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: ranitidine / aldactone attending: chief complaint: abd pain and melena major surgical or invasive procedure: esophagogastroduodenoscopy - prbc transfusions x 3 history of present illness: ms. is a 55f with h/o chf on home o2, atrial fibrillation on warfarin, dm, and h/o antral gastric ulcer who presented with abdominal pain and black stools. . one day prior to admission she noticed decreased energy and malise. in the evening, she developed abdominal discomfort and headache. her abdomen was tender on the right side, with a constant achy pain in intensity. there was no associated dyspnea or lightheadedness, but that evening she did experience some nausea and vomiting, without hematemesis or coffee. the day of admission, she noticed some black stool when wiping herself. she had no hematochezia. she denies any other bleeding problems or changes in her warfarin dosing. she does not use nsaids or drink alcohol. +mildly lightheaded at home, no falls. had egd that showed 3-4mm antral ulcer with path c/w "chemical gastropathy," h. pylori negative. prior colonoscopy showed diverticulosis only. . review of systems is negative for chest discomfort, increased dyspnea, dysuria, diarrhea, or constipation. she did feel a little sweaty when having the abdominal pain and vomiting and did experience palpitations. . in the ed, vitals were t 99.2 p 60 bp 136/45 rr 24 o2 99% on 3l. she was normotensive. labs were notable for k of 7.2 with cr of 3 (baseline ~1 ), hct of 20.6 (down from 26 ), and inr of 3.9, platelets 183. she was given kayexalate, zofran, calcium gluconate, insulin/d50, and albuterol as well as empiric unasyn 3 grams. ruq ultrasound showed no acute findings. she was guiac positive per records. he vitals in the ed were notable for pulses in 40's but normotensive. a central line was placed, and she was admitted to the micu. she was transfused 3 units prbcs and given 2.5mg vitamin k. hct nadir 19.5 reached in am. she was seen by the gi consult service who plan to perform egd when inr ~1.5 as she has clinically stabilized. past medical history: 1. nonobstructive hypertrophic cardiomyopathy with diastolic congestive heart failure: - echo () with ef >60%, mild symmetric left ventricular hypertrophy and evidence of impaired relaxation - uses 2l o2 with exertion - cath with no cad () 2. hypertension 3. hyperlipidemia: flp () - tc 166, tg 163, hdl 45, ldl 88 4. paroxysmal atrial fibrillation on coumadin 5. diabetes mellitus, type ii: a1c () - 7.4% 6. asthma: spirometry () - fvc 34%, fev1 36%, mmf 20%, fev1/fvc 102%, tlc 83% 7. multifactorial sleep disordered breathing with hypoventilation and obstructive componenet: - per omr note () uses bipap 10/5 with 2 liters oxygen 8. depression 9. chronic pain (neck, headache, joints) 10. history of gi bleed secondary to antral ulcer in ; negative for h.pylori 11. history of positive ppd -- no inh per patient 12. history of pericarditis complicated by tamponade () 13. history of thalamic stroke () 14. s/p tah social history: lives with family, from barbados. no etoh, tobacco, illicits. family history: n/c physical exam: t 98.4 p 54 bp 118/62 rr 20 i2 97% on 3l general: pleasant, obese woman in no acute distress heent: sclera white, conjunctiva pale, mmm neck: no jvd pulm: lungs clear, no rales or wheezes cv: regular bradycardic s1 s1 ii/vi sem rusb abd: soft, obese, +bowel sounds, mild tender to deep palpation ruq without rigidity or guarding extrem: warm, no edema, 2+ distal pulses neuro: alert and interactive pertinent results: labs: admission: chem 143/4.8/103/30/46/1.7<88 ca 9.8, mag 2.3, phos 4.0 cbc wbc 8.7, hb/hct 9.6/28.4, plts 180 inr 2.8, ptt 33.1 discharge: 0 07:30am blood wbc-9.5 rbc-3.51* hgb-9.7* hct-29.9* mcv-85 mch-27.7 mchc-32.5 rdw-16.5* plt ct-180 07:30am blood pt-13.9* ptt-27.6 inr(pt)-1.2* . ekg : sinus brady @55, nl axis, tinv v3-v6, i,ii,vl, +lvh similar to prior . ruq u/s impression: no son evidence for cholelithiasis or acute cholecystitis. . cxr moderately enlarged heart is stable. the cardomegally has a flask shape suggesting the presence of pericardial effusion. the mediastinal and hilar contours are prominent. mild increased interstitial marking of pulmonary edema have improved. no pleural effusion, pneumothorax, or focal consolidation is identified. the tubing projecting in the epigastrium is most likely external in nature. impression: improving pulmonary edema. . egd : findings: esophagus: normal esophagus. stomach: mucosa: very small 2mm erosion of the mucosa was noted in the antrum. duodenum: normal duodenum. impression: very small 2mm erosion in the antrum brief hospital course: the patient is a 55 year-old female with complex medical history notable for chf, atrial fibrillation on anticoagulation, gastric ulcer, and dm admitted with abdominal pain and melena . 1. gi bleed: the patient initially presented with evidence of melena with suspected upper gi source, especially given history of prior gastric ulcer. the patient was transfused with 3u prbc with stabilization of hct and hemodynamics. she was also given vitamin k to decrease inr (supratherapeutic at 3.9 on admission). the gi service was consulted on admission, and performed an egd on . egd showed a small antral erosion but no site of active or recent bleeding. the gi service recommended outpatient capsule endoscopy to further evaluate the small bowel. if negative, they suggest further workup with colonoscopy (previous normal colonoscopy in ). the patient was continued on a ppi throughout admission and upon discharge. aspirin and coumadin were held on discharge pending further workup of gi bleed. she will f/u in gi suite for capsule endoscopy on . . 