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: ambien attending: chief complaint: black stools. major surgical or invasive procedure: esophagogastroduodenoscopy (egd), . history of present illness: this is an 84 year old male with chf (ef 20%), cad s/p cabg, afib on coumadin, htn, h/o prostate ca, presents with dark colored stools. per the patient, he has been noting black stool on the toilet paper intermittently for a few weeks. also with loose stools and occasional incontinence of stool. has been feeling more fatigued over the past month with mild exertion and notes that he has been falling asleep easily while at social occasions or watching a movie. he went to see his pcp today for regularly scheduled follow-up visit. pcp checked hct which was 20 (from 30.4 in ). bp was reportedly 80/50 in pcp's office. he was sent to the ed for further evaluation. the patient denies fevers, chills, dizziness, lightheadedness, abdominal pain, nausea, vomiting, or hematemesis. no chest pain or sob. he does mention that he had an egd 2-3 years ago in as part of a dysphagia work-up and as far as he knows this was negative. colonoscopy here in was only notable for polyps. he has no known history of gi bleeding. denies use of nsaids or significant etoh. in the ed, vitals t 97.3, bp 97/42, hr 71, rr 18, sao2 100%. sbp ranged from 85-89 to low 90s (baseline is 90s to low 100s, per pcp). on exam, looked dry, jvd flat, lungs clear. abdomen non-tender. rectal exam revealed dark brown, guaiac positive stool. hct was 20.7, inr 3.7. he was also noted to have an elevated creatinine of 2.5 (baseline 1.6). ekg reportedly unremarkable (though not in chart). received 1u rbc and 10 iv vitamin k. admitted to the micu for close monitoring overnight. past medical history: -diabetes type ii, diet-controlled -cad s/p 3 stents to the rca , stent to prox rca, rpl in -2v cabg with mitral valve repair (at osh in ) -pacemaker placement for complete heart block; pacemaker upgrade to biventricular icd (in ); s/p cardiac arrest pacer/icd malfunction -afib on coumadin -hyperlipidemia -hypertension (htn) -ckd, baseline cr 1.6 -prostate cancer s/p prostatectomy ' with complication requring colostomy, reversed 3 months later - history of c. diff in social history: married, 3 children, lives in , ma with wife and oldest daughter. veteran. remote tobacco use, quit in or , previously 2 pks/wk x 30 yrs. social etoh, no ivda. family history: father who died of pancreatic ca at age 60. mother with heart dz, passed away at 76. brother with cad, s/p ptca in his 70s. physical exam: on admission: bp 111/62, hr 80 (v-paced), rr 14, sao2 100% on 2l--> 100% on ra general: alert, frail-appearing, thin elderly male, no respiratory distress. heent: perrl, eomi, dry mm. neck: flat jvp, supple, no cervical or supraclavicular lad. heart: rrr, no murmur appreciated. lungs: ctab. abdomen: multiple surgical scars, +bs, soft, nontender, nondistended, no hepatosplenomegaly. extrem/skin: warm. 2+ radial pulses, 1+ dp pulses, no le edema neuro: a+o x 3, grossly intact pertinent results: labs on admission: 12:55pm blood wbc-7.3 rbc-2.46*# hgb-6.9*# hct-20.7*# mcv-84 mch-28.2 mchc-33.6 rdw-17.9* plt ct-329# 12:55pm blood neuts-70.0 lymphs-18.9 monos-7.9 eos-2.9 baso-0.3 01:28pm blood pt-34.7* ptt-55.9* inr(pt)-3.7* 12:55pm blood glucose-107* urean-139* creat-2.5* na-136 k-4.6 cl-103 hco3-19* angap-19 03:15am blood calcium-9.0 phos-5.3*# mg-2.6 chest x-ray : possible trace pleural effusions and otherwise no acute cardiopulmonary process. brief hospital course: this is an 84 year old male with history of cad, chf, afib on coumadin, who presented with fatigue, hematocrit drop, and guaiac positive black stools. # hematocrit drop: this was felt to likely be secondary to upper gi bleed in the setting of mildly supratherapeutic inr. two peripheral iv's, an active type and screen, and iv protonix were initiated and maintained. the patient received a total of 5 units of prbcs during hospitalization with serial hcts revealing stability at hct of ~34. on the morning of , his hct was 32.3 and the patient was hemodynamically stable overnight. inr then was down to 1.5. egd on revealed only mild gastritis, which is unlikely to have caused a bleed this brisk and severe. the patient was prepped for colonscopy on during which gi was unable to advance the scope beyond the sigmoid due to the fixed loop formation likley secondary to previous abdominal surgery. the procedure was an otherwise normal colonoscopy