A case of recurrent obscure gastrointestinal bleeding: Heyde’s syndrome – case report and review

Ramachandran, Rajarajeshwari; Uqdah, Hakim; Jani, Niraj

doi:10.1080/20009666.2018.1470441

Cited by 13 publications

(13 citation statements)

References 15 publications

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“…For patients who are not surgical candidates or those with numerous comorbidities placing them at a high risk for surgical intervention, TAVR is always preferred. 9 Additionally, for patients who decline TAVR or those who are not candidates for valve replacement, medical management becomes the primary treatment approach. 8 It consists of oral iron supplementation and/or regular blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

Heyde Syndrome: An Unusual Cause of Gastrointestinal Bleeding

Dahiya

Kichloo

Zain

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Heyde syndrome is a multisystem disorder characterized by the classical triad of aortic stenosis, gastrointestinal (GI) angiodysplasias, and acquired von Willebrand syndrome. GI angiodysplasias, common in older patients, are tortuous, thin-walled blood vessels seen in the mucosa or submucosa of the GI tract and are highly prone to rupture resulting in GI bleeds. In this case report, we describe an elderly female with a past medical history of end-stage renal disease and chronic anemia who presented to the emergency department (ED) with complaints of dark-tarry stools and associated abdominal cramping. Patient reported a history of dark-tarry stools and multiple blood transfusions in the past, secondary to severe anemia. An inpatient echocardiogram was performed, revealing severe aortic stenosis. Additionally, gastroenterology was consulted for esophagogastroduodenoscopy and colonoscopy, which were negative for active bleeding. About a year ago, the patient underwent capsule endoscopy at an outlying facility, which was positive for angiodysplasia. Therefore, due to high clinical suspicion, presence of aortic stenosis, and GI angiodysplasia, a platelet function assay was ordered. It was found to be abnormal, pointing to the presence of acquired von Willebrand syndrome. Hence, a diagnosis of Heyde syndrome was established. The patient gradually improved and was discharged with a follow-up appointment with the cardiologist for a possible transcatheter aortic valve replacement procedure. The patient underwent the procedure without complications, after which she did not report episodes of GI bleeding. In this case report, we discuss the presentation, pathophysiology, diagnostic approach, and management of patients with Heyde syndrome.

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Section: Discussionmentioning

confidence: 99%

Heyde Syndrome: An Unusual Cause of Gastrointestinal Bleeding

Dahiya

Kichloo

Zain

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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“…It reduces the mechanical shear stress on the HMW vWF multimers inhibiting their cleavage by ADAMTS13 and consequently improves coagulation abnormalities implicated in Heyde's syndrome. There are several observational studies that have demonstrated potential therapeutic benefits of AVR [45][46][47][48][49][50][51][52][53]. All studies were published between 2010 and 2020; cessation of gastrointestinal bleeding following AVR was the most measured outcome.…”

Section: Aortic Valve Replacementmentioning

confidence: 99%

Reappraising the spectrum of bleeding gastrointestinal angioectasia in a degenerative calcific aortic valve stenosis: Heyde’s syndrome

2021

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Background The occurrence of bleeding gastrointestinal angioectasia in elderly patients with degenerative calcific aortic stenosis is one of the most challenging clinical scenarios. A number of studies have shown that this clinical phenomenon is known as Heyde’s syndrome. Main body of the abstract The pathogenesis of Heyde’s syndrome is mainly due to the loss of high-molecular-weight von Willebrand factor (HMW vWF) multimers, as a consequent fragmentation of HMW vWF multimers as they pass through the stenosed aortic valve leading to acquired von Willebrand syndrome type IIA. Aortic valve replacement has proven to be a more effective management approach in the cessation of recurrent episodes of gastrointestinal bleeding. Short conclusion Physicians should have a high index of suspicion when dealing with elderly patients with established aortic stenosis presenting with iron deficiency anemia or unclear gastrointestinal bleeding. Parallel consultations between different specialties are essential for appropriate management.

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“…Subsequently, the patient underwent a balloon valvuloplasty for his severe symptomatic AS. He was not deemed to be a candidate for surgical aortic valve replacement (AVR) given his social status of being homeless and was also 1 1 Upon discharge, the patient was admitted again multiple times with recurrent melena, dizziness, and acute blood loss anemia requiring blood transfusions. An EGD with push enteroscopy was repeated twice, which showed multiple duodenal and jejunal angiodysplastic lesions (Figure 2), which were treated with argon plasma coagulation.…”

Section: Case Presentationmentioning

confidence: 99%

“…The coexistence of aortic valve stenosis (AS) and recurrent gastrointestinal (GI) bleeding from intestinal angiodysplasia (IA) is known as Heyde's syndrome [1,2]. This association was first described by Edward Heyde, MD, in 1958, when he reported 10 elderly patient cases with concurrent AS and GI bleeding [3].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Gastrointestinal Bleeding in a Patient With Severe Aortic Valve Stenosis: A Diagnosis of Heyde’s Syndrome

Obeidat¹,

Kim²

2021

Cureus

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Heyde's syndrome is defined as the coexistence of aortic valve stenosis (AS) and recurrent gastrointestinal (GI) bleeding from intestinal angiodysplasia (IA). Despite the fact that Heyde's syndrome was first described decades ago, the association between AS and IA remains frequently unidentified, and thus, a high clinical suspicion is needed for its diagnosis. Here we present a case of a 60-year-old man with a history of severe AS, who presented with recurrent GI bleeding and was found to have multiple intestinal angioectasias on endoscopy.

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A case of recurrent obscure gastrointestinal bleeding: Heyde’s syndrome – case report and review

Abstract: Gastrointestinal bleeding from angiodysplasias in patients with aortic stenosis is termed as ‘Heyde’s syndrome’. We report a case of Heyde’s syndrome successfully treated with trans-catheter aortic valve replacement.

Cited by 13 publications

References 15 publications

Heyde Syndrome: An Unusual Cause of Gastrointestinal Bleeding

Heyde Syndrome: An Unusual Cause of Gastrointestinal Bleeding

Reappraising the spectrum of bleeding gastrointestinal angioectasia in a degenerative calcific aortic valve stenosis: Heyde’s syndrome

Recurrent Gastrointestinal Bleeding in a Patient With Severe Aortic Valve Stenosis: A Diagnosis of Heyde’s Syndrome

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