2. acute renal failure on crf: the patient developed arf with maximum creatinine of 3.2 on day of admission. this was felt to be of pre-renal etiology given hypovolemia with blood loss. cr improved post transfusions to baseline ~ 1.6. acei and lasix were initially held and were started back upon discharge. . 3. bradycardia: the patient has a history of sinus bradycardia both with and without bb therapy. admission ekg was without significant change compared to , at which time she had also been bradycardic in 40's. the patient's bb was held bradycardia with increase of hr to the 50's. beta-blocker was held on discharge, and should be restarted per the patient's outpatient cardiologist. . 4. hyperkalemia: the patient had hyperkalemia to value of 6.2, which was thought to be arf. this resolved with volume-resuscitation, as above. the patient was restarted on lasix prior to discharge. . 5. chf and nonobstructive hypertrophic cardiomyopathy: the patient is maintained on a bb for her outpatient regimen. this was held, as above, and may be restarted per her outpatient cardiologist. . 6. atrial fibrillation: the patient remained in sinus rhythm during admission. she was continued on amiodarone, and bb was held as above. the patient was given vitamin k per supratherapeutic inr in setting of active bleeding. coumadin was held upon discharge until further workup of gi bleed could be performed. . 7. dm: the patient was continued on home iss while inhouse with no acute issues. . the patient was discharged to home on in good condition, hd stable with stable hct. follow-up was arranged with gi and her pcp's office. medications on admission: medications 1. aspirin 81 mg daily 2. simvastatin 10 mg daily 3. metoprolol 25 mg daily (reports not taking; had been stopped in ) 4. lisinopril 20 mg daily 5. amlodipine 5 mg daily 6. amiodarone 200 mg daily 7. lasix 120 mg daily 8. warfarin 2 mg daily 9. humalog sliding scale 10. lantus 30 units qhs 11. metoclopramide 10 mg before meals 12. pantoprazole 40 mg daily 13. gabapentin 300 mg every other day 14. clobetasol 0.05 % cream . meds on tx from icu: pantoprazole 40 mg iv q12h acetaminophen 325-650 mg po q6h:prn simvastatin 10 mg po daily insulin sc: glargine 30 qhs discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. tablet, delayed release (e.c.)(s) 4. reglan 10 mg tablet sig: one (1) tablet po qac. 5. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 6. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 7. neurontin 300 mg capsule sig: one (1) capsule po qod. 8. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 10. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime. 11. insulin sliding scale breakfast lunch dinner bedtime 151-200 mg/dl 2 units 2 units 2 units 0 units 201-250 mg/dl 4 units 4 units 4 units 2 units 251-300 mg/dl 6 units 6 units 6 units 4 units 301-350 mg/dl 8 units 8 units 8 units 6 units 351-400 mg/dl 10 units 10 units 10 units 8 units discharge disposition: home with service facility: vna discharge diagnosis: primary 1. gastrointestinal bleeding 2. acute on chronic renal failure secondary 1. chf chronic diastolic 2. diabetes 3. atrial fibrillation discharge condition: good, hemodynamically stable, tolerating po well discharge instructions: you came into the hospital because of fatigue and concern for bleeding in your stools. you were evaluated by the gastroenterology doctors who performed endoscopy study, which showed no evidence of ulcers or bleeding. you have been set up for another study (capsule endoscopy) to further evaluate for a possible source of bleeding. . your heart rate was also found to be slow, so your metoprolol was stopped. you should follow up with dr. in cardiology clinic for further management of your heart disease. your aspirin and coumadin was also temporarily stopped until further workup for the cause of your gi bleeding is done. your lasix dose was also decreased due to your renal function. please discuss restarting these medications with dr. . . please take all of your medications as directed and keep your follow-up appointments. please do not use pain medications such as ibuprofen (motrin) at home as these can irritate your stomache and potentially cause worsened bleeding. you can take tylenol as directed for pain. . call dr. and seek medical attention if you develop: ** worsening abdominal pain, black or bloody stools, vomiting, lightheadedness or dizziness, chest pain or worsening shortness of breath, or any other symptoms that worry you followup instructions: please follow-up with (dr. office) on wednesday at 3:40pm to discuss your hospitalization. phone: . . please follow-up with the clinic as below for your capsule endoscopy. please arrive at 7:45 am. provider: (st-4) gi rooms date/time: 8:00 provider: , md phone: date/time: 8:00 . please make an appointment to see dr. (cardiology) within 2 weeks to discuss your low heart rate. phone: (. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine diagnoses: hyperpotassemia other chronic pain anemia, unspecified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified atrial fibrillation asthma, unspecified type, unspecified depressive disorder, not elsewhere classified chronic kidney disease, unspecified other specified cardiac dysrhythmias long-term (current) use of insulin blood in stool long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits chronic obstructive asthma, unspecified chronic diastolic heart failure other specified gastritis, without mention of hemorrhage cardiac rhythm regulators causing adverse effects in therapeutic use sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere cardiomyopathy in other diseases classified elsewhere hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified 

Answer: The patient is high likely exposed to