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: ugib major surgical or invasive procedure: egd history of present illness: 71 yo female w/ pmh significant for cad, thn, mvr (), and h/ tear admitted to micu on from osh for persistent ugib (admitted to osh w/ blood tinged vomitus and melena, with subsequent egd revealing 3 tears with fresh clot tx'd w/ injection of epi/bicap x 3). pt initially started on heparin ss for mvr but d/c'd on . also started on amp/gent. was transfused 3units prbcs in micu. hct stable at 34 on micu transfer. no further episodes of hematemesis or melena. denies n/v/d/sob/cp, as well as abd pain/f/c/cough/lightheadedness. past medical history: htn cad s/p cabg x 2 mvr w/ s/p ccy h/o hernia repair h/o mallor tear p cabg h/o chf social history: pt lives in , nc with wife; is visiting for daughter's wedding. denies tobacco use; one drink etoh qod. family history: non-contributory physical exam: vs: t=98.6 bp=152/68 hr=68 rr=19 02=99% (ra) gen: elderly man, lying in bed, speaking in full sentences, nad heent: perrl ou, eomi bilaterally, op clear, mmm lymph: no lad cv: jvp not visible, non-displaced pmi, rrr, mechanical hs, no m/r/g resp: no accessory muscle use, no dullness to percussion, cta bilaterally, no w/r/r abd: normo active bs, non-tender, no rebound, non-distended, no masses, no organomegaly appreciated ext: no cyanosis/clubbing/edema skin: no rashes pulses: dp/pt pulses 2+ bilaterally neuro: a&ox3; cn ii-xii intact bilat; sensation and motor exams intact bilaterally pertinent results: 12:58pm blood wbc-9.7 rbc-3.80* hgb-11.2* hct-31.9* mcv-84 mch-29.4 mchc-35.0 rdw-14.4 plt ct-220 10:25pm blood wbc-10.8 rbc-3.17* hgb-9.8* hct-26.4* mcv-83 mch-30.8 mchc-37.0* rdw-14.7 plt ct-161 05:01am blood wbc-8.0 rbc-3.95* hgb-11.8* hct-33.5* mcv-85 mch-30.0 mchc-35.4* rdw-14.3 plt ct-243 12:58pm blood neuts-72.2* lymphs-14.6* monos-5.3 eos-7.5* baso-0.4 12:58pm blood pt-13.1 ptt-26.8 inr(pt)-1.1 10:00am blood pt-13.6* ptt-38.1* inr(pt)-1.2 12:58pm blood glucose-89 urean-23* creat-1.2 na-144 k-3.4 cl-108 hco3-25 angap-14 05:01am blood glucose-91 urean-21* creat-1.1 na-140 k-4.0 cl-104 hco3-27 angap-13 12:58pm blood alt-55* ast-60* alkphos-66 12:58pm blood calcium-9.3 phos-2.1* mg-1.9 05:35am blood calcium-9.1 phos-3.2 mg-1.9 07:25am blood triglyc-154* hdl-39 chol/hd-4.7 ldlcalc-112 * cxr () findings: the study is compared to previous examination of the same day earlier and shows continued application of the right ij cvp line. there is left lower lobe partial atelectasis. the remainder of the lungs are clear. there has been some worsening the degree of left lower lobe partial atelectasis since the previous study. there is no evidence of free intra- peritoneal air. there is no evidence of mediastinal air to suggest esophageal perforation. impression: right ij line remains unchanged in position. left lower lobe partial atelectasis appears to be slightly more pronounced at this time. no evidence of free intraperitoneal air or mediastinal air. * ct abd () 1. no extraluminal air or contrast seen adjacent to the esopahgus. the distal esohpagus is enlarged. it is unclear whether this represents a hiatal hernia or is due to multiple attempted endoscopic - tear ablations. no full thickness esophageal tear is present. 2. small to moderate left-sided pleural effusion and a small right pleural effusion. 3. two clips in the stomach, and one within the proximal small bowel. these could have been placed during multiple attempted endoscopic procedures. no evidence of oral contrast leak from the stomach. * ct chest () 1. no extraluminal air or contrast seen adjacent to the esopahgus. the distal esohpagus is enlarged. it is unclear whether this represents a hiatal hernia or is due to multiple attempted endoscopic - tear ablations. no full thickness esophageal tear is present. 2. small to moderate left-sided pleural effusion and a small right pleural effusion. 