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: history of present illness: the patient is a 55 year old female with a history of coronary artery disease, st. aortic valve replacement, congestive heart failure, diabetes mellitus type 2, now insulin-requiring with a gastrointestinal bleed. on , the patient was admitted to with a congestive heart failure exacerbation and was treated with lasix, had an inr of 2.7 on coumadin for her aortic valve replacement. on , the patient's hematocrit was 28.7, she felt constipated and had bright red blood per rectum with bloody stools and clots. in the morning of , hematocrit went from 20 down to 12. the patient's bleeding and coagulation were reversed with 4 units of fresh frozen plasma, 4 units of packed red blood cells. a nasogastric tube was placed with clear gastric return. on transfer the patient had an inr of 1.7, hematocrit of 20.7 after the third unit. heartrate was in the 90s to 100s. blood pressure in the 90s/40s. of note the patient had a history of recurrent gastrointestinal bleeds over the last six months before admission requiring multiple transfusions. five weeks before admission the patient underwent cautery of her right angiodysplastic lesion in her colon. past medical history: 1. diabetes mellitus type 2, now insulin requiring with history of neuropathy and mild nephropathy; 2. hypercholesterolemia; 3. congestive heart failure. echocardiogram with an ejection fraction of 50 to 55% with global hypokinesis, 2+ mitral regurgitation and 3+ tricuspid regurgitation, well-seated aortic valve replacement; 4. aortic valve replacement with st. jude's valve in ; 5. history of rheumatic fever; 6. status post myocardial infarction status post percutaneous transluminal coronary angioplasty in ; 7. history of left atrial mass, nonneoplastic, status post resection in ; 8. history of atrial fibrillation, status post pacemaker placement, dual chamber; 9. chronic obstructive pulmonary disease requiring home oxygen for five years at 2 liters; 10. depression; 11. status post ovarian cyst removal; 12. status post cholecystectomy. medications on admission: albuterol 2 puffs b.i.d., enteric coated aspirin 325 mg p.o. q. day; bupropion 150 mg p.o. q. day; captopril 6.25 mg p.o. t.i.d.; digoxin 0.125 mg p.o. q.d.; colace 100 mg p.o. b.i.d.; fluticasone 2 puffs metered dose inhaler b.i.d.; ancef 1 gm q. 8 hours; nitropaste; quinine sulfate 260 mg p.o. q.h.s.; protonix 40 mg intravenously; spironolactone 25 mg p.o. q. am and spironolactone 50 mg p.o. q. pm; zolpidem 10 mg p.o. q.h.s. allergies: no known drug allergies. family history: mother with diabetes mellitus. social history: two to three pack per day smoker since the age of 14. quit five years ago. no alcohol use and lives with husband at home. physical examination: physical examination on admission, in general the patient was awake, arousable but somnolent. vital signs, pulse 74, blood pressure 82/33, respirations 22, oxygen saturations at 100%. temperature 100.4. head, eyes, ears, nose and throat, pupils are equal, round, and reactive to light. neck supple. right internal jugular central line. cardiovascular examination, regular rate and rhythm, ii/vi systolic murmur. respirations clear to auscultation bilaterally. abdomen, soft, positive bowel sounds, nontender, nondistended, obese. extremities, positive lower extremity swelling, erythematous region, halfway up shin. laboratory data: white count 16.9, hemoglobin 8.5, hematocrit 24.1, platelets 194. neutrophils 93, 4 bands. sodium 131, potassium 3.7, chloride 86, bicarbonate 37, bun 31, creatinine 0.9, glucose 113. calcium 8.4, magnesium 1.8, phosphorus 2.7. alt 16, ast 28, ldh 329, ck 253, ck mb 11. amylase 42, alkaline phosphatase 102, total bilirubin 1.8, albumin 3.1. troponin 7.6. digoxin level 1.2. electrocardiogram, paced electrocardiogram with no acute changes. impression: the patient is a 55 year old male with multiple medical problems including coronary artery disease, congestive heart failure, atrial fibrillation with pacemaker, chronic obstructive pulmonary disease, diabetes, aortic valve replacement on coumadin, now with a gastrointestinal bleed from a likely arteriovenous malformation with an myocardial infarction in the setting of a hematocrit down to 12. hospital course: 1. cardiovascular - the patient had an myocardial infarction with a troponin up to 7.6 in the setting of her hematocrit down to 12, had chest pain, multiple times throughout her hospital admission which responded to nitroglycerin and