Hoarseness was the only presenting symptom in a 14-year-old girl with mitral insufficiency. The onset of hoarseness before other symptoms of cardiovascular disease in this patient suggests that heart disease be considered in children presenting with persistent hoarseness.
Balfour HH, Ayoub EM. Hoarseness as the Presenting Symptom of Mitral Insufficiency. JAMA. 1968;204(13):1190–1193. doi:10.1001/jama.1968.03140260030014
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