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: penicillins attending: chief complaint: severe anemia, supertherautic inr major surgical or invasive procedure: r femoral central line history of present illness: 53 yo f with pmh significant for cad (lad 60-70%) with avr (st. jude's valve), for hx endocarditis, h/o mitral valve endocarditis now with 4+ mr, pvd, hepatitis c and a history of gib presents with 4 days of lethergy, sob, and chest pain which has been intermittant for many months. she was in her usoh until a few weeks ago when per omr notes, she was beginning to feel fatigued, sob, and chest pain. she r/o for an mi in and had a stress with fixed defects. the pt was seen by her pcp with the same complaints, lethergy, sob and chest pain. at that time she was guaiac negative. her hct on was 35, was 24, and on admission was 17. she denies taking any over the counter, prescription, or illicit medications. she has not changed her diet. denies melena, brbpr, hematemesis, or bleeding of any kind. she has been feeling lightheaded. she has had nausea and anorexia. her chest pain is dull, left sided, and not associated with exertion. it is relieved by rubbing. no changes in coumadin dose. today she went to clinic where she had her pt/inr and hct checked. she had been on lovenox over the weekend because her friday inr was high??. the monitor in clinic could not read her hct, indicating that it was low. in the ed she was 99.1, 128/60, 18, 99% ra. her bp dropped to the 80's briefly but came up with volume. labs showed that she had a hct of 17 nad inr of 8. she was given prbc 2units, 4 liters of ns, ffp 2 units, vit k 2.5 sc, protonix 40 iv, hydrocort 100 iv, maalox, and anzemet. she refused an ng lavage and did not want to speak with the gi fellw saying that she would not want an endoscopy or colonoscopy. she also refused a foley. past medical history: 1. recurrent endocarditis, first aortic then mitral involvement s/p avr with st. jude's valve in c/b embolic cva and seizure. mrv possible will be replaced in the future. 2. chronic venous stasis 3. pvd - s/p left fem ant tibial bypass graft with saf vein for non healig ulcers 4. venous stasis ulcer for 4 years, s/p failed skin graft. . plastics considering vac. 5. anemia, iron deficiency 6. h/o ugib gastritis with hct of 23 - egd : normal egd to third part of the duodenum, erythema in the antrum compatible with gastritis colonoscopy : incomplete exam, reason for exam: dark blood per rectum egd : medium hiatal hernia, schatzki''s ring, otherwise normal egd to second part of the duodenum 7. iv drug use on methadone 8. hepatitis c - hep c viral load -over 2 mill.no bx done 9. peripheral neuropathy 10. hearing loss (ad) 11. mild gastritis 12. s/p cabg, cad with 60-70% lad lesion, rt. dominant - pmibi on showed fixed defects. social history: has a history of iv heroin use 20 years ago, denies any current drug use. denies current tobacco use but used to smoke cigarettes/day for 15 years. denies any etoh use. she currently lives with her mother and is on disability. family history: no family history of dm, cad, or htn. physical exam: vs: t 98, hr 77, bp 94/46, rr 18, sao2 99-100%/2l gen: nad female heent: ncat, mmm. adentulous cv: rrr, nl s1, s2, iii/vi holosystolic murmur with a late systolic click. jvd 6cm chest: crackles at the left base, otherwise clear abd: soft, nontender, slightly distended, bs+. no hsm ext: pp 2+, no edema. 15x4cm venous stasis ulcer with granulation tissue. bone was exposed. neuro: alert, conversant, appropriate, though very poor insight. skin: warm and dry pertinent results: 05:13pm wbc-8.1 rbc-2.26* hgb-6.8* hct-19.8* mcv-88 mch-30.2 mchc-34.4 rdw-16.1* 05:13pm plt count-203 05:13pm pt-18.0* ptt-36.7* inr(pt)-2.3 05:13pm ret aut-3.6* 02:15pm urine color-yellow appear-clear sp -1.020 02:15pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:15pm urine rbc->50 wbc-0-2 bacteria-few yeast-none epi-0-2 01:32pm k+-4.4 01:32pm hgb-6.2* calchct-19 01:20pm glucose-96 urea n-22* creat-0.6 sodium-135 potassium-4.4 chloride-103 total co2-24 anion gap-12 01:20pm alt(sgpt)-11 ast(sgot)-23 ld(ldh)-280* ck(cpk)-88 tot bili-0.2 dir bili-0.1 indir bil-0.1 01:20pm ck-mb-notdone ctropnt-<0.01 01:20pm haptoglob-<20* 01:20pm wbc-6.3 rbc-1.96*# hgb-5.6*# hct-17.1*# mcv-87 mch-28.5 mchc-32.7 rdw-16.9* 01:20pm neuts-67.2 lymphs-27.6 monos-4.0 eos-0.9 basos-0.3 01:20pm hypochrom-1+ anisocyt-1+ poikilocy-1+ macrocyt-1+ 01:20pm plt count-276 01:20pm pt-33.0* ptt-48.5* inr(pt)-8.2 _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ radiology final report chest (portable ap) 7:49 pm chest (portable ap) reason: eval for pna medical condition: 53 year old woman with chest pain, anemia, crackles on exam reason for this examination: eval for pna indication: chest pain, anemia and crackles on exam. evaluate for pneumonia. comparison: . upright ap chest: the patient is post median sternotomy. cardiomegaly is unchanged. there is upper zone vascular redistribution and perihilar haze consistent with mild congestive heart failure. no pleural effusion or pneumothorax. no consolidation to suggest pneumonia. impression: mild congestive heart failure. brief hospital course: 53 yo female with h/o with cad, avr secondary to endocarditis, hepatitis c and a history of gib admitted with severe anemia, supertherapuritc inr, and chest pain. 1. anemia: pt has a history of recurrent gi bleeds of unclear etiology. she was guaiac positive during this admission, although her stool remained brown. she had a hct of 17 and inr of 8, but