morphine. the patient underwent a cardiac catheterization on . total occlusion of her right coronary artery which appeared chronic with right to right collaterals and left to right collaterals to tiny and distant right coronary artery vessels, was not felt to be repairable with percutaneous transluminal coronary angioplasty or bypass. also had a 60% tubular stenosis of her obtuse marginal 1 which was felt not to be a critical lesion and did not have the appearance of an unstable plaque, was not percutaneous transluminal coronary angioplastied or sent. the patient was medically managed for her coronary artery disease on sublingual nitroglycerins which were switched to imdur, was also started on low dose zestril as well as metoprolol and diuresed with lasix and metolazone. the patient returned briefly to the medical intensive care unit for more aggressive diuresis for right-sided heart failure with a diuresis of nearly 12 liters during the three days of her stay there. at the time of discharge the patient has subjectively improved her breathing as well as continued to be chest pain free for over one week with oxygen saturations consistently in the high 90s to 100% on 2 liters which is a home oxygen. for her history of aortic valve replacement, the patient has been restarted on coumadin with a goal inr of 2 to 3, for anticoagulation with the aortic valve replacement as well as her atrial fibrillation. she has not shown any evidence of embolic phenomenon from either while on heparin. 2. infectious disease - initial presentation was one of bilateral lower extremity cellulitis which was treated with intravenous ancef, was then discontinued after resolution of her symptoms as well as physical examination appearance. she had a brief course of levofloxacin for a urinary tract infection. no evidence of infection currently. 3. heme - hematocrit has been in the range of 29 to 32. she has required multiple units of packed red blood cells to maintain her hematocrit. she was started on iron and folate. she may continue to need transfusions in that she continues to have blood in her stools. she will need to stay on coumadin for her aortic valve replacement as well as for her atrial fibrillation with a goal inr of 2.0 to 3.0. 4. endocrine - the patient has a history of diabetes for which she was covered with an insulin sliding scale and was given nph insulin with fingersticks in the 100s to 200s. on discharge her fingersticks have been more stable in the low 100 range on nph insulin as well as regular insulin sliding scale. 5. gastrointestinal - the patient presented with a gastrointestinal bleed likely from an arteriovenous malformation in her colon. these arteriovenous malformations were discovered on colonoscopy as well as enteroscopy at showing arteriovenous malformations in her right colon as well as her transverse colon. the patient underwent an interventional radiology embolization of her right colon after a bleeding scan was suggestive of continued bleeding in the area. after the procedure the patient continued to have melanotic stools which gradually resolved and continued to be occult blood positive. the patient may still have a small amount of bleeding in her colon, however, it does not warrant further workup at this point, given the fact that the bleeding is considerably smaller and that interventional embolization seems to have stopped the major source of bleeding. if bleeding continues in the future, the patient will need to undergo a tagged red blood cell scan to identify the source and will likely need another embolization. 6. renal - electrolytes have been stable. the patient has not experienced any decrement in her renal function during the aggressive diuresis. 7. disposition - the patient was seen by physical therapy, was able to walk up to 300 feet with the assistance of a walker. will continue to need home physical therapy as well as and will get a significant amount of help from her husband at home. discharge diagnosis: 1. gastrointestinal bleed from arteriovenous malformation 2. coronary artery disease 3. myocardial infarction , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters left heart cardiac catheterization injection or infusion of other therapeutic or prophylactic substance arteriography of other intra-abdominal arteries diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified atrial fibrillation cellulitis and abscess of leg, except foot angiodysplasia of intestine with hemorrhage diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to