# Heyde syndrome secondary to hypertrophic obstructive cardiomyopathy: a case report

## TL;DR

A rare case of Heyde syndrome caused by hypertrophic obstructive cardiomyopathy is reported, highlighting the importance of considering this condition in patients with unexplained gastrointestinal bleeding and heart issues.

## Contribution

This case report identifies hypertrophic obstructive cardiomyopathy as a new variant of Heyde syndrome.

## Key findings

- Heyde syndrome can occur in the context of hypertrophic obstructive cardiomyopathy, not just aortic stenosis.
- Treatment with octreotide and nadolol improved the patient's symptoms and hemoglobin levels.
- The case emphasizes the need for tailored diagnosis and treatment in patients with gastrointestinal bleeding and cardiac murmurs.

## Abstract

Heyde syndrome is an uncommon clinical condition characterized by the triad of aortic stenosis, gastrointestinal angiodysplasia, and acquired von Willebrand syndrome. Its occurrence in the context of hypertrophic obstructive cardiomyopathy is rare. Common in individuals over 65, diagnosis is challenging due to the prevalence of these conditions. Hypertrophic obstructive cardiomyopathy increases shear stress, leading to von Willebrand Factor degradation and a higher risk of gastrointestinal bleeding.

A 69-year-old male presented to the outpatient clinic with melena, abdominal cramping, and fatigue, along with a history of anemia requiring blood transfusions. Despite a negative upper gastrointestinal endoscopy, further tests revealed angiodysplasias with recent bleeding. He was also diagnosed with hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. After being treated with octreotide and nadolol, his condition improved markedly, with hemoglobin levels rising and no further episodes of bleeding.

Recognizing hypertrophic obstructive cardiomyopathy as a new variant of Heyde syndrome broadens our understanding of this complex disorder. It emphasizes the need to consider hypertrophic obstructive cardiomyopathy in patients with unexplained gastrointestinal bleeding and cardiac murmurs, prompting a more tailored approach to diagnosis and treatment.