Rheumatic fever is the main cause of mitral stenosis worldwide. Ortner’s syndrome (cardio-vocal syndrome) is a rare complication of rheumatic mitral stenosis. It is caused by recurring paralysis of the left laryngeal nerve, mainly caused by mechanosuppression of the nerve from enlarged cardiovascular structures. A 76-year-old woman with chronic rheumatic heart disease (RHD) complained of hoarseness for 17 days, accompanied by shortness of breath, nausea, and vomiting for 1 week. Auscultatory examination revealed a loud first heart sound in the mitral region as well as an irregular rhythm. An electrocardiogram examination revealed right axis deviation and atrial fibrillation. Chest X-ray showed cardiomegaly. Despite normal left and right ventricular function, echocardiography showed severe mitral stenosis with mild mitral regurgitation. Conservative treatment was given with a combination of diuretics, beta-blockers, vitamin K antagonists, and angiotensin receptor blockers. An otolaryngologist was consulted, and the patient was treated conservatively.