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Evaluation System (DES) to determine if they are amenable 2. de Loizaga SR, Arthur L, Arya B, et al. Rheumatic heart disease
16
for continued military service. Most will undergo a medical in the United States: forgotten but not gone: results of a 10 year
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3. Salman A, Larik MO, Amir MA, et al. Trends in rheumatic
Conclusion heart disease-related mortality in the United States from 1999
to 2020. Curr Probl Cardiol. 2024;49(1):102148. doi:10.1016/j.
RHD is rare within the SOF population but may cause sig- cpcardiol.2023.102148
nificant morbidity and potential mortality if unidentified and 4. Sika-Paotonu D, Beaton A, Raghu A, Steer A, Carapetis J. Acute
untreated. While recognition and treatment of streptococcal rheumatic fever and rheumatic heart disease. In: Ferretti JJ, Ste-
infection attempt to combat this disease process, autoim- vens DL, Fischetti VA, eds. Streptococcus pyogenes: Basic Biology
mune destruction can generate MS or MR. Patients present to Clinical Manifestations. University of Oklahoma Health Sci-
ences Center; 2016.
with chronic and progressive dyspnea, orthopnea, syncope or 5. Simpson MT, Kachel M, Neely RC, et al. Rheumatic heart dis-
near-syncope, and exercise intolerance; in the SOF population, ease in the developing world. Struct Heart. 2023;7(6):100219.
decreased exercise tolerance from their typically high baseline doi:10.1016/j.shj.2023.100219
of physical fitness may be particularly noticeable. A thorough 6. Perone F, Peruzzi M, Conte E, et al. An overview of sport partici-
workup may demonstrate non-specific ECG changes and po- pation and exercise prescription in mitral valve disease. J Cardio-
vasc Dev Dis. 2023;10(7):304. doi:10.3390/jcdd10070304
tential dysrhythmia, though diagnosis is confirmed with a 7. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guide-
TTE. Heart failure can be managed conservatively while the line for the diagnosis and management of group A streptococcal
severity of mitral valvular disease will dictate if further inter- pharyngitis: 2012 update by the Infectious Diseases Society of
vention is indicated. SOF medics and providers should main- America. Clin Infect Dis. 2012;55(10):e86–102. doi:10.1093/cid/
tain a high level of clinical suspicion in those complaining of cis629
dyspnea, near-syncope or syncope, and decreased exercise tol- 8. Passos LSA, Nunes MCP, Aikawa E. Rheumatic heart valve dis-
erance to ensure timely diagnosis and treatment of this rare ease pathophysiology and underlying mechanisms. Front Cardio-
vasc Med. 2021;7:612716. doi:10.3389/fcvm.2020.612716
but potentially life-threatening condition. 9. Cunningham MW. Rheumatic fever, autoimmunity, and molec-
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Author Contributions 2014;33(4):314–329. doi:10.3109/08830185.2014.917411
KO, DD, AC, and RB generated the manuscript. MM provided 10. Reményi B, Wilson N, Steer A, et al. World Heart Federation
care for the patient and provided edits. All authors approved criteria for echocardiographic diagnosis of rheumatic heart dis-
the final draft. ease—an evidence-based guideline. Nat Rev Cardiol. 2012;9(5):
297–309. doi:10.1038/nrcardio.2012.7
11. Kumar RK, Antunes MJ, Beaton A, et al. Contemporary diagno-
Disclaimer sis and management of rheumatic heart disease: implications for
The view(s) expressed herein are those of the author(s) and closing the gap: a scientific statement from the American Heart
do not reflect the official policy or position of Madigan Army Association. Circulation. 2020;142(20):e337–e357. doi:10.1161/
Medical Center, the U.S. Army Medical Department, U.S. CIR.0000000000000921
Army Special Operations Command, the U.S. Army Office of 12. Karthikeyan G, Ntsekhe M, Islam S, et al. Mortality and morbidity
the Surgeon General, the Department of the Army, the Depart- in adults with rheumatic heart disease. JAMA. 2024;332(2):133.
doi:10.1001/jama.2024.8258
ment of the Navy, the Department of the Air Force, Uniformed 13. Shah SN, Sharma S. Mitral stenosis. In: StatPearls. StatPearls Pub-
Services University of the Health Sciences, Department of De- lishing; 2025. https://www.ncbi.nlm.nih.gov/books/NBK430742/
fense, or U.S. Government. 14. Dougherty S, Okello E, Mwangi J, Kumar RK. Rheumatic heart
disease. J Am Coll Cardiol. 2023;81(1):81–94. doi:10.1016/j.jacc.
Disclosures 2022.09.050
The authors have nothing to disclose. 15. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA
guideline for the management of patients with valvular heart
disease: executive summary: a report of the American College
Funding of Cardiology/American Heart Association Joint Committee on
No funding was received for this work. Clinical Practice Guidelines. Circulation. 2021;143(5). doi:10.
1161/CIR.0000000000000932
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