P139 | Caught in the crossfire: understanding Heyde syndrome in the contest of severe aortic valve stenosis and colonic angiodysplasia

Background: Heyde syndrome, the coexistence of aortic stenosis and gastrointestinal bleeding from colonic angiodysplasias, can involve coagulation disorders due to functional von Willebrand factor alteration.Case report: A 81-year-old woman was admitted to the emergency room due to pulmonary edema. Clinical examination reported a systolic murmur on the aortic outflow tract and bilateral swollen limbs. The arterial blood pressure was 90/50 mmHg, heart rate 125 bpm, and oxygen saturation was 87% on room air. The ECG showed atrial fibrillation. Bedside echocardiography demonstrated a mildly reduced ejection fraction and severe aortic stenosis. Laboratory blood tests revealed iron deficiency anemia. The patient was treated with levosimendan, allowing improvement in clinical and hemodynamic conditions. Furthermore, to prevent cardioembolic events, LMWH was initiated. Due to worsening hemoglobin values, a search for occult blood in the stool was conducted, resulting positive. Suspecting Heyde syndrome, the vWF Ristocetin Co Factor (vWF RiCOF) was measured and fell within normal ranges, while its activity, determined by the vWF RiCOF/vWF antigen (vWF Ag) ratio, was below normal limits. Endoscopic examination revealed the presence of colonic angiodysplasia. After a successful transcatheter aortic valve implantation, the patient was discharged in good hemodynamic condition with normal hemoglobin and vWF RiCOF/vWF Ag values.Conclusions: Recognizing Heyde syndrome is crucial, especially in elderly patients, as prompt identification and management can improve clinical outcomes.