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.