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: esophagogastroduodenoscopy (egd) history of present illness: mr. is a 67 yo m with history of multiple myeloma, paroxysmal atrial fibrillation, and prior known duodenal ulcer who presented to an outside hospital with one day history of melena and hypotension to sbp in the 80s at home. he had chemotherapy with valcade and dexamethasone at three days prior to admission. at osh, he was guaiac positive, and his hct was found to be 22 down from a baseline in the mid 30s per his wife. was transfused two units of packed red cells and a cordis was placed. patient also complained of chest pain on presentation and had dynamic st depressions in the lateral leads. he was given nitro and blood with resolution of his symptoms. patient was transferred to for further management. in the ed, initial vs were: 97.0, 99, 128/89, 20, 100% 10l nrb. patient was given a iv bolus and started on a ppi drip. he had a negative ng lavage but was again guaiac positive. repeat labs here showed hematocrit of 24.8 (he did not bump his hematocrit after the two units given at the osh). ekg here showed atrial fibrillation without any st changes. gi was consulted, and he was admitted to the icu for further management. on transfer, vitals were 107, 122/76, 14, 99% 2l nc. in the micu, the patient received a total of 4 units which he tolerated well without complaints. his chest pain completely went away when he received blood products. patient had 18 hours of diarrhea after taking his chemo on friday but did not notice any blood at that time. he did have three hours of melena on saturday night but has had no further bms since. no abdominal pain, nausea, vomiting, constipation. no change in po intake, difficulty breathing or dyspnea on exertion. past medical history: multiple myeloma on chemo paroxysmal afib cad s/p ptca in htn h/o gastric ulcer tias hypercholesterolemia pfo with asd on echo with right to left & left to right shunts presumed diagnosis of amyloid angiopathy h/o ich while on warfarin (no longer anticoagulated) social history: he is married and his wife is his hcp. denies smoking, etoh or drugs. family history: uncle: died of mi in 70's father: leukemia, mi at age 65 also aml uncle: died of mi in 40's physical exam: on transfer in the er temp:97.0 hr:99 bp:128/89 resp:20 o(2)sat:100 normal constitutional: comfortable heent: normocephalic, atraumatic; pale conjunctiva oropharynx within normal limits chest: clear to auscultation cardiovascular: tachy regular rate and rhythm, normal first and second heart sounds abdominal: soft, nontender, nondistended pertinent results: admission labs: 06:25am blood wbc-15.0*# rbc-2.87*# hgb-8.8*# hct-24.8*# mcv-87 mch-30.8 mchc-35.5* rdw-16.5* plt ct-214 06:25am blood neuts-85.7* lymphs-10.0* monos-4.0 eos-0.1 baso-0.1 04:09am blood hypochr-normal anisocy-1+ poiklo-1+ macrocy-1+ microcy-1+ polychr-1+ spheroc-2+ ovalocy-1+ schisto-occasional 06:25am blood pt-12.3 ptt-19.4* inr(pt)-1.0 06:25am blood glucose-128* urean-72* creat-1.6* na-139 k-3.9 cl-105 hco3-25 angap-13 01:46pm blood calcium-7.9* phos-2.8 mg-2.5 01:46pm blood alt-19 ast-15 ck(cpk)-63 alkphos-66 totbili-1.3 06:25am blood ctropnt-0.02* 01:46pm blood ck-mb-4 ctropnt-0.05* 03:20pm blood ck-mb-4 ctropnt-0.05* 08:42pm blood ck-mb-3 ctropnt-0.06* 04:09am blood ck-mb-3 ctropnt-0.05* 08:08pm blood ck-mb-3 ctropnt-0.04* . ecg study date of 6:22:00 am atrial fibrillation with rapid ventricular response. diffuse non-specific st-t wave flattening. compared to the previous tracing of the lateral ischemic appearing t wave abnormalities are no longer recorded. however, pseudonormalization cannot be excluded, given the rapid rate. atrial fibrillation has appeared. followup and clinical correlation are suggested. intervals axes rate pr qrs qt/qtc p qrs t 105 0 84 362/440 0 -3 134 . egd normal esophagus. edematous, erythematous antral fold noted consistent with inflammation and possibly underlying ulcer. a single non-bleeding 2 mm ulcer was found in the stomach body. otherwise normal egd to third part of the duodenum brief hospital course: mr. is a 67 yo male with history of paroxysmal atrial fibrillation, coronary artery disease, hypertension and multiple myeloma s/p recent chemo. he has a known duodenal ulcer and presented with melena and hypotension (sbp 80's) to an outside hospital. there he was found to have a hematocrit of 22 down from his baseline in the mid 30's. he also complained of chest pain with lateral st depressions noted on ekg that resolved when he received nitroglycerin and 2 units prbcs. . icu course: he was transferred to . on initial evaluation in the emergency room he had a hematocrit of 24 despite the 2 units prbcs from the outside hospital and was noted to be in atrial fibrillation with a ventricular rate greater than 100. he was started on a ppi drip and admitted to the icu for further management. while in the icu, his atrial fibrillation was controlled with metoprolol iv and reinstitution of his sotalol. the patient had one further episode of chest tightness that resolved with nitrates as he received an additional 4 units of prbc's with his hematocrit stabalizing in the low 30's. he was ruled out for an mi and remained stable from a cardiac standpoint after that single episode. he had no further melena or guaiac positive stools in the icu and underwent egd on with the results as noted above. on transfer to the hospital floor on , he had a transient episode of hypotension with a pressure of 85/58 when he was transferring from the stretcher to the bed, which was attributed to the patient having restarted his home dose of labetalol on the evening of transfer. his labetalol was subsequently held (until the day of discharge) and his blood pressure stabalized. . # gi bleed: egd: edematous, erythematous antral fold noted c/w inflammation and possibly underlying ulcer; single non-bleeding 2 mm ulcer was found in the stomach body. the patient was treated with a total of 6 units of prbcs with stabalization of his hematocrit. his intravenous pantoprozole was changed to po and the patient's diet was advanced. on the 4th and 5th hospital days following transfer from