200 Section - Aortic Turbulence and Musculoskeletal Decline: A PM&R-Driven Diagnosis of a Complex Cardioenteric Heyde's Syndrome

Case Diagnosis: Heyde's Syndrome

Case Description: A 75-year-old man with chronic rectal bleeding, peripheral arterial disease, multiple myeloma, and
recent right below knee amputation was admitted to the hospital with weakness and bright red blood
per rectum. Hemoglobin was < 7 g/dL, requiring transfusion.  In the hospital, he developed recurrent hematochezia with hypotension, with hemoglobin dropping to 5.8 g/dL. CTA and pill endoscopy were unrevealing of a source.  Workup revealed
severe aortic stenosis, however decision to replace valve was deferred to after rehabilitation. Upon
admission to acute rehab, the patient again decompensated with MAP 64 and hemoglobin 4.4 g/dL requiring urgent resuscitation before transfer for higher-level care.

Discussions: Heyde’s syndrome is the triad of severe aortic stenosis, gastrointestinal bleeding from
angiodysplasia, and acquired type 2A von Willebrand factor deficiency. Clinically significant GI
bleeding occurs in up to 20–30% of patients with severe aortic stenosis, and high-grade valvular
disease is more common in older adults with unexplained, recurrent, transfusion-dependent
bleeding. The syndrome is highly relevant in rehabilitation settings, where patients are medically
complex, deconditioned, and recovering from major surgeries or vascular events. Recurrent bleeding
can hinder therapy participation, delay prosthetics, and cause hemodynamic
instability.  Recognition in rehab is essential to expedite timely treatment, as definitive treatment is aortic valve replacement.

Conclusions: This case illustrates the diagnostic challenge and clinical impact of Heyde’s syndrome in a patient
with recurrent, transfusion-dependent GI bleeding. Persistent hematochezia, hemodynamic
instability, and severe aortic stenosis emphasized the need to recognize this underappreciated triad. In rehabilitation, ongoing bleeding disrupts medical stability, limits therapy participation, and delays functional progress. Coordinated management among cardiology, GI,
hematology, and PM&R is essential. Definitive treatment, often aortic valve replacement. This offers the best chance to reduce bleeding recurrence and support meaningful rehabilitation outcomes. Awareness of Heyde’s
syndrome in rehab settings helps prevent diagnostic delays and improves patient recovery.