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: tape / lipitor attending: chief complaint: shortness of breath, dizziness major surgical or invasive procedure: upper endoscopy rij history of present illness: 69 yo m h/o cad s/p mi and stent, mechanical x 2, vt s/p icd placement and multiple gibs who presents following an episode of shortness of breath, diaphoresis and dizziness at home. the patient was in his usual state of health until three weeks ago at which time he noticed inreasing shortness of breath with exertion (at baseline he can walk to the mailbox and back and recently he has had pain with limited movement around his house). over the past four days he has noted increasing anginal episodes for which he has used nitroglycerin 5 times. he has also noticed black colored stools over the past four days. on the morning of presentation he was preparing food and he became lightheaded, diaphoretic and short of breath and felt as if he would pass out but did not lose consciousness or fall down. during this episode he did not experience any chest pain, nausea, vomiting, or abdominal pain. recently he denies any fevers or chills. he denies any episodes of icd firing. he denies hematochezia, hematemasis or brbpr. . in the ed the patient was chest pain free. he was found to have a hematocrit of 23.7, a troponin of 0.06, was guaiac positive with a negative ng lavage. ekg revealed a ventricularly paced rhythm at 68 bpm. he received aspirin 325 mg, protonix iv and 2 units prbcs. he underwent central line placement secondary to poor iv access and coumadin was held for supratherapeutic inr . transferred to micu for further management. past medical history: 1. status post st- and redo (96 and 99) for as/ai, on coumadin 2. cad status post cabg x 2, s/p multiple ptca/stents, last in 3. history of gi bleeds (prior endoscopies with gastritis, and duodenal avms seen on capsule endoscopy ) 4. status post ppm/aicd for vt 5. chf with ef 30% 6. sle with history of lupus nephritis 7. s/p thyroidectomy 8. anemia social history: former smoker (h/o 1.5 ppd x 30 years, quit ) occasional ethanol. denies illicit drug use. lives with his wife, daughter and grand-daughter. wife helps him with medications. fomer truck driver. family history: mother, father and sister died from liver failure. father alcoholic but mother and sister were not. his sister died 1 year ago with liver failure and lupus. physical exam: micu physical exam: vitals: t: 98.1 hr: 67 bp 123/83 rr 16 o2: 100% on ra general: alert, oriented, no distress heent: eomi, perrl, sclera anicteric, oropharynx clear neck: jvp difficult to assess. cvl bleeding profusely. cv: rrr, prominent valvular click resp: ctab, no wheezes, rales, ronchi gi: soft, non-tender, non-distended, + bs, no hsm gu: no foley ext: wwp, 1+ pulses, good capillary refill, 2+ edema in lle, 1+ in rle, no clubbing or cyanosis. neuro: grossly intact pertinent results: : 09:30am blood wbc-5.1 rbc-2.82*# hgb-7.9*# hct-23.7*# mcv-84 mch-28.1 mchc-33.4 rdw-22.7* plt ct-230 09:30am blood pt-37.8* ptt-49.0* inr(pt)-4.2* 09:30am blood glucose-106* urean-74* creat-2.0* na-137 k-5.1 cl-106 hco3-17* angap-19 09:30am blood ck(cpk)-87 09:30am blood ctropnt-0.06* 10:26am blood lactate-1.2 . egd per gi note: egd showed mild petechiae in prepyloric region and mild duodenitis. no active bleeding. . brief hospital course: impression: the patient is a 69-year-old male with a history of cad s/p mi and stenting, mechanical x 2, vt s/p icd placement and gib who presents with gib and found to have duodenitis. . 1. gib: the patient was admitted with a gi bleed in the setting of a supratherapeutic inr. on the night of admission he received ffp to reverse his anticoagulation. on hospital day 2 he underwent upper endoscopy which failed to reveal a discrete bleeding source but showed mild duodenitis. he required a total of 5 units prbc over the course of three days before his hematocrit stabilized. cardiac enzymes were mildly elevated on admission and peaked at a troponin of 0.11 and in the setting of blood loss and reduced renal function this was thought to be most likely secondary to demand ischemia. on admission the patient was also noted to have an elevated creatinine kinase which continued to rise on hospital days 2 and 3 out of proportion to his elevation in cardiac enzymes. it was decided to stop the patient's statin and upon doing so his cks immediately began to trend down. the patient's coumadin and aspirin were restarted on hospital day 5 for anticoagulation in the setting of a mechanical aortic valve. . 2. anemia: patient was guaiac positive with dark brown stool in the ed with a negative gastric lavage. patient has a history of ileal avm diagnosed in after experiencing a similar episode of bleeding. his baseline hematocrit is 30-32 but was 38 on . he had a negative colonoscopy in and a normal egd in of this year. possible etiologies include rebleeding avm vs. duodenal ulcer. lower gi etiologies less likely given lack of brbpr. patient received ffp and blood transfusions. patient's inr was 4.2 on admission and coumadin was held. upper endoscopy showed duodenitis. he was treated with transfusions plus lasix to limit volume overload, ppi , serial hct checks. coumadin and aspirin were restarted on hd 5 for anticoagulation in the setting of a mechanical valve. . 