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: sulfamethoxazole/trimethoprim / valium / erythromycin base / neurontin / estrogens / quinine / zoloft / paxil / barbiturates attending: chief complaint: melena major surgical or invasive procedure: none history of present illness: the patient is a 62 yo female with pmh cad, mvr (on coumadin), aaa, copd, anemia presents with gib. pt was recently admitted to last week for cardiac cath for work up of recent doe/sob and increasing chest pain over the past month. cardiac cath revealed no changed - she had patent rca stents and lima to lad. pt was put on heparin bridge and restarted on coumadin prior to discharge. pt states that she saw her pcp 3 days pta (monday) to have her checked, which was 3.2. on the day prior to admission, pt developed worsening fatigue, weakness, and lightheadedness. she had a brief episode of chest discomfort at rest, which she describes as a pressure like feeling. that evening, pt had an episode of bloody diarrhea, which she describes as black stool w/dark red blood mixed in. pt denies any prior hx of gib. pt denies hematemesis, coffee ground emesis, nausea, vomiting, abdominal pain. denies recent nsaid use, other that daily baby ; denies steroid use. pt had no further episodes of bloody stools that evening. she presented to hospital the following morning. she states she was given vitamin k there and was transferred to . in the , pt was given 2u ffp, 2u prbc. 3 large bore ivs were placed. ng lavage was negative. pt was seen by gi, who may consider egd in am. ekg was noted to have st depressions in the lateral leads. she underwent colonoscopy - were able to reach the ascending colon - no obvious source of bleed. patient has been transfused a total of 7 u prbcs since admission on . no further bloody bowel movements or melena during admission. ontransfer from unit to floor, pt denied cp, sob, states weakness/fatigue is improved. past medical history: mitral valve replacement(#25 carbomedics valve) aaa (3.6 cm in on mri) cad s/p s/p st elevation imi , cabg in lima to lad, reverse svg from aorta to r pda multiple caths as follows: : rca engaged with difficulty heavily calcified with diffuse plaquing prox-mid 60%, distal 40% in-stent restonosis, distal 60% just before pda, 70% prox pda; lima to lad patent; svg -rca known occluded; no intervention : patent lima, native rca with 40% proximal disease, 40-50% isr in the mid stent, rca was very difficult to engage, but was finally done with an al1 catheter. : patent lima, svg to rca was occluded, 2 hepacoat stents to her native mid + distal rca. : 2.75 x 18 mm stent to her rca. () stress test with reversible ant wall defect. ef 75% past medical history: - porphyria cutanea tarta- presented with blisters on hands, scleral icterus, red urine, diagnosed with + protoporphyrins in urine, not active x 4 years, hx of phlebotomy for this, none in several years - copd - nucleated l eye - complications from trauma -> leading to trigeminal neuralgia -> s/p surgery for pain control -> loss of nerve function with damage to eye -> enucleation - anemia - trigeminal neuralgia - chf - calculated lvef on p-mibi 83%, 50-55% on last tte in - hyperlipidemia - kidney stones 8 months ago - s/p l ankle repair social history: retired speech therapist, married, 30+ pack year tobacco history, quit 3 years ago, no etoh, no drug use. family history: mother is alive and well father has disease physical exam: vs: t97.7, p67 (60-80), 116/37 (110-120/40-50s), rr12, 100%ra gen: pale, nad heent: pale conjunctiva, anicteric, l prosthetic eye, dry mm cvs: soft hs, rrr, nl s1 s2, holosystolic murmur at upper sternal border, difficult to appreciate mechanical valve lungs: ctab, no c/w/r abd: soft, nt, nd, +bs ext: no edema pertinent results: ekg: nsr@91, nl axis, 1st degree av delay, new twi and slight downsloping std in 1, l; new twi and 1-2mm std in v2-6 gi studies: egd (): erythema, congestion and edematous folds in the stomach body and fundus compatible with gastritis. salmon colored mucosa distributed in a segmental pattern, suggestive of barrett's esophagus colonoscopy (): normal brief hospital course: the patient is a 62 yo female with pmh cad, mvr (on coumadin), aaa, anemia, porphyria cutanea tarda