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: no known allergies / adverse drug reactions attending: chief complaint: chest pain and anemia major surgical or invasive procedure: colonoscopy and upper endoscopy history of present illness: 70 year old man with afib on coumadin, insulin dependent dm, obseity, systolic and diastolic heart failure lvef 40-45%, cad s/p cabg ', ptca', stemi with bms to the svg-om graft , presents with fatigue and dyspnea on exertion over past week. he was initially feeling well after discharge and began exercising and losing weight. however, this past week dyspnea increased and exertional capacity decreased. he called his cardiologist who thought he might be overdiuresed, therefore his lasix and spironolactone were reduced to half prior doses. dyspnea worsened despite this change. then on the day of admission he had 2 bowel movements, the second of which was dark black. the bowel movement was preceeded by crampy abdominal pain. he attempted to walk from the bathroom to the kitchen but because acutely dyspneic. he sat down and then developed chest pain, took a nitro with relief. tried to walk again but the chest pain returned, thus called ems and was brought to an osh. there his chest pain was relieved by repeated nitroglycerin and he was eventually started on a nitroglycerin drip. labs at osh were notable for hct 25, inr 3.7, k 7. enroute to , his sbp dropped with increasing nitro drip doses. upon arrival to , he was chest pain free with vs 97.6 99/56, 74 16 97% 2l. ecg showed a new lbbb, trop negative. labs notable for k 7.2 (not hemolyzed) and thus he received calcium, d50/insulin, and kayexalate. inr was 4.9. gi was called given hct drop from 31 to 25 and made plans to scope in the morning. rectal exam notable for brown stool guaiac positive with specks of black stool. nitroglycerin drip was stopped and his pain was controlled with morphine prn. he received 1l ns. vitals prior to transfer 98.1 69 109/41 16 99% ra pain 0. on arrival to the micu, he was initially comfortable, but then developed chest pain prompting morphine 2mg x3 without relief. sl nitro was given with improvement in pain. ecg showed narrow complex sinus rhythm with st depressions in i, v4-v6. he later had another episode of pain relieved by sl nitroglycerin. past medical history: cad s/p cabg in , s/p cath in wiuth bms to lcx, revealing a severe stenosis in the svg to the om s/p bms x 3, at (patient says stent but unknown location) iddm morbid obesity copd sleep apnea on bipap chf, diastolic, with ef 71% per osh reports afib htn cva with right sided numbness history of rheumatic fever social history: lives with wife and four children. worked as a carpenter. no tob/etoh/ivda. family history: adopted, unknown physical exam: admission exam: vitals: 98f 108/44 71 9 99% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, obese, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation discharge exam: vs - 98.0, 98.6, 96/49 (94-145/48-71), 71 (52-81), 20, 100ra general - obese late-middle aged man in nad. oriented x3. heent - ncat. oropharynx clear neck - supple, unable to assess jvd due to habitus cardiac - rrr, normal s1, s2. no m/r/g. no s3 or s4. lungs - ctab, no crackles, wheezes or rhonchi. abdomen - soft, obese ntnd. no hsm or tenderness. extremities - wwp, no le edema, no clubbing skin - multiple scars across lower extremities from vein harvesting, some chronic stasis changes pertinent results: admission labs: =============== 11:55pm blood wbc-11.2* rbc-2.82* hgb-8.0* hct-24.7* mcv-87 mch-28.3 mchc-32.3 rdw-19.2* plt ct-178 11:55pm blood neuts-85.1* lymphs-10.4* monos-3.0 eos-1.3 baso-0.2 11:55pm blood pt-49.3* ptt-56.2* inr(pt)-4.9* 11:55pm blood glucose-187* urean-78* creat-1.9* na-131* k-7.2* cl-99 hco3-22 angap-17 03:20am blood calcium-9.6 phos-4.1 mg-2.6 pertinent labs: =============== 11:55pm blood ctropnt-<0.01 03:20am blood ck-mb-4 ctropnt-0.02* 08:55am blood ck-mb-5 ctropnt-0.04* 10:58pm blood ck-mb-4 ctropnt-0.05* 10:50am blood hapto-164 10:50am blood ld(ldh)-195 totbili-2.0* dirbili-0.5* indbili-1.5 helicobacter pylori antibody test: positive by eia. urine culture - no growth discharge labs: =============== 06:35am blood hct-29.5* 11:00am blood pt-11.9 ptt-33.3 inr(pt)-1.1 11:10am blood glucose-108* urean-21* creat-1.1 na-136 k-4.6 cl-100 hco3-28 angap-13 11:10am blood calcium-8.0* phos-3.5 mg-3.2* micro/path: =========== urine culture (final ): no growth. helicobacter pylori antibody test (final ): positive by eia. mrsa screen (final ): no mrsa isolated. imaging/studies: ================ cxr - status post sternotomy, with mild prominence of the cardiomediastinal silhouette. there is upper zone re-distribution without overt chf. there is minimal atelectasis at both bases. no frank consolidation or effusion. ekg - lbbb -> sinus rhythm narrow complex, st depressions v4-v6 and i, avl egd - nodularity in the whole stomach compatible with nodular gastritis. normal egd to third part of the duodenum. ct abd/pelvis - 1. no evidence of retroperitoneal bleed or acute intra-abdominal process. 2. fatty infiltration of the liver. 3. cholelithiasis. 