FOCAL SEPSIS IN RELATION TO HEART DISEASE

The role of focal septic infection in the production of heart disease is uncertain apart from the production of subacute bacterial endocarditis which has been discussed. It is also possible that septic foci may be of astiological importance in some cases with heart block of milder grades and in cases with obstinate extrasystolic irregularities. In such cases, removal of the foci is desirable and is generally without risk if suitable prophylactic measures are taken by pre- and post-operative treatment with penicillin.
The matter is not so simple, however, when symptoms or signs of gall¬bladder disease are found in a patient with heart disease. It is held by some that many patients with cardiac pain and congestive failure may owe their condition to toxaemia from an infected gall-bladder. Others contend that chance association determines the simultaneous occurrence of the two conditions. The subjects of cholecystitis are of the habitus and age in which arterial degeneration and its sequelas of angina and myocardial failure are common. The evidence in favour of the so-called gall-bladder heart is not convincing, and operations for removal of the gall-bladder should be undertaken only when there are clear indications, apart from the cardiac condition, to justify the step. The high mortality attending this operation in patients with hypertension, obesity and impaired myocardial efficiency should be kept in mind.