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: dyspnea. major surgical or invasive procedure: endoscopy, colonoscopy, right and left cardiac catheterization with bare metal stent placement history of present illness: this is a 63 year old gentleman with cad s/p cabg (svg-d, svg-rca and lima-lad svg-rca which was occluded on catheterization), diastolic chf, atrial fibrillation/flutter, type ii diabetes presented to an osh with worsening dyspnea over one day. of note patient was recently admitted to with an acute mi in , at that time pci was performed with svg to the diag was performed. the patient was to return for pci on the native om. also of note, the pt's post-cath course on prior admission was complicated by large groin hematoma; he required 3 units prbc and repair by vascular surgery. pt also noted to have one guaiac positive stool. . since that time the patient has developed worsening shortness of breath over several weeks associated with non-productive cough. he denies any chest pain, or fever. over the last few days he has been using his wife's oxygen with some relief. he could only move a few feet before becoming short of breath. . on admission to osh on , he found to have +2 pedal edema, o2 sats 85-90% on ra. no mention is made of other vital signs. the patient was briefly on bipap, transitioned to 4l nc maintaining sats between 97-100%. he was diagnosed with chf exacerbation. he was treated with lasix 60 iv and nebulizers. his respiratory status improved. the patient had a leukocytosis to 20,000 but this was not commented on in the notes. there was some concern for abscess and mention is made of obtaining mri, per the patient this was not done because of his heart monitor. in general the course at the osh is poorly documented, with no discharge summary and confusing, at times, illegible notes. . the patient reported currently feeling somewhat better. he denies any chest pain and feels his breathing is improved. . ros: chronic back pain since . no nausea/vomiting, but he did have some diarrhea this morning. no abdominal pain except with coughing. no dizziness, weakness, imbalance, loss of continence. a total of 10 of 14 systems were reviewed and, other than those mentioned, were negative. past medical history: myasthenia cad s/p cabg hypertension dyslipidemia atrial flutter/fibrillation diabetes mellitus ventral abdominal hernia s/p mva in . lower back pain, has l-spine compression fractures gi bleed social history: quit tobacco ; rarely drinks alcohol; lives with his wife; currently on disability, former director of an exercise company family history: grandmother with pacemaker, no other known heart disease physical exam: t 98.6; hr 60-65; bp 112/62; rr 19; o2 99% on 4l gen: obese male caucasian, no acute distress. heent: clear op, mmm neck: supple, obese neck, jvp about 10 cm. cv: irregularly, irregular, nl rate. distant heart sounds. no murmurs, rubs, gallops. lungs: fair air movement, occasional crackles, no wheezes. abd: obese; inch ventral hernia - easily reducible, nontender; soft, nt, nd. nl bs. ext: 1+ pedal edema, improved per patient. neuro: a&ox3. appropriate. cn 2-12 grossly intact. normal coordination. gait assessment deferred pertinent results: wbc 20.4 hct 31.7 (baseline around 30) plt 434 90 neutophils, 4 bands p-bnp 1650 ck 24 trop 0.06 inr 0.9 ptt 21.8 na 141 k 4.1 cl 107 bun 26 cr 1.4 gluc 182 digoxin 1.2 . ekg: atrial fibrillation, rate 65, low voltage . cxr: osh (image unavailable) no pulmonary edema, "r lower lobe opacity" (my read) mild pulm congestion, r costophrenic angle missing, no focal infiltrates seen, no effusions. . echocardiogram 1.the left atrium is moderately dilated. the left atrium is elongated. 2.there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). 3. right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the ascending aorta is mildly dilated. 5.the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. 6.the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. 7.the estimated pulmonary artery systolic pressure is normal. 8.there is no pericardial effusion. bleeding study : following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen for 120 minutes were obtained. a left lateral view of the pelvis was also obtained. blood flow images show no sites of abnormal radiotracer uptake. dynamic blood pool images show no active gastrointestinal bleeding. impression: no active gastrointestinal bleeding after 2 hours. bleeding study : following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen from 0-79 minutes and from 150-180 minutes were obtained. a left lateral view of the pelvis was also obtained. blood flow images show a normal pattern of tracer distribution. dynamic blood pool images show somewhat heterogeneous blood pool throughout the abdomen, most prominent in the left lower quadrant. the activity does change in distribution throughout the examination but does not appear to collect. the changing pattern could reflect physiologic bowel movement. impression: no