4. right renal cyst. colonoscopy : impression: grade 1 internal hemorrhoids diverticulosis of the sigmoid colon otherwise normal colonoscopy to cecum brief hospital course: 70 year old man with afib on coumadin, insulin dependent dm, obseity, systolic and diastolic heart failure lvef 40-45%, cad s/p cabg ', ptca', stemi with bms to the svg-om graft , presents with fatigue and dyspnea on exertion, found to have hematocrit drop secondary to gi bleed. active diagnoses: ================= # chest pain: demand ischemia in setting of gi bleed. he has known coronary vascular disease with refractory angina that is not amenable to intervention per cardiology team. no evidence of consolidation or ptx on cxr to suggest pulmonary cause. patient was transfused a total of 8 units prbcs; hematocrit initially stabilized and when heparin gtt and coumadin were re-started, hematocrit dropped again and chest pain returned without ekg changes. he was continued on aspirin, plavix, and ranolazine. imdur was started at a lower dose than home dose given concern for hypotension in setting of bleeding, but bp remained stable so imdur was titrated up to his home dose. he then had return of chest pain, with dynamic st changes in v3-v5 and i/avl, consistent with known non-intervenable areas of disease. his imdur was increased to 240mg and metoprolol was increased to tartrate 150mg po bid without further episodes of chest pain. # ugib/h.pylori + nodular gastritis: on egd, patient had evidence of nodular gastritis with superficial erosions. h.pylori returned positive and patient began triple therapy with amoxicillin (not candidate for clarithromycin given interaction with ranolazine), metronidazole and pantoprazole. coumadin was held and inr was reversed with vitamin k. patient had ongoing hematocrit drop without obvious bleeding once heparin drip was restarted, so both coumadin and heparin were stopped. patient will complete 2 weeks of triple therapy, then continue pantoprazole. he does not require gi follow-up or test of cure. he also underwent colonoscopy which did not reveal an additional or alternative source of his bleeding. if he continues to bleed, the next step would be a capsule endoscopy. he will have a check prior to his pcp appointment to assess his hematocrit. # acute blood loss anemia: source suspected to be gastritis as above. coumadin was held on admission to the icu and reversed with vitamin k and ffp. he was transfused a total of 8 units during admission; initially 4 units in the icu as he had an inappropriate response to blood, then again on the floor as with initiation of coumadin and bridge with heparin drip, patient's hematocrit drifted down. haptoglobin and ldh were normal, and indirect bilirubin was only slightly elevated (and was post transfusion) so low suspicion for hemolysis. with discontinuation of heparin drip and coumadin, hematocrit stabilized and patient did not require transfusion for >72 hours prior to discharge. # constipation: significantly constipated during admission. required 2 days of prep prior to his colonoscopy. patient discharged on senna/colace/miralax to prevent further constipation. # acute on chronic systolic heart failure: on admission, patient had mild pulmonary edema secondary to decreased lasix and spironolactone dose over past week prior to admission. patient was diuresed in the icu, and was euvolemic on transfer to the floor. he was continued on home lasix 40mg daily, with extra doses with transfusions. he had a few episodes of orthostatic hypotension prompting decrease of his lasix dose to 20mg po daily. patient was euvolemic at the time of discharge, and weight was stable at 120 kg. # hyperkalemia: 7.2 on admission likely secondary to arf, spironolactone, and lisinopril. ecg improved to narrow complex once potassium normalized. potassium remained stable for remainder of admission. spironolactone was not restarted, and lisinopril was restarted at lower dose of 5mg po daily. # lbbb: suspect metabolic etiology given improved with k correction. trop negative suggesting against acute coronary syndrome. lbbb resolved after correction of k. # acute renal failure: likely secondary to systolic chf with poor forward flow with second hit of poor perfusion due to acute gib. patient's creatinine trended down and was 1.1 on day of discharge. # leukocytosis: unclear etiology, but may be due to stress of gib. no evidence of infectious colitis, ua without evidence of infection and no consolidation seen on cxr. white count resolved and remained normal for remainder of admission. chronic diagnoses: ================== # hld: continued atorvastatin # depression: continued venlafaxine # dmii: blood sugar well controlled during admission. transitional issues: # spironolactone held on discharge given hyperkalemia to 7.2 on admission. # coumadin held on discharge -> we anticipate holding this medication for about a month while his gastritis heals with protection against stroke with aspirin 325mg and plavix 75mg in the interim. # lisinopril decreased to 5mg daily to prevent hyperkalemia and increase pressure room to uptitrate imdur to 240mg po daily and metoprolol to 150mg tartrate # h.pylori triple therapy treatment to continue through # hematocrit and electrolytes should be rechecked by pcp at appointment, he has a script for this. # insulin decreased to 70/30 mix 80 units daily given in-house hypoglycemia. we suggest setting him up with for further diabetes management but wanted him to discuss this with his pcp . # weight on discharge 120kg, discharged on furosemide 20mg daily. medications on admission: 1. aspirin 325 mg daily 2. nitroglycerin 0.4 mg q5min prn 3. furosemide 40 mg po daily 4. lisinopril 10 mg po daily 5. atorvastatin 80 mg po daily 6. insulin nph & regular human 100 unit/ml (70-30) suspension sig: one hundred (100) units subcutaneous twice a day. 7. metformin 500 mg po daily 8. venlafaxine 75 mg po daily 9. warfarin 5 mg po once a day. 10. pantoprazole 40 mg po once a day. 12. ranolazine 1,000 mg po twice a day. 13. clopidogrel 75 mg po daily 14. isosorbide mononitrate 60 mg po once a day. 15. metoprolol succinate 200 mg po once a day. 16. spironolactone 25 mg po once a day. discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. ranolazine 500 mg tablet extended release 12 hr sig: two (2) tablet extended release 12 hr po bid (2 times a day). