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: this is a 68 year-old male with a significant history of coronary artery disease, coronary artery bypass graft times three, last redo in , status post inferior myocardial infarction in , history of celiac sprue, iron deficiency anemia, aortobifemoral bypass, chronic renal insufficiency who was recently discharged on after admission for chest pain now status post redo coronary artery bypass graft, saphenous vein graft from aorta to obtuse marginal one, stents to left main, left anterior descending coronary artery and d one complicated by acute on chronic renal insufficiency and black tarry stools for which esophagogastroduodenoscopy and ct to evaluate for aorta fistulas were recommended, but not performed. the patient now returns with one week of melena, reports shortness of breath with exertion of 40 yards and general weakness. no lightheadedness, dizziness, chest pain, abdominal pain, nausea or vomiting. the patient has had blood transfusions in the past. no history of intravenous drug use. no history of jaundice. past medical history: 1. coronary artery disease, coronary artery bypass graft times three, last redo . status post aortobifemoral . 2. hypertension. 3 dyslipidemia. 4. cerebrovascular accident in . 5. right mca with residual left sided weakness. 6. frequent falls. 7. chronic renal insufficiency with a baseline creatinine of 3.5. 8. celiac sprue. 9. iron deficiency anemia. 10. remote seizure disorder. 11. gout. 12. aortic atheroma. 13. status post bilateral cea . 14. status post renal artery stenosis. 15. status post left subclavian stent. 16. history of sinus bradycardia. allergies: no known drug allergies. medications: 1. metoprolol 100 b.i.d. 2. aspirin 325 q day. 3. tylenol. 4. clopidogrel 75 po q.d. 5. allopurinol 100 q.o.d. 6. atorvastatin 80 mg po q day. 7. imdur 60 mg b.i.d. 8. hydrochlorothiazide 25 mg q.i.d. 9. nystatin. 10. pantoprazole 40 mg po q day. 11. zoloft 50 mg po q day. 12. __________. physical examination: vital signs 96.1, 121/69, heart rate 51, respirations 16, 98% on room air. general tired appearing, pale. heent normocephalic, atraumatic. pupils are equal, round and reactive to light. sclera anicteric. conjunctiva pale. chest fine inspiratory rales bilaterally. regular rate. normal s1 and s2. flat jvp with carotid bruit. abdomen soft, nontender, nondistended. no organomegaly. bowel sounds present. neurological cranial nerves ii through xii intact. left hemiplegia. extremities warm. pulses not palpable. no edema. laboratory studies: white blood cell count 5.7, hematocrit 22.3 down from 33.6 on . platelets 168, sodium 139, potassium 3.8, chloride 106, bicarb 25, bun 55, creatinine 3.8, glucose 112. echocardiogram left moderate dilation, ef of 35%, 3+ mitral regurgitation, hypokinesis, inferior, inferolateral, inferoseptal moderate pulmonary hypertension. cardiac catheterization on 70% distal lmca, 90% osteal left anterior descending coronary artery, 80% d1. electrocardiogram normal sinus rhythm at a rate of 51, left ventricular hypertrophy, left bundle branch block. social history: retired, quit tobacco five years ago with a 50 pack year history. no alcohol or intravenous drug use. family history: diabetes, neck cancer, congestive heart failure. hospital course: the patient was admitted to the intensive care unit and his hospital course was significant for the following issues. 1. gi: the patient underwent nasogastric lavage, which was negative for blood. he was transfused to keep the hematocrit greater then 30 and was started on intravenous proton pump inhibitor. he was prepped for esophagogastroduodenoscopy and colonoscopy. his diuretics and antihypertensives were held. a gi consult was obtained and esophagogastroduodenoscopy was done on and positive for a small hiatal hernia, erythema and friability in the antrum compatible with gastritis, celiac disease and otherwise normal esophagogastroduodenoscopy to the third part of the duodenum. a colonoscopy performed on showed stool in the transverse colon and ascending colon, diverticulosis of the sigmoid colon and descending colon, grade one internal hemorrhoids, melena was noted in the right side of the colon and this raised the question of whether the bleeding source was an upper gastrointestinal bleed. there was no red blood seen in the colon. there was no active bleeding seen in the colon. the patient was transfused a total of 3 units of packed red blood cells and he was called out of the intensive care unit and sent to the floor on where he continued to have guaiac positive stool, but his hematocrit remained stable. his diet was advanced and he tolerated a gluten free cardiac diet for several days prior to discharge with no further evidence of bleeding. an mri/mra to rule out aorta enteric fistula was not obtained since the patient had recent catheterization with stent placement. this can be done as an outpatient if clinically indicated. the patient should also follow up with gi to have a small bowel series as the likely source of bleeding with a small bowel avm. prior to discharge the patient was seen by physical therapy who recommended short term rehab stay. 2. coronary artery disease: the patient is status post coronary artery bypass graft and pci. despite the gastrointestinal bleed he was continued on aspirin and plavix per discussion with gastrointestinal and cardiology. the patient had no evidence of active ischemia. 3. congestive heart failure: the patient was noted to have a systolic dysfunction with an ef of 35%. no evidence of decompensated failure on examination. prior to discharge to the floor the patient was noted to have some rales on examination and shortness of breath, which improved with lasix. he was gently diuresed. o2 was weaned and the patient was off oxygen satting well on room air for several days prior to discharge. the patient was continued on his medications. 4. hypertension: prior to leaving the intensive care unit the patient was noted to have high blood pressures, which required labetalol drip. upon transfer to the floor he was restarted on his home blood pressure medications, his blood pressure remained on the low side and medications were titrated accordingly. he remained on metoprolol, hydralazine and isosorbide for blood pressure control. 5. acute on chronic renal failure: patient with increased creatinine since his discharge status post coronary artery bypass graft and received large doses of dye in previous catheterizations. nephro toxic medications were avoided. the patient was noted to have eosinophils in his urine perhaps consistent with cholesterol emboli. upon transfer to the floor his creatinine increased slightly with diuresis. once the congestive heart failure had improved the diuretics were discontinued and his creatinine began to trend back down. 6. rash: once transferred to the floor the patient developed a macular papular rash on his chest. no new medications had been started. the patient was given sarna lotion and the rash continued to improve prior to discharge. condition on discharge: good, ambulating with assistance and oxygenating well off oxygen. discharge status: short term rehab. discharge diagnoses: 1. gastrointestinal bleed. 2. anemia. 3. coronary artery disease status post aortobifemoral bypass. discharge medications: 1. allopurinol 100 mg po q.o.d. 2. aspirin 81 mg po q day. 3. isosorbide dinitrate 40 mg t.i.d. 4. atorvastatin calcium 80 mg po q day. 5. metoprolol 50 mg po b.i.d. 6. clopidogrel 75 mg po q day. 7. temazepam 15 mg q.h.s. prn. 8. sertraline 50 mg po q day. 9. pantoprazole 40 mg b.i.d. 10. hydralazine 50 mg po q 6 hours. follow up appointments: the patient had follow up with dr. on at 9:00 a.m. as well as with provider on and with cardiology with dr. on . the patient should also follow up for small bowel follow through. dr., 12-988 dictated by: medquist36 procedure: other endoscopy of small intestine colonoscopy diagnoses: mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) gout, unspecified aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute on chronic systolic heart failure angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to