3. chest pain: patient has had increasing anginal episodes over the past week relieved with nitroglycerine. most likely secondary to decreased hematocrit causing demand ischemia. troponin was 0.06 on admission and peaked at 0.11. ekg unrevealing secondary to paced ventricular rhythm. treated with bb, statin, imdur, ntg. aspirin was initially held until patient stabilized. elevated creatinine kinase which continued to rise on hospital days 2 and 3 out of proportion to his elevation in cardiac enzymes. it was decided to stop the patient's statin and upon doing so his cks immediately began to trend down. . 4. mechanical av: reluctant to fully reverse his anticoagulation secondary to his mechanical valve. coumadin was held and his inr trended down slowly. the patient's coumadin and aspirin were restarted on hospital day 5 for anticoagulation in the setting of a mechanical aortic valve. antibiotics given for prophylaxis for egd. . 5. elevated creatinine: baseline creatinine is 1.5-1.6. on admission was slightly elevated at 2.0 likely secondary to blood loss. at the time of discharge creatinine was at baseline. . 6. hypertension: stable - continue imdur, metoprolol . 7. hyperlipidemia: lipitor, lopid. on admission the patient was also noted to have an elevated creatinine kinase which continued to rise on hospital days 2 and 3 out of proportion to his elevation in cardiac enzymes. it was decided to stop the patient's statin and upon doing so his cks immediately began to trend down. . 8. hypothyroidism - continue levoxyl medications on admission: allopurinol 100 mg daily ambien 10 mg prn insomnia aspirin 81 mg daily ambien cr 6.25 mg--1 tablet(s) by mouth once a day coumadin coumadin 3mg diovan 160 mg daily folic acid 1mg daily imdur 60 mg daily lasix 40mg daily levoxyl 125mcg daily lipitor 40mg daily lopid 600mg mvi ntg 0.4mg prn protonix 40mg pyridoxine hcl 50mg daily toprol xl 25 mg daily aranesp discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 3. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 4. hexavitamin tablet sig: one (1) cap po daily (daily). 5. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). 6. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime). 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day) for 2 days. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*180 tablet, delayed release (e.c.)(s)* refills:*2* 10. aspirin 81 mg tablet sig: one (1) tablet po once a day. 11. toprol xl 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. tablet sustained release 24hr(s) 12. warfarin 2 mg tablet sig: 1.5 tablets po daily (daily). 13. valsartan 80 mg tablet sig: one (1) tablet po daily (daily). 14. imdur 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 15. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual prn as needed for chest pain: take as directed for chest pain. seek medical attention of chest pain persists. 16. lasix 20 mg tablet sig: one (1) tablet po once a day. 17. outpatient work inr, hct work for discharge disposition: home discharge diagnosis: gib from duodenitis/gastritis cad on coumadin arf htn hypothyroidism discharge condition: stable, anticoagulated, hematocrit stable. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet . please come back to the emergency room, if you have black or blood stools or vomiting or if you have any chest pain, that does not resolve with nitroglycerin. . we were holding your statin because of an elevated ck. you should rediscuss starting your statin with your pcp. . please take all your medications as directed. you have been started on gembirozil since your lipitor is being held. your diovan dose is now half (80mg daily instead of 160mg daily). you should rediscuss increasing the dose with your pcp. lasix dose has been cut in half for low bp. please reevaluate medication changes with your pcp. . check your inr tomorrow and have your pcp look at the results after it is drawn. continue to have your inr checked regularly. followup instructions: please follow up with your primary care doctor: provider: , ( ) internal medicine (nhb) date/time: 11:45 . you also have the following appointments available: provider: , .d., ph.d.: date/time: 2:30 . provider: , md phone: date/time: 10:30 . have your inr checked tomorrow morning . continue to have your inr checked with your pcp on regular bassis. md procedure: other endoscopy of small intestine transfusion of packed cells transfusion of other serum diagnoses: chronic glomerulonephritis in diseases classified elsewhere acidosis systemic lupus erythematosus abnormal coagulation profile congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status chronic kidney disease, unspecified heart valve replaced by other means long-term (current) use of anticoagulants unspecified gastritis and gastroduodenitis, with hemorrhage automatic implantable cardiac defibrillator in situ duodenitis, with hemorrhage 

Answer: The patient is high likely exposed to