When your heart takes your voice and your swallowing away: Massive Left Atrial Dilation Leading to Ortner's Syndrome and Dysphagia Megalatriensis

Background Ortner’s syndrome, or cardiovocal syndrome, involves paralysis of the recurrent laryngeal nerve due to cardiac causes, while Dysphagia Megalatriensis, also known as cardiac or cardiogenic dysphagia, results from esophageal compression caused by left atrial enlargement. The coexistence of these entities is very rare and typically linked to significant left atrial dilation. The aim of this case report is to highlight the clinical progression and management considerations for such complex unusual cases. Case presentation: We report the case of a 79-year-old woman who was diagnosed late with a severe rheumatic mitral stenosis leading to massive left atrial enlargement, causing compression of both the recurrent laryngeal nerve (Ortner’s syndrome) and the esophagus (dysphagia megalatriensis). She was treated with anticoagulation and heart failure drugs as she refused any surgical intervention with improvement in her clinical condition. Conclusions This case emphasizes the importance of early managing of rheumatic heart disease to avoid complications like left atrial enlargement, which can lead to Ortner’s syndrome and dysphagia megalatriensis. This case also highlights the need for a holistic patient evaluation, as extracardiac symptoms can sometimes reveal serious underlying cardiac conditions requiring appropriate treatment.