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Case Report|Articles in Press

An unusual cause of iron deficiency anemia in a patient with severe aortic stenosis and heart failure

Published:January 25, 2023DOI:https://doi.org/10.1016/j.jccase.2023.01.002
An unusual cause of iron deficiency anemia in a patient with severe aortic stenosis and heart failure
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      Abstract

      There has been an exponential increase in incidence of severe aortic stenosis partially due to the lengthening of average lifespan. Among the most disabling symptoms of aortic stenosis are chest pain, fatigue, and dyspnea up to heart failure and pulmonary edema. In some cases, to worsen this symptomatology, there are coagulation disorders linked to an alteration of functional von Willebrand factor, responsible for progressive anemia. In elderly patients with severe aortic stenosis, the simultaneous presence of an angiodysplasia of the colon can favor blood dripping, which may cause iron deficiency anemia. The coexistence of colonic angiodysplasia and acquired von Willebrand disease in patients with aortic stenosis was identified as Heyde's syndrome. In the long term, Heyde's syndrome can contribute to worsen the clinical manifestations of severe aortic stenosis leading to heart failure. Here, we describe the case of a patient suffering of severe calcific aortic stenosis who developed Heyde's syndrome achieving a condition of heart failure with mildly reduced ejection fraction.

      Learning objectives

      Severe aortic stenosis can alter the conformation of the circulating von Willebrand glycoprotein, causing an alteration of the hemostatic balance. When angiodysplasia of the colon coexists with aortic stenosis, a gastrointestinal blood drip can occur inducing an iron deficiency anemia that worsens the symptoms of aortic valvulopathy. This condition often remains undiagnosed. We discuss the pathophysiologic and hemodynamic mechanisms responsible for acquired von Willebrand syndrome in patients with severe aortic stenosis focusing on the clinical elements useful to raise the diagnostic suspicion and analyzing different alternative tools to recognize it promptly.

      Keywords

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      Article info

      Publication history

      Published online: January 25, 2023
      Accepted: December 27, 2022
      Received in revised form: December 14, 2022
      Received: August 29, 2022

      Publication stage

      In Press Corrected Proof

      Identification

      DOI: https://doi.org/10.1016/j.jccase.2023.01.002

      Copyright

      © 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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