to sigmoid colon. the patient underwent a ct colonography which showed no evidence of masses or polyps in the colon. the patient underwent a capsule study which was still pending on discharge. as the patient was hemodynamically stable and hct remained stable in the 30s, the patient was restarted on aspirin on . coumadin was not restarting during his stay given the risk of bleeding. # acute on ckd: at admission, the patient's cr was up to 2.5 from baseline of 1.8. etiology was likely pre-renal in the setting of gi bleed. following resuscitation, cr has improved to 1.6 on . bun also trended down to 57 on , and was likely elevated in setting of gi bleed. # cad: the patient has a history of multiple stents and cabg but no chest pain. in the setting of gi bleed and hypotension, aspirin, lisinopril, and nadolol were held on admission. eventually lisinopril, metoprolol and aspirin were restarted. the patient was continued on zetia. # chronic congestive heart failure (chf): the last echo in our system is from with ef 20%. the patient appeared euvolemic on admission. on admission, lisinopril, nadolol, spironolactone, and lasix were held in the setting of gi bleed and borderline bp. lisinopril and spironolactone were restarted, however had to be held on numerous occassions because of borderline blood pressures. eventually the patient was restarted on metoprolol, but spironolactone was held. the patient was discharged on lisinopril, metoprolol and aspirin only with instructions to check weights daily and report to vna. # hypotension with history of hypertension (htn): the patient on admission was borderline hypotensive, however baseline sbp is ~90s to low 100s. on admission, lisinopril, nadolol, and lasix were held. the patient remained with borderline blood pressures during hospital stay. lisinopril and spironolactone were restarted, however nadolol and lasix continued to be held. # afib: inr was supratherapeutic on admission. coumadin was held and inr reveresed with 10mg vitamin k in the setting of gi bleed. coumadin was restarted prior to discharge. medications on admission: aspirin 81mg po daily nadolol 20mg po daily lisinopril 2.5mg po daily lasix 80mg po daily spironolactone 25mg po daily warfarin 2.5mg po daily levothyroxine 50 mcg po daily zetia 10mg po daily sublingual nitroglycerin (sln) prn discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 2. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 3. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. aspirin 81 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: gi bleed secondary diagnoses: diabetes type ii, diet-controlled coronary artery disease atrial fibrillation hyperlipidemia hypertension chronic kidney disease prostate cancer history of c diff discharge condition: good, breathing comfortably on room air, tolerating oral intake. discharge instructions: you were admitted to for evaluation of blood in your bowel movements. many tests were done, however the source of the bleeding was not found. most likely the bleeding was related to your blood thinner, coumadin. this medication was stopped during your hospital stay, you should not restart this medication without discussing it with your primary care provider. had a capsule endoscopy study, for which the results are still pending. medication changes: stop lasix, nadolol, spironolactone, coumadin - do not take these medications on discharge start metoprolol 12.5mg twice a day start pantoprazole 40mg daily continue lisinopril at decreased rate of 2.5mg once a day you should weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet and fluid restriction: 2l you will have a visiting nurse to monitor your blood pressures and daily weights. if you develop sudden chest pain, shortness of breath, fever, chills, or any other concerning symptoms please call your primary care doctor or return to the emergency room. followup instructions: please call to make an appointment to see your primary care doctor within the next 2 weeks. name: , location: cardiology associates of greater address: , , phone: provider: clinic phone: date/time: 8:30 provider: . phone: date/time: 9:00 md procedure: other endoscopy of small intestine colonoscopy diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft chronic kidney disease, unspecified other and unspecified hyperlipidemia chronic systolic heart failure long-term (current) use of anticoagulants cardiac pacemaker in situ hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to