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: aspirin attending: chief complaint: dark stools x3 days, lethargy major surgical or invasive procedure: endotracheal intubation arterial line placement femoral line placement history of present illness: mr. is a yom with pmh significant for chf, cad, htn, dm, mild dementia, cva, pe on coumadin, and s/p l hip repair on , who was was found to be semi-repsonsive at home on . patient has been weak and lethargic for a few days since returning home from on , and wife mentioned that he has been having dark stool for three days. while patient was walking to the bathroom, pt felt weak and became acutely less responsive. mrs. called 911 and he was brought to the ed for further evaluation. . in the ed, initial vitals were: afebrile 139/63 56 19 94% on 2l. he was lethargic but reponded appropriately to questions, denying cp/sob. his rectal exam showed red blood, but no frank hemorrhage. labs revealed hct 20 from baseline 29. his ekg was significant for new st depressions in v2-v6. an ng lavage was performed which was negative. gi was consulted, recommended iv ppi bolus and gtt. given his st depressions in v2-v6, cards was called, and recommended continuing plavix and coumadin (therapeutic), but no asa due to allergy (anaphylaxis). received 2 units of ffp and 2 large bore ivs and was admitted. . upon immediate arrival to micu, while being turned by nursing, the patient was noted to be agonally breathing and became asystolic on the monitor. a code blue was called. pt was intubated. a sinus ryhthm of 20 was noted, and the patient received 1 round of epinephrine and atropine and regained both pulse and blood pressure. rhythm was noted to be svt with abberency. no antiarryhthmics were administered. central and arterial access was obtained, and he received 1 unit of prbcs and 1l ns wide open. then he was intubated. . his cardiac arrest was thought to be likly due to demand ischemia from gi bleed which triggered myocardial infarction and potentially cardiac arrest. coumadin was held and plavix was given instead. his gi bleed ceased and hct stabilized at 31.4 post total 5 units of tranfusion and fluid resuscitation. echo was done to evaluate lvef and showed ef of 35%-->20%. he had acute on chronic renal failture at cr of 3.2 from 2.7, now at 3.4. gi was consulted and considered egd but decided to do as an elective egd prior to d/c if pt re-bleeds since no further episodes of gi bleed occured and hct stabilized. patient was extubated on and pt tolerated well at o2 sat greater than 95%. oxygen was weaned as tolerated. given patient's moderatly stable conditon, it was decided to transfer pt to regular floor for further management. past medical history: 1. dm2 -latest a1c 6.1% 2. cad s/p cabg x4 in , svg to post and lat circ, svg to om, lima to lad 3. s/p mi (15 years ago) 4. chf: echo -ef 30-35% -moderate mr, moderate to severe tr 5. h/o afib -per chart. patient denies this. 6. ckd -baseline cr 2.3 7. peripheral neuropathy 8. hypertension - not currently being treated 9. pvd s/p fem- bypass in 10. hypercholesteremia 11. depression 12. memory loss 13. cva 14. left intertrochanteric fracture s/p orif 15. recent pe in early , on coumadin 16. histoy of r cea social history: lives at home with wife of 60 years. just d/c'ed form . ambulates without assistance of walker or cane. denies tobacco, illicit drugs. occasional etoh use. family history: non-contributory physical exam: vs: 96.8 64 122/54 19 94% general: elderly causasian male, pale, lying on bed, nad heent: nc/at. perrla. sclera anicteric. conjunctiva pale. dry mm, partially edentoulus. neck: supple with no visible jvd cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. lungs: equal bs bilaterally, mild bilateral rales. abdomen: soft, mildy distended, non-tender. + bowel sounds extremities: no c/c/e. pneumoboots in place distal pulses present. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: heme: 10:45am blood wbc-6.9 rbc-2.11*# hgb-6.6*# hct-20.1*# mcv-95# mch-31.2 mchc-32.7 rdw-18.4* plt ct-321 01:20pm blood wbc-10.2 rbc-4.13* hgb-12.7* hct-37.3* mcv-90 mch-30.8 mchc-34.1 rdw-16.1* plt ct-416 . coags: 10:45am blood pt-26.3* ptt-30.7 inr(pt)-2.6* 01:20pm blood pt-14.6* ptt-74.1* inr(pt)-1.3* . chem: 10:45am blood glucose-269* urean-85* creat-3.2* na-138 01:20pm blood glucose-226* urean-66* creat-2.6* na-137 k-4.4 cl-100 hco3-27 angap-14 . lfts: 04:08pm blood alt-59* ast-59* ck(cpk)-106 alkphos-147* totbili-0.8 06:03am blood alt-43* ast-31 ld(ldh)-295* ck(cpk)-75 alkphos-144* totbili-0.9 . ce's: 10:45am blood ck-mb-12* mb indx-11.3* 10:45am blood ctropnt-0.42* 06:03am blood ck-mb-notdone ctropnt-1.22* . lactate: 01:52pm blood lactate-6.7* 04:40pm blood lactate-1.2 . bilat lower ext veins cresentic thrombus within the left popliteal vein which is only partially occlusive and is most consistent with chronic dvt with recanalization. no evidence of acute dvt within the lower extremities. . echo the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 20 %) with global hypokinesis and inferior, septal and apical akinesis. