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: dark stools, shortness of breath. major surgical or invasive procedure: small bowel enteroscopy history of present illness: the patient is a 68m with h/o cad s/p cabg ', as , ischemic cm with ef 45% and h/o gi due to avms in the past who now p/w 4 days of maroon colored stool, stomach upset and also with increased weight. the patient reports being in his usual state of health until 3 days ago when he noticed that his stool had been becoming darker and had some bright red blood. he has been noticing some exertional cp (stabbing pain in chest) and dyspnea when walking around the house and from the house to the car. he also had an episode 2 days ago of stabbing chest pain when lying down to go to sleep. his symptoms were relieved with a sl nitroglycerin. also noticed dizziness and lightheadedness over the past 24 hours. . ros: weight prior to was 184. over past month has been creeping up up to between 195-200 over last few days. pt reports he "gets in trouble with sob when over 190". + throbbing pain in left hand over last few days. . in the ed an ngl was negative, he was given a ppi. two 18g peripheral iv's were placed. his sbp's remained approximately 100-110's with hr in the 60's. original ekg was without ischemic changes. while in the ed, the patient began to experience jaw pain and a repeat ekg showed new st depressions and t wave inversions. he was transfused 2 units of . also the patient had a k=6 and was treated with insulin/amp d50/ bicarb/and calcium gluconate. past medical history: -- cabg ' (lima-lad, svg lad, svg om) -- cath : three vessel native coronary artery disease, patent grafts, moderate aortic stenosis, patent previously placed stents, elevated left sided filling pressure. -- stress test : poor functional status. 3.5 minutes of exercise on protocol. ef 30% and multiple fixed perfusion defects and minor inferior defect. -- multiple coronary stents in ,, and -- aortic stenosis: 0.8 mm hg. -- ischemic cm/chf - diastolic, systolic ef 45%, recent admit for diuresis in late . -- dm2, last hga1c in of 7.1 -- anemia: baseline hct 31-33 -- hypothyroidism -- osa on cpap -- depression -- ckd- with baseline cr 1.5-2.0 -- hypercholesterolemia -- oa -- gout -- ibs-diarrhea predominant -- obesity -- pvd -- ugi and lgi bleeding secondary to avms social history: lives with his wife in . retired , worked for globe for >45 years. denies smoking, etoh, or "other funny stuff". has 1 daugther who lives in and 2 sons who live locally. family history: there is no family history of premature coronary artery disease or sudden death physical exam: pe: t: bp:104/31 hr:81 rr: 22 o2 100% ra gen: pleasant, well appearing, nad heent: no conjunctival pallor. no icterus. mmm. op clear. neck: supple, no lad, no jvd. no thyromegaly. cv: 3/6 sem lungs: good breath sounds b/l, minimal crackles at bases abd: nt/nd, small areas of ecchymosis from insulin injections ext: no c/c/e; discoloration consistent with chronic venous stasis neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. pertinent results: 05:30pm blood wbc-6.7 rbc-2.81* hgb-9.3* hct-26.2* mcv-93 mch-33.3* mchc-35.7* rdw-15.7* plt ct-176 12:29am blood hct-26.5* 03:09am blood wbc-7.3 rbc-3.59* hgb-11.6* hct-32.7* mcv-91 mch-32.2* mchc-35.4* rdw-16.1* plt ct-144* 09:35am blood wbc-7.0 rbc-3.76* hgb-12.3* hct-34.2* mcv-91 mch-32.8* mchc-36.1* rdw-16.4* plt ct-147* 06:35am blood wbc-7.4 rbc-3.46* hgb-11.9* hct-32.0* mcv-93 mch-34.5* mchc-37.3* rdw-18.6* plt ct-153 03:15pm blood wbc-8.5 rbc-3.51* hgb-11.4* hct-32.0* mcv-91 mch-32.4* mchc-35.6* rdw-15.8* plt ct-126* 05:30pm blood plt ct-176 09:15pm blood plt ct-161 03:15pm blood plt ct-126* 05:30pm blood glucose-97 urean-112* creat-2.9*# na-133 k-6.3* cl-104 hco3-19* angap-16 09:15pm blood glucose-130* urean-66* creat-2.0* na-136 k-4.8 cl-103 hco3-19* angap-19 09:35am blood glucose-181* urean-53* creat-1.8* na-138 k-5.0 cl-103 hco3-24 angap-16 06:35am blood glucose-165* urean-52* creat-1.5* na-134 k-4.7 cl-104 hco3-20* angap-15 05:30pm blood ck(cpk)-105 12:29am blood ck(cpk)-104 09:06am blood ck(cpk)-98 07:56pm blood ck(cpk)-94 05:30pm blood ck-mb-8 ctropnt-0.11* 12:29am