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: lisinopril / kefzol / sulfa (sulfonamide antibiotics) attending: chief complaint: transfer for gi bleed major surgical or invasive procedure: cardiac catheterization history of present illness: pt is a 62 year-old w with pmh of hypertension, hyperlipidemia, atrial fibrillation, diastolic dysfunction, tricuspid regurgitation/ mitral regurgitation, pulmonary hypertension, and alcohol abuse, transferred from with dyspnea on exertion. . at , patient was diuresed with iv lasix and aldactone. she was diagnosed with acute renal failure, her electrolytes were abnormal, the aldactone and lasix discontinued, and she was given kayexalate and magnesium. she was transferred to for further management. . during admission, patient developed hematemesis. ng tube was placed. red blood was lavaged. gi was consulted and patient was transferred to ccu for urgent scope. in the ccu, urgent scope revealed large ulceration in the duodenal bulb with adherent clot. gi injected epinephrine and cauterized visible vessel. . pt's vs were stable throughout procedure and stat hct on arrival to ccu was unchanged. past medical history: cardiac risk factors: dyslipidemia, hypertension . other past history: - atrial fibrillation on aspirin - ulcerative colitis - alcohol induced liver disease - alcohol abuse - ventral hernia repair - back surgery? - history of gi bleed - hypokalemia - hyponatermia social history: no smoking history. positive alcohol which she claims to be rare, but has been documented as daily use and is a barrier to her anticoagulation for afib. she is a retired teacher, lives with her husband. family history: father with mi at age 68. mother with breast cancer at 52. physical exam: vitals - bp 100/45, hr 77, rr 12, 100% on 2l. gen: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. cv: irregular, normal s1, s2. no m/r/g. no thrills, lifts. chest: no chest wall deformities, resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft/nt/nd ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: 06:40am blood wbc-4.5 rbc-3.88* hgb-13.4 hct-37.4 mcv-96 mch-34.4* mchc-35.7*# rdw-14.6 plt ct-211 06:40am blood pt-13.7* ptt-30.1 inr(pt)-1.2* 06:50pm blood glucose-98 urean-35* creat-1.7* na-128* k-4.7 cl-93* hco3-24 angap-16 06:40am blood alt-9 ast-31 ld(ldh)-214 alkphos-289* totbili-1.0 06:40am blood triglyc-53 hdl-71 chol/hd-2.0 ldlcalc-63 06:50pm blood tsh-5.6* 06:40am blood t4-7.1 free t4-1.4 . h. pylori ab: negative . ecg: atrial fibrillation, rate 73, nl axis, nl intervals, right-bundle morphology with no significant change compared with prior dated . cardiac catheterization: 1. coronary arteries are normal. 2. elevated left and right sided filling pressures with near equalization consistent with possible constriction. though due to underlying atrial fibrillation restriction cannot be excluded. additionally, possibility for pseudoconstriction due to volume overload. 3. mild pulmonary hypertension . tte: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. intrinsic function is likely more depressed given the severity of tricuspid regurgitation. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the right ventricular is more dilated, the severity of tricuspid regurgitation is slightly increased, and the estimated pulmonary artery systolic pressure is higher. the severity of mitral regurgitation appears reduced. . cxr: no active disease in the chest. mild cardiomegaly. . egd: medium hiatal hernia blood in the stomach ulcer in the first part of the duodenum (injection, thermal therapy) otherwise normal egd to second part of the duodenum brief hospital course: 62 year old woman with pmh of atrial fibrillation, hypertension, hyperlipidemia, diastolic heart failure, moderate 3+ tr, severe right sided failure admitted for diuresis and course complicated by upper gi bleed from duodenal ulcer. # gastrointestinal bleed/anemia. the patient was admitted for congestive heart failure but course was complicated by gi bleed for which she was transferred from . she had an ng tube placed and lavage showed bright red blood. she underwent an egd on which showed a duodenal bleed which was injected and cauterized. the patient was followed by serial hcts. she continued to have melanotic stools. she was transferred out of the ccu on and then transferred back in on the same day for dropping hct and melanotic stools. on she stopped having blood in her bowel movements. her hct dropped to 25.8. she refused to have blood transfusions. she was given pantoprazole gtt. h. pylori ab was negative. her blood pressures stayed in the 100s systolic with hr in the 100s in atrial fibrillation. a colonoscopy in showed decrease in vascularity of the whole colon but was otherwise wnl to the cecum. she was otherwise asymptomatic without lightheadedness or chest pain. her hematocrits remained stable between 22 and 26 for the remainder of her hospital stay. at the time of discharge, her hct was 23.4. she denied chest pain or angina. she was discharged on prilosec 20mg po bid, fe po and gi outpatient follow up. . # right sided heart failure. this was deemed likely secondary to severe tr. she was initially started on lasix gtt for mild hypervolemia in setting of low bps, but this was