Hoarseness is a common clinical condition with underlying causes which can vary from reversible and benign to life-threatening and malignant. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when the recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structures. We report a 28-year-old male who presented to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness. He had undergone irregular treatment for pulmonary tuberculosis (TB) two years previously. Fiber-optic laryngoscopy indicated left vocal cord palsy and a computed tomography scan of the chest revealed features of pulmonary hypertension with extensive enlargement of the pulmonary arteries. An echocardiogram confirmed severe pulmonary arterial hypertension with severe tricuspid regurgitation. He was diagnosed with left recurrent laryngeal palsy secondary to cardiovocal syndrome. Although reports exist of recurrent laryngeal palsy in TB, this case appears to be the first to report cardiovocal syndrome in a patient treated for pulmonary TB