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: patient recorded as having no known allergies to drugs attending: chief complaint: gi bleed major surgical or invasive procedure: l tlc central line placement history of present illness: ms. is a year old female with a pmh significant for dementia, htn, colon ca s/p colectomy admitted on for bilateral shoulder pain for several days and tachycardia to 120s with associated lightheadedness. on initial presentation to the ed, she was noted to be in atrial fibrillation with rvr with an old lbbb and received iv diltiazem with conversion to nsr. . since her admission, the patient has ruled in for nstemi with peak cardiac biomarkers of ck 379, mb 61, and tnt 1.43 (, 11:55 pm). she was started on asa, plavix, heparin gtt, metoprolol, losartan, plavix, and atorvastatin. in addition, the patient was noted to be hypertensive to sbp 170s, so was placed on a nitro gtt. of note, initial family was held with the decision for the patient to be made dnr/dni with medical management and no cardiac catheterization. this morning, the patient was noted to have a hematocrit of 35.4 from 40, and this evening she was noted to several large grossly blood bowel movements with associated hypotension with a sbp nadir in the 60s with a hct of 29.2. she was also noted to have approximately 50 cc of hematemesis. after discussion with the family, the patient was initially confirmed to be dnr/dni with the additional decision for no escalation of care. however, this was changed upon further discussion with the team with the decision to place a cvl and consult gi for possible endoscopy/colonscopy. she received 4l ivf and 2 units prbc on the floor with improvement in her bp from 90s/60s to 180/100, and was transferred to the ccu for further management. . currently, the patient is resting comfortably without complaints. denies any cp/sob,f/c/s, n/v/d, abd pain, ha. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, myalgias. she denies recent fevers or chills. all of the other review of systems negative. . cardiac review of systems was significant for absence of dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, or edema. past medical history: 1. cardiac risk factors: +hypertension 2. cardiac history: -cabg: none reported -percutaneous coronary interventions: none reported -pacing/icd: none reported 3. other past medical history: -history of colon ca (s/p colectomy) -hypertension -hard of hearing -osteoarthritis -mild dementia -mr . social history: has lived in rehab for the past 14 months. -tobacco history: reports a remote tobacco history; quit smoking in her 40's. -etoh: socially; hasn't had a drink in a while family history: brother with a cva; another brother colon ca; a sister with unspecified colon problems. reports no fhx of heart disease or dm. physical exam: vs: 99.5 83 200/95 26 97%2l nc gen: age appropriate female. heent: perrl, eomi, sclerae anicteric. mmm, op clear without lesions, exudate, or erythema. neck supple without lymphadenopathy. cv: regular s1+s2, iii/vi late peaking systolic murmur throughout the precordium loudest at the rusb radiating to the carotids. ii/vi diastolic murmur at the apex. pulm: bilateral early inspiratory crackles at the base abd: s/nt/nd +bs gu: deferred given grossly bloody bm on floor ext: no c/c/e, 1+ dp/pt bilaterally neuro: oriented to person. pertinent results: on admission: wbc-8.8 rbc-4.30 hgb-12.9 hct-40.5 mcv-94 mch-30.0 mchc-31.8 rdw-14.7 plt ct-170 neuts-88.9* lymphs-8.4* monos-2.2 eos-0.2 basos-0.3 pt-12.4 ptt-22.6 inr(pt)-1.0 glucose-128* urean-22* creat-1.1 na-140 k-4.1 cl-104 hco3-23 angap-17 ck-mb-61* mb indx-16.1* ctropnt-1.43* on discharge: wbc-10.7 rbc-3.77* hgb-11.7* hct-34.6* mcv-92 mch-31.1 mchc-33.9 rdw-15.0 plt ct-137* glucose-119* urean-25* creat-0.9 na-140 k-3.7 cl-113* hco3-20* angap-11 calcium-7.4* phos-1.5* mg-1.5* ck-mb-13* mb indx-5.7 ctropnt-0.81* triglyc-103 hdl-49 chol/hd-2.4 ldlcalc-46 type-art po2-94 pco2-28* ph-7.44 caltco2-20* base xs--3 imaging: echo the left atrium is mildly dilated. the interatrial septum is aneurysmal. the estimated right atrial pressure is 0-5 mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output and increased stroke volume due to aortic regurgitation. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is moderate thickening of the mitral valve chordae. there is systolic anterior motion of the mitral valve leaflets. