GI Bleeding

Question 1

What condition is also known as Heyde’s syndrome, which links aortic stenosis to gastrointestinal (GI) bleeding from angiodysplasia (vascular malformations) in the gastrointestinal tract?

Answer 1

Heyde’s Syndrome

Question 2

What is Heyde’s syndrome?

Answer 2

Heyde’s syndrome is the association of acquired von Willebrand disease (loss of HMW vWF multimers) with gastrointestinal bleeding from angiodysplasia and aortic stenosis.

Question 3

What is the pathophysiologic mechanism behind bleeding in Heyde’s syndrome?

Answer 3

Aortic stenosis causes high shear forces as blood passes through a narrowed valve.

Shear forces cause unfolding of vWF multimers, making them susceptible to cleavage by ADAMTS13.

Loss of large vWF multimers impairs platelet adhesion, especially in high-shear vessels like those in angiodysplasia.

Question 4

What are the clinical clues for Heyde’s syndrome?

Answer 4

Elderly patient with recurrent or chronic GI bleeding.

GI bleeding is from angiodysplasia (vascular malformations) seen on colonoscopy.

Aortic stenosis found on auscultation (systolic murmur at right upper sternal border).

No other obvious cause of bleeding (like diverticulosis or hemorrhoids).