DOI: https://doi.org/10.36347/sjmcr.2026.v14i07.030

Pages: 1739-1746

Background: Heyde syndrome is characterized by the association of severe aortic stenosis, gastrointestinal bleeding from intestinal angiodysplasia, and acquired von Willebrand syndrome. In elderly patients, severe calcific aortic stenosis may also coexist with transthyretin cardiac amyloidosis, a combination associated with advanced myocardial dysfunction and adverse outcomes. Case presentation: An 80-year-old man with hypertension, insulin-treated type 2 diabetes mellitus, peripheral arterial disease, chronic obstructive pulmonary disease, end-stage renal disease on maintenance hemodialysis, and recurrent gastrointestinal bleeding from previously documented small-bowel and colonic angiodysplasia was admitted for progressive dyspnea, recurrent melena, and symptomatic anemia. Echocardiography demonstrated severe calcific aortic stenosis, concentric biventricular hypertrophy disproportionate to pressure overload, advanced diastolic dysfunction, biatrial enlargement, a granular sparkling myocardial appearance, a small pericardial effusion, and a dilated non-collapsible inferior vena cava. Electrocardiography showed atrial fibrillation with low QRS voltage, creating a voltage-mass discrepancy highly suggestive of cardiac amyloidosis. The patient received two units of packed red blood cells by slow transfusion and was transferred to the cardiac intensive care unit. Despite diuretics, maintenance hemodialysis with controlled ultrafiltration, antibiotic therapy, oxygen supplementation, and escalating inotropic and vasopressor support, he developed refractory cardiogenic shock characterized by severely depressed cardiac output and markedly elevated left ventricular filling pressures. He died before cardiac magnetic resonance imaging, bone scintigraphy, or tissue biopsy could be performed. Conclusion: This case highlights the need to consider concomitant transthyretin cardiac amyloidosis in elderly patients with severe aortic stenosis and Heyde syndrome when ventricular hype