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . ecg sinus bradycardia. ventricular ectopy. left axis deviation. right bundle-branch block with left anterior fascicular block. there are q waves in the inferior leads consistent with prior myocardial infarction. there are tiny r waves in the anterior leads consistent with probable prior anterior myocardial infarction. compared to the previous tracing there is no significant change brief hospital course: this is a yo male with extensive cardiac disease including cad s/p mi and cabg, pe on coumadin, who presents with lethargy and black stools, found to have a gi bleed, who is s/p cardiac arrest and resuscitation. patient was intubated and sedated in micu, successfully extubated on , and transferred to regular floor() for further care. . # cad s/p cardiac arrest: extensive previous cardiac history s/p cabg. his ekg on this admission demonstrated changes c/w ischemia, most likely due to demand from gi bleeding. trop-t was elevated in the setting of acute on chronic renal failure, but mb-index was positive, again likely due to demand ischemia. this could have triggered myocardial infarction and potentially his cardiac arrest. less likely to be acs/unstable plaque rupture. patient was transferred to regular floor after extubation in micu. pt was monitored on tele with no acute episode of cardiac symptoms or any signs of cardiogenic shock. the benefit of icd was discussed since lvef at 20%, but cardiologist thought that he would not benefit much from icd placement given his comorbidities and he and his wifes wishes to avoid invasive procedures. it was recommended to have repeated echo to re-eval lvef as out patient per his cardiologist. plavix was discontinued and heparin drip was started for his atrial fibrillation. pt was resummend on his regular bp meds at adjusted doses and he tolerated this well. we started on coumadin in addition to heparin and closly monitored hct. his hct was stable at 37.3 on discharge. no asa given- allergy. it is important to closly monitor his hct given h/o acute blood loss and resulted in cardiac arrest. pt need to be transitioned off heparin once inr is therapeutic with coumadin. . # gi bleed: gi followed patient and decided not to perform endoscopy/colonoscopy due to recent cardiac arrest and per patient/family request. pt was on ppi gtt then switched to po ppi. no further signs of bleeding noted. coumadin started on and hct was checked q4d while on iv heparin. hct was stable on d/c at 37.3. it is important that his hct closly monitored for potential recurrent blood loss. and iv heparin need to be transitioned off once inr is therapeutic. plavix was held for risk of bleeding and pt need to discuss with his cardiologist for when to restart plavix. . # respiratory failure is setting of cardiac arrest. pt. weaned off respirator and did well on 98% at ra. . # chronic systolic heart failure: recent ef of 35%-->20% post cardiac arrest. does not appear decompensated currently given cxr. initially held lasix and aldactone but restarted on . pt needs to obtain repeated echo to re-eval lvef as out patient. . # acute on chronic rf - baseline cr has been 2.2-2.5 in early . likely prerenal in etiology given gib. concern for ischemic atn in setting of cardiac arrest. his cr stablized to his baseline 3.2->3.7->2.6 with volume resuscitation. . # dm - last a1c was 6.1%. he was on home regimen of nph 20 units am 12 units pm with ssi with fsg qid. bs well countrolled aroung 130. . # h/o pe: inr was therapeutic in the ed, but pt was reversed with ffp in setting of gi bleed. leni showed left chronic popliteal vein dvt. decision was made to re-anticoagulate him and iv heparin was started with hct check every 6 hours. pt was stable on heparin then coumadin 2.5mg daily was added on with close hct monitoring. his hct was 37.3 on discharge. pt will need to be transitioned off heparin once inr is therapeutic (goal 2.0-2.5). please monitor hct closly. . # delirium: we held his venlafaxine and donepezil due to acute delirium but not resolved. pt need to discuss with primary care physician when to resume these medications. . # s/p hip fracture: previous hardware survey appears intact. pain controlled and no acute issue noted . # htn: continue home meds . # fen-cariac and diabetic healthy diet . # ppx- on po ppi, br standing, hep iv, pboots . # code - full code confirmed with family, but if pt deteriorates would not want life to be prolonged by life support . # dispo: to medical facility medications on admission: 1. carvedilol 6.25 mg tablet sig:one(1)tablet po bid(2 times a day). 