the icu, the patient had an episode of black tarry stool on each day. in consultation with the gi service, these episodes were felt to be due to old blood from his initital upper gi bleed. his hematocrit and blood pressure remained stable over the course of these two days with no further evidence of new bleeding. . # chest pain: the patient's episode of chest tightness was felt to be demand ischemia related to gi bleed superimposed on atrial fibrillation and rapid ventricular response. pain improved with sl nitroglycerin and blood transfusions. his troponins remained flat and he ruled out for an mi. he has been continued on his statin. the hospital course was reviewed with the patient's primary cardiologist and the patient will follow up with him on . . # atrial fibrillation: the patient has paroxysmal atrial fibrillation treated with sotalol and labetalol. his rapid ventricular response at the outside hospital appeared related to hypovolemia and ischemia from his gi bleed. his rate has been controlled with single doses of metoprolol iv when in the icu and reinstitution of his sotalol. he converted to nsr by hospital day 4. on the last hospital day, he has been restarted on a lower dose of his labetalol (in addition to sotalol) to prevent further rapid ventricular response, but his dose is limited by his earlier hypotensive episodes. the patient is anticoagulated with low dose aspirin and aggrenox, but these were held during his gi bleed. he received a single dose of each on the 4th hospital day just prior to having two further guaiac positive, melenic stools. although, the stools are thought to be from old blood and the patient's hematocrit has remained stable, his anticoagulation was discontinued. this has been discussed with his primary cardiologist by phone, and the patient will see him in follow up on to address restarting low dose aspirin and aggrenox. . # multiple myeloma: last chemo with velcade and decadron at . the patient was continued on bactrim and acyclovir prophylaxis and he will follow up with dr. at the on where he will be evaluated and the decision whether or not to proceed with chemotherapy will be made. . # hypertension: he takes numerous antihypertensives at home including amlodipine, tekturna, labetalol, clondine and losartan. these had been held in the setting of his hypotension and gi bleeding and only clonidine and labetalol have been reinstituted at the time of discharge. he will follow up with his cardiologist on and his pcp on to reinstitute these medications as tolerated. medications on admission: aggrenox 200 mg-25 mg amlodipine-atorvastatin 10 mg-80 mg daily aliskiren 300 mg daily sotalol af 120 mg daily labetalol 400 mg clonidine 0.1 mg furosemide 80/40 mg daily aspirin low-strength 81 mg chewable daily (takes ) losartan 100 mg daily folic acid 1 mg daily vitamin d 50,000 unit qweek nitroglycerin 0.4 mg sublingual prn multivitamin 1 daily amlodipine besylate 5mg daily dexamethasone -- unknown strength revlimid -- unknown strength valcade unknown sig bactrim -- unknown strength qmonday wednesday friday acyclovir unknown daily discharge medications: 1. sotalol 80 mg tablet sig: 1.5 tablets po daily (daily). 2. simvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). 4. acyclovir 400 mg tablet sig: one (1) tablet po daily (daily). 5. clonidine 0.1 mg tablet sig: one (1) tablet po twice a day. 6. omeprazole 40 mg tablet, sig: one (1) tablet, po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. labetalol 100 mg tablet sig: one (1) tablet po bid (2 times a day): do not take if your pulse is less than 50 beats per minute. disp:*60 tablet(s)* refills:*2* 8. folic acid 1 mg tablet sig: one (1) tablet po once a day. 9. vitamin d 50,000 unit capsule oral 10. multivitamin oral 11. take your chemotherapy medicines as directed by your oncologist these include revlimid, dexamethasone, and velcade discharge disposition: home discharge diagnosis: upper gastrointestinal bleed from gastric ulcers atrial fibrillation coronary artery disease hypercholesterolemia multiple myeloma tias s/p intracranial hemorrhage on warfarin for afib presumed amyloid angiopathy patent foranen ovale with asd on echo with righ to left and left to right shunts discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with a bleeding ulcer that required intensive care because your blood pressure was low. you were treated with blood transfusions and a new medicine to decrease your stomach acid production. your anemia and low blood pressure caused you to have chest pain from your heart disease and caused your heart to beat fast from your atrial fibrillation (afib). the blood transfusions and heart medicine helped to stop the chest pain. there are no signs that you had a heart attack. in the setting of your bleeding, your blood thinners for your afib and heart disease were stopped. you will work with your cardiologist to decide the right time to restart your blood thinners. because your blood pressure has been low, we have stopped most of your high blood pressure medicines. do not take your losarten, amlodipine, tekturna (also called aliskiren), or lasix until advised to restart these medications by your doctors. do not take your aggrenox or low dose aspirin. you should avoid taking any aspirin, ibuprofen or drugs containing aspirin or nsaids (motrin or aleve)unless you have asked one of your doctors. you were taking caduet - a combination blood pressure and statin, but you will take only atorvastatin now. followup instructions: hematology oncology name: dr. when: monday at 1pm cardiology name: dr. when: wednesday at 1pm department: primary care name: dr. when: thursday at 12 pm address: 199 route 101 , , phone: department: div. of gastroenterology when: wednesday at 3:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: other endoscopy of small intestine diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status chronic kidney disease, stage iii (moderate) ostium secundum type atrial septal defect multiple myeloma, without mention of having achieved remission chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction amyloidosis, unspecified 

Answer: The patient is high likely exposed to