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 an 86-year-old female who was transferred from an outside hospital with a lower gastrointestinal bleed. the patient presented to an outside hospital one day prior to admission after developing persistent and increased bright red blood per rectum that was associated with lightheadedness. the patient was unable to quantify how much blood had passed. at the outside hospital, the patient was noted to be hypotensive with systolic blood pressures in the 80s and heart rate of 60. the patient was treated with 3.5 liters of crystalloid and 3 units of packed red blood cells. the patient was also noted to have dynamic changes on his electrocardiogram. prior to emergency medical service, the patient reportedly passed out. the patient was recently admitted to the veterans administration three weeks prior to admission with a similar complaint of dark stools for one year. a colonoscopy that was performed on at the veterans administration showed internal hemorrhoids, diverticula, and a bleeding arteriovenous malformation in the ascending colon that was actively bleeding and was subsequently cauterized. the patient was discharged to home four days later. on the day of admission, the patient apparently still had bright red blood per rectum but denied any chest pain, shortness of breath, palpitations, abdominal pain, nausea, vomiting, diarrhea, hematemesis, fevers, chills, cough, sputum, or lower extremity edema. the patient was still having persistent dark stools on admission. the patient reportedly that the bleeding had stopped after the procedure was done at the outside hospital but the restarted the day after he was discharged to home. in the emergency department, the patient was typed and crossed and given fresh frozen plasma and 2 liters of normal saline. the patient was then subsequently transferred to the medical intensive care unit. past medical history: (the patient's (past medical history is significant for) 1. coronary artery disease; status post coronary artery bypass graft. 2. porcine aortic valve. 3. hypertension. 4. basal cell carcinoma. 5. atrial fibrillation. 6. gastroesophageal reflux disease. 7. gout. 8. urethral stricture. 9. status post pacemaker placement. 10. diabetes. 11. hyperlipidemia. medications on admission: (the patient's medications on admission were) 1. nitroglycerin tablets as needed. 2. aspirin 81 mg by mouth once per day. 3. lovastatin 20 mg by mouth once per day. 4. lactulose. 5. senna. 6. allopurinol 300 mg by mouth once per day. 7. hemorrhoid cream. 8. colace as needed. 9. iron sulfate. 10. coumadin 2 mg by mouth at hour of sleep. 11. metformin 500 mg by mouth every day. 12. lasix 20 mg by mouth twice per day. 13. omeprazole 40 mg by mouth once per day. 14. toprol-xl 50 mg by mouth once per day. 15. lisinopril 40 mg by mouth once per day. 16. hydrochlorothiazide 25 mg by mouth once per day. allergies: the patient is allergic to bacitracin. family history: the patient family history was noncontributory. social history: the patient is married and has two daughters. the patient's does not have a history of any alcohol, tobacco, or intravenous drug use. the patient receives all of his care at the veterans administration hospital. his primary care physician is . at the veterans administration hospital. physical examination on presentation: the patient's vital signs on admission revealed his blood pressure was 91/41, his heart rate was 60, his respiratory rate was 17, and his oxygen saturation was 100% on 2 liters via nasal cannula. the patient's temperature was 96 degrees fahrenheit. in general, the patient an obese elderly gentleman. head, eyes, ears, nose, and throat examination revealed the sclerae were anicteric. the pupils were equal, round, and reactive to light. the oropharynx was clean and dry. the patient had a basal cell carcinomatous lesion on his right upper forehead. neck examination revealed that the neck was supple. there was no lymphadenopathy and no bruits. his lung examination revealed crackles at the bases bilaterally. cardiovascular examination revealed a regular rate and rhythm. normal first heart sounds and second heart sounds. the patient had a 2/6 systolic ejection murmur. there was a midline scar consistent with his coronary artery bypass graft in the past. the abdominal examination revealed normal active bowel sounds. the abdomen was soft, nontender, and nondistended. there was no hepatosplenomegaly. there were no masses. his rectal examination revealed brown stool that was mixed with bright red blood. his extremity examination revealed trace edema. the pulses were 1+ in the lower extremities. there were no rashes. pertinent laboratory values on presentation: the patient's laboratories on admission were notable for a hematocrit of 24.9 at the outside hospital. at the patient's hematocrit was 29.8. at the outside hospital the patient's creatine kinase was 38 and his troponin was 0.05. he had an inr of 2.7. the patient's creatine kinase on admission here at was 43. the mb was not done. the troponin was less than 0.01. pertinent radiology/imaging: the patient's electrocardiogram on admission revealed ventricular pacing at 60. there were st depressions in leads v3 through v6. there was a biphasic t wave in leads v4 and v5. the patient's echocardiogram done in at the veterans administration remainder unavailable throughout hospital hospitalization. concise summary of hospital course by issue/system: the hospital course was as follows. 