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, hypotension. major surgical or invasive procedure: egd history of present illness: this is a 70 year old gentleman with ischemic cardiomyopathy ef 20%, atrial fibrillation on coumadin, history of barrett's esophagitis, colonic polyps, asthma, hypothyroidism, and depression. he presents with black loose stools for one day. yesterday morning, the patient woke up and had diarrhea that was black and tarry in nature. he proceeded to have a loose stool movement every 15 minutes over the day. over the course of the day he became more lightheaded and this morning felt like he was going to fall down prompting him to seek medical attention in the ed. he did not notice frank blood in his bowel movements. he also has had some nausea with poor appetite (has not eaten in two days) but no vomiting or hematemesis. no abdominal pain. no coldness in extremities. . the patient was bought in by his wife to the . there the patient was noted to have a low blood pressure in the high 80s systolic, p 105. hct was 42 (baseline 31) and bun/cr 56/2.4 (baseline cr 1.5-1.8). ng lavage negative. believed to be volume depleted. he received 3 l ns, 2 units prbc, and 1 unit ffp (addtl' units ordered). given iv protonix. transferred to micu, on transfer pt says he feels somewhat better. . of note, he is known to have barrett's esophagus seen on egd. in addition, he is s/p removal of adenomatous polyp (path with dysplasia) in , no polyps seen on colonoscopy. past medical history: 11. cad, s/p 1-vessel cabg and ascending aortic arch repair. last cath in with no significant cad, patent lima to lad. p-mibi in with slight worsening of partially reversible, moderate perfusion defects in the basilar anterolateral, mid anterolateral, basilar posterolateral, mid posterolateral, and lateral walls (entire lateral portion of the left ventricle). 2. ischemic cardiomyopathy with ef 15-20%, nyha class iii. 3. chronic renal insufficiency, baseline creatinine around 1.5-1.7 4. atrial fibrillation 5. hypothyroidism 6. status post aicd placement, multiple firing episodes, last at in in setting of hypokalemia. 7. asthma 9. hyperlipidemia 10. depression 11. dementia 12. anemia, baseline hct around 30. 13. barrett's esophagus seen on egd 14. s/p removal of adenomatous polyp (path with dysplasia) in , no polyps seen on colonoscopy. social history: married, lives with wife, has five children. formerly drank alcohol but not since years ago. no smoking or illicit drug use. retired painter. family history: non-contributory. physical exam: vs: t 97.6 p 77 bp 109/71 rr 22 o2 98 ra gen: wd/wn male caucasian, nad. eyes: sclerae anicteric, perrl. mouth: no bruising, no petechiae. neck: obese, no jvd (jvp to 6 cm) chest: lungs cta b/l no wheezes, fair air movement abd: obese, non tender, some nausea elicited with palpation. ext: no edema, faint but palpable dp pulses neurol: alert and oriented to time,place, and person pertinent results: 08:01pm hct-35.2* 02:56pm urine hours-random urea n-361 creat-43 sodium-85 02:19pm hct-34.0* 12:15pm urine color-straw appear-clear sp -1.008 12:15pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:15am glucose-112* urea n-56* creat-2.4* sodium-137 potassium-4.3 chloride-101 total co2-25 anion gap-15 10:15am estgfr-using this 10:15am ck(cpk)-129 10:15am alt(sgpt)-16 ast(sgot)-26 alk phos-79 amylase-84 tot bili-0.4 10:15am ck-mb-3 ctropnt-0.03* 10:15am lipase-33 10:15am digoxin-1.3 10:15am ck-mb-3 ctropnt-0.03* 10:15am wbc-6.3 rbc-4.66# hgb-13.8*# hct-42.0# mcv-90 mch-29.7 mchc-32.9 rdw-14.1 10:15am neuts-77.1* lymphs-11.5* monos-9.0 eos-1.9 basos-0.5 10:15am plt count-160 10:15am pt-31.0* ptt-31.9 inr(pt)-3.3* brief hospital course: upper gi bleed: pt. initially with borderline hypotension and tachycardia. responded well to fluid resuscitation. admitted initially to icu, where an egd was performed on am of hospital day 2. egd revealed duodenitis, no active bleed, no ulcer, barrett's esophagus. in the icu, was transfused 2 units prbc, 1 unit ffp. given initial low bp and gib, all antihypertensives were initially held, as was coumadin.throughout the rest of hospital stay, pt. had stable vital signs, no further gib. hct responded appropriately to transfusion, remained stable. antihypertensives and coumadin were restarted on hd 3 and were tolerated well. overall, continued asa and warfarin, but stopped plavix after consultation with cardiology. . respiratory distress/asthma flare: on hospital day 3, began to have increasing respiratory distress. exam notable for marked wheezing. cxr with no definite infiltrates. while initially volume overloaded after micu stay, no longer had evidence of chf. overall, he was treated with prednisone and nebs for asthma flare. also empirically treated for pna - although limited evidence for this on cxr - with rocephin/azithro. will be d/c with levaquin to complete 7 day course. . chest pressure: on the night of hd 3, patient had an episode of l-sided chest pain that was ssociated with diaphoresis and an increased 02 requirement (responded to 2l nc). pain resolved quickly with 3 sl