A 50−60-YEAR-OLD MAN with ongoing alcohol and methamphetamine abuse and a suspected history of intravenous drug use presented to the emergency department with a 1-month history of bilateral leg pain. Physical examination was significant for a cold left foot and absent left dorsalis pedis and tibialis posterior pulses. Auscultation revealed a 4/6 crescendo-decrescendo systolic murmur heard loudest over the right upper sternal boarder, and a 3/6 diastolic decrescendo murmur heard loudest over the right lower sternal boarder.