definite evidence of gi bleeding. upper endoscopy: findings: esophagus: normal esophagus. stomach: mucosa: erythema of the mucosa with no bleeding was noted in the stomach body and antrum. these findings are compatible with gastritis. duodenum: protruding lesions a single small non-bleeding polyp was found in the second part of the duodenum. impression: erythema in the stomach body and antrum compatible with gastritis polyp in the second part of the duodenum otherwise normal egd to second part of the duodenum : colonoscopy: findings: contents: red blood, with some clots was seen in the whole colon. flat lesions many angioectasias that were not bleeding were seen in the cecum. mono-polar cautery unit was applied for hemostasis. the avms did not bleed on cauterization. protruding lesions four sessile 3-4mm polyps of benign appearance were seen. 2 in the cecum and 2 distally (descending and sigmoid colon). they were not removed at this time. excavated lesions multiple diverticula were seen in the whole colon. no active bleeding was seen in the diverticuli. other few small ulcerations were seen in the ileum. they were not bleeding. there was no blood in the ileum. impression: blood in the whole colon diverticulosis of the whole colon angioectasias in the cecum (thermal therapy) polyps in the cecum few small ulcerations were seen in the ileum. they were not bleeding. there was no blood in the ileum. otherwise normal colonoscopy to cecum and terminal ileum brief hospital course: this is a 63 year old gentleman with cad s/p cabg, chf (diastolic) and atrial flutter/fibrillation who presented to an outside hospital for dyspnea and found to be hypoxic on room air. he was diagnosed with chf exacerbation and this improved after diuresis. he was transferred here for chf management and for repeat catheterization. on transfer his oxygen status appeared improved after diuresis and patient seemed more comfortable. he did have some jugular vein distention, scattered rales and le edema. he was therefore diuresed on hd1. further diuresis was stopped as his creatinine trended upward the following day. . of more importance was that his troponin was noted to trend upward and he ruled in for mi. heparin was started. the patient was therefore started on heparin on hd 2. subsequent to this the patient was noted to have brown, guaiac positive stools with his hct trending downward. heparin was discontinued for this reason. his hematocrit trended further downward and the patient developed brbpr, melena was not noted. planned catheterization on hd 3 was therefore deferred. gi was consulted and they planned for endoscopy to be done on prior to his catheterization. on hd patient had multiple episodes of brbpr; however his hematocrit remained stable. bp and pulse remained stable until the afternoon of hd 5. . at this time when the patient became tachycardic to the 130's with sbp to 70's after another episode of brbpr. ng lavage was negative and stat blood draw revealed no change. ekg revealed st depressions in inferolateral leads consistent with posterior. posterior lead ekg was also consistent with posterior territory ischemia the blood pressure spontaneously trended to the 90's range systolic. the patient received one 250 cc bolus and a unit of prbc. his blood pressure stabilized for the next two days. it was believed the hypotension was secondary to posterior ischemia given the anatomy of his cad and his ekg changes . on hd 7 the patient underwent catheterization with des to the om1. of note the patient was briefly hypotensive in the cath holding area. this resolved spontaneously (pt was on pre-cath fluids). importantly, the pt was found to have a melanotic stool movement the prior night and had an additional melanotic movement the afternoon after catheterization. this was not reported to the medical team until the afternoon of hd 7. his blood pressure and pulse remained unchanged. gi consult was notified and he was taken to the intensive care unit for endoscopy and further monitoring. upper endoscopy revealed gastritis but no active source of bleeding. he continued to have melanic stools, and his hct continued to trend down although vital signs remained stable. he required 1-2units prbcs daily. bleeding scan was negative x2. a colonoscopy was preformed which was filled with blood. it also showed diverticula and avms (which were cauterized) although no active source of bleeding was noted. the ileum showed ulcers but since there was no blood seen on colonoscopy in the ileum, this is likely not the source of the bleed. he was treated with ppi iv. he was continued on aspirin and plavix given recent mi and s/p cardiac cath with stent placement which likely contributed to persistent bleeding. eventually, the melanic stools and brbpr resolved and hct remained stable. ## cardiovascular disease, s/p pci to om1 a) ischemia: cad s/p cabg. he is s/p bms to omi and was treated with aspirin and plavix, metoprolol and lisinopril. . b) pump: chf, diastolic, initially presented