Key result
GDMT improves heart failure symptoms but fails to resolve Ortner syndrome hoarseness.
Case Report (n=1)
No
New-onset hoarseness in a patient with severe cardiovascular disease should raise suspicion for Ortner syndrome, emphasizing the need for early initiation of guideline-directed medical therapy to prevent adverse cardiac remodeling.
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Hoarseness may persist after GDMT improves other decompensated HF symptoms; this case leaves open the natural history of Ortner syndrome resolution.
Ortner's syndrome or cardiovocal syndrome is a clinical condition associated with hoarseness due to left recurrent laryngeal nerve palsy from compression of surrounding cardiovascular structures. Atrial enlargement, commonly caused by chronic mitral regurgitation (MR) may be a source of compression. We present a case of a 53-year-old man with decompensated heart failure (HF) with a new onset of hoarseness. Chest radiograph showed cardiomegaly with evidence of fluid overload; transthoracic echocardiography showed bi-atrial enlargement secondary to severe chronic mitral regurgitation and moderate pulmonary hypertension. As a result, the diagnosis of Ortner's syndrome was made. For patients with new onset hoarseness with a history of severe cardiovascular disease, Ortner's syndrome should be considered and early initiation of therapy can help reduce the incidence.
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Song et al. (2023) conducted a case report in Decompensated heart failure, severe chronic mitral regurgitation, and Ortner syndrome (n=1). Guideline-directed medical therapy for heart failure was evaluated on Resolution of heart failure symptoms and hoarseness. Guideline-directed medical therapy for decompensated heart failure improved the patient's shortness of breath and edema, but hoarseness secondary to Ortner syndrome did not resolve by early follow-up.
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