En elderly woman with a pmh of mechanical aortic valve on coumadin admitted 2 mos. prior with symptomatic anemia with a negative EGD/colo who re-presented with melena and symptomatic anemia. Repeat EGD demonstrated AVMs in the jejunum and the patient was ultimately diagnosed with Heyde’s syndrome.
Key Take Home Points:
-For presumed upper GI bleed with negative EGD, first step is to repeat the EGD.
-Consider obscure source GI bleeding do a capsule endoscopy to evaluate the small bowel
-What are you looking for on EGD? — high vs. low risk ulcers — low risk ulcers are clean based (can transition to oral PPI and send home) high risk ulcers are those with a visible vessel or adherent clot (require 72 hours of IV PPI and inpatient monitoring)
-Syndrome of GI bleeding in the setting of angiodysplasia + aortic stenosis
-vWF becomes depleted as it flows through the narrowed valvular stenosis and subsequently gets degraded by ADAMTS13 – vWF cannot clot damaged vessels and GIB
-Management involves aortic valve replacement