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: mr. is an 80-year-old gentleman with multiple medical problems including coronary artery disease, peripheral vascular disease, hypertension, chronic renal insufficiency, hypercholesterolemia, anemia, with a recent admission for congestive heart failure and new onset atrial fibrillation, failed cardioversion times two, and received biventricular pacemaker, and recently started on coumadin. since his last hospitalization the patient has been feeling weak and has noticed black stools. he was initially admitted to the medical intensive care unit on this admission and transferred out to the floor on . he any syncope, falls, bright red blood per rectum, or a history of gastrointestinal problems prior to this admission. he said that he had been feeling weak since he was discharged in and has noticed several black stools on the days prior to admission. he says he uses aspirin once per day for cardiac protection, but he any other nonsteroidal antiinflammatory drug use. he any abdominal pain, nausea, or vomiting. he was initially admitted to the medical intensive care unit from to the emergency department on after he was noted to have a hematocrit of 22 (down from his baseline of 30). a nasogastric lavage in the emergency department was negative, and he received vitamin k and fresh frozen plasma and was sent to the medical intensive care unit. he received a total of two units of fresh frozen plasma, vitamin k, and three units of packed red blood cells, protonix 40 mg twice per day and was seen by gastrointestinal in the medical intensive care unit. he had an esophagogastroduodenoscopy on which showed nodularity and petechiae in the esophagus, antral erosions in the stomach; consistent with aspirin and nonsteroidal antiinflammatory drug induced erosive gastropathy. erosions in the distal bulb of the duodenum. it was recommended that serum helicobacter pylori serologies be checked and a repeat esophagogastroduodenoscopy be done in five to eight weeks. his aspirin was discontinued. per gastrointestinal, it was felt appropriate to restart his coumadin in approximately three to four days after discharge and to continue protonix 40 mg by mouth twice per day indefinitely. there were no other problems in the medical intensive care unit, and his hematocrit rose after the transfusions, and he was hemodynamically stable. therefore, it was felt appropriate to transfer him out to the regular medicine service. past medical history: 1. coronary artery disease. (a) status post cardiac catheterization in . (b) status post right coronary artery percutaneous transluminal coronary angioplasty and stent. 2. congestive heart failure (with an ejection fraction of 20%). 3. peripheral vascular disease; status post arthrectomy. 4. carotid stenosis; status post carotid endarterectomy in . 5. hypertension. 6. hypercholesterolemia. 7. chronic renal insufficiency. 8. renal artery stenosis. 9. nephrolithiasis. 10. anemia. 11. history bell's palsy. 12. gout. 13. history of femoral-popliteal bypass and aortofemoral bypass. 14. status post biventricular pacemaker placement in . 15. atrial fibrillation. 16. hypothyroidism. family history: family history was noncontributory. social history: mr. any alcohol use. he reports a 50-pack-year smoking history and says he quit 20 years ago. he lives at home with his wife. any other drug use. allergies: the patient has no known drug allergies. medications on transfer: (from the medical intensive care unit) 1. protonix 40 mg by mouth twice per day. 2. gemfibrozil 600 mg by mouth once per day. 3. lipitor 10 mg by mouth once per day. 4. nortriptyline 10 mg by mouth q.h.s. 5. amiodarone 200 mg by mouth once per day. 6. allopurinol 300 mg by mouth once per day. 7. synthroid 25 mcg by mouth every day. 8. ambien 5 mg by mouth q.h.s. 9. tylenol by mouth as needed. 10. metoprolol 12.5 mg by mouth twice per day. physical examination on presentation: physical examination revealed vital signs of a temperature of 97.8 degrees fahrenheit, his blood pressure was 150/82, his heart rate was 79, his respiratory rate was 20, and his oxygen saturation was 99% on room air. in general, mr. was alert and oriented times three. in no acute distress. he was very pleasant. head, eyes, ears, nose, and throat examination revealed no scleral icterus. his pupils were equally round and reactive to light. his extraocular muscles were intact. there was no conjunctival pallor. his oropharynx revealed the mucous membranes were moist. there were no lesions or exudates. his cardiovascular examination revealed a 2/6 systolic ejection murmur heard best at left upper sternal border. his had normal first heart sounds and second heart sounds. his lungs were clear to auscultation bilaterally. his abdomen was soft, nontender, and nondistended. he had no palpable hepatosplenomegaly. he had a well-healed midline scar. extremity examination revealed no evidence of clubbing, cyanosis, or edema. his pulses were 2+ and symmetric. pertinent laboratory values on presentation: laboratories on transfer revealed a complete blood count with a white blood cell count of 7.7, his hematocrit was 28.6, his mean cell volume was 90, and his platelets were 354. his prothrombin time was 14.7, and his inr was 1.4, and his partial thromboplastin time was 28.7. chemistries revealed his sodium was 138, potassium was 4.3, chloride was 105, bicarbonate was 20, blood urea nitrogen was 48, and his creatinine was 2.4 (up from his baseline of 2). he had helicobacter pylori serologies pending from his esophagogastroduodenoscopy. pertinent radiology/imaging: of note, an echocardiogram in revealed an ejection fraction of less than 25%, left atrial mild dilation, 1+ aortic regurgitation, 1+ mitral regurgitation, and severe global left ventricular hypokinesis. his esophagogastroduodenoscopy on revealed no blood in the stomach, small prepyloric benign ulcerations with no evidence of active bleeding, small duodenal ulcerations, and mild diffuse gastritis. in the middle third of the esophagus was noted patchy nodularity and petechiae of the mucosa with a stigmata of recent bleeding. this was also noted in the lower third of the esophagus. it was remarked that this was likely due to his nasogastric tube but should be re-evaluated with a repeat endoscopy in five to eight weeks. concise summary of hospital course by issue/system: while on the medicine service. 