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: darvocet-n 50 attending: chief complaint: epistaxis, nausea, hypotension major surgical or invasive procedure: egd history of present illness: the patient is a 65 yo m with hx of multiple cvas, cad with stents (des to rca , off plavix), htn, pacemaker, mechanical aortic valve who has had several recent admissions to for anemia (thought secondary to epistaxis and hematuria). most recently admission was(), where he initially presented with sob, dizziness and hct of 22, and guaiac pos stools. he was transfused, and did not bump appropriately to transfusions; labs were suggestive of hemolysis although coombs and antibody testing were normal. his hct stabilized and was 23.6 on discharge; he was sent home with a plan to f/u with hematology and undergo outpatient egd/. overnight, he experienced an episode of copious epistaxis and returned to the ed today complaining of ha, nausea and mild sob. in the ed, initial vs were: 98.8 86 93/48 18 100% on ra. bp declined to 70s/40s and hct was down approx 3 pts to 20.8 with inr 3.1. rectal exam showed black, guaiac pos stool and nasal examination showed slight oozing of the septum. the patient was given approximately 800 cc ns, protonix 80 mg iv, zofran iv, and given 3 units prbcs. during his transfusion, reportedly passed a large amount of melena, and was cross-matched for another 4 units prbcs. vitals on transfer were: bp 86/50, hr 74, rr 25, 100% on ra. he was admitted to the icu for ongoing hypotension in the setting of anemia. on the floor, patient reports dizziness, nausea and abdominal tenderness. has some sob, which he describes as chronic. no epistaxis today. review of systems: (+) per hpi, also reports recent constipation the past week (relieved with today's melena, as well as intermittent black stools for the past several months. (-) denies fever, chills, night sweats, recent weight loss or gain. denies sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - cva x 4 (most recent while on warfarin, asa and plavix) - htn - cad - single vessel distal lad - mi - in , 3 stents unknown type unknown date - s/p icd implantation parciology pc - chf - preserved ef, diastolic - avr - mechanical valve - dm-ii - copd - low back pain - nephrolithiasis - duodenal ulcer on egd social history: -smoking/tobacco: 60 pack years, quit 2 years ago -etoh: seldom -illicits: iv drugs once in his life when young, never again -lives at/with: daughter and her family. she assists with his medications. independent with adls and ambulates with cane. from - he lived in and so we have no records of his care at that time. he states that he has never been in the military, never been incarcerated although he has been around individuals who have. he is not currently sexually active and has had female partners in the past. family history: (from omr) there is diabetes mellitus, hypertension and dyslipidemia in several immediate family members. his sister had chf/?mi begining in her late 40s. his mother had breast cancer and chf. physical exam: vitals: t: 96.6 bp: 83/46 p: 70 r: 18 o2: 99% on ra general: elderly aa man, appearing in mild discomfort heent: ncat, sclera anicteric, mmm, oropharynx clear, nasal mucosae with dried blood visible on nasal septum b/l lungs: mild bibasilar rales, otherwise ctab cv: regular rate and rhythm, normal s1 + s2, ii-iii/vi systolic murmur loudest rusb abdomen: soft, non-distended, bowel sounds present, ttp in upper quadrants b/l, no rebound tenderness or guarding gu: no foley ext: warm, well perfused, 2+ pulses, 2+ pitting edema b/l (per family, slightly improved from baseline) discharge: pertinent results: admission labs wbc-6.8 rbc-2.49* hgb-8.1* hct-23.6* mcv-95 mch-32.6* mchc-34.4 rdw-18.2* plt ct-184 pt-38.0* ptt-47.9* inr(pt)-3.9* glucose-105* urean-22* creat-0.7 na-133 k-4.1 cl-105 hco3-21* angap-11 hct nadir 20.8 cxr (): small bilateral pleural effusions, larger on the left side associated with adjacent atelectasis worse in the left side are new. cardiomegaly is stable. left transvenous pacemaker leads terminate in standard position in the right atrium and right ventricle. mild vascular congestion is new. sternal wires are aligned. degenerative changes are in the thoracic spine. patient is status post avr. egd: erythema and contact bleeding in the antrum compatible with diffuse gastritis 07:00am blood pt-28.8* ptt-106.5* inr(pt)-2.8* 06:35am blood pt-23.8* ptt-83.0* inr(pt)-2.3* 07:25am blood pt-22.4* ptt-65.5* inr(pt)-2.1* 09:54am blood pt-20.9* ptt-47.5* inr(pt)-1.9* 06:18pm blood pt-20.8* ptt-39.7* inr(pt)-1.9* brief hospital course: 1. acute blood loss anemia: multifactorial with (a) epistaxis; (b) gastritis; (c) anticoagulation. a total of 8 units of prbc were transfused and aspirin/warfarin were held. no reversal of anticoagulation was done given mechanical valve and prior stroke. after egd showed gastritis, pantoprazole dose was increased. ent follow-up was arranged to help manage epistaxis which stopped spontaneously. 