Severe Calcific Aortic Valve Stenosis and Bleeding: Heyde's Syndrome
Bibliographic record
Abstract
In 1958 Dr. Edward C. Heyde, an internist living and working in Vancouver, WA, first reported in a letter to the New England Journal of Medicine, 10 cases of calcific aortic stenosis and grastrointestinal bleeding. The association between severe calcific aortic stenosis and iron deficency anemia due gastrointestinal bleeding, from colonic angiodysplasia was described as Heyde syndrome. A letter appearing shortly after confirmed an odd ratio of almost 3.0 between the two diseases. (1) In the same year Goldman noted that within the population of severe aortic stenosis there was a three fold higher prevalence of gastrointestinal bleeding, and few years later Cattell published a more drastic position, due to the the fact that patient with aortic stenosis could bleed from a lesion in the ascending colon which has not been demonstrated by the pathologist, and recommended blind right haemicolectomy as a treatment for recurrent anaemia. Dystrophic calcification of heart valves was first described by dr. Monckeberg in 1904. With the advent of the extracorporeal circulation discovered by Gibbon in 1954, applied to cardiac surgery operations, a new frontiere for valve disease was achieved, and valve therapy radically changed in those years, in favour of valve replacement. Unfortunately for many years the association between these two condition has been underestimated and it has not been verified with a methodological approach intil the '80s, when Greenstein and King reported in two different publications this association between aortic stenosis and bleeding. (2,3). In a first attempt to treat this syndrome, an empirical approach was used with blood transfusion; but in those years it has been noticed that, after aortic valve replacement, there was a complete cessation of the bleeding, and the restoring of the normal gastrointestinal mucosa. By 1987, 30 cases of upper and lower gastrointestinal angiodysplasia had been cured by AVR. Angiodysplasia might remain visible at endoscopy even after AVR, but only 1 of the 30 cases ever developed recurrent gastrointestinal bleeding. Patients with Heyde syndrome who are treated by intestinal resection generally continue to bleed from other sites, while AVR usually cures the clotting disorder and anaemia. A
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".