56 yo F with no PMHX, presents complaining of increased DOE and orthopnea for several weeks. She also reports intermittent, mild mucosal bleeding. She denies syncope. Physical exam is notable for an obvious crescendo- decrescendo murmur over the right sternal border. CXR shows an enlarged heart and pulmonary congestion.
The patient is suffering from severe aortic stenosis. There is evidence that patient’s with severe AS have an increased risk of bleeding. This increased risk of bleeding is likely related to an acquired vWF disease. vWF multimers are thought to be disrupted when exposed to turbulent flow across the aortic valve, and thus, the degree if vWF disease is related to the severity of AS.
Heyde’s Syndrome is another bleeding disorder described in patients with AS. It refers to bleeding in the GI tract caused by angiodysplasia. However, unlike vWF disease, the relationship between Heyde’s Syndrome and AS is not firmly established.
Summary: Patient’s with AS are at a higher risk of several diseases including sudden cardiac death, atrial fibrillation and other arrhythmias, endocarditis, CAD, and increased bleeding tendency.