2. hypotension: per family and the patient, he has had chronically low bps for at least the past month. likely secondary to hypovolemia in the setting of acute bleed. sbp remained in 90s after stabilization of bleeding. given chf/cad, low dose beta blocker and daily morning lasix was resumed on discharge since bp was at its baseline. 3. epistaxis: patient with multiple episodes of epistaxis in the past several months. last ent evaluation showed evidence of anterior bleeding. afrin was given for 3 days was given as well as nasal saline, humidified air and vaseline to nasal mucosa. ent follow-up was arranged. 4. gastritis: given guaiac positive stool, egd was done and showed gastritis. pantoprazole dose was increased. 5. mechanical avr: anticoagulated with goal inr 2.5-3.5. managed with a heparin gtt with warfarin resumed after stabilization of hct. he was instructed to take 2mg warfarin on discharge (), repeat level will be drawn by vna on and will be in touch with patient. pt's pcp (dr. was paged and this issue discussed. date - inr value:warfarin dose - 1.9:3mg - 1.9:3mg - 2.1:3mg - 2.3:3mg - 2.8:2mg 6. congestive heart failure, diastolic, acute on chronic: initially dry to euvolemic but after administration of prbc, experienced orthopnea with cxr showing mild vascular congestion. improved with one day of iv furosemide diuresis. as above, resumption of beta-blocker and lisinopril was initially limited by sbp, though bp normalized to his baseline of low 90s. once daily lasix and low dose betablockade was resumed. medications on admission: (list confirmed with patient on arrival to the floor) - flovent hfa 110 1 puff twice daily - folic acid 1 mg daily - furosemide 20 mg daily - glyburide 10 mg daily - combivent 18-103 mcg 1 puff twice daily as needed for shortness of breath - lisinopril 2.5 mg daily - metoprolol succinate (toprol) 12.5 mg daily - nitroglycerrin sl 0.4 mg as needed chest pain - oxycodone 10 mg daily as needed for back pain - polyethylene glycol 3350 17 gram daily as needed for constipation - aspirin 81 mg daily - colace 100 mg twice daily - warfarin with goal inr 2.5-3.5 - recently prescribed but not yet taken: ferrous sulfate 300 mg daily and omeprazole 20 mg daily discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. fluticasone 110 mcg/actuation aerosol sig: one (1) puff inhalation (2 times a day). 3. glyburide 5 mg tablet sig: two (2) tablet po once a day. 4. combivent 18-103 mcg/actuation aerosol sig: one (1) puff inhalation twice a day as needed for shortness of breath or wheezing. 5. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po daily (daily). 6. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual as needed as needed for chest pain. 7. oxycodone 5 mg tablet sig: two (2) tablet po once a day as needed for back pain. 8. polyethylene glycol 3350 17 gram powder in packet sig: one (1) packet po once a day as needed for constipation. 9. colace 100 mg capsule sig: one (1) capsule po twice a day. 10. ferrous sulfate 324 mg (65 mg iron) tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). :*60 tablet, delayed release (e.c.)(s)* refills:*2* 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm: take night of (sunday). discuss monday night's dose with nurse. :*10 tablet(s)* refills:*0* 14. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po daily (daily). 15. furosemide 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: 1. acute blood loss anemia 2. gastritis, diffuse with active bleeding 3. epistaxis 4. mechanical heart valve 5. prior stroke 6. coronary artery disease, native 7. chf, diastolic, chronic 8. diabetes, type ii, controlled discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with a low blood count (anemia). this is most likely from both a nose bleed (epistaxis) but may also be from some bleeding in your stomach (gastritis). you received a total of 8 units of blood transfused. to help promote healing of the stomach, we have increased your dose of pantoprazole to twice daily. you had some fluid overload (heart failure) from the transfusions and required a higher lasix dose, but this has been readjusted back to your baseline. you were treated with iv heparin bridge until your inr was at normal levels again. you will need to have your inr and blood count checked tomorrow and faxed to your doctor's office. followup instructions: department: post clinic when: wednesday at 10:50 am with: dr building: sc clinical ctr campus: east best parking: garage this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: otolaryngology (ent) when: wednesday at 1:45 pm with: , m.d. building: lm campus: west best parking: . garage department: cardiac services when: monday at 3:30 pm with: dr. building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: wednesday at 4:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: other endoscopy of small intestine diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified personal history of tobacco use heart valve replaced by other means hypotension, unspecified long-term (current) use of anticoagulants cardiac pacemaker in situ personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits lumbago epistaxis chronic diastolic heart failure other specified gastritis, with hemorrhage 

Answer: The patient is high likely exposed to