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: gi bleeding/melena major surgical or invasive procedure: egd colonoscopy history of present illness: 65 f h/o htn, afib, s/p avr/mvr rf, developed low back pain and dark stools 3d pta. she presented to pcp ~2d pta, and left a stool sample. labs revealed inr=4.7, hct=32->31 (baseline 38-10), and pt was called earlier on morning of admission and told to present to ed. pt denied diarrhaea, constipation, recent nsaid use, or regular alcohol consumption. in the ed, vs: 97.8 70 102/59 16 97%ra. she was guiaic positive rectally. ngl was negative. she was given 1l ivf and started on protonix. . she was in the micu with stable hd and stable hct since that time. gi was consulted and plans for scope likely on monday. she is on a heparin gtt to allow her inr to drift down in preparation for procedure. past medical history: aortic valve replacement, mitral valve replacement in secondary to rheumatic heart disease hypertension atrial fibrillation on coumadin hyperlipidemia herniated lumbar disc disease foraminal stenosis chronic back pain social history: denies alcohol use, has been using snuff tobacco since she was young, no smoking hx, denies ivdu. retired housekeeper. emigrated from ~20 yrs ago. family history: no known history of blood clotting disorder. physical exam: vs: 97.0 70 128/63 19 96%ra. gen: nad heent: perrla, eomi, sclera anicteric, op clear, mmm, cv: rrr, nl s1, s2, no m/r/g. pulm: ctab, no r/r/w. abd: soft, nt, nd, + bs, no hsm. ext: warm, 2+ dp/radial pulses bl. neuro: alert & oriented x 3, cn ii-xii grossly intact. strength symmetric ue and le. pertinent results: hematology 12:45pm wbc-5.7 rbc-3.36* hgb-10.7* hct-31.7* mcv-94 mch-32.0 mchc-33.9 rdw-14.3 12:45pm neuts-60.4 lymphs-34.1 monos-4.1 eos-1.2 basos-0.2 12:45pm plt count-247 12:45pm pt-27.0* ptt-31.3 inr(pt)-2.8* 05:36pm ret aut-4.1* 05:36pm pt-32.6* ptt->150* inr(pt)-3.5* . 05:36pm wbc-7.6 rbc-3.00* hgb-9.7* hct-28.0* mcv-93 mch-32.5* mchc-34.9 rdw-14.4 05:36pm plt count-206 . 11:32pm wbc-6.9 rbc-2.95* hgb-9.5* hct-27.5* mcv-93 mch-32.1* mchc-34.5 rdw-14.3 11:32pm plt count-196 11:32pm ptt-36.1* . 05:36pm tot bili-1.2 05:36pm iron-58 05:36pm caltibc-321 ferritin-22 trf-247 . chemistries. 12:45pm glucose-99 urea n-18 creat-1.0 sodium-143 potassium-3.9 chloride-107 total co2-30 anion gap-10 . urine 02:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 02:30pm urine color-straw appear-clear sp -1.003 . . studies: ekg: nsr, prolonged av-conduction, no ste/std. . tte: the left atrium is moderately dilated. the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened. there is mild aortic valve stenosis. moderate (2+) aortic regurgitation is seen. the mitral valve shows characteristic rheumatic deformity with fused commissures and tethering of leaflet motion. there is moderate mitral stenosis. due to co-existing aortic regurgitation, the pressure half-time estimate of mitral valve area may be an overestimation of true mitral valve area. moderate (2+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. brief hospital course: 65 f h/o afib, htn, avr/mvr, presented with 3 day history of melena, elevated inr, stable hct, transferred from micu to medicine service. . # gib - to evaluate her gi bleeding, an egd and colonoscopy were performed. colonoscopy clear. egd shows antral erosions. h. pylori studies were negative. anticoag risk: bigger cardiac/cva risk of not anticoagulating, compared to anticoagulation risk for gib. she was put on a planned course of ppi for one month, and daily ppi thereafter. she was bridged back to coumadin with a heparin drip, a process which took considerable time. . # htn: held ace and bb for concern for possible new bleeding and risk for hypotension, monitored closely. normotensive with regular rate in the hospital, and did not restart these medicines in the hospital or on discharge. . ## mechanical heart valve: was on heparin bridge while off coumadin in preparation for procedure, and until therapeutic after egd/. this latter heparin to coumadin bridge took considerable time and was the main reason for the length of her admission. she was discharged with an inr of 2.6. . #fen: heart healthy diet after . . #ppx: heparin/coumadin, as above; ppi, as above. . #code: full . #dispo: to home once inr >2.5 #comm: with patient and family. main family contact: daughter , . used creole translators for daily h+ps and discussions with patient. medications on admission: toprol xl 50 mg po qdaily quinipril 20 mg po qdaily lipitor 10mg po qdaily protonix 40 mg po qdaily lasix 20 mg po qdaily colace 100mg po qdaily ativan 1.5mg po qhs discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. methyl salicylate-menthol 15-15 % ointment sig: one (1) appl topical (2 times a day) as needed for back pain. disp:*1 tube* refills:*2* 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours) as needed for antral erosions for 1 months. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 5. warfarin 2.5 mg tablet sig: two (2) tablet po at bedtime: talk to your doctor about whether you should change your dose of warfarin. . disp:*28 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: gi bleed secondary to supratherapeutic inr and antral erosions. discharge condition: good discharge instructions: you were admitted to the hospital because you were having bleeding in your gastrointestinal system. the doctors performed two ; one looked inside your large intestine, and the other looked inside your stomach. the study that looked inside your stomach showed that there were some spots in your stomach lining that had eroded away, and were bleeding. . you have been taking coumadin (also called warfarin), a blood-thinning medicine that is important for you because you have mechanical heart valves. coumadin helps to prevent strokes in people with these heart valves. but coumadin can also make it easier to bleed. it is likely that with too high a coumadin level, the erosions in your stomach bled more than they would have otherwise. . you should continue to take the coumadin, and to get your blood checked regularly. your doctor or nurse may need to change the dosage in order to make sure the coumadin level is correct. . sometimes leafy green vegetables can lower your coumadin level. if eating leafy green vegetables is important in your diet, talk to your doctor about trying to find ways that you can eat your vegetables and have a stable coumadin level. for now, avoid leafy green vegetables like kale and collard greens until you can discuss this with your doctor. followup instructions: make an appointment with dr as soon as possible-- they need to check your blood levels of coumadin, the blood thinner. make an appointment with the gastrointestinal clinic for one month from now. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine colonoscopy transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation other and unspecified hyperlipidemia heart valve replaced by other means blood in stool long-term (current) use of anticoagulants anticoagulants causing adverse effects in therapeutic use hematemesis 

Answer: The patient is high likely exposed to