nitroglycerin, albuterol neb, and iv lasix. cardiac enzymes were trended and over the following day climbed from 0.05 to a peak of 0.08. he had no further events, and had stress mibi in hospital prior to discharge, which again demonstrated his severe ischemic dilated cardiomyopathy and also multiple predominantly fixed perfusion defects - previous stress in with progressively worse reversible perfusion defects. will continue medicla management. . arf on ckd: pt. had briefly elevated cr, which returned quickly to baseline with fluid resuscitation. in setting of gib, seemed c/w prerenal picture. acei was initially held, but restarted without adverse effect once cr returned to baseline. remained at baseline thereafter with re-introduction of meds. . abdominal pain/constipation: on hd 3, pt. developed bilateral lower quadrant abdominal pain, which he attributed to not having had a bowel movement since admission to hospital. abdominal exam was benign, kub unremarkable. had relief after bm. . medications on admission: 1. lasix 40 mg tablet sig: one (1) tablet po once a day. 2. aldactone 25 mg tablet po once a day. 3. metoprolol succinate 100 mg tablet sustained release 24hr 4. digoxin 125 mcg tablet daily 5. atorvastatin 20 mg po daily 6. aspirin 81 mg tablet, po daily 7. clopidogrel 75 mg po daily. 8. lisinopril 5 mg po daily 9. warfarin 5 mg tablet sig: one (1) tablet po hs adjusted accordingly to inr. 10. levothyroxine 112 mcg po daily. 11. citalopram 60 mg po daily. 12. pantoprazole 40 mg e.c. po q24h (every 24 hours). 13. mexiletine 150 mg po q8h. 14. docusate sodium 100 mg po bid. 15. senna 8.6 mg po bid prn. 16. quetiapine 50 mg tablet po qam, 25 mg po qpm, 225 mg qhs. 17. clonazepam 0.5 mg po tid (3 times a day). 18. fluticasone-salmeterol 100-50 mcg/dose disk with device 19. trazodone 25 mg tablet po hs prn. 20. donepezil 5 mg po hs. discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 3. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 4. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 6. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). 7. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 8. mexiletine 150 mg capsule sig: one (1) capsule po q8h (every 8 hours). 9. albuterol sulfate 0.083 % solution sig: inh inhalation q3-4h (every 3 to 4 hours) as needed. inh 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 13. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 16. nebulizer please dispense home nebulizer set-up. 17. warfarin 1 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 18. levaquin 500 mg tablet sig: one (1) tablet po once a day for 3 days. disp:*3 tablet(s)* refills:*0* 19. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q4h (every 4 hours). disp:*180 neb* refills:*2* 20. prednisone 20 mg tablet sig: three (3) tablet po daily (daily) for 3 days. disp:*9 tablet(s)* refills:*0* 21. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours). disp:*120 neb* refills:*2* 22. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 23. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 24. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 25. quetiapine 50 mg tablet sig: 4.5 tablets po qhs (once a day (at bedtime)). 26. quetiapine 25 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). 27. quetiapine 25 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 28. metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: 1. upper gi bleed secondary to gastritis, duodenitis secondary diagnoses: 1. cad, s/p 1-vessel cabg 2. ischemic cardiomyopathy with ef 15-20%, nyha class iii. 3. chronic renal insufficiency, baseline creatinine around 1.5-1.7 4. atrial fibrillation 5. hypothyroidism 6. status post aicd placement 7. asthma 9. hyperlipidemia 10. depression 11. dementia 12. anemia, baseline hct around 30. 13. barrett's esophagus seen on egd 14. s/p removal of adenomatous polyp discharge condition: good discharge instructions: continue all previously prescribed medications. you may resume your usual diet weigh yourself every morning, md if weight gain > 3 lbs. adhere to 2 gm sodium diet return to the hospital or call your doctor immediately for: -any further very dark or bloody stools -feeling weak or dizzy -fainting or feeling that you might faint -any trouble breathing -any other concerning symptoms followup instructions: please call your primary care doctor to arrange a follow-up appointment. you will also need a repeat endoscopy to monitor your esophagus, which is a potentially pre-cancerous condition. your primary care doctor can arrange the appointment with gastroenterology for you, or you can call ( to schedule an appointment. you should see them within the next 4 weeks. procedure: other endoscopy of small intestine transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia long-term (current) use of anticoagulants unspecified gastritis and gastroduodenitis, with hemorrhage chronic obstructive asthma with (acute) exacerbation anticoagulants causing adverse effects in therapeutic use barrett's esophagus volume depletion, unspecified duodenitis, with hemorrhage 

Answer: The patient is high likely exposed to