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: epigastric pain major surgical or invasive procedure: egd colonoscopy barium swallow with small bowel follow-through history of present illness: 69 year-old femalw with a past medical history significant for dm type 2, rheumatic valve disease s/p mvr with st-judes valve in on coumadin therapy, s/p ppm for symptomatic bradycardia, as well as a history of chf, who presents with a 3-day history of epigatric abdominal pain with radiation to the back, r>l. she also describes associated n/v x 2, no hematemesis. no change in bowel habits. she denies recent c/p or sob. in the ed, initial vitals were . she was found to have an elevated inr at 8.9, not reversed. r/o mi was also initiated by the ed team. she was observed overnight, and in am was found to have an inr of 11.5 and hct drop from 29-->23.4 with a history of blood-tinged stools. in the ed, however, she refused iv placement, blood draws, t&s and admission. her pcp spoke to her, who felt that she had si. psych was called, but the patient changed her mind and agreed to be admitted. psych consult deferred. past medical history: 1. rheumatic mitral valve disease s/p valvuloplasty in 01/90, s/p st-judes mvr in 03/. 2. s/p multiple cardiac catheterizations with clean coronaries. 3. atrial fibrillation. 4. s/p vvi placement for symptomatic bradycardia in . 5. dm type 2 6. history of chf 7. hypercholesterolemia 8. history of hepatic congestion of unclear etiology, as well as history of hemangiomas improved after mvr> 9. depression 10. breast mass with negative work-up. 11. vitamin b12 deficiency anemia. social history: she is married with 3 children, lives with her husband. history of etoh or alcohol consumption. family history: non-contributory physical exam: physical exam on admission: vitals: t 98, hr 71, bp 151/88 --> 142/71--> 118/40, rr 24, sat 97% on room air. gen: agitated, in nad heent: ncat. eomi. no scleral icterus. clear op. neck: jvp flat. resp: cta bilaterally. cvs: rrr. gi: bs normoactive. abdomen soft. mild tenderness to palpation ofver epigastrium, no rebound or guarding. trace guaiac postivie stools. ext: no pedal edema. neuro: cn ii-xii intact, strenght throughout. pertinent results: releavant laboratory data on admission: cbc: brief hospital course: 1. gi bleed: pt had gi bleed of unclear source before admission, likely supratherapeutic inr in setting of coumadin therapy for mvr. she was initially admitted to the micu markedly decreased hct on anticoagulation. however, she was hemodynamically stable during her entire hospital course. coumadin was d/c on admission and the pt was placed on heparin gtt for anticoagulation in prep for workup for source of bleed. egd showed gastric erosion w/ no evidence of active bleeding. colonoscopy was normal. sbft was performed and demonstrated no clear source of bleeding. coumadin was restarted when no source of bleeding was identified, and heparin was continued until inr reached goal of 2.5-3.5, after which the heparin was d/c. at d/c, there is no evidence of active bleeding and hct is stable. it is likely that her initial bleed was gastric bleeding in setting of inr of 11. she will require f/u after d/c for coumadin monitoring. 2. mvr: the pt was initially supratherapeutic on coumadin w/ inr 11. coumadin was d/c until inr was normal. meanwhile, the pt was anticoagulated w/ heparin gtt as above. when inr normalized, coumadin was restarted for goal inr of 2.5-3.5, and heparin was continued until inr reached goal as above. the pt will need to continue coumadin after d/c. 3. afib: rate controlled during this admission, pt w/ vvi pacer. 4. chf: no evidence of decompensated heart failure during this admission. treatment was continued w/ her outpt dose of lasix w/ good effect. 5. dm2: pt's oral meds were held on admission in case of need for iv contrast. bg was controlled w/ riss during that time. at d/c, the pt will resume her usual outpt regimen. 6. code status was full code during this admission. medications on admission: 1. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 2. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 3. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. atorvastatin calcium 10 mg tablet sig: one (1) tablet po once a day. 6. glyburide 5 mg tablet sig: one (1) tablet po twice a day. 7. metformin hcl 500 mg tablet sig: one (1) tablet po twice a day. 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 9. warfarin sodium 5 mg tablet sig: one (1) tablet po once a day. 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 11. spironolactone 25 mg tablet sig: one (1) tablet po twice a day. 12. niferex-150 150-50 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. coumadin 2.5 mg tablet sig: one (1) tablet po 2 days per week (monday, thursday). disp:*30 tablet(s)* refills:*2* discharge medications: 1. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 2. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 3. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. atorvastatin calcium 10 mg tablet sig: one (1) tablet po once a day. 6. glyburide 5 mg tablet sig: one (1) tablet po twice a day. 7. metformin hcl 500 mg tablet sig: one (1) tablet po twice a day. 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 9. warfarin sodium 5 mg tablet sig: one (1) tablet po once a day. 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 11. spironolactone 25 mg tablet sig: one (1) tablet po twice a day. 12. niferex-150 150-50 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. coumadin 2.5 mg tablet sig: one (1) tablet po 2 days per week (monday, thursday). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: 1. gi bleed in setting of supertherapeutic inr secondary: rhreumatic mv-s/p valvuloplasty and mvr in afib on coumadin s/p vvi pacer for symptomatic bradycardia chf with normal ef dm-2 with neuropathy colonic polyps b12 deficiency discharge condition: good, with no gi bleeding, stable hct. she has persistent anemia that will need to be followed as an outpt. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet please call your pcp or return to the ed for blood in your stool or black tarry stool, dizziness, fainting, shortness of breath, chest pain, fevers/chills, or other concerning symptoms. take medications as prescribed. follow-up as below. followup instructions: please see your pcp, . , in one week. call to make an appointment. ask him if you need to change your dose of digoxin, and if you might benefit from starting an ace-inhibitor medication. present to coumadin clinic on friday, for evaluation and leb testing. provider: , m.d. where: cardiac services phone: date/time: 4:30 provider: , where: phone: date/time: 2:00 procedure: other endoscopy of small intestine colonoscopy transfusion of packed cells transfusion of other serum diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes heart valve replaced by other means cardiac pacemaker in situ hemorrhage of gastrointestinal tract, unspecified other and unspecified coagulation defects 

Answer: The patient is high likely exposed to