09 May 2026
: Case report 
An Uncommon Presentation of Heyde Syndrome: Absence of Visible Endoscopic Angiodysplasia With Resolution After Transcatheter Aortic Valve Replacement
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment
Ronnie A. Napoles ABCDEFG 1*, Cristina Benites
ABCDEFG 2, Gabriella Morey ABCDEFG 2, Anthony H. Xu E 2, Luis Santiago Zayas ABCDEFG 3, Kristen Santana ABCDEFG 3, Livasky Concepcion Perez ABCDEFG 3
DOI: 10.12659/AJCR.951614
Am J Case Rep 2026; 27:e951614
Table 1 Diagnostic assessments and care of HS. The table delineates the evolution of symptoms, clinical observations, and therapies, encompassing transfusions, endoscopic assessments, and TAVR. Diagnostic challenges due to overlapping symptoms with common geriatric conditions are highlighted.
| Timeline | Events |
|---|---|
| 73-year-old woman with history of CAD, AS, hypertension, hyperlipidemia, type 2 diabetes, and hypothyroidism presented with a 2-week history of melena and 1 week of fatigue. Scheduled for cardiac catheterization for AV replacement | |
| Records showed 9-month intermittent melena requiring multiple EGDs, VCE, and colonoscopies without bleeding source identified. VCE revealed melena in the proximal jejunum | |
| Temperature: 37.2°C, HR: 71 bpm, RR: 18 bpm, BP: 100/52 mmHg, SatO2: 96% on room air. Physical exam revealed pale mucous membranes and a loud harsh late-peaking systolic aortic murmur radiating to the carotids | |
| Hypokalemia (3.3 mmol/L), low Hb (7.7 g/dL), borderline low MCV (80.3), decreased MCHC (31.1), elevated RDW (16), fibrinogen (335 mg/dL). Post-transfusion, Hb improved to 9.8 g/dL, MCV decreased to 77.1, indicating microcytic hypochromic anemia from gastrointestinal bleeding. Elevated troponin (1.300 ng/mL) | |
| Showed normal systolic left ventricular function, EF 55%, mild LVH, severe AS with AVA of 0.7 cm, AV V max of 4.23 m/s, mean pressure gradient of 47.11 mmHg, and DVI of 0.24 | |
| Hemorrhoids in the perianal region, hematin throughout the colon, preventing terminal ileum intubation; no specimens collected. Upper endoscopy showed normal esophagus, erosive gastropathy without bleeding stigmata; no specimens collected | |
| Demonstrated severe AS (AVA 0.4 cm) and severe CAD in circumflex artery/OM disease, RCA CTO with left to right collaterals, and patent LAD with stent. Plan for outpatient follow-up for TAVR | |
| Aspirin and high-intensity statin for CAD. PPI initiated for acute on chronic blood loss anemia. Cardiothoracic surgery replaced the stenotic AV with a prosthetic valve via TAVR. Recommended for DBE if bleeding recurred | |
| Six months after TAVR, patient was asymptomatic, denying fatigue, melena, or bleeding, with resolved blood loss anemia, Hb 14.0 | |
| HS diagnosed as bleeding attributed to small-intestine angioectasias secondary to AS, despite absence of angiodysplasia. The presence of severe AS and resolution of post-TAVR bleeding supports the diagnosis |