Sean Goldman, D.O.
Resident Physician
University of Miami
Boca Raton, Florida, United States
Nicole Pontee, MD
Assistant Professor of Clinical Physical Medicine & Rehabilitation
University of Miami
Miami, Florida, United States
57-year-old male with past medical history of HTN, HLD, DM2 who presented with chest pain associated with SOB, and palpitations. Found to have ischemic changes on EKG and elevated troponin, BNP. Echo showed new HFrEF (EF 10-15%) and severe AS. Coronary angiography and RHC revealed severe ischemic cardiomyopathy, Type II pulmonary hypertension, and multi-vessel CAD and successfully underwent TAVR on 8/15 after medical optimization. Patient evaluated by ENT for his one month long history of worsening dysphagia and hoarseness. Nasofiberoptic scope examination revealed left vocal fold paresis and underwent prolaryn injection into the left paraglottic space with improvement in glottic gap and phonation.
Discussions: The recurrent laryngeal nerves, branching from the vagus nerve, hooks under the arch of the aorta in close proximity to the left atrium before innervating the laryngeal muscles for vocalization. Cardiovocal syndrome, first described by Ortner in 1897, involves hoarseness due to compression of the left recurrent laryngeal nerve, often by cardiac conditions or mediastinal structures. To make this diagnosis, compressive masses, inciting trauma, ischemia, and brain lesions must be ruled out.
Conclusions: In conclusion, our case highlights the rare occurrence of cardiovocal syndrome secondary to severe cardiac and pulmonary pathology. MRI brain and CT neck were negative for any masses, bleeds, or aneurysms and patient was never intubated at any point during hospitalization. Echocardiogram revealed significant dilatation of the left ventricle, left atrium, and pulmonary arteries. These anatomical distortions likely led to compression of the left recurrent laryngeal nerve, resulting in hoarseness. The diagnosis was confirmed through nasofiberoptic scope, and intervention with unilateral hemiparetic vocal cord injection using Prolaryn markedly improved the patient’s dysphonia. This case underscores the importance of considering cardiovocal syndrome in patients with severe cardio-pulmonary conditions presenting with new-onset hoarseness and available treatment options.
