Authors

• Daren Lučinger — Croatia — ORCID: 0000-0001-8848-0472
• Nenad Lakušić — Croatia — ORCID: 0000-0002-2329-2582
• Duško Cerovec — Croatia — ORCID: 0000-0002-5675-4202
• Krunoslav Fučkar — Croatia — ORCID: 0000-0002-2723-8356
• Ljubica Vincelj Šalković — Croatia — ORCID: 0000-0003-2432-802X

Abstract

The classic triad of aortic stenosis symptoms – angina pectoris, heart failure, and syncope - is well-known among clinicians, but manifestations of aortic stenosis on other systems often remain unrecognized. Gastrointestinal (GI) angiodysplasia, like aortic stenosis, is degenerative disease and both entities are more common in older patients. Heyde syndrome refers to a triad of aortic stenosis, acquired coagulopathy (von Willebrand syndrome type 2A), and sideropenic anemia due to bleeding from gastrointestinal angiodysplasia or from an idiopathic site. Acquired coagulopathy arises from degradation of vWF multimers by the shear stress across the stenotic aortic valve. Aortic valve replacement leads to rise in vW factor multimers and ultimate resolution of gastrointestinal bleeding and sideropenic anemia. In patients with established aortic stenosis, development of iron deficiency anemia should raise the possibility of Heyde syndrome, but patients with GI bleeding with presence of angiodysplasia or failure of endoscopy to find the site of GI bleeding should also be evaluated for aortic stenosis.

Keywords

Heyde syndrome, aortic stenosis, anemia, bleeding, von Willebrand factor

DOI

Full Text

## Conclusion Heyde syndrome is often neglected in everyday clinical practice. It is important to keep in mind the “atypical” manifestations of common diseases such as aortic stenosis. Timely recognition of this syndrome can lead to breaking the undesirable vicious circle and choosing the right treatment modality, which is aortic valve replacement.