In a 61-year-old male patient with exertional dyspnea and a hematocrit of 27%, what should be the next step in management?

In the context of a 61-year-old male patient presenting with exertional dyspnea and a hematocrit of 27%, it’s crucial to consider potential causes of anemia that could be contributing to his symptoms. The low hematocrit indicates significant anemia, which can lead to decreased oxygen-carrying capacity and result in exertional dyspnea.

Given the patient's age and the symptom of exertional dyspnea, performing a colonoscopy is an important and appropriate next step to evaluate for possible sources of gastrointestinal bleeding. In older adults, especially males, anemia can often be due to malignancies or significant underlying diseases such as colorectal cancer. A colonoscopy allows direct visualization of the colon and rectum, and it provides an opportunity for biopsy or treatment of any lesions that may be identified.

While starting iron supplementation might seem logical for treating iron deficiency anemia, it doesn't address the potential underlying causes that should be investigated first, particularly in the context of such a hematocrit level. A chest X-ray may help assess for cardiac issues or lung problems but is less direct in addressing the current concern regarding the cause of anemia. Cardiac evaluation could be relevant depending on the patient's overall clinical profile, but it does not directly investigate the most common