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: history of present illness: the patient is a 71 year old male with a history of ischemic cardiomyopathy (ef of 10 to 15%) and history of recurrent gi bleeds (previously on coumadin for left ventricular aneurysm), status post recent admission in , for a gi bleed with evidence of avm's on esophagogastroduodenoscopy requiring 17 units of packed red blood cells. the patient presented to the emergency room on the day of admission with a history of fatigue, decreased exercise tolerance and black tarry stools. the patient denied any chest pain but mid-back pain is the patient's anginal equivalent. the patient called his primary care physician who referred him to the emergency room for evaluation. in the emergency room, the patient's blood pressure was 78/40 and rectal revealed melena. hematocrit on admission was 17.3. the patient received 800 cc of intravenous fluids and 3 units of packed red blood cells with an increase in blood pressure to 110/60. of note, the patient's baseline systolic blood pressure is 80 to 90. review of systems: on review of systems, the patient denied any abdominal pain, nausea, vomiting. reports good appetite. no fevers, chills or cough. past medical history: 1. coronary artery disease status post anterior lateral myocardial infarction in . status post cardiac catheterization with stent placement to the left anterior descending, , complicated by apical thrombus requiring emergent coronary artery bypass graft. 2. congestive heart failure with an ejection fraction of 10 to 15%, severe left ventricular dilatation, global hypokinesis starting at the base, known apical aneurysm. on coumadin previously which was discontinued at prior hospitalization for gi bleed. severe mitral regurgitation and tricuspid regurgitation. 3. history of atrial fibrillation. 4. status post ddd pacemaker and aicd placement. 5. status post cerebrovascular accident. 6. hypercholesterolemia. 7. chronic renal insufficiency with baseline creatinine of 1.4. 8. history of gi bleed. colonoscopy in , showed diverticulosis with a single polyp at 12 cm. egd in , showed avm's in the third part of the duodenum. 9. status post ablation of atrial tachycardia. 10. history of methicillin resistant staphylococcus aureus pneumonia. 11. status post appendectomy. 12. depression. medications on admission: 1. lasix 80 mg p.o. twice a day. 2. toprol xl 12.5 mg p.o. q. day. 3. amiodarone 200 mg p.o. q. day. 4. digoxin 0.125 mg p.o. q. day. 5. lipitor 20 mg p.o. q. day. 6. zoloft 100 mg p.o. q. day. 7. niferex 100 mg p.o. q. day. 8. aldactone 25 mg p.o. q. day. 9. prilosec 40 mg p.o. q. day. 10. multivitamin. 11. zestril 40 mg q. day. of note, the patient's aspirin and coumadin were discontinued in , after admission for gi bleed. the patient reports he was not restarted on aspirin after this discharge. allergies: neosporin eye drops. social history: the patient lives with his wife and adopted five year old son. the patient quit smoking tobacco approximately 11 years ago. has a 50 pack year history of smoking. the patient quit drinking alcohol approximately 40 years ago. physical examination: on admission, afebrile, blood pressure 100/40; heart rate 80 and paced; respiratory rate 14; o2 saturation 100% on room air. in general, well appearing, pale, in no acute distress. heent: pupils equally round and reactive to light. extraocular muscles are intact. lungs are clear to auscultation bilaterally. cardiovascular: diffuse point of maximum impulse, positive s4, regular rate, iii/vi systolic murmur heard best at the base. abdomen soft, nontender, nondistended, normal bowel sounds. no hepatomegaly. extremities one plus pretibial pitting edema. dorsalis pedis two plus bilaterally. neurologic: alert and oriented times three. rectal: guaiac positive with melena per emergency department. laboratory: on admission, white blood cell count 6.2, hematocrit 17.3, platelets 155,000, inr 1.2, creatinine 2.3, bun 133, glucose 159. cpk 57, digoxin 2.0. hematocrit at the day of discharge, 31.6. radiographic imaging: chest x-ray showed no evidence of pneumonia. there is a persistent right sided pleural effusion and massive cardiomegaly. repeat chest x-ray , showed massive cardiomegaly with left ventricular predominance. no evidence of congestive