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Did You Know That H...

Metadata

• Author: @WilliamAird4 on Twitter
• Full Title: 1/7
  Did You Know That H...
• Category: #tweets
• URL: https://twitter.com/WilliamAird4/status/1627405504904323074

Highlights

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  Did you know that HEYDE SYNDROME, which today is defined by a triad of 1) aortic stenosis, 2) recurrent bleeding from GI angiodysplasia, and 3) acquired type IIA von Willebrand syndrome was first described by Edward Heyde in a 1958 correspondence to the NEJM?
  (View Tweet)
• 2/7
  ... and that he described the association of calcific aortic stenosis and massive GI bleeding (not angiodysplasia per se, and certainly not with any understanding of pathogenesis).
  (View Tweet)
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  MECHANSISM
  The current leading hypothesis explaining the pathophysiology of Heyde’s syndrome is acquired von Willebrand syndrome (AVWS): (View Tweet)
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  MECHANSISM (cont'd)
  1. Stenotic aortic valve causes shearing/depletion of high molecular weight (HMW) von Willebrand factor (vWF) multimers, leading to acquired type IIA von Willebrand syndrome (AVS). (View Tweet)
• 5/7
  MECHANISM (Cont'd)
  2. Depletion of HMW VWF leads to loss of VWF-mediated repression of angiogenesis, resulting in formation of angiodysplasias. (View Tweet)
• 6/7
  MECHANISM (Cont'd)
  3. Angiodyplastic vessels present in patients with AVS, coupled with the depletion of HMW VWF, increase the risk for GI bleeding. (View Tweet)
• 7/7
  TREATMENT
  1. Treatment of acute GI bleeding with endoscopic procedures and VWF concentrate/DDAVP.
  2. Valvular repair/replacement. (View Tweet)