Severe Rheumatic Heart Disease Requiring Mechanical Valve Placement in a Special Operations Forces Soldier

Rheumatic heart disease (RHD) has become exceedingly rare in the United States, but a recent resurgence may place military Servicemembers at increased risk for this diagnosis. Our case describes a 29-year-old U.S.-born Special Operations Forces (SOF) Soldier who presented for recurrent exertional near-syncope and progressive exercise intolerance with subsequent workup remarkable for RHD. Initial electrocardiogram was notable for benign early repolarization and intraventricular conduction delay. Cardiology evaluation with transthoracic and transesophageal echocardiograms revealed severe mitral regurgitation and rheumatic appearing mitral valve leaflets. The patient underwent a successful mechanical mitral valve replacement, requiring lifelong anticoagulation with warfarin. Depending on severity of valvular disease, treatment modalities range from conservative medical therapies to invasive and minimally invasive surgical intervention. This case demonstrates the importance for SOF medics and providers to remain vigilant of this resurging disease process. Additionally, it emphasizes the necessity for a high level of clinical suspicion in those with exertional complaints and decreased exercise tolerance to ensure timely diagnosis and treatment of rare but potentially life-threatening conditions.