heart failure. hospital course: the patient is a 72 year old male with a history of ischemic cardiomyopathy with ejection fraction of 10 to 15%. recent admission in , when he presented with hypotension and melena. egd at that time showed avm's in the third part of the duodenum. the patient received approximately 17 units of packed red blood cells during this time. the patient is now admitted with progressive fatigue, melena and orthostasis on examination. the patient's hematocrit on admission was 17.3. the patient denied any abdominal pain, nausea or vomiting at the time of admission but did complain of back pain which is anginal equivalent and was out by myocardial infarction by serial cardiac enzymes. during this hospitalization, the patient underwent egd on , and . first egd showed a small hiatal hernia and lots of coffee ground blood in the stomach and three avm's in the stomach fundus which were cauterized. the first one-third of the duodenum was visualized with no evidence of bleeding. the patient received approximately five units of packed red blood cells with an increase in hematocrit from 17.3 to 20.1. on hospital day number two, the patient's sodium started to increase as the patient had been diuresing spontaneously and was npo for several days. d5w was started. on hospital day number four, sodium increased to 152 and d5w rate was increased with no evidence of congestive heart failure on examination or chest x-ray despite ejection fraction of 10 to 15% and multiple packed red blood cell transfusions. urine sodium initially was 26 which decreased to less than 10 approximately two days later. the patient's serum sodium eventually decreased to 147 and d5w was discontinued. the patient had a continual low hematocrit of approximately 25 despite 10 to 15 units of packed red blood cells. in addition, the patient also received fresh frozen plasma. on , the patient underwent a second egd with further exploration into the distal duodenum. gastric avm's previously seen were no longer bleeding. did find spreading avm's in the distal third of the duodenum which were cauterized. since second egd the patient was transfused 4 units of packed red blood cells with stable hematocrit of 30. at this time, the patient was transferred from medical intensive care unit to the medical floor. 1. gastrointestinal: the patient is status post egd times two as above with three gastric fundi avm's cauterized and one distal spreading avm in the duodenum cauterized. the patient's hematocrit remained stable at 30 in the 48 hours prior to discharge. in total, the patient received 17 units of packed red blood cells. given his history of ischemic cardiomyopathy and coronary artery bypass graft. the patient was restarted on aspirin 81 mg p.o. q. day two days prior to discharge. 2. cardiovascular: the patient received a total of 17 units of packed red blood cells, 2 units of fresh frozen plasma and 12 liters of d5w. despite large volume given, the patient had no evidence of congestive heart failure during this admission. at the time of discharge, the patient was restarted on all his home medications except his lasix dose was decreased from 80 mg p.o. twice a day to 40 mg p.o. q. day. the patient is to follow-up with his cardiologist at discharge. 3. renal: the patient presented with an elevated creatinine of 2.3 with baseline of 1.4. the patient received a large amount of intravenous fluids with a decrease in creatinine to baseline at the time of discharge. condition on discharge: stable. discharge status: the patient was discharged to home. discharge diagnoses: 1. upper gastrointestinal bleed. 2. ischemic cardiomyopathy. medications at the time of discharge: 1. aspirin 81 mg p.o. q. day. 2. toprol xl 25 mg p.o. q. day. 3. zestril 40 mg p.o. q. day. 4. aldactone 25 mg p.o. q. day. 5. lasix 40 mg p.o. q. day. 6. digoxin 0.125 mg p.o. q. day. 7. amiodarone 200 mg p.o. q. day. 8. lipitor 20 mg p.o. q. day. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding diagnoses: mitral valve disorders congestive heart failure, unspecified atrial fibrillation other specified forms of chronic ischemic heart disease angiodysplasia of intestine with hemorrhage hyperosmolality and/or hypernatremia diseases of tricuspid valve angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to