3. two clips in the stomach, and one within the proximal small bowel. these could have been placed during multiple attempted endoscopic procedures. no evidence of oral contrast leak from the stomach. brief hospital course: 1) ugib: to tear appeared to be resolved after clipping in icu. received 3 units prbcs in micu. egd on showed tears w/ ongoing bleeding and possible perf, however ct did not reveal perf. anti-coag was d/c'ed initially. iv protonix and sulcrafate were continued. diet was advanced to solids. hct was stable at around 33 after d/c from icu. stool is no longer guaiac positive. gi and cardiology followed the patient. eventually, after >72 hours without acute bleeding, anti-coag was restarted. patient given coumadin 5 mg x 3 days, then decreased to 3 mg. * 2. mvr: pt w/ valve; restarted heparin after >72 hrs w/o bleeding; also started coumadin at 5 mg x 3 days. through entire admission, there were no signs of tia. cardiology was involved and approved pt could be d/c'd on lovenox until inr becomes therapeutic. lovenox started one day prior to d/c. pt was taught on use. patient will go to hosp in on sunday or monday for inr check. prescription for blood draws was sent to hospital. results from hospital will be sent to me next week for adjustment of his coumadin dose as an outpatient until he returns to nc on . * 3. htn: initially, pt's toprol and accupril were held while actively bleeding in icu. after transfer from icu, bp still high (150's systolic). the patient's accupril was increased to 20 mg po qd which heldped control his bp * 4. cad s/p cabg and mvr. checked lipid panel in hospital. lcl was 112. patient had been on statin prior to bleed, but med held in icu. pt restarted on statin at discharge, but pcp may consider increasing dose. * 5. bph. held flomax; restarted on d/c. * 6. code: full * 7. dispo. pt's daughter to be married on sat; pt should be stable for d/c on friday. will be in mass until , will need inr checks after d/c before he returns to nc. will need f/u arranged with pcp (dr. at adult medicine ). medications on admission: accupril 10 mg po qd toprol 50 mg po qd flomax 0.4 mg po qd denadex 5 mg po qd asa 81 mg po qd coumadin 3 mg po q m,w,r,f,sun; 4 mg po q tues/sat discharge medications: 1. multivitamin capsule sig: one (1) cap po qd (once a day). 2. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po qd (once a day). 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 4. quinapril hcl 10 mg tablet sig: two (2) tablet po qd (once a day). 5. psyllium 58.6 % packet sig: one (1) packet po tid (3 times a day) as needed for constipation. 6. enoxaparin sodium 60 mg/0.6ml syringe sig: sixty (60) mg subcutaneous q12h (every 12 hours) for 2 days. disp:*240 mg* refills:*0* 7. coumadin 3 mg tablet sig: one (1) tablet po qhs: except tuesdays and saturdays (take 4 mg on these days). 8. coumadin 4 mg tablet sig: one (1) tablet po qtuesday and qsaturday: take 4 mg only on tuesdays and saturdays. 9. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: upper gi bleeding discharge condition: stable discharge instructions: please return to the emergency room if you experience vomiting with blood or coffee grounds, or black stool or stool with red blood. also return to the emergency room if you experience weakness, numbness, slurred speech, or difficulty with your vision. take all medications as prescribed. return to hospital on monday for blood draw to have your inr level checked. you should go to have this level checked at least once a week until returning home to nc. once returning to nc, you should visit you primary care physician. followup instructions: please follow up at hospital for blood draws (inr checks) every week. please follow up with your primary care physician within one week of returning home to nc. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine transfusion of packed cells diagnoses: unspecified essential hypertension acute posthemorrhagic anemia coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status heart valve replaced by other means long-term (current) use of anticoagulants gastroesophageal laceration-hemorrhage syndrome 

Answer: The patient is high likely exposed to