Case presentation
A 78-year old male, with a past medical history of atrial fibrillation
(AF), psoriasis, hypertension and hyperlipidaemia, presented to the
emergency department with syncope after passing 500ml of brisk fresh
blood per rectum. 20 years prior, he had an uncomplicated elective
infrarenal aorto bi-iliac graft repair of an AAA. His regular
medications included bisoprolol, rivaroxaban and methotrexate at the
time of admission.
The patient was hypotensive on presentation to the emergency department,
with a blood pressure (BP) of 80/44 mmHg and heart rate of 124
beat/min.