she had no evidence of rp bleed, ich, etc. she was also ruled out for an mi. she received a total of 5 units prbc, and her hct subsequently remained stable. pt refused a gastric lavage, and she required pursuasion to undergo any other work-up. she did, however, agree to capsule endoscopy. the results of this study were pending at the time of discharge. of note, she had a very similar admission one year ago () during which she left ama without intervention. it was thought that pt likely had gib in setting of elevated inr, in addition to having low grade hemolysis. at time of discharge, hct was 36, and she appeared hemodynamically stable. she was provided with home services, as well as follow-up within 2 weeks. she is to f/u with both pcp and gi. 2. coagulopathy: pt has been taking coumadin for her avr; also, she had been taking lovenox in the days prior to admission. it was unclear why she was supratherapeutic with inr of 8, but pt may have confused the coumadin dosing. she was reversed with ffp and vit k with good effect. coumadin was restarted shortly after admission, and she was bridged with a heparin drip while waiting for inr levels to be therapeutic. however, given that she received multiple doses of vitamin k at admission, it was difficult to achieve therapeutic anticoagulation. after consulting with dr. , pt's cardiologist, felt that it was acceptable to use lovenox for bridge therapy. both she and her mother (with whom she lives) have used lovenox in the past, and they were taught once again, prior to discharge. pt will be followed up in the . 3. hypotension: patient's normal baseline bp is in the 90's - 100's systolic. she was hypotensive to the 70s in the ed. this was likely secondary to hypovolemia as it stablized after volume repletion. she was restarted on enalapril and lasix, and she had no further episodes of hypotension. 4. chf/severe mitral regurgitation: the patient takes lasix 40 mg daily as an outpatient. this was held initially as she appeared stable despite receiving multiple blood transfusions. daily lasix was restarted when pt c/o sob and had pitting edema in lower extremities; did not have rales and never has rales as a manifestation of volume overload. her symptoms were improved with diuretics. 5. pvd: the patient has a chronic venous stasis ulcer on lle. seen recently by plastics and did not have any signs of infection on lle x-ray. she was followed by plastics in-house who recommended that she continue dressing changes daily. 6. h/o iv drug use - continue methadone and given letter for home service prior to d/c to make sure pt has medication at home. 7. seizure d/o: continued tegretol at home dose. 8. code status: full medications on admission: acetaminophen 500mg-- by mouth every day as needed for pain coumadin 7.5 mg nightlt enalapril maleate 5mg--take one tablet every day ferrous sulfate 325(65)mg--one by mouth twice a day flonase 50mcg--2 sprays each in the morning every day fluconazole 200 mg--one by mouth twice a day furosemide 40 mg--one tablet by mouth every morning hydrocortisone 0.25%--apply to affected area twice a day lovenox 40 mg/0.4ml--take by subcutaneou injection twice a day, 12 hours apart - recieved this over the weekend. methadone hcl 10mg--40mg per program percocet 5-325mg--one tablet(s) by mouth qd to prn pain as needed for pain protonix 40mg--one every day tegretol xr 200mg--take one tablet by mouth twice a day miralax 17 g (100%)-- packet by mouth once a day for constipation discharge medications: 1. methadone 10 mg tablet sig: three (3) tablet po daily (daily). 2. carbamazepine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 3. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 6. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). 7. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 9. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. 10. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 11. enoxaparin 60 mg/0.6ml syringe sig: one (1) subcutaneous q12h (every 12 hours) for 14 days. 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home with service facility: gentiva discharge diagnosis: primary: gib . secondary: 1. st. aortic valve replacement in . 2. history of endocarditis (staph, strep, candidal) 3. history of hepatitis c. 4. peripheral vascular disease with nonhealing le ulcers. 5. cerebrovascular disease. 6. hypertension. 7. reflux disease. 8. anemia. 9. coronary artery bypass graft in . 10. history of gastrointestinal bleed (-) colonoscopy x2; (-) angio in . discharge condition: good discharge instructions: please return for further care if you have fever, chills, weakness, lightheadedness, acute shortness of breath, chest pain, fainting, blood in your sputum or stool, tarry stool, abdominal pain, nausea, vomiting or any other symptoms that are concerning to you. . please keep the appointments that have been scheduled for you - the details are provided below. followup instructions: provider: , md phone: date/time: 11:45 . provider: , date/time: 11:40 md procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine transfusion of packed cells diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia unspecified viral hepatitis c without hepatic coma other convulsions opioid type dependence, continuous ulcer of other part of foot heart valve replaced by other means hemorrhage of gastrointestinal tract, unspecified other and unspecified coagulation defects atherosclerosis of native arteries of the extremities with ulceration 

Answer: The patient is high likely exposed to