Title : Heyde Syndrome: A case report on medical management of Heyde Syndrome
Heyde syndrome is a triad of anemia due to bleeding colonic angiodysplasia, aortic stenosis and acquired coagulopathy. It is most commonly seen in elderly between 60-80 years of age. We present a case of Heyde syndrome presenting with severe anemia secondary to bleeding angiodysplasia or arteriovenous malformations (AVM) in the lower gastrointestinal (GI) tract with acquired von Willebrand factor deficiency due to moderate aortic stenosis.
What will audience learn from your presentation?
In the elderly population, aortic stenosis is a fairly common finding due to age-related aortic calcification, but patients presenting with concomitant gastrointestinal bleeding should necessitate evaluation for Heyde syndrome. Moderate to severe aortic stenosis has been shown to cause shear-induced von Willebrand factor conformational changes leading to increased proteolysis of von Willebrand factor thereby causing deficiency of von Willebrand factor. The deficiency of the von Willebrand factor reduces both adhesion and aggregation of the platelets thereby causing bleeding from previously latent intestinal angiodysplasia. Association of anemia due to bleeding angiodysplasia, aortic stenosis, and acquired coagulopathy to Heyde syndrome should be high on differentials for these patients as there is a multidisciplinary action plan for these patients with treatment options ranging from medical treatment with estrogen or thalidomide, etc. to surgical options such as endoscopic laser treatment or aortic valve replacement or colectomy (either partial or total) in severe case.