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 56 year old greek female with a history of recurrent gastrointestinal bleeding, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease and other comorbidities, who presents from her nursing home with maroon stools times ten to fourteen days and bright red blood per rectum for the past two days. for the past ten to fourteen days, she has also had crampy intermittent lower left quadrant pain, nonexertional shortness of breath and moderate fatigue. falling hematocrit necessitated transfusion of two units of packed red blood cells at center where she has been living for four months. she denies the following: chest pain, syncope, nausea, vomiting, dysphagia, dysuria or hematuria. she also denies a history of peptic ulcer disease or gastroesophageal reflux disease. she does report swelling and erythema of her legs which has been unchanged for the past six months. gastrointestinal bleeding history: 1. to , recurrent gastrointestinal bleeds over these months requiring eighteen transfusions at various hospitals. 2. , hospital. video endoscopy did not reveal bleeding, upper endoscopy showed papular gastropathy but no source of chronic bleeding. 3. , hospital. colonoscopy revealed a single nonbleeding angiectasia in the transverse colon which was treated with electrocautery. 4. , and then transferred to medical intensive care unit - presented at with bright red blood per rectum, hematocrit fell from 28.0 to 12.0 and was transferred four units; transferred to . coumadin and heparin were held. there was a bleeding scan positive for bleeding from angiodysplasia of the cecum or ascending colon past the distal ileocolic artery. she received interventional radiology embolization of the right colon. coumadin and heparin were restarted after embolization. in addition, the patient was hypotensive throughout the admission with blood pressure nadiring at 82/30; her hematocrit on that admission 24.0, inr 2.6; and in this setting, she had a myocardial infarction with peak ck of 300 and troponin of 34. an echocardiogram showed an ejection fraction of 40%. in addition, the patient had a catheterization that showed one vessel disease which seemed chronic. she was transfused four units at for a total of eight. her hematocrit stabilized and bleeding was mostly resolved. 5. , medical intensive care unit. the patient presented with bright red blood per rectum initially progressing to maroon colored stools plus intermittent substernal chest pain relieved with sublingual nitroglycerin. she was hypotensive to 99/56. her electrocardiogram showed 0. depressions in leads ii and iii. she ruled out for myocardial infarction and was transfused five units total. interventional radiology elected not to embolize due to the risk of mesenteric ischemia. coumadin and heparin were held. bleeding resolved. 6. - the patient presented to with hypotension and malaise. colonoscopy showed a continuous area of nonbleeding shallow ulcer of the mucosa with no stigmata of recent bleeding present in the ascending colon distal to the cecum, three ulcers next to each other, largest 1.0 centimeter, nonbleeding internal hemorrhoids as well. past medical history: 1. gastrointestinal bleeds as above. 2. status post aortic valve replacement with a st. jude valve in . 3. congestive heart failure with transthoracic echocardiogram on , showing normal left ventricular systolic function, inability to assess the ejection fraction due to irregular rhythm although an ejection fraction of 40% was shown on . right ventricle was dilated with moderately reduced systolic function. aortic valve prosthesis was well seated, no aortic insufficiency, 2+ mitral regurgitation, 3+ tricuspid regurgitation, pulmonary artery pressure 70 mmhg, mitral valve calcified at the commissures but mobile without stenosis, dilated inferior vena cava suggestive of elevated right heart diastolic pressures. 4. coronary artery disease. the patient is status post percutaneous transluminal coronary angioplasty in . she is status post multiple myocardial infarctions. cardiac catheterization on , demonstrated 100% proximal right coronary artery stenosis with diffuse right coronary artery disease, not felt to repairable by angioplasty or bypass. septal inferior artery with 60% occluded, obtuse marginal 60% occluded and the first diagonal 20% occluded. 5. hypercholesterolemia. 6. atrial fibrillation, status post pacemaker placement. 7. history of rheumatic fever. 8. diabetes mellitus type 2. the patient is now requiring insulin. history of neuropathy and mild nephropathy. 9. chronic obstructive pulmonary disease. she requires home oxygen at three liters since . 10. klebsiella urinary tract infection in . 11. depression. past surgical history: as above. 1. left atrial mass resection , nonneoplastic infected atrial myxoma. 2. ovarian cyst removal. 3. cholecystectomy. allergies: no adverse reactions, no known drug allergies. medications on admission: 1. albuterol, ipratropium nebulizers four times a day. 2. aspirin 81 mg p.o. once daily. 3. captopril 6.25 mg p.o. three times a day. 4. digoxin 0.125 mg p.o. once daily. 5. docusate 100 mg p.o. twice a day. 6. furosemide 160 mg p.o. twice a day. 7. gabapentin 100 mg p.o. q.h.s. 8. metolazone 5 mg p.o. twice a day. 9. metoprolol 12.5 mg p.o. twice a day. 10. ocean spray nasal spray two puffs each naris three times a day. 11. nph insulin 26 units subcutaneous q.a.m., 6 units subcutaneous q.p.m. 12. protonix 40 mg p.o. once daily. 13. simvastatin 10 mg p.o. once daily. 14. spironolactone 25 mg p.o. once daily. 