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: near syncopal episode, melena major surgical or invasive procedure: with biliary stent placement and cautery of sphincterotomy site history of present illness: 78 yo m with st jude's valve on lovenox and coumadin, dm, cad, previous prostate ca who is s/p from who was visiting a friend in the hospital yesterday when he developed lightheadedness when standing associated with one episode of black tarry stool and a very small amount of emesis which he reports may have been dark in color. he felt better when he laid back down on the streatcher and he did not fall. he was brouh to the where vital signs were initially bp 119/54 and later 98/52 and he received 1l ivf. his hct was found to be 26.4 (from reported baseline of 30) and inr of 1.5. he denied any chest pain, shortness of breath, arm pain, jaw pain, abd pain, or palpitations at the time of the incident. it is unclear if he 80mg of iv pantoprazole and he was then transferred to for further management. of note he did have one black stool while at 5 days ago prior to recent discharge and one black stool 3 days ago. he restarted his coumadin and lovenox on with last dose of lovenox in am. he has no other history of gi bleed. in the emergency department vs were: 97.7 68 107/47 18 100%ra. exam showed guaiac positive dark black stool. hct was 25.8. he had one episode of melena in the ed. he remained hemodynamically stable. saw the patient and recommended repeat in the am. he was typed and crossed and recieved a total of 3 units of prbcs in the ed and 2l of ivf. his current access is 16 and 18 gauge from and a 20 gauge from osh. vitals prior to transfer to the floor were hr66 bp117/57 rr17 o2 sat 100 on 2l nc. currently, he is feeling well. . vss were stable on arrival to the icu. ros + for headache at with resolution with tylenol. he denied dizziness, abd pain, chest pain, shortness of breath, arm pain, or jaw pain. past medical history: # s/p st jude's valve (approx ) # cad s/p 1 vessel cabg # pacemaker in # prostate ca s/p radiation and hormone tx in # bladder cancer s/p local resection approx # s/p cholecystectomy in the setting of pancreatitis yrs ago # dm # hl # htn # back for herniated disk social history: previous smoker quit 25 yrs ago etoh use 1-2 drinks/wk no illicits family history: father with mi in 70s physical exam: t=96. bp=138/55 hr=66 rr=13 o@ 100% ra physical exam general: pleasant, well appearing in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla. mmm. op clear no blood in pharynx. cardiac: rrr. normal loud click of mechanical valve. no murmurs, rubs or . no jvd. no carotid bruit. cabg scar. lungs: ctab, good air movement biaterally. abdomen: +bs. soft, nt, nd. no hsm. no ruq tenderness. rash from previous ekg lead. old black stool present. guiac + in ed. extremities: no edema, 2+ dorsalis pedis. skin: + erythematous macules on back. neuro: alert and responding appropriately to questions. cn 2-12 intact. preserved sensation throughout grossly. 5/5 strength ue and le. gait assessment deferred psych: listens and responds to questions appropriately, pleasant. pertinent results: 09:52pm hct-26.8* 02:26pm ck(cpk)-21* 02:26pm ck-mb-2 ctropnt-<0.01 02:26pm hct-29.7* report : the ampulla was located, and a small amount of fresh ooze was seen at the site of the previous sphincterotomy. biliary cannulation was successful and deep using a sphincterotome. contrast was injected resulting in complete opacification. no filling defects were identified. a 5cm by 10fr plastic biliary double pigtail stent was placed successfully. a 7fr gold probe was successfully applied to the apex of the sphincterotomy for hemostasis. (stent placement, thermal therapy) otherwise normal egd to third part of the duodenum brief hospital course: mr. is a 78 year-old gentleman with coronary artery disease s/p mechanical aortic valve replacement (st jude's valve), dm, previous prostate ca who is s/p () resulting in sphincterotomy, who was admitted to the icu for melena and lightheadedness. * syncope - mr. arrived to the icu on and received 3 units of prbcs. he underwent egd/ on and the source of bleeding was identified at his sphincterotomy site from . a double pigtail biliary stent was placed and he tolerated the procedure well. his anticoagulation was held for the procedure but given his extensive cardiac history and mechanical valve, cardiology was consulted regarding this issue. they recommended restarting warfarin as soon as possible. he was started on a heparin drip on as a bridge to coumadin with the plan of initiating coumadin once he was therapeutic on the heparin drip for 24 hours. he remained hemodynamically stable throughout the rest of his icu course and did not require further blood transfusions. he