Heyde’s syndrome – a case report

Abstract

Heyde's Syndrome is composed by the association between aortic stenosis, acquired deficit of von Willebrand factor and gastrointestinal bleeding. The pathophysiology of the syndrome encompasses shearing of von Willebrand factor in the turbulent flow caused by aortic stenosis, leading to its alteration and favoring its proteolysis and dysfunction, which favors the bleeding of lesions such as intestinal angiodysplasia. The objective of this case is to bring to light aspects of this syndrome and its diagnostic and therapeutic challenges. The case was monitored at the Santa Casa de Caridade de Diamantina, and a literature review on the subject was carried out in the main databases. This is a woman, 85 years old, hospitalized with heart failure associated with lower digestive hemorrhage with iron deficiency anemia. Colonoscopy and upper digestive endoscopy inconclusive. Echocardiogram confirmed severe aortic stenosis. The hypothesis of Heyde's syndrome was raised, with indication of transcatheter implantation of the aortic valve, a procedure not available locally. Patient evolves to death without completing investigation or therapy due to new cardiac decompensation. Although the result of the endoscopies was inconclusive, there are situations inherent to the method and the examiner that make it difficult to identify certain lesions, and it is recommended to repeat the exams when there is clinical suspicion. The patient died before completing the investigation, which does not exclude the possibility of Heyde’s syndrome. There are still difficulties in the diagnostic and therapeutic management of the syndrome, however, when indicated, diagnostic work-up must be performed in order to define the best long-term treatment and improve the prognosis of patients.