You Can’t Heyde Forever

Heyde’s syndrome describes an association between aortic stenosis and a predisposition to bleeding from intestinal angiodysplasia resulting from acquired von Willebrand disease. We present the case of an 82-year-old woman with recurrent intestinal bleeding, severe anaemia and secondary myocardial infarction. Investigation identified ileal angiectasia as the source of haemorrhage. As echocardiography revealed severe aortic stenosis the patient underwent surgical valve replacement. At her 3-month follow-up, the patient reported no new bleeding episodes and her functional status had improved. This case highlights Heyde’s syndrome, an entity probably underdiagnosed despite the high prevalence of aortic stenosis and intestinal angiodysplasia in elderly patients. LEARNING POINTS: In a patient with bleeding intestinal angiectasia, Heyde’s syndrome should be considered in the differential diagnosis. Although supportive therapy is crucial for clinical stabilization, aortic valve replacement is the therapeutic gold standard. Appropriate management of these patients requires a multidisciplinary approach.