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: brbpr major surgical or invasive procedure: enteroscopy history of present illness: ms. is a 67-year-old woman with a history of hypertension, rheumatic heart disease, status post mechanical aortic and mitral valve replacement in and history of gastrointestinal bleed with normal colonoscopy and endoscopy in who now presents with gi bleed. . recently admitted to from to . during this hospitalization her hematocrit trended 28.5 -> 24.4 after which she was transfused one unit of prbc; her subsequent hct was 27.6. at the time of discharge, her hct was 29.1. . on the day prior to admission, an outpatient hct was drawn and 26.2. she was seen at on the day of admission, noted be tachycardic and was sent to the ed for further evaluation. . in speaking with the patient through the creole interpreter, she reports feeling well since discharge with less blood in her stool. she did note that her heart was beating fast, though she denies any chest pains, shortness of breath. since receiving a unit of blood, she feels improved ("i'm fine"). . in the ed, t 99.6, hr 110, bp 125/66, rr 18, 98% on room air. she was given a liter of normal saline and a unit of prbc. past medical history: 1. status-post avr/mvr in secondary to rheumatic heart disease 2. history of ugib with antral erosions per egd in . egd and colonscopy were normal in . 3. hypertension 4. atrial fibrillation 5. hyperlipidemia 6. herniated lumbar disc disease 7. foraminal stenosis 8. chronic back pain social history: denies alcohol use, has previously used snuff tobacco when she was younger; no tobacco smoking history. retired housekeeper. emigrated from >20 yrs ago. family history: no known history of blood clotting disorder. otherwise non-contributory. physical exam: vitals - bp 140/77, hr 85, rr 24, 98% on room air. gen - sitting in bed, in good spirits. heent - mild conjunctival palor. no icterus. clear op. cv - regular. mechanical s1 and s2. pulm - clear. no rales/wheeze. abd - soft and non-tender. non-distended. ext - warm. no edema. pertinent results: admission labs: 11:48am wbc-5.7 rbc-3.21* hgb-8.5* hct-26.2* mcv-82 mch-26.6* mchc-32.6 rdw-17.7* 11:48am plt count-211 11:48am pt-34.8* inr(pt)-3.7* 07:54pm glucose-149* urea n-17 creat-0.8 sodium-143 potassium-3.6 chloride-110* total co2-23 anion gap-14 07:54pm calcium-8.7 phosphate-2.0* magnesium-1.9 07:54pm alt(sgpt)-15 ast(sgot)-24 ld(ldh)-392* ck(cpk)-135 tot bili-1.0 dir bili-0.2 indir bil-0.8 07:54pm urine color-yellow appear-clear sp -1.001 07:54pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg brief hospital course: 67 woman with avr/mvr, chronically anti-coagulated, presenting with gi bleed and downtrending hct. . #. gi bleed/acute blood loss anemia: patient was observed in the icu unit overnight to monitor her hct closely. her hct increased appropriately to 2 units of prbcs. her hct was stable thereafter. patient has a history of recent admissions with gib without obvious source (negative egd/colonscopy). it is possible that she has small bowel lesion (e.g. avm) to explain her chronic blood loss. her iron studies suggest iron deficiency. in addition, pt was noted to have an elevated inr. her coumadin was held. her inr dropped to 1.7 and pt was started on a heparin gtt. hct remained stable on heparin gtt. . # anemia: this is likely multifactorial as the avr/mvr makes this patient susceptible to low-level hemolysis (hapto <20 with normal ldh/bili). pt had 2 units of prbcs. . #. rheumatic heart disease status-post avr/mvr: her goal inr is 2.5-3.5. over the last few weeks, all inrs in omr are >3.5. it appears that she was discharged on 5mg coumadin per day, whereas she had previously been taking 2.5 or 5.0 as directed. coumadin was held until her inr fell to 1.7 and she was restarted with a heparin gtt. . #. hypertension: pt was normotensive on home antihypertensives as tolerated. . #. paroxysmal atrial fibrillation: pt was mostly in normal sinus rhythm. pt was anticoaguled on coumadin/heparin. she was continued on her metoprolol. . #. hyperlipidemia: pt was continued on atorvastatin. . #. full code medications on admission: 1. quinapril 20 mg daily 2. atorvastatin 10 mg daily 3. pantoprazole 40 mg tablet 4. colace 100 mg 5. toprol xl 25 mg 6. ferrous sulfate 325 mg daily 7. warfarin 5 mg daily 8. lorazepam 1 mg qhs discharge disposition: home discharge diagnosis: primary: acute blood loss anemia gi bleed . secondary: rheumatic heart disease s/p avr, mvr hypertension paroxysmal atrial fibrillation hyperlipidemia discharge condition: stable discharge instructions: you were admitted for bleeding from you gastrointestinal tract. you were found to have a high inr of 3.7 on admission. with recent colonoscopy (lower gi scope) and esophagogastroduonoscopy (upper gi scope) showing no bleeding source, an enteroscopy was performed this time but showed no bleeding source. your warfarin was restarted. please follow up with the clinic on as instructed below for inr check. . please continue to take your medications as directed. . please keep your follow up appointments. . if you develop worsening bleeding, lightheadedness, dizziness, shortness of breath, chest discomfort, or any other worrisome symptoms, please call your primary care provider . at or go to the emergency department. followup instructions: please keep the following appointments: provider: , internal medicine phone: date/time: 10:00 provider: , md phone: date/time: 10:45 procedure: other endoscopy of small intestine diagnoses: unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation heart valve replaced by other means hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to