discontinued due to gib on . echo showed elevated rap, lvef >55% w/ nl thickness, rv moderately dilated with mild global free wall hypokinesis, severe tr and moderate pah. pt. recveived ivf for gib. she was euvolemic on exam for the remainder of hospital stay. she had no dyspnea. her metoprolol was held gib (see above) and was restarted on and was continued through the remainder of hospitalization without episodes of hypotension. she was started on lasix 20mg po bid on day prior to discharge. . #. cad: patient had no evidence of cad on cath which showed elevated left and right sided filling pressures w/ pseudoconstriction due to volume overload and mild pah. her asa was held due to gib. asa status will be restarted as op based on further gi evaluation. . #. atrial fibrillation patient was rate controlled. chads score = 2 considering diastolic disfunction and hypertension, however patient is not currently anticoagulated, given concern for her alcohol abuse. asa was held gib. her bbk was restarted prior to discharge, please see above. . #. history of alcohol abuse. patient did not have evidence of withdrawal. ciwa scores were 0. she received folic acid, thiamine and mvi during hospitalization and discharged home with this regimen. . #. uc. this was inactive during hospitalization. she was continued on mesalamine per home regimen. . #. ppx. patient was on pneumoboots due to gib. she was discharged in a hemodynamically stable condition, w/o symptoms of heart failure and with low, but stable hct of 23. a close follow up was arranged with gi and cardiology. the medication list at discharge was discussed with patient and understanding was checked. medications on admission: atenolol 100mg daily furosemide 20 spironolactone 100mg asa 325mg mag 84mg epi pen fexofenadine 180 flonase folate 1mg iron asacol 400mg, 2 tabs tid oxycodone prn discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. mesalamine 400 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po tid (3 times a day). 3. fexofenadine 180 mg tablet sig: one (1) tablet po once a day. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. oxycodone 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 6. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itchiness. 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 8. caltrate plus 600-400 mg-unit tablet sig: one (1) tablet po once a day. 9. magnesium 84 mg tablet sustained release sig: one (1) tablet sustained release po once a day. 10. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 11. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 12. toprol xl 50 mg tablet sustained release 24 hr sig: 2.5 tablet sustained release 24 hrs po once a day. disp:*75 tablet sustained release 24 hr(s)* refills:*2* 13. outpatient lab work please draw cbc and chem-7 on monday and send results to dr. at 14. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: acute on chronic diastolic congestive heart failure: ef 55% atrial fibrillation bleeding gastric ulcer acute blood loss anemia hypertension hyperlipidemia discharge condition: stable, afebrile, chest pain free. discharge instructions: you were admitted for shortness of breath, due to excess fluid build-up in your body. this is related to your heart function. you received iv diuretics to removed this fluid. you should continue to take your diuretics as precribed to prevent fluid from building up again. you should also follow a low sodium diet and weigh yourself daily. call your doctor if your weight increases by more than 3lbs. you also had some bleeding from an ulcer in your small intestine. you should avoid medicines that can cause bleeding for 3-6 months. an appointment was made with dr. to follow this ulcer after you are home. medications changes: 1. stop taking atenolol 2. start taking toprol xl instead: this ia a better beta blocker medicine for congestive heart failure 3. increase you furosemide to 20 mg twice daily 4. stop taking your aspirin 5. start taking prilosec twice daily for your ulcer 6. use sarna lotion as needed for itch . please adhere to your follow-up appointments. they are important for managing your long-term health. please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, dark or tarry stools, or any other symptoms that you are concerned about.weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 pounds in 3 days adhere to 2 gm sodium diet fluid restriction: 1500cc or about 7 cups per day followup instructions: primary care: , phone: date/time: monday at 1pm. . chf cardiologist: , md phone: date/time: at 9am. . gastroenterology: provider: , md phone: date/time: 1:45. you are on the wait list for an earlier appt. the office will call you if one becomes available. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters endoscopic control of gastric or duodenal bleeding angiocardiography of right heart structures diagnoses: mitral valve disorders congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia hyposmolality and/or hyponatremia atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases other and unspecified hyperlipidemia chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction ulcerative colitis, unspecified diseases of tricuspid valve 

Answer: The patient is high likely exposed to