SHM Converge Scientific Abstract ePoster Gallery-Recurrent Upper Gastrointestinal Bleeding Due to Severe Mitral Regurgitation: A Rare Case of Heyde's Syndrome

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This case describes a 75-year-old man with recurrent upper gastrointestinal bleeding due to Heyde’s syndrome, a condition classically associated with severe aortic stenosis and angiodysplasia-related bleeding. He presented with lightheadedness, fatigue, and dark stools, and was found to have profound anemia (hemoglobin 4.2 g/dL). His history was notable for prior aortic stenosis treated with TAVR, moderate-severe mitral regurgitation, chronic kidney disease, and atrial fibrillation without anticoagulation.<br /><br />Endoscopy revealed multiple bleeding and non-bleeding angiodysplasias in the stomach and duodenum, which were treated with argon plasma coagulation. Because of recurrent bleeding and concern for acquired von Willebrand syndrome, further testing was performed. Von Willebrand factor activity-to-antigen ratio was reduced, and multimer analysis showed decreased/absent high molecular weight multimers, consistent with acquired von Willebrand syndrome.<br /><br />Although Heyde’s syndrome is usually linked to aortic stenosis, this case suggests that significant mitral regurgitation can also create enough shear stress to cause the same bleeding tendency. The patient’s stable aortic valve prosthesis made recurrent aortic stenosis less likely as the cause. Cardiology concluded that the mitral regurgitation was the likely driver of the acquired von Willebrand abnormality and recommended observation with possible future transcatheter mitral valve replacement.<br /><br />The report emphasizes that Heyde’s syndrome should be considered in elderly patients with recurrent gastrointestinal bleeding from angiodysplasia, even when severe mitral regurgitation rather than aortic stenosis is present.

Asset Subtitle

Bibek Saha

Meta Tag

Author List Allison A. Reinhardt, Bibek Saha, Bright Thilagar, Darine Daher, Jenny Jia Ling Cao, Kayla Finnegan

Category Clinical Vignettes

Concept Heyde Syndrome

Concept Acquired von Willebrand Syndrome

Concept Gastrointestinal Bleeding

Concept Angiodysplasia

Concept High-Molecular-Weight Multimers

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester

Presenting Author Bibek Saha

Track Adult

Keywords

Heyde syndrome

gastrointestinal bleeding

angiodysplasia

acquired von Willebrand syndrome

mitral regurgitation

aortic stenosis

TAVR

argon plasma coagulation

high molecular weight multimers

anemia

Heyde Syndrome

Acquired von Willebrand Syndrome

Gastrointestinal Bleeding

Angiodysplasia

High-Molecular-Weight Multimers