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

BackgroundThe 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 abstractThe 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 conclusionPhysicians 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.

Automated summary

The occurrence of bleeding gastrointestinal angioectasia in elderly patients with degenerative calcific aortic stenosis, known as Heyde's syndrome, is a challenging clinical scenario. Heyde's syndrome is mainly caused by the loss of high-molecular-weight von Willebrand factor (HMW vWF) multimers due to their fragmentation passing through the stenosed aortic valve, resulting in acquired von Willebrand syndrome type IIA. Aortic valve replacement has been shown to be a more effective management approach for cessation of recurrent episodes of gastrointestinal bleeding, and a high index of suspicion is needed when dealing with elderly patients with established aortic stenosis presenting with iron deficiency anemia or unclear gastrointestinal bleeding. Collaboration between different specialties is essential for appropriate management.