1. gastrointestinal issues: given his history of upper gastrointestinal bleed and admission to the medical intensive care unit, the patient was followed by the gastrointestinal service when he came out to the floor. he was hemodynamically stable the whole time, and his stools remained occult-blood positive. this was felt likely to be secondary to continued passage of the blood that he had bled before. there seemed to be no other signs of rebleeding. he was continued on his protonix 40 mg by mouth twice per day. his aspirin was discontinued, and he was advised that he was never to take aspirin again. his hematocrit and coagulations were followed when he came to the floor, and his hematocrit remained stable in the 28 to 30 range until the day of discharge. it was felt safe to discharge him home on . he had a repeat endoscopy scheduled with gastroenterology prior to discharge. as an outpatient, the patient was never to use nonsteroidal antiinflammatory drugs or aspirin again. he was to be continued on his protonix 40 mg by mouth twice per day, and he was to have a repeat endoscopy in five to eight weeks; as scheduled per gastroenterology. he was allowed to restart his coumadin on the tuesday after discharge. 2. cardiovascular issues: the patient has a history of congestive heart failure with an ejection fraction of less than 25%. he was continued on his beta blocker and lasix as needed once he came to the medicine floor. it was felt appropriate at this time to restart his beta blocker given the stability of his blood pressure and his hematocrit and no further evidence of bleeding. he also has a history of recent new onset atrial fibrillation; status post biventricular pacemaker placement. he was continued on his amiodarone, and his coumadin was held in the setting of a recent gastrointestinal bleed. per gastroenterology, he was to restart his coumadin on the tuesday after discharge. there was no evidence of atrial fibrillation while he was admitted. he also has a history of coronary artery disease and ruled out for a myocardial infarction on admission to the medical intensive care unit. he was continued on his beta blocker. his aspirin was to be held indefinitely. he was continued on his lipitor at 10 mg by mouth once per day. he was also transfused for a hematocrit of less than 30 in the setting of coronary artery disease. lastly, the patient also has a history of hypertension. once he came to the floor, he was continued on his metoprolol 12.5 mg by mouth twice per day. his other hypertensive medications had been held in the medical intensive care unit and were restarted on discharge. this included hydralazine 10 mg by mouth q.6h. 3. pulmonary issues: the patient has a history of congestive heart failure, as previously mentioned, with an ejection fraction of less than 25%. he was given lasix with transfusions in the medical intensive care unit with no evidence of pulmonary edema or hypoxia. 4. renal issues: the patient has a history of chronic renal insufficiency, and on transfer to the floor his creatinine was 2.4. it was felt that this was most likely due to hypovolemia in the setting of a gastrointestinal bleed. after looking back over old records, it was realized that this was his baseline creatinine and no further investigation was necessary. 5. endocrine issues: due to his history of hypothyroidism, the patient's was continued on synthroid. no thyroid function tests were tested on this admission. 6. musculoskeletal issues: the patient was seen by physical therapy prior to discharge who felt that he was strong and safe to go home on his own. discharge diagnoses: 1. upper gastrointestinal bleed; likely secondary to erosive gastropathy. 2. coronary artery disease. 3. congestive heart failure. 4. hypertension. 5. hypercholesterolemia. 6. chronic renal insufficiency. 7. anemia. medications on discharge: 1. protonix 40 mg by mouth twice per day. 2. gemfibrozil 600 mg by mouth once per day. 3. lipitor 10 mg by mouth once per day. 4. nortriptyline 10 mg by mouth q.h.s. 5. amiodarone 200 mg by mouth once per day. 6. allopurinol 300 mg by mouth once per day. 7. synthroid 25 mcg by mouth every day. 8. ambien 5 mg by mouth q.h.s. 9. metoprolol 12.5 mg by mouth twice per day. 10. isordil 10 mg by mouth three times per day. 11. hydralazine 10 mg by mouth q.6h. 12. coumadin (to be restarted on the tuesday after discharge). discharge instructions/followup: 1. the patient was instructed to follow up with his primary care physician (dr. ) in one week. 2. the patient was also to have a repeat endoscopy in five to eight weeks after discharge which has been scheduled by gastroenterology. 3. the patient was strictly instructed never to use aspirin or nonsteroidal antiinflammatory drugs again. 4. the patient was instructed to continue his protonix 40 mg by mouth twice per day indefinitely. 5. the patient was instructed to restart his coumadin on the tuesday after discharge, with inr checks and followup per dr. . 6. the patient had serum helicobacter pylori serologies checked at his endoscopy which were to be followed up for proper treatment if necessary by gastroenterology. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine diagnoses: congestive heart failure, unspecified unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism atrial fibrillation percutaneous transluminal coronary angioplasty status blood in stool other specified gastritis, without mention of hemorrhage unspecified analgesic and antipyretic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to