A Case Report of Ortner's Syndrome, Cardiovocal Hoarseness—An Infrequent Entity in the Contemporary World

Rheumatic fever (RF) and rheumatic valvular disease remain prevalent and are still significant health hazards in developing nations. Hoarseness of voice, although a common symptom in ENT, is a rare finding in cardiac patients. However, hoarseness of voice due to recurrent laryngeal nerve paralysis is an infrequent finding secondary to mitral stenosis. This case illustrates an unusual presentation of rheumatic heart disease (RHD) in young women. This case report highlights the importance of early reporting and diagnosis of RHD-RF, being very prevalent in developing nations and yet neglected.

Congestive Hepatopathy

Liver disease resulting from heart failure (HF) has generally been referred as “cardiac hepatopathy”. One of its main forms is congestive hepatopathy (CH), which results from passive venous congestion in the setting of chronic right-sided HF. The current spectrum of CH differs from earlier reports with HF, due to ischemic cardiomyopathy and congenital heart disease having surpassed rheumatic valvular disease. The chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis (“cardiac cirrhosis”) and hepatocellular carcinoma after several decades of ongoing injury. Contrary to primary liver diseases, in CH, inflammation seems to play no role in the progression of liver fibrosis, bridging fibrosis occurs between central veins to produce a “reversed lobulation” pattern and the performance of non-invasive diagnostic tests of liver fibrosis is poor. Although the clinical picture and prognosis is usually dominated by the underlying heart condition, the improved long-term survival of cardiac patients due to advances in medical and surgical treatments are responsible for the increased number of liver complications in this setting. Eventually, liver disease could become as clinically relevant as cardiac disease and further complicate its management.

Clinical scenarios in chronic rheumatic heart disease

Chronic rheumatic heart disease is the most important cause of valvular heart disease in the developing world. In the current era, multivalvular disease is the most common presentation in adults and requires careful judgement of each scenario on a case-by-case basis. It behoves the clinician to integrate the haemodynamic understanding of each lesion and its impact on other lesions and on various cardiac chambers’ structure and function. In this way, meaningful interpretation of clinical scenarios and therapeutic options may occur. This chapter accentuates a few key issues in rheumatic valvular disease with an emphasis on individual lesions.

Stroke in Patients with Infective Endocarditis: A 15-Year Single-Center Cohort Study

Objective: To explore the relationship between infective endocarditis (IE) and stroke. Methods: The clinical data of patients diagnosed with IE from January 2003 to December 2017 in Beijing Anzhen Hospital Affiliated to Capital Medical University were retrospectively analyzed. Results: A total of 861 patients (mean age: 40.79 ± 16.27 [SD]) with IE was recruited. Vegetations were confirmed in 97.32% of all the patients, among whom 296 were diagnosed with congenital heart disease and another 53 with rheumatic valvular disease. The most common pathogens were Streptococcus, Staphylococcus, and various types of fungi (13.12, 7.31, and 1.16% respectively). Out of the 138 patients diagnosed with stroke, 101 cases were of ischemic stroke, 23 cases were of hemorrhagic stroke, and 12 cases were of concurrent ischemic and hemorrhagic stroke. There were 31 patients who had infarction lesions in more than 2 vascular systems. The mean age of stroke patients was significantly higher than that of patients without stroke (45.76 ± 17.88 vs. 39.83 ± 15.77, p = 0.000). The incidence of mitral valve vegetation (57.24 vs. 43.01%, p = 0.002), atrial fibrillation (4.34 vs. 1.38%, p = 0.018), fungal infection (2.89 vs. 0.83%, p = 0.038) in patients with stroke was significantly higher than those without stroke. Mitral valve vegetation (OR 1.648; 95% CI 1.113–2.442) and age (OR 1.019; 95% CI 1.007–1.032) were independent risk factors for stroke in IE patients. Stroke increased the risk of hospital deaths (OR 7.673 95%CI 3.634–16.202). Conclusion: Stroke is a common complication of IE. Mitral valve vegetation and old age may incerease the risk of stroke in patients with IE.