Abstract

A 78 year old man with history of hypertension, severe pulmonary hypertension, hyperlipidemia, permanent atrial fibrillation on Eliquis, CKD stage IV, iron deficiency anemia, alcohol use disorder, chronic HFrEF with EF 30 35%, symptomatic bradycardia s/p bi ventricular pacemaker, coronary artery disease, STEMI status post angioplasty to mid and distal LAD in 1/2005, colon polyps, colitis of cecum, submucosal varicosities of sigmoid colon and rectum, large internal hemorrhoids, diverticulosis, and hepatic stea tosis presented to the emergency department for evaluation of generalized weakness, sob and dyspnea on exertion for 6 months. His hemoglobin was notable for level of 4.7. He reported no overt signs of gastrointestinal bleeding. Pertinent examination findi ngs included dark blue compressive papules on the hands and soles of the feet.