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a fat pad. impression: moderate left ventricular hypertrophy with normal systolic function. there is a mild left ventricular resting outflow gradient. mild to moderate aortic regurgitation. mild to moderate mitral regurgitation. moderate estimated pulmonary artery systolic hypertension. ct head 1. no evidence of acute intracranial abnormalities. 2. small chronic lacunar infarction in the left lentiform nucleus. moderate chronic small vessel ischemic disease. cxr findings: as compared to the previous examination, today's radiograph shows slightly increased interstitial markings as well as newly appeared kerley b lines. overall, the changes suggest increased interstitial fluid content consistent with moderate pulmonary edema. the size of the cardiac silhouette is unchanged. on the right, the costophrenic sinus is blunted, there might be a small pleural effusion. no newly acquired focal parenchymal opacity suggesting pneumonia. unchanged course and position of the central venous access line. brief hospital course: pre-icu course: y/o f with pmhx significant for htn, colon ca (s/p colectomy), hearing loss, and mild dementia who presented with new-onset atrial fibrillation that was noted at rehab on the morning of presentation. converted back to sinus rhythm after administration of iv diltiazem. # atrial fibrillation / nstemi - on arrival to the floor, the patient was back in sinus rhythm. the patient denied any current or previous chest pain. a tsh was sent and was within normal limits. additionally, cardiac enzymes were followed. the first set of cardiac enzymes showed a slight elevation of troponin to 0.10, which was initially attributed to demand ischemia in the setting of a.fib with rvr. however, overnight, the patient's second set of cardiac enzymes showed a significant rise. troponin was now 1.43. the patient was loaded with plavix, started on a heparin drip, and started on a high-dose statin. the following morning, the patient triggered for hypertension to the 210's. she was given iv labetalol and started on a nitroglycerin drip. her pressure then decreased to the 90's, but she was asymptomatic. nitroglycerin drip was stopped. the medical situation was discussed with the family and the decision was made to likely not pursue cardiac catheterization and to treat the patient medically. later in the afternoon, the patient triggered for hypotension, diaphoresis, and weakness while she was walking back from the urinating in the bathroom. the hypotension quickly resolved with positioning the patient in the trendelenberg position. this episode was initially thought to be vagal in nature. several hours later, however, the patient was noted by nursing to have a large, loose bloody stool, with subsequent drop in sbp to the 70's. at that point, all of the patient's antihypertensives as well as her heparin drip and plavix with stopped. she was ultimately transferred to the ccu for further management (see gi bleed section below).... # gi bleed - overnight, on the night of admission, the patient ruled in for acs and was loaded with plavix and started on a heparin drip. in the afternoon of the following day, the patient was noted by her nurse to have a large, loose bloody bowel movement with subsequent drop in sbp to the 70's. at that point, the patient was given ns at a maximal rate and the iv nurse to obtain better iv access. after several attempts, the best access obtainable by the iv nurse was one 20g iv in the right forearm. the ccu team was also called. the family was called and consented to administration of blood products but said that they did not want further escalation of care (including a central line). the decision was made at that point to keep the patient on the floor. during this time, the patient had several large dark bloody liquid stools. she also had an episode of hematemesis of approximately 50 cc. on further discussion after the patient's family arrived, the became amenable to cvl placement, endoscopy, and possible administration of pressors. by that point, the patient had received 2 l ns and was receiving her 1st unit of blood. she was transferred to the ccu for further management.... . ccu course - in the ccu, patient was transfused 4 units of prbcs and rescuscited with 5lns. the patient's pressures stabilized as well as did her hematocrit. an egd was done, which