started a diet of clears advanced to full liquids and was called out to the general medical floors on . on , pt had an episode of explosive gassy bowel movement with dark melena of unclear volume. it remained unclear if this represented a new episode of bleeding, or if this was melena that remained from his prior bleed (this was the first time moving bowels since procedure). he was found to be orthostatic and he was bolused iv fluids. team was notified and followed closely. serial h/h revealed a decreased hct to 24 and pt was transfused an additional unit of prbc. his heparin gtt was held, but restarted later that evening. his hct remained stable and his inr rose to 2.8 on . given his high risk of bleeding, his heparin gtt was discontinued and he was monitored for an additional 24 hours. his hct remained stable on the day of discharge and his inr was 2.6 on the day of discharge. he was discharged on coumadin 4mg daily and will follow up with his coumadin clinic at the va in . he will need a follow up hct with his pmd on . * syncope - due to his history of near syncopal episode (and cardiac history), he was ruled out for myocardial infarction. he was ruled out with negative cardiac enzymes and it was felt that his near syncope was secondary to his gi bleed and hypoperfusion. * cad s/p cabg - his outpatient medications were continued. lisinopril was decreased to 20mg daily * htn - norvasc was held through out much of his hospitalization, but was restarted on the day before discharge. lisinopril was reduced to 20mg daily. his bp was stable on discharge. * ckd (stage iii) - his cr on admission was 1.7 and ranged throughout his admission between 1.4-1.7. he will have a cr check on friday before his pmd appointment. * hyperlipidemia - statin continued * dm ii - metformin was discontinued in the setting of his cr. he remained on riss throughout his hospitalization and required small amounts of humalog. on the day before discharge, he did not require any sliding scale insulin. he will need his blood sugars followed by his pmd. * mechanical avr - was bridged with heparin gtt to coumadin. was discharged with an inr 2.6. medications on admission: amlodipine 5mg daily lisinopril 40mg daily metoprolol tartate 25mg b12 1000mg daily fish oil 1200mg 2 caps qhs pravastatin 40mg qhs coumadin 3mg on m, w, f, sa, ; 4mg on tu, th stool softeners 2 caps qhs pantoprazole 40mg qhs ??? omeprazole 20mg daily ??? pancrease 4500/ 2 cap at noon and qhs discharge medications: 1. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. warfarin 4 mg tablet sig: one (1) tablet po once a day. 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. pancrease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po twice a day. 8. b-12 dots 500 mcg tablet sig: two (2) tablet po once a day. discharge disposition: home discharge diagnosis: # acute blood loss anemia # acute bleed at sphincterotomy site # anticoagulation with coumadin # presence of mechanical heart valve # chronic kidney disease # hypertension # hyperlipidemia # diabetes # coronary artery disease, s/p cabg # type 2 diabetes, controlled discharge condition: stable discharge instructions: you were admitted to the hospital after an episode of bleeding at the site of your previous , which likely occurred due to your need to be on coumadin. you underwent to stop the bleeding, and you remained in the hospital while we managed your anticoagulation. please seek medical attention if you develop blood in your stools, black tarry stools, lightheadedness, dizziness, increasing fatigue, or any other concerns. the following medications were changed: 1. coumadin 4mg daily (to follow up with coumadin clinic) 2. decreased lisinopril to 20mg daily 3. stopped pancrease enzymes, but can restart on discharge. followup instructions: provider: 2 (st-4) gi rooms date/time: 8:00 provider: , md phone: date/time: 8:00 please follow up with your primary care doctor, dr. on at 10:30am. you will need to have your cbc and your chemistry panel checked on friday . please go to the building at , (laboratory) on friday to have these labs checked. please follow up in your coumadin clinic tomorrow (if possible) or thursday. procedure: endoscopic control of gastric or duodenal bleeding endoscopic insertion of stent (tube) into bile duct diagnoses: coronary atherosclerosis of native coronary artery acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of prostate other and unspecified hyperlipidemia heart valve replaced by other means chronic kidney disease, stage iii (moderate) hemorrhage complicating a procedure long-term (current) use of anticoagulants personal history of malignant neoplasm of bladder cardiac pacemaker in situ other and unspecified coagulation defects 

Answer: The patient is high likely exposed to