Heyde's Syndrome Manifesting as Recurrent Gastrointestinal Bleeding After Valve Replacement

Heyde's syndrome is a clinical entity that combines aortic stenosis, gastrointestinal angiodysplasia, and an acquired von Willebrand factor disorder. This syndrome is characterized by the association between aortic stenosis and recurrent gastrointestinal bleeding episodes, typically linked to angiodysplasias. Effective treatment requires addressing the underlying condition, specifically aortic stenosis, which leads to the structural destruction of coagulation proteins, resulting in the acquired von Willebrand factor disorder and perpetuating the bleeding. Therefore, managing gastrointestinal bleeding alone is insufficient. Although initially underestimated by physicians due to its nonspecific presentation and overlapping symptoms, this syndrome has significant implications for diagnosis and management, particularly in older adults. Many patients with Heyde's Syndrome are often misdiagnosed with unrelated gastrointestinal conditions until the association with aortic stenosis is identified. This diagnostic delay can lead to repeated hospitalizations, chronic anemia, and a decline in quality of life. Aortic valve pathology and coagulopathy should be actively suspected and investigated, directing treatment toward correcting the aortic stenosis. The objective of this case report is to highlight the importance of suspecting this syndrome in patients with valvular disease, such as aortic stenosis, and recurrent bleeding episodes, as these conditions may not always represent two independent problems, even if the patient has previously undergone valve replacement. This is demonstrated in the presented case, where a 74-year-old female patient with cardiovascular disease treated years earlier with valve replacement developed valve dysfunction, leading to new episodes of gastrointestinal bleeding. This illustrates the need to reevaluate the valve to prevent recurrent complications.