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. 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* 5. venlafaxine 75 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po daily (daily). 6. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 7. metformin 500 mg tablet sig: one (1) tablet po once a day. 8. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 4 days. :*12 tablet(s)* refills:*0* 9. amoxicillin 500 mg tablet sig: two (2) tablet po twice a day for 4 days. :*16 tablet(s)* refills:*0* 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. :*30 tablet(s)* refills:*0* 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). :*30 capsule(s)* refills:*2* 12. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. metoprolol tartrate 50 mg tablet sig: three (3) tablet po twice a day. :*180 tablet(s)* refills:*2* 14. insulin nph & regular human 100 unit/ml (70-30) suspension sig: eighty (80) units subcutaneous twice a day. 15. imdur 60 mg tablet extended release 24 hr sig: four (4) tablet extended release 24 hr po once a day. 16. miralax 17 gram powder in packet sig: one (1) po once a day. :*30 packets* refills:*2* 17. lisinopril 5 mg tablet sig: one (1) tablet po once a day. :*30 tablet(s)* refills:*0* 18. furosemide 20 mg tablet sig: one (1) tablet po once a day. :*30 tablet(s)* refills:*0* 19. outpatient work please obtain cbc, chem 7 prior to your appointment. have the results communicated to your pcp: : , address: , , phone: fax: discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: # unstable angina # h. pylori + nodular gastritis with erosions # blood loss anemia secondary diagnosis: # coronary artery disease # atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (rolling walker) discharge instructions: dear mr. , it was a pleasure taking care of you! you were admitted to for evaluation and treatment of chest pain, shortness of breath, and gi bleeding. you were found to have a low blood count likely due to a slow bleed in your gi tract related to all of your blood thinners and gastritis with erosions from h. pylori (a bacteria that pre-disposes to gastritis and ulcers). you were started on a medication to protect your gi tract, treatment for your infection, and you were given blood transfusions to improve your blood counts. you underwent an upper endoscopy which showed the inflammation of the stomach and erosions and a colonoscopy which was without source of bleeding. you also had an elevation in your potassium level, so your spironolactone was discontinued. we attempted re-starting anticoagulation but you began to bleed again. as a result, your coumadin is being held until resolution of your gastritis. we suggesting waiting a month or so until resuming coumadin and would like to re-assure you that you are recieving protection against stroke from your afib from your aspirin and plavix. the following changes were made to your medication regimen: - start metronidazole three times day through monday to treat the infection in your stomach - start amoxicillin twice a day through monday to treat the infection in your stomach - increase pantoprazole to twice a day to protect your stomach lining - increase imdur to 240mg by mouth daily - change to metoprolol tartrate 150mg by mouth twice daily - decrease lisinopril to 5mg daily - decrease lasix to 20mg daily - decrease insulin 70/30 to 80 units twice daily - stop spironolactone - stop coumadin -> you will have to discuss with your primary care doctor restarting this medication about a month from now once your gastritis has healed - start senna and colace twice a day as needed for constipation - start miralax once daily as needed for constipation please follow up as suggested below. followup instructions: name: ,md specialty: primary care address: , , phone: when: tuesday, at 3:15pm -please have your labs checked prior to this appointment, on discharge your hematocrit was 29.5 department: cardiac services when: thursday at 9:40 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: other endoscopy of small intestine colonoscopy diagnoses: hyperpotassemia obstructive sleep apnea (adult)(pediatric) 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 acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status constipation, unspecified disturbance of skin sensation long-term (current) use of insulin other late effects of cerebrovascular disease old myocardial infarction other left bundle branch block morbid obesity long-term (current) use of anticoagulants acute on chronic systolic heart failure other and unspecified coagulation defects diverticulosis of colon (without mention of hemorrhage) leukocytosis, unspecified helicobacter pylori [h. pylori] other acute and subacute forms of ischemic heart disease, other other specified gastritis, with hemorrhage 

Answer: The patient is high likely exposed to