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: elevated inr major surgical or invasive procedure: none history of present illness: 68 f with esrd on hd, chf with ef 15%, cad s/p cabg, afib on coumadin, admit from ed with significantly elevated inr now s/p 4 units ffp. patient reports being in her usual state of health with exception of mild diarrhea starting yesterday. patient reports daughter gave her a medication for this. on , inr checked and noted to be 8.6. during hd today, inr rechecked and greater than assay. initial bp 81/36, post bp 93/50 (range 73-93). hgb 9.2. other than diarrhea, patient has been feeling well. no abdominal pain, fever, chest pain, bloody stools, epistaxis, hematemesis or other e/o bleeding; no dyspnea, though feels "wheezy" following ffp, feels like she got too much fluid. no dysuria though has had "dark urine". . in ed, vitals 98.4, hr 72, bp initially 76/40, r20, 100% on 4l. started on 4 units ffp, received 5 vit d sq and 5 iv. hct 32 (at baseline). 3pm labs pending. likely to dialysis tomorrow. ace and b-blocker have been held. . hospital course: s/p 4 u ffp. hct stable w/o source of bleed. bp now in 90s. past medical history: 1. chf with ef of 15% s/p biv pacer on coumadin, recently admitted for chf exacerbation in 2. esrd - on hd since , *edw 64.4 kg* 3. cad s/p mi & cabg x 2 ( and revised in ) 4. dmii x 4yrs on insulin 5. s/p l aka 6. hypothyroidism 7. a-fib on coumadin 8. home oxygen (needed at night when sleeping) social history: lives at home with daughter. remote smoking history less than 2-3yrs total, pt has not smoked in over 30yrs. there is no history of alcohol abuse or ivdu. family history: non-contributory physical exam: vitals: t 97 (afeb), bp 105/55 (80-100/40-50), hr 78 (paced), r 16, 100% 2l. wt 69 kg; i/o 170/anuric general: pleasant female, nad heent: nc/at, perrl, sclera anicteric, mm slightly dry neck: supple, no adenopathy. l ej in place chest: +bilateral rhonchi with few wheezes, no crackles appreciated heart: rrr s1 s2, sm at lusb abdomen: soft, ntnd, no hsm, +bs extrem: s/p l aka, rle without edema. neuro: alert, appropriate, mae. pertinent results: labs: 03:00pm blood wbc-4.4# rbc-3.49* hgb-10.0* hct-32.5* mcv-93 mch-28.7 mchc-30.9* rdw-20.8* plt ct-158 07:15am blood wbc-5.0 rbc-3.21* hgb-9.1* hct-31.7* mcv-99* mch-28.4 mchc-28.8* rdw-21.4* plt ct-189 03:00pm blood glucose-104 urean-14 creat-1.4* na-139 k-7.4* cl-100 hco3-34* angap-12 07:15am blood glucose-148* urean-37* creat-1.9* na-141 k-4.2 cl-101 hco3-34* angap-10 04:42am blood albumin-2.8* calcium-8.1* phos-3.5 mg-1.6 07:15am blood calcium-8.5 phos-3.8 mg-2.1 04:42am blood alt-16 ast-32 ld(ldh)-242 alkphos-234* totbili-0.3 04:42am blood tsh-5.2* 01:10pm blood free t4-1.3 03:00pm blood vanco-13.2 04:23pm blood lactate-1.2 . inr 04:15pm blood pt-150* ptt-150* inr(pt)->22.8* 04:00pm blood pt-17.7* inr(pt)-1.6* . blood cx- no growth . cxr : impression: persistent small bilateral pleural effusions. marked interval improvement in right-sided pleural effusion. support lines as described. no pneumothorax. increased airspace opacity involving both lungs may simply reflect low lung volumes, but mild pulmonary edema is not excluded. brief hospital course: assessment and plan: 68 f with esrd on hd, chf, afib on coumadin; admit to micu with supratherapeutic inr now s/p 4 units ffp and iv vit k. . # elevated inr. the patient had an elevated inr which was greater than assay at one point early on in her admission. of note, the patient took a bowel regimen for constipation and reports significant diarrhea prior to admission. the patient was not taking excess coumadin doses. in addition the patient was on vancomycin for a previous hd catheter infection which could have contributed to the increased inr. the patient had no signs of bleeding at the time of admission or during her hospitalization. her inr normalized with giving iv vit k and 4 units of ffp. the patient was restarted on coumadin prior to discharge. she was discharged on 4mg of coumadin daily with a follow up inr check at hemodialysis. . # hypotension. the patient became hypotensive with sbps in the 70s in ed and at hd. she was admitted to the micu for monitoring and her home bp medications were stopped. she had a negative blood cx and a negative cxr. she was receiving vancomycin with hd for a previous line infection. her sbp on the day of discharge ranged from 100-110s and she was not restarted on her bp meds prior to discharge. . #hypothyroidism: she had and elevated tsh at 5.2 and a normal free t4. her dose of levothyroxine was increased from 125 to 150mcg daily. . # systolic chf: the patient has systolic chf with an ef of 15%. she received 4 units ffp plus additional ivf while in the micu. she did not require early hd as