2. clopidogrel 75 mg tablet sig: one (1) tablet po q other day. 3. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid 5. senna 8.6 mg tablet sig: one (1) tablet po bid prn 6. simvastatin 40 mg tablet sig: one (1) tablet po daily 7. venlafaxine 75 mg capsule, sust. release 24 hr sig: 8. tamsulosin 0.4 mg capsule, sust. release 24 hr po hs 9. acetaminophen 500 mg tablet sig: two (2) tablet po q6h 10. isosorbide mononitrate 30 mg one tablet sust release 24hr po daily 11. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: twenty seven (27) units subcutaneous qam. 12. insulin nph & regular human 100 unit/ml (70-30) cartridge sig: twelve (12) units subcutaneous q pm. 13. oxycodone 5 mg tablet sig: 0.5 tablet po q6h prn for 2 weeks. 14. spironolactone 25 mg tablet sig: 0.5 tablet po daily 15. lasix 40 mg tablet sig: one (1) tablet po once a day. 16. hydralazine 10 mg tablet sig: one (1) tablet po qid 17. nitroglycerin 0.4 mg tablet, sublingual sig: tablet, prn discharge medications: 1. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 2. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 3. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 4. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. furosemide 20 mg tablet sig: two (2) tablet po daily (daily). 7. hydralazine 10 mg tablet sig: one (1) tablet po tid (3 times a day). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. other 13. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 14. insulin regimen at your home dose nph: 20 units at breakfast and 12 units with dinner 15. heparin gtt (goal ptt 60-100) discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: 1. gastrointestinal bleed 2. cardiac arrest 3. congestive heart failure 4. diabetes mellitus 2 5. coronary artery disease 6. history of myocardial infarction status post coronary artery bypass graft 7. atrial fibrillation 8. hypertension 9. hypercholesteremia . secondary: 1. peripheral neuropathy 2. depression 3. dementia discharge condition: stable, no evidence of blood loss discharge instructions: you were admitted with weakness and dark stool x 3 days which suggested gastrointestinal bleed. your hematocrit was at 20.1 on admission and red blood was noted in your rectum and you were transfused with blood. you experienced cardiac arrest in medical intensive care unit and you were resuscitated with cpr and medications. in total, you were transfused 5 units of blood with 2 units of plasma. . once your condition was stable (no evidence of bleeding) you were again restarted on heparin and coumadin, your blood levels remained stable and there was no evidence of bleeding. it was necessary to restart these medications as you are at risk for a stroke due to atrial fibrillation and you have a chronic lower leg vein blood clot. , in accordance with you and your wife's wishes, we did not do an endoscopy or colonoscopy to investigate the initial source of your bleeding. you will need to carefully monitor your inr and your blood level (hematocrit) with your primary care doctor for signs of bleeding. we strongly recommend your hematocrit to be closely monitored since you experienced cardiac arrest secondary to acute blood loss. . if you feel weakness or further dark stool, it is important that you call your primary care or come to emergency room. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet and fluid restriction. . medication changes: your donepezil and venlafaxine, these medications should be restarted in consultation with your physician. , we stopped your plavix in consultation with your cardiologist. do not restart without speaking with dr. first. followup instructions: provider: , md phone: date/time: 9:45 provider: xray (scc 2) phone: date/time: 8:40 provider: , md phone: date/time: 9:00 . please call dr. office ( to make a follow up appointment in approximately 2 weeks after leaving . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization transfusion of packed cells cardiopulmonary resuscitation, not otherwise specified transfusion of platelets diagnoses: acidosis subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases peripheral vascular disease, unspecified depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified acute respiratory failure other specified cardiac dysrhythmias cardiac arrest blood in stool chronic systolic heart failure long-term (current) use of anticoagulants personal history of venous thrombosis and embolism personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits unspecified hereditary and idiopathic peripheral neuropathy diseases of tricuspid valve right bundle branch block and left anterior fascicular block nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney background retinopathy, unspecified 

Answer: The patient is high likely exposed to