blood ck-mb-7 ctropnt-0.07* 09:06am blood ck-mb-notdone ctropnt-0.11* 07:56pm blood ck-mb-notdone ctropnt-0.12* . . ekg: nsr, 78bpm, no ste, std, normal axis, intervals. twi in avl only. . egd - single nonbleeding 18mm dudoneal ulcer. brief hospital course: pt was admitted to the medical intensive care unit in hemodynamically stable condition, with ongoing dark stools. . . # gi bleeding. pt is a a 68 m with h/o recurrent gi bleeding from avms, cad s/p cabg, chf (ef45%) who presented with 4d of dark colored stools, stomach upset, and dyspnea, found to have hct of 26. he was felt to be hemodynamically stable (97.2 94/39 64 18 98%ra). ngl was negative in ed, initial ekg showed st depression and twi. creatinine was slightly elevated, k was 6 on admission. pt received insulin/bicarb/calcium gluconate, 2u prbc, and 2l ns in the emergency department. he was then transferred to the micu (hr 65 bp 119/32 100%2l), seen by the gi service, and transfused 2u (pt received a total of 4u prbc), with hct stabilizing at 32. egd performed on revealed a non-bleeding duodenal ulcer. . pt was transferred to the general medical floor. repeat hct was stable 32-34. he continued to have dark stools without frank bleeding, despite stable hct and sbps. h. pylori serologies were obtained which were unremarkable. pt was treated with sucralfate and protonix as per gi service recommendation. he was discharged home on with instructions to follow-up with his gastroenterologist within 2-3 weeks. in addition, he was instructed to follow-up with his primary care physician 2 weeks regarding restarting his bumex and xaroxolyn as below. . . # cardiac: # ischemia - pt presnted with dynamic ekg changes while in ed (deeping of inverted t's and st depressions), this was felt likely to represent demand ischemia in the setting of gi bleeding and anemia. his symptoms of sob were resolved s/p 2u prbc, and did not recur during his admission. pt was seen by the cardiology service in the ed who recommended correcting his anemia, and managing him medically. . pt's aspirin and plavix were initially held, but were restarted once pt's hematocrit stabilized in light of his s/p recent placement of cypher stent in . pt was instructed to follow-up with his cardiologist within 4 weeks regarding the specific duration of his plavix therapy in light of his multiple recurrent gi bleeding episodes. pt was otherwise discharged on his prior cardiac regimen of toprol 50mg qdaily, imdur 60 mg qdaily, zetia 10mg po qdaily, and simvastatin 80 mg po qdaily. . # pump - pt with h/o chf (ef 45%), on standing bumex, zaroxlyn and zestril at home. these medications were held in the micu ugib and arf. zestril was restarted prior to . pt was discharged home with instructions not to take his bumex or zaroxlyn until seen by his pcp, whose nurse practitioner he had an appointment 2d after , given his lack of clinical volume overload and still resolving arf. . # rythym - pt remained in nsr during his hospitalization. . . # acute on chronic renal failure - etiology of pt's arf was felt most likely hypoperfusion/prerenal in the setting of gi bleeding. creatinine peaked at 2.9, and came down to 1.5 at time of (baseline 1.4-1.7) with ivf hydration. pt restarted on his zestril, but discharged with instructions not to take his prior bumex and zaroxlyn until seen by pcp who will assess volume status and follow pt's cri. pt has an appointment with his np 2-3d after . . . # dm2: pt was continued on his previous regimen of nph 60qam/50qpm and humalog 30qam/20qpm. he was given additional coverage as needed with humalog sliding scale. . # hypothyroidism: pt was continued on his home regimen of synthroid 200mcg qd. . # hyperlipidemia: pt was continued on his home regimen of pravastatin 60 qhs. . # gout: pt has a h/o of gout for which he is treated with allopurinal. he was continued on this regimen, though initially dosed qod arf. as his renal function improved, this was switched to daily dosing. on pt developed right knee pain. ultrasound and doppler studies were obtained to rule out cyst and aneurysm. pt was afebrile without elevated wbc count, thus septic arthritis was felt unlikely. pt was treated with