A Case of dysphagia was evaluated properly and was diagnosed as a case of Ortners syndrome. This slides discuss the litereture review of ortners syndrome also

2. Dr. Azim Anwar
Chairman: Dr. Md. Khurshid Ahmed
Asso. Professor, Dept of Cardiology, BSMMU

3. Case Based Management of MS and
Summery of
ESC 2021 & ACC AHA 2020
Rcommendations

5. Beuty Rani, 50 Years
 Palpitations 2 Months
 Shortness of Breath
Dysphagia
Coughing out of blood– 2 weeks

6. • Reasonably well 2 Months Back…..

7. • Reasonably well 2 Months Back…..
 Palpitations

8. • Reasonably well 2 Months Back…..
 Palpitations
Initially, Occasional with Moderate exertion

9. • Reasonably well 2 Months Back…..
 Palpitations
Initially, Occasional with Moderate exertion
Gradually Increasing in severity

10. • Reasonably well 2 Months Back…..
 Palpitations
Initially, Occasional with Moderate exertion
Gradually Increasing in severity
 Palpitations on mild exertion

11. Not Associated With
Chest Pain
Lightheadedness
Syncope
Polyuria

14. Coughing Out of Blood
• 5-6 times / 15 Days

15. Coughing Out of Blood
• 5-6 times / 15 Days
• Half TSF each time…

16. Coughing Out of Blood
• 5-6 times / 15 Days
• Half TSF each time…
• Not mixed with Phlegm or food particle

17. Coughing Out of Blood
• 5-6 times / 15 Days
• Half TSF each time…
• Not mixed with Phlegm or food particle
• No bleeding from any other orifices of the
body

18. No………
• Fever, Wt loss, Night Sweats
• Childhood Rhematic fever
• Contact with TB + patients
• Purulent Sputum
• Joint pain, Rash, Skin tightening
• Thyroid problems
• Ankle / Neck swelling
• Childhood Allergy
• Malabsorption
• No such disease running in the family
• Nonalcoholic
• Non Smoker

19. On Query
• Admitted in NICVD on 2011
• Had ECG, Echocardiography
• Underwent a surgical procedure
• Can’t mention the name
• Was well since then, upto December,2021
Consulted different physicians and multiple tests
No improvement, So, attended to BSMMU

20. Drug History
• Warfarin ------------- at 5 pm, except friday
• Salbutamol
• Thyroxine NONE
• Theophylene

21. On Examination
• Dyspnic, R-R- 21/mins
• Pulse 92b/m
• BP 100/60 mmhg
• Temperature- Normal
• Edema +
• JVP, LN, Thyroid Absent

22. Precordium

23. • P2: Present
• Left parasternal Heave: Present
• Thrill: Diastolic in mitral area
• Epigastric Pulsation Present

24. Ausculation
• Loud HS1
• P- HS2 : PROMINENT
• MDM --- LLRR
• Opening Snap
• Presystolic Accentuation

27. MS LOUD HS1
MDM Opening Snap
Pre Systolic
Accentuation
Loud P2 if
Pulmonary
hypertension
ASD
LOUD HS1 MDM Fixed wide
splittting of HS2
Loud P2 if
pulmonary
hypertension
LA
Myxoma
LOUD HS1
(Tumor causes
delay in closure
of MV, due to
prolapse of
tumor in MV
orifice.)
MDM
(Due to
obstruction of
LV)
Diastolic atrial
rumble due to
MV obstruction
Change with
position,
Tumor plop at
early diastole
Loud P2 if
pulmonary
hypertension

28. INVESTIGATIONS

29. ECG

30. 2D, M, Color Doppler Echo
PLAX View

37. A4C

42. PSAX

47. TEE

51. • SP- CMC
• Ortner’s Syndrome
• CRHD– Symptomatic Severe MS with
• Severe Pulmonary Hypertension

53. Management Plan
• General Management
• Interventional Management
• Surgery
• Follow Up

55. Medical Management

56. Intervention: Should We Perform
PTMC ?

57. Intervention
PTMC
Favourable Clinical No Contraindications
Charecteristics
No Comissurotomy before
NYHA II-III
AF Not permanent
Pulmonary Hypertension Mild-Mod
Echo Score <8
Cormier Score < 3 (Fluroscopic)
No concominent AS_AR_TS_TR_CAD
High risk/Contraindication to Surgery

58. PTMC in Asymptomatic MS

59. Surgery
• 3) Severe MS+ Mod AS/AR, when DVR is risky.
• Severe MS + Severe TR, if LA Mod enlarged and TR is Functional

64. •

65. Follow UP
After PTMC- Yearly
Asymptomatic Severe MS- Yearly
Asymtomatic Moderate MS- 2/3 Yearly

66. Follow Up After MVR

67. 5 Take Home Massage
• Compressive Symptoms of Ortner’s
Syndrome does not always correlates with
LA size.
• Planimetry is the method of choice to
determine severity of MS.
• Post CMC Mitral Valve thrombosis needs
MVR
• VHD assessment and management need
formation of Heart Team
• Post MVR timely followup is needed as per