presents with gi bleed in setting of supratherapeutic . . gi bleed: the patient presented with a hct of 16/ 8.5 and melena/dark red blood. the patient had a stable aaa and no evidence of fistula on aortic u/s . ddx includes avm, ulcer, angioectasia, dieulafoy's. an ng lavage was negative in the er. she received 2 units ffp, vitamin k, and 2 units prbc in the ed. we held her beta , , and coumadin. significantly decreased (to 2.5) after ffp and vitamin k. she was started on iv protonix and gi was consulted. the patient was admitted to the icu and an egd was performed. there were healed erosions but no evidence of acting bleeding. she was eventually transfused a total of 5 units of prbc and her hct bumped to 38. hct stabilized. she was scheduled for a colonoscopy on which found erythema in the distal rectum and anus most likely reflecting trauma from rectal tube. no polyps, diverticula, or other findings to explain gi bleed. no blood or clots seen in colon. the scope could not be passed beyond ascending colon due to poor tolerance. will need to aim for tight control. if patient starts to bleed again while on anticoagulation, will likely need capsule endoscopy. patient was discharged on protonix. . cad: pt's recent chest pain is likely secondary to ischemia in the setting of anemia, as seen on ekg (lateral depressions). enzymes were cycled and were negative. she was continued on her statin. she had another episode of chest pain on the evening of in which she was treated with sl nitro, lasix, morphine, and metoprolol. her ekg was unchanged. a cxr showed pulmonary edema. her symptoms quickly improved. cardiac enzymes were again cycled and were negative. continued on statin, isordil, beta , and aspirin. . s/p mvr: on coumadin. presented with supratherapeutic of 8.5. the patient was placed on a heparin drip after her dropped below 2.5. 3.2 on discharge. continue coumadin with plan to check on as outpt. . history of chf: recent normal echo (). on the patient second night of admission she had an acute onset of chest tightness with evidence of pulmonary edema on cxr. she was treated with 10mg lasix iv with improvement of symptoms. she was restarted on her home dose of lasix 20mg qd. . cri: creatinine at baseline . trigeminal neuralgia: continued on dilaudid and fentanyl patch. . insomnia: continued amitriptyline qhs. . hyperlipidemia: continued lipitor. medications on admission: allergies: 1. sulfamethoxazole/trimethoprim 2. valium 3. erythromycin base 4. neurontin 5. estrogens 6. quinine 7. zoloft 8. paxil 9. barbiturates medications: 1. aspirin 325 mg qd 2. amitriptyline 50 mg qhs 3. hydromorphone 4 mg q4h prn 4. fentanyl 100 mcg/hr patch q72hr 5. atorvastatin 10 mg qd 6. metoprolol tartrate 25 mg 7. cyanocobalamin 1000 mcg qd 8. pantoprazole 40 mg qd 9. isosorbide dinitrate 40 mg sr 10. furosemide 20 mg qd 11. coumadin 3 mg (tues//sun) 2mg (,mo,wed,fri,sat) discharge disposition: home discharge diagnosis: primary diagnoses: 1. gi bleed in setting of supratherapeutic 2. coronary artery disease 3. mitral valve replacement secondary diagnoses: 1. trigeminal neuralgia discharge condition: good discharge instructions: 1. please take all your medications exactly as prescribed and described in this discharge paperwork. 2. please follow up with your pcp as described below. 3. please call your pcp if you are experiencing chest pain, shortness of breath, fever, chills, bleeding/blood in your stools, or with any other concerning symptoms. followup instructions: please call your pcp, . () to schedule follow up within 1 week of discharge. you should have your checked on . . continue to have your inrs checked as you have been doing, goal 2.5-3.5 procedure: other endoscopy of small intestine colonoscopy transfusion of packed cells transfusion of other serum diagnoses: acidosis coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) chronic airway obstruction, not elsewhere classified aortocoronary bypass status diaphragmatic hernia without mention of obstruction or gangrene heart valve replaced by other means blood in stool anticoagulants causing adverse effects in therapeutic use other and unspecified coagulation defects disorders of porphyrin metabolism 

Answer: The patient is high likely exposed to