oxycodone 5mg prn with good releif. nsaids, colchicine, and prednisone were avoided given pt's arf and gib respectively. pt was discharged home with a 7d supply of oxycodone. should his pain persist, he was instructed to follow-up with his pcp. . # depression: cont zoloft. . # osa: pt continued to use his own cpap at night. . # dispo - pt discharged home with strict instructions to follow-up with gi within 2-3 weeks regarding his chronic gi bleeding, and ongoing dark stools despite stable hct. he was instructed to follow-up with cardiology regarding duration of plavix therapy. he was instructed to follow-up with his pcp/pcp nurse regarding restarting bumex and zaroxlyn and future follow-up of his creatinine. medications on admission: allopurinol 150mg po qday ambien 5mg qhs prn asa 325mg qday bumex 0.5mg calcitriol 0.25mg qday carafate 1 gram qid ferrous sulfate 325mg qday insulin humulin n as directed insulin humulin r as directed isosorbide mononitrate 60mg qday levoxyl 200mcg qday ntg 0.4mg sl q5 minutes prn chest pain x3 plavix 75mg qday protonix 40mg qday simvastatin 80mg qday spironolactone 25mg qday toprol xl 50mg qday zaroxlyn 2.5mg prn for increasing weight zestril 5mg qday zetia 10mg qday zoloft 50mg qday medications: 1. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 2. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 4. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 5. toprol xl 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. allopurinol 300 mg tablet sig: 0.5 tablet po daily (daily). 9. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). 10. isosorbide mononitrate 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 12. 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* 13. oxycodone 5 mg tablet sig: one (1) tablet po three times a day as needed for hand or knee pain for 5 days. disp:*15 tablet(s)* refills:*0* 14. humalog (insulin) please take 30 units with breakfast and take 20 units with dinner. 15. nph (insulin) please take 60 units with breakfast and take 50 units with dinner. 16. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po once a day. 17. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn chest pain as needed for chest pain: place one tablet under toungue if you develop chest pain, may repeat up to three times, take 5 minutes apart. if used, please call your pcp or the emergency department. . 18. levoxyl 200 mcg tablet sig: one (1) tablet po once a day. 19. calcitriol 0.25 mcg capsule sig: one (1) capsule po once a day. disposition: home diagnosis: upper gi bleeding condition: stable instructions: please continue to take all of your medications as prescribed. you were discharged with a new perscription for oxycodone for knee pain x 5 days. your protonix was increased to twice daily. please continue to weigh yourself every morning, md if weight increases by > 3 lbs. adhere to 2 gm sodium diet . your bumex and zaroxylyn were discontinued, you should wait until you are seen by dr. or her nurse practitioner to restart these if you have more edema. . if you have recurrent vomitting of blood, or bloody stools, chest pain, shortness of breath, fevers, chills, or other worrisome symptoms, please contact your primary care physician or the emergency department. followup instructions: upon arriving home, please contact your gastroenterologist and arrange to be seen within 2-3 weeks regarding your ongoing gi bleeding. . please contact your primary care physician and arrange to be seen within 2-3 weeks regarding restarting your bumex. . please contact your cardiologist and arrange to be seen within 4-6 weeks regarding continuing to take aspirin and plavix. provider: , rn,bsn,msn phone: date/time: 12:00 . provider: , m.d. phone: date/time: 1:00 . provider: , md phone: date/time: 2:30 procedure: other endoscopy of small intestine transfusion of packed cells diagnoses: obstructive sleep apnea (adult)(pediatric) pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism gout, unspecified aortocoronary bypass status aortic valve disorders chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified angina pectoris chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to