Case Presentation: An 86-year-old male with small bowel carcinoid tumor, complicated by heart disease (CHD), severe tricuspid (TR) and pulmonary regurgitation (PR), right-sided heart failure, atrial fibrillation, and end-stage renal disease on hemodialysis, presented with new-onset dyspnea. His oxygen saturations ranged from 70-88%, improving to 92% with high-flow nasal cannula. Physical exam demonstrated cachexia, pansystolic [...]