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: history of present illness: the patient is an 83 year-old male with a past medical history of coronary artery disease status post left anterior descending coronary artery stent, history of recurrent lower gastrointestinal bleeding with a history of arterial venous malformations, colon cancer status post colectomy and ileocolonic anastomosis who presented with melanic stools and lightheadedness times three days. initially the patient presented to his primary care physician's office complaining of dark tarry stools. serial laboratory work was noted that the patient's hematocrit was decreasing dropping reportedly from 37 to 29.6 within several days. at that time the patient continued to complain of lightheadedness, but denies any shortness of breath, chest pain or abdominal pain. he was instructed by his primary care physician to go to the emergency department for further evaluation. in the emergency department the patient's blood pressure was labile ranging from 80s to 115s systolic. he received 2 units of packed red blood cells and thereafter was hemodynamically stable. he was seen by the gastroenterology service who recommended a tagged red blood cell scan followed by an esophagogastroduodenoscopy. past medical history: 1. coronary artery disease status post stent to the left anterior descending coronary artery. 2. hypertrophic cardiomyopathy with mitral regurgitation. 3. history of multiple arterial venous malformations with a 15 year history of recurrent gastrointestinal bleeding. 4. gastroesophageal reflux disease. 5. history of duke's a colon cancer status post right hemicolectomy in . 6. history of jejunal lipoma in . 7. status post cholecystectomy in . 8. history of prostatectomy. 9. history of left inguinal hernia repair in . 10. hyperlipidemia. medications on admission: 1. atenolol 100 mg po q day. 2. celexa 20 mg po q day. 3. hydrochlorothiazide 12.5 mg po b.i.d. 4. lipitor 10 mg po q day. 5. prevacid 30 mg po q day. 6. isordil 10 mg po b.i.d. allergies: the patient reports no known drug allergies. social history: the patient quit smoking approximately 35 years ago. he is married with several children. he reports no alcohol or drug use. family history: the patient's mother deceased from a cerebrovascular accident at age 67. physical examination on admission: vital signs temperature 99.0, blood pressure 120/58, pulse 84, respiratory rate 20, weight 72 kilograms. generally, the patient was a well developed thin male in no acute distress. head and neck examination revealed normocephalic, atraumatic. sclera anicteric. pupils are equal, round and reactive to light and accommodation. mucous membranes are moist. lungs clear to auscultation with good breath sounds and air movement. no rhonchi, rales or wheezing. heart was regular rate and rhythm with a grade 3 out of 6 holosystolic murmur heard best at the apex. no rubs or gallops. abdomen was soft, nontender, nondistended. there were positive normoactive bowel sounds. stool was guaiac positive. no evidence of hepatosplenomegaly. extremities were warm and well perfuse with no clubbing, cyanosis or edema. distal pulses were full. hospital course: 1. gastrointestinal bleeding: the patient underwent a tagged red blood cell scan on , which demonstrated a very small amount of gastrointestinal bleeding mostly in the left lower quadrant most likely within the small bowel. therefore he underwent enteroscopy on , which demonstrated polyps in the stomach, body and fundus as well as blood in the duodenum and proximal jejunum. no angiomata were seen at that time, otherwise enteroscopy was normal. he continued to have melena as well as lability in his blood pressure and hematocrit. he was monitored with serial hematocrits and transfused to keep his hematocrit greater then 28 to 30. he underwent additional studies including esophagogastroduodenoscopy and duodenoscopy on , which demonstrated angiectasias in the second part of the duodenum, which was treated with thermal therapy. also noted were diverticuli in the second part of the duodenum. because of dropping hematocrits and recurrent melanotic stools the patient underwent a pill study on , which showed fresh blood and active bleeding from the arterial venous malformations seen in the proximal small bowel. he continued again to have melanotic stools and had repeat esophagogastroduodenoscopy on . this demonstrated erythema nodularity in the antrum compatible with gastritis, as well as angiectasias in the proximal jejunum. again thermal therapy was applied. thermal therapy was also applied to angiectasias in the second part of the duodenum. the patient tolerated most of these procedures well until when he had recurrent melena. this was accompanied with diaphoresis, shortness of breath and lightheadedness. blood pressure fell to 80/40 with a heart rate in the 90s. he was volume resuscitated with normal saline. gastrointestinal lavage demonstrated 2 liters of normal saline with dark red material that was not fully cleared. due to his instability he was transferred to the medical intensive care unit at that time. repeat