetes mellitus, type ii - chronic kidney disease - cardiac wheezing discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were transferred to the for management of your gastrointestinal bleeding that is caused by avm (arterio-venous malformation). you underwent a procedure called enteroscopy and multiple avms were treated with caudery. after the procedure you were monitored for rebleeding. your hematocrit did slowly trickle downward, but you did not demonstrate any visible blood in your stools. your discharge hematocrit level is 29.7. medication instructions: 1. duoneb one unit dose nebulized every 4 hours as needed for shortness of breath or wheezing. 2. stop lisinopril 10 mg daily until you see your regular doctor. this was not given because your blood pressure was lower during the hospitalization. 3. reduce dose glipizide 2.5 mg twice daily for blood sugar control. if your sugars are consistently higher than 150mg, then you can go back to your previous dose of 5 mg twice daily. 4. continue all other medications unchanged. heart failure instructions: - weigh yourself every morning. if you have greater than 3 pound weight gain, call your doctor. followup instructions: name: , location: cardiology address: , ste#6, , phone: appointment: monday 1:45pm name: ,mamdouh m. address: unit 2a, , phone: appointment: tuesday 2:45pm procedure: venous catheterization, not elsewhere classified endoscopic control of gastric or duodenal bleeding esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease hypotension, unspecified chronic systolic heart failure automatic implantable cardiac defibrillator in situ hypovolemia other specified disorders of stomach and duodenum epistaxis angiodysplasia of stomach and duodenum without mention of hemorrhage nonspecific low blood pressure reading atrophic gastritis, without mention of hemorrhage wheezing 

Answer: The patient is high likely exposed to