with volume overload and responded to diuresis. he was treated with lisinopril, metoprolol, diuresis. daily weights, o2 sats and symptoms improved. c) rhythm: atrial fibrillation/flutter, the patient had episodes of paf and atrial flutter and responded to metoprolol. he was also on digoxin. he is not on anticoagulation given history of groin hematoma and gib. ## leucocytosis, noted at osh but no action taken. range 12,00 20,000 now . likely secondary to long term steroid use. he remained afebrile, negative cultures, negative c.diff. . ## elevated creatinine--1.4 on admission, baseline 1.1, climbed to 2.1 after diuresis. back to baseline prior to discharge. . ## myasthenia , continue home regimen of imuran, prednisone, and mestinon. the patient had previously been on cell cept instead of prednisone for myasthenia but due to insurance coverage issues, cellcept was discontinued. the patient required intubation in after first stopping cellcept and had to be started on prednisone. given the increased risk the prednisone has on heart disease, gib and diabetes (all of which the patient suffers), we contact his insurance company regarding the need for cellcept coverage. the insurance company agreed to cover a generic form of cellcept and the patient has a follow-up appointment with his neurologist to change his outpatient regimen. . ## diabetes mellitus type 2: glyburide was initially held for elevated creatinine and he was covered with insulin. his outpatient regimen was eventually restarted and his creatinine remained at baseline at the time of discharge. . ## full code. medications on admission: aspirin 325 daily plavix 75 daily metoprolol 75 lisinopril 5 daily lasix 10 daily prn swelling prednisone 60 daily azathioprine 50 crestor 10 daily percocet 325-5 1-2 tablets prn q4-6 hours iron 325 daily protonix 40 once a day discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. prednisone 20 mg tablet sig: three (3) tablet po daily (daily). 3. rosuvastatin 10 mg tablet sig: one (1) tablet po once a day. 4. azathioprine 50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*28 tablet(s)* refills:*0* 6. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 8. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po q3h (every 3 hours). 9. pyridostigmine bromide 180 mg tablet sustained release sig: one (1) tablet sustained release po qhs (2300-2400) (). 10. aspirin 81 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). disp:*60 tablet, chewable(s)* refills:*2* 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 13. glyburide 5 mg tablet sig: one (1) tablet po once a day. 14. lasix 20 mg tablet sig: one (1) tablet po once a day as needed for leg swelling: take once daily as needed for leg swelling. . disp:*30 tablet(s)* refills:*0* 15. toprol xl 50 mg tablet sustained release 24hr sig: two (2) tablet sustained release 24hr po once a day. disp:*60 tablet sustained release 24hr(s)* refills:*2* discharge disposition: home with service facility: vna assoc. of discharge diagnosis: primary diagnosis: congestive heart failure exacerbation gastrointestinal bleeding . secondary diagnosis: coronary artery disease hypertension diabetes mellitus myasthenia atrial fibrilation/flutter dyslipidemia discharge condition: good, respiratory status stable, ambulatory discharge instructions: please take all medications as prescribed. continue to take your aspirin and plavix for at least 6 months and speak with your cardiologist before stopping these medications. do not start taking mycophenolate mofetil until you speak with your neurologist. please keep all follow-up appointments. please call your primary care doctor or return to the emergency department if you experience weight gain greater than 3 pounds, shortness of breath, chest pain, blood in your stools, light headedness, dizziness, feeling faint. followup instructions: please call your primary care doctor, dr. ( to schedule a follow-up appointment within 1-2 weeks of discharge. you will need to continue plavix and aspirin for at least 6 months from for the drug eluting stent that was placed. . follow up with your neurologist dr. , to transition from prednisone to generic cellcept. please do not change your prednisone dose or start cellcept prior to discussing this with dr. . let you doctor know that the prior authorization request number is 1-. additionally you should discuss imaging for your lower back pain, including mr for further evaluation. procedure: other endoscopy of small intestine injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures endoscopic destruction of other lesion or tissue of large intestine transfusion of packed cells insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation acute on chronic diastolic heart failure atrial flutter other and unspecified hyperlipidemia diverticulosis of colon with hemorrhage myasthenia gravis without (acute) exacerbation ulcer of ankle angiodysplasia of intestine (without mention of hemorrhage) 

Answer: The patient is high likely exposed to