esophagogastroduodenoscopy on showed red blood and clot overlying a prior cautery site in the mid to distal duodenum. it was washed with no active bleeding. there was significant blood and clot in the jejunum. the patient therefore was taken to the interventional radiology suite where he underwent angiography and embolization of the gastroduodenal and left gastric artery. this embolization was performed after a heparin tissue plasminogen activator challenge did not result in any bleeding. status post embolization the patient was monitored in the intensive care unit and was then was transferred out to the general medical floor on . he continued to pass melanotic and grossly guaiac positive stools. repeat enteroscopy was performed on , which demonstrated red blood in the second part of the duodenum and an ulcer ni the second part of the duodenum. basically the patient was afforded with serial transfusions to keep his hematocrit appropriate above 30 in light of his history of coronary artery disease. as an outpatient he will have serial hematocrit checks and was arranged to have outpatient blood transfusions if necessary. 2. coronary artery disease/aortic stenosis: the patient has a history of myocardial infarction with anemia. echocardiogram on showed hyperdynamic with ef 75% with severe resting outflow tract obstruction left ventricular hypertrophy as well as 3+ mitral regurgitation consistent with hypertrophic cardiomyopathy. therefore treatment goals were to increase beta-blockade, increase filling time and to keep the patient at least euvolemic to decrease obstruction. we were unable to titrate the beta-blocker up in light of his low blood pressure. his previous medications of atenolol, hydrochlorothiazide and isordil will not be continued as an outpatient. 3. depression: the patient was maintained on celexa. 4. tachycardia: the patient demonstrated several instances of tachycardia mostly in the setting of volume depletion during episodes of bleeding. tachycardia improved after volume resuscitation. again in light of his history of cardiomyopathy, the goal is to keep him maximally beta-blocked as much as tolerable by his hypotension. discharge condition: good. hematocrit stabilized, melena decreased and tolerating a regular diet. no chest pain or shortness of breath. visiting nurses are to check the patient's hematocrit biweekly. he was to be transfused for a hematocrit of less then 30 at the center. dr. will be responsible for following up on the patient's hematocrit values and ordering transfusions as necessary. discharge status: the patient was discharged to home with services. discharge diagnoses: 1. recurrent gastrointestinal bleeding with a history of multiple avms status post thermal therapy of jejunal angiectasia. 2. status post angio embolization of the left gastric and gastric duodenal arteries. 3. coronary artery disease status post percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery in , status post myocardial infarction times two in the setting of anemia, baseline electrocardiogram of right bundle branch block. 4. anemia secondary to blood loss. 5. diastolic dysfunction. 6. aortic stenosis. 7. status post cholecystectomy. 8. hypercholesterolemia. 9. gastroesophageal reflux disease. 10. history of colon cancer status post right hemicolectomy. 11. status post prostatectomy. 12. status post left inguinal hernia repair. discharge medications: 1. citalopram 20 mg po q.d. 2. lipitor 10 mg po q.d. 3. multivitamin one capsule po q.d. 4. tylenol 650 mg po q 6 hours as needed. 5. ambien 5 mg po q.h.s. as needed. 6. mylanta 15 to 30 ml po q.i.d. as needed. 7. lansoprazole 30 mg po q day. 8. lopresor 12.5 mg po b.i.d. 9. sucralfate 1 gram po t.i.d. follow up plans: the patient was instructed to call his primary care physician . and/or his gastroenterologist dr. within a week following discharge regarding his recent hospital stay. he was instructed that if he noticed bright red blood in his stool, increasing darkening stools, shortness of breath, chest pain, fatigue or lightheadedness that he return to the emergency room immediately. he was instructed that we added metoprolol to his medication regimen as this had long term beneficial effects for people with heart disease. we instructed him to discontinue taking his isordil, atenolol and hydrochlorothiazide until follow up with dr. . he had an appointment made with the outpatient center on if a blood was needed. he also had a follow up echocardiogram on . , m.d. dictated by: medquist36 d: 06:03 t: 10:52 job#: procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine other endoscopy of small intestine arterial catheterization endoscopic control of gastric or duodenal bleeding arteriography of other intra-abdominal arteries transcatheter embolization for gastric or duodenal bleeding transfusion of packed cells diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia acute posthemorrhagic anemia aortic valve disorders percutaneous transluminal coronary angioplasty status angiodysplasia of intestine with hemorrhage benign neoplasm of stomach 

Answer: The patient is high likely exposed to