70 year old female was admitted to the hospital with CC: Rectal bleeding x 1 day. Bleeding started gradually, getting worse, BRBPR, mixed with stool, no rectal or abdominal pain, 4 BM since yesterday, no similar symptoms before. She felt weak for 2 days. PMH: Admitted for CP and hematemesis 5 months ago. EGD showed an actively bleeding Mallory-Weiss tear, she was on NSAIDs at that time. Cath.
showed stenosis Cx 60%, LAD 40%, EF 45%; medical management recommended. She had a CVA with left sided weakness 1 year ago, the weakness resolved and she has been warfarin for stroke prophylaxis ever since. HTN, COPD, CVA, CAD, Mallory-Weiss tear, hypercholesterolemia. Medications: Aspirin, Warfarin, Lisinopril, isosorbide mononitrate, Atorvastatin, Pantoprazole. Physical examination: VS: 37-16-43-110/76 with orthostatic changes WD/WN in NAD Neck: no JVD Chest: CTA (B) CVS: Clear S1S2, bradycardic…