she was not volume overloaded. her carvedilol and acei were held due to her hypotension and not restarted prior to discharge. . # diabetes type ii: the patient was continued on her home lantus and iss. . # esrd on hd: the patient received hd while at the hospital as per her normal schedule. she finished her doses of vancomycin for her previous line infection. . # cad. the patient has a history of cad and cabg x2 with chf. she was continued on asa while in the hospital. the patient was not able to tell me the name of her new pcp so could not find out why she was no longer on a statin. i did confirm her medications with her pharmacy and she was not receiving a statin. her ace and beta-blocker were held due to her hypotension. these medications should be restarted as an out-patient after follow up with her pcp. . #lesions on back of calf and bleeding of r big toe secondary to nail clipping. the lesion of the back of her calf is surrounded by erythematous tissue suggesting adequate blood flow to heal the lesion. . left phantom limb pain. the patient felt her ultram was not helping her. she uses a lidocaine patch on her left leg which provides some relief. i started gabapentin which the patient requested to be discharged on. . # full code: discussed with patient pgy-1, medications on admission: carvedilol 3.125 mg daily lantus 12 units at hs senna 1 tab humalog sliding scale asa 325 mg daily lorazepam 0.5 mg hs prn albuterol neb qid prn wheeze lisinopril 5 mg daily percocet 5-325, 1-2 tabs qid prn pain tramadol 50 mg q6h prn colace 100 levothyroxine 125 daily warfarin 5 mg daily flovent mdi vanco with hd zolpidem 5mg qhs bisocodyl 5mg 1-2 tabs daily enulose 90ml, 15ml q4hrs vicadin 5 tabs 5/500 q4hrs lidoderm patch 5% 1 daily prn limb pain discharge medications: 1. sevelamer hcl 400 po tid w/meals 2. levothyroxine 150 mcg po once a day. 3. aspirin 325 mg po daily 4. docusate sodium 100 mg po bid: prn as needed for constipation. 5. senna 8.6 mg po bid:prn as needed for constipation. 6. acetaminophen 500 mg two tablet po q6hrs: prn pain as needed for pain. 7. zolpidem 5 mg po hs (at bedtime) as needed for insomnia. 8. bisacodyl 5 mg tablet sig: 1-2 tablets po once a day as needed for constipation. 9. lactulose 10 gram/15 ml solution fifteen ml po every four (4) hours as needed for severe constipation. 10. lorazepam 0.5 mg po qhs as needed for anxiety. 11. lidocaine 5 %(700 mg/patch) one adhesive patch daily 12. oxycodone 5 mg po every four (4) hours as needed for pain. 13. guaifenesin 600 mg tablet po twice a day as needed for cough. 14. insulin glargine continue home dose of 12units subcut qhs 15. humalog continue previous home sliding scale 16. warfarin 4 mg po once a day. 17. fluticasone 110 mcg/actuation aerosol two puff inhalation 18. albuterol sulfate 2.5 mg /3 ml (0.083 %) one inhalation every six (6) hours as needed for wheeze. 19. gabapentin 300 mg one capsule po q24h as needed for limb pain. discharge disposition: home with service facility: vna discharge diagnosis: primary 1. supratherapeutic inr 2. hypotension 3. end stage renal disease on hemodialysis . secondary 1. chronic congestive heart failure with ef 15% 2. coronary artery disease s/p myocardial infarction 3. left above the knee amputation 4. hypothyroidism 5. atrial fib discharge condition: blood pressure stable and inr no longer supratherapeutic discharge instructions: you were admitted with a supratherapeutic inr and with decreased blood pressure. your supratherapeutic inr was treated with fresh frozen plasma and vitamin k. your blood pressures have improved and you have been put back on coumadin with a goal inr of . . the doses of the following medications were changed: -warfarin -levothyroxine . the following medications were discontinued: -carvedilol -lisinopril -dextromethorphan-guaifenesin . the following meds were started: gabapentin . adhere to 2 gm sodium diet fluid restriction to 2l . please return to the hospital if you develop dizziness, difficulty breathing, chest pain, blood in stool, vomiting blood, blood in urine, any sign of bleeding, or any new medical condition. . please check inr with dialysis followup instructions: please follow up with your pcp 1-2 weeks and discuss restarting your blood pressure medications. procedure: hemodialysis diagnoses: end stage renal disease abnormal coagulation profile congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypotension, unspecified long-term (current) use of insulin old myocardial infarction chronic systolic heart failure cardiac pacemaker in situ personal history of venous thrombosis and embolism hyperparathyroidism, unspecified anticoagulants causing adverse effects in therapeutic use above knee amputation status 

Answer: The patient is high likely exposed to