was negative for bleed. icu course was complicated by labile hypertension with sbp in 200s that needed to be controlled with a nitro gtt. because the patient's hematocrit remained stable >72 hours, a colonscopy was deferred to be done as an outpatient. the patient returned to the floor with stable vitals, stable hematocrits. post icu course gib: pt without significant bleeding. hct remained stable for >48 hours. coronaries: pt remained without chest pain the remainded of the admission. rhythm: pt back in sinus with atrial ectopy, suggestive pre atrial fibrillation. if patient converts to a fib again, would recommend considering amiodarone. pt currently on carvedilol 25mg po bid for rate and bp control. htn: pt with longstanding labile hypertension, intractable to multiple medications. was treated with carvedilol 25mg po bid and then bottomed out to 70s/40s, asymptomatic. was given some ivf and bp responded nicely. pump: however, after 1.5l of ns for hypotension, pt was a bit fluid overloaded with elevated jvp and pulmonary edema on cxr. was given lasix 20mg iv on day of discharge with improvement of symptoms, however could still benefit from further diuresis. headache: pt with headache in setting of significant htn. neurologic exam completely normal. ct head negative for e/o bleed. ha resolved with tylenol/codeine. dnr/dni: pt and family still interested in minimally invasive procedures such as colonoscopy and egd. medications on admission: medications (home): losartan 150 mg daily metoprolol succinate 50 mg daily poly iron 150 mg daily tylenol 975 ca carbonate 1300 mg daily vitamin d2 once a week (last time 21st) sodium fluoride 10 ml swish and spit at bedtime . medications (transfer): acetaminophen 325-650 mg po q6h:prn pain atorvastatin 80 mg po daily calcium carbonate 1250 mg po daily iron polysaccharides complex 150 mg po daily discharge medications: 1. atorvastatin 40 mg tablet sig: two (2) tablet po once a day. 2. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po daily (daily). 4. tylenol 325 mg tablet sig: three (3) tablet po twice a day. 5. fluorigard 0.05 % solution sig: ten (10) ml dental at bedtime. 6. poly-iron 150 mg capsule sig: one (1) capsule po once a day. 7. aspirin 81 mg tablet sig: one (1) tablet po once a day. 8. carvedilol 6.25 mg tablet sig: one (1) tablet po twice a day. 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po daily (daily). 10. lasix 20 mg tablet sig: 0.5 tablet po once a day. discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: primary: a fib in rapid ventricular rate non-st elevation myocardial infarction lower gastrointestinal tract bleed labile hypertension discharge condition: stable vitals, afebrile. discharge instructions: you came to the emergency department for shoulder pain. you were found to have a very fast and irregular heart rate called atrial fibrillation and were admitted to the cardiology floor. during this time, you were also found to have a small heart attack. you were treated medically with blood thinners, however during this treatment you developed bleeding from your gastrointestinal tract. you received 4 units of blood and 5 liters of iv fluids. an upper gastrointestinal (gi) scope was negative for a source. because your blood counts remained stable for more than 72 hours, and because the blood thinners were stopped, the acute bleed was thought to have ceased and you are to follow up with gi in 4 weeks. we have made several changes to your medications: stop taking metoprolol 50mg by mouth daily stop taking losartan 150mg by mouth daily start taking aspirin 81mg by mouth daily start taking carvedilol 6.25mg by mouth twice a day start taking furosemide (lasix) 10mg by mouth once a day start taking potassium 20meq by mouth once a day if you develop any chest pain, shortness of breath, fevers, or any symptoms that are concerning to you, please come to the emergency department immediately. followup instructions: you have an appointment with provider: , md phone: date/time: 9:40 on of . dr. office has been in touch with rehab and will call you there to set up a follow up cardiology appointment for you. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation acute on chronic diastolic heart failure mitral valve insufficiency and aortic valve insufficiency personal history of malignant neoplasm of large intestine hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to