15. vitamin c 500 mg p.o. twice a day. 16. warfarin 5 mg p.o. q.h.s. 17. zinc sulfate 220 mg p.o. twice a day. social history: two to three pack per day smoker since the age of 14, 70 to 100 pack years total. quit six years ago. no alcohol use. had lived at home with husband until four months ago when she moved to center. family history: mother with type 2 diabetes mellitus. physical examination: vital signs revealed a temperature 97.6, pulse 89, respiratory rate 20, blood pressure 105/60. oxygen saturation 100% on three liters. in general, this is an elderly female with mild respiratory distress, alert, cooperative and oriented times three. cranium was normocephalic and atraumatic. the pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. sclera anicteric. mucous membranes are slightly dry, no lymphadenopathy. difficult to assess jugular venous distention. bilateral bibasilar crackles on auscultation. irregularly irregular rhythm, s1, mechanical s2, grade iii/vi holosystolic ejection murmur radiating to the axilla. large pannus, normoactive bowel sounds, soft, nontender, nondistended. stools guaiac positive. no costovertebral angle tenderness. extremities - 2+ edema in the lower extremities bilaterally. kyphoscoliotic changes. cranial nerves ii through xii are intact. strength and sensation are intact. no rashes. laboratory data: on admission, sodium 137, potassium 3.6, chloride 94, bicarbonate 32, blood urea nitrogen 26, creatinine 0.7, glucose 107. calcium 8.1, magnesium 1.4, albumin 2.8. inr 1.9. hematocrit 27.6, white blood cell count 7.6, platelet count 320,000. electrocardiogram on admission showed no significant change since electrocardiogram on , atrial fibrillation, premature ventricular contractions or aberrant ventricular conduction, incomplete right bundle branch block, extensive but nonspecific st-t wave changes. chest x-ray was consistent with congestive heart failure. the heart is enlarged. cardiac pacer device is seen and sternal clips consistent with prior coronary artery bypass graft. hospital course: in the emergency department, the laboratories and studies reported above were obtained. her systolic blood pressure dropped to the 80s and she received intravenous fluids 500cc bolus normal saline and then 100cc and made 900cc of urine in three hours. she received two units of packed red blood cells because of her hematocrit. she also received levofloxacin and metronidazole intravenously for empiric coverage of gastrointestinal infection. she was admitted to the medical intensive care unit. her anticoagulants were held and her gastrointestinal bleeding gradually decreased. the colonoscopy was obtained on , which was normal to the cecum and terminal ileum. however, ulcers in the hepatic flexure possibly from ischemia were noted. bicap cautery was applied to a small red spot that was considered stigmata of previous bleeding, no recurrent arteriovenous malformations were seen, however, prep was very poor. biopsies were not taken. dr. of gastroenterology was involved in her care. also in the medical intensive care unit, cardiology evaluated the patient as moderate risks for perioperative and postoperative complications and made recommendations for intraoperative management if hemicolectomy was part of her potential management. the patient was started on heparin and transferred out of the medical intensive care unit. on the medical floor, the patient's heparin was titrated to achieve a goal partial thromboplastin time between 60 and 80. she did not experience any more gross blood per rectum. her stools with two exceptions were guaiac negative. her hematocrit stabilized around 30.0. during the rest of her stay, she experienced one episode of respiratory distress with a bump in her troponin level of 7.6 which was believed to be due to an acute exacerbation of her congestive heart failure. pulmonary evaluated the patient on , and reported moderately severe obstructive airways disease likely due to emphysematous and moderately severe restrictive lung dysfunction, low tlc likely due to kyphosis, obesity and right effusion. her pulmonary function tests showed the tlc 53% of predictive, fev1 0.74 which was 34% of predicted, fvc 1.31, fev1/fvc ratio 74% of predicted. it is believed that there would be a significant risk of pulmonary problems. echocardiogram was obtained on . the left atrium was moderately dilated, overall left ventricular systolic function was estimated near normal, left ventricular ejection fraction greater than 55%, right ventricular cavity was moderately dilated. it was believed the patient risk of having colectomy outweighed risk of leaving the patient with less anticoagulation given her poor cardiopulmonary status. it was believed that a repeat colonoscopy with biopsy with an excellent preparation would help us better assess the source of her bleeding and would aid in the nonoperative management of future gastrointestinal bleeds. the patient refused the procedure. the patient's clinical picture continued to improve with aggressive diuresis. she was transitioned from heparin to warfarin. condition on discharge: her condition on discharge was improved. discharge diagnoses: 1. gastrointestinal bleed. 2. congestive heart failure. 3. status post aortic valve replacement. 4. coronary artery disease. 5. chronic obstructive pulmonary disease. 6. atrial fibrillation. 7. diabetes mellitus type 2. 8. hypercholesterolemia. medications on discharge: 1. albuterol inhaler two puffs four times a day. 2. captopril 6.25 mg p.o. three times a day. 3. digoxin 0.125 mg p.o. once daily. 4. furosemide 120 mg p.o. three times a day. 5. gabapentin 100 mg p.o. q.h.s. 6. insulin. 7. ipratropium inhaler two puffs four times a day. 8. metolazone 5 mg p.o. twice a day. 9. metoprolol 12.5 mg p.o. twice a day. 10. pantoprazole 40 mg p.o. once daily. 11. simvastatin 10 mg p.o. once daily. 12. spironolactone 25 mg p.o. once daily. 13. warfarin 2.5 mg p.o. q.h.s. 14. sulfadem 5 mg p.o. q.h.s. p.r.n. discharge status: she will return to her rehabilitation facility. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine endoscopic destruction of other lesion or tissue of large intestine diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) chronic airway obstruction, not elsewhere classified atrial fibrillation hemorrhage of gastrointestinal tract, unspecified ulceration of intestine 

Answer: The patient is high likely exposed to