1. lower gastrointestinal bleed issues: the patient received 6 units of fresh frozen plasma and 6 units of packed red blood cells during his medical intensive care unit stay. the patient's aspirin and coumadin were on hold for at least two weeks secondary to his gastrointestinal bleed. both the gastroenterology service and surgery service were consulted. the patient received a bleeding scan that was notable for a negative result, and according to the gastroenterology service, the patient was planned for an outpatient esophagogastroduodenoscopy if the patient remained stable throughout his hospital stay. the patient did not have any repeat bleeding throughout his hospital course, and the patient's hematocrit remained stable. on admission, his hematocrit was 29. the patient's hematocrit after the blood transfusions remained stable. the patient was discharged with a hematocrit of 36.4 on the day of discharge. the patient was instructed to follow up at the veterans administration hospital for an outpatient esophagogastroduodenoscopy after discharge. the patient also reported throughout the hospitalization that he had no further episodes of lightheadedness or dizziness. 2. cardiovascular issues: the patient has a history of coronary artery disease and had dynamic changes on his electrocardiogram from the outside hospital that was most likely due to demand ischemia. the patient's cardiac enzymes were cycled, and the results were negative for a myocardial infarction. the patient's antihypertensive medications were held initially throughout his hospitalization and then restarted on day three of hospitalization without any complications. although the patient was restarted on his beta blocker, and statin, and ace inhibitor medications the patient's aspirin and coumadin were held secondary to the risk of gastrointestinal bleeding. 3. congestive heart failure issues: the patient was deemed to have congestive heart failure exacerbation during his hospitalization secondary to the extensive fluids and blood products that were given to the patient for his lower gastrointestinal bleed. the patient responded very nicely to intravenous lasix diuresis. on the day of discharge, the patient was saturating 93% to 95% on room air and had returned to his baseline weight of 185 pounds. the patient's pulmonary examination also improved throughout his hospital course, responding to the lasix diuresis. on the day of discharge, the patient's pulmonary examination revealed that he only had mild crackles bilaterally. the patient was restarted on his lasix medication at his outpatient dose of 80 mg by mouth twice per day on discharge. the patient was also instructed to weigh himself daily, and if his weight increased by more than three pounds over two days he was instructed to take an extra dose of lasix and see his primary care physician . 4. history of atrial fibrillation issues: the patient was rate controlled throughout his hospital stay with a rate of 60 and remained in a normal sinus rhythm throughout his hospitalization. the patient's anticoagulation with coumadin was held throughout his hospital stay secondary to his gastrointestinal bleed, and the patient was given instructions to restart his coumadin after he had seen his primary care physician in approximately one to two weeks after he was discharged from the hospital. 5. diabetes issues: the patient was continued on his outpatient diabetes medication with glucophage and fingerstick checks done four times per day and an insulin sliding-scale given if necessary. the patient's fingerstick check remained fairly well controlled throughout his hospitalization. the patient was discharged on his same outpatient glucophage dose. 6. fluids/electrolytes/nutrition issues: the patient was restarted on a by mouth diet after he was made nothing by mouth for the bleeding scan and colonoscopy during his hospitalization. the patient tolerate the by mouth diet and was advanced to a full regular diet without any complications. the patient also developed hyponatremia and a contraction alkalosis secondary to extensive lasix diuresis that the patient received. this contraction alkalosis and hyponatremia improved over his hospitalization, and when the patient was discharged his sodium and his bicarbonate were within normal limits. 7. prophylaxis issues: the patient was maintained on a proton pump inhibitor and given pneumatic boots throughout his hospitalization. 8. code status issues: the patient was a full code throughout his hospitalization. condition at discharge: the patient's condition on discharge was stable. discharge status: the patient's discharge status was to home with home physical therapy and home to evaluate for safety. discharge instructions/followup: the patient was given very explicit discharge instructions to follow up with his primary care physician within one week of discharge and to follow up with his cardiologist both at the veterans administration hospital for his congestive heart failure exacerbation during this hospitalization. discharge diagnoses: 1. lower gastrointestinal bleed. 2. congestive heart failure. 3. coronary artery disease. 4. atrial fibrillation. 5. diabetes mellitus. medications on discharge: (the patient was discharged on the following medications) 1. pantoprazole 40 mg by mouth once per day. 2. allopurinol 300 mg by mouth once per day. 3. lisinopril 20-mg tablets two tablets by mouth once per day. 4. metformin 500 mg by mouth once per day. 5. metoprolol 50-mg tablets 0.5 tablet by mouth twice per day. 6. albuterol and atrovent nebulizers 1 to 2 puffs inhaled as needed. 7. furosemide 80 mg by mouth twice per day. discharge diet: the patient was discharged on a cardiac-healthy and diabetic diet. , m.d. dictated by: medquist36 procedure: transfusion of packed cells diagnoses: congestive heart failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status angiodysplasia of intestine with hemorrhage heart valve replaced by transplant other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to