Focal Infection as a Factor in Heart Disease*
All possible etiologie factors in cardiac failure warrant thorough consideration since heart disease is today by far the most frequent cause of death. Clark1 states that in the year 1928 the number of deaths from heart disease in certain states having an aggregate population of 25,000,000 was 228 per 100,000 persons as compared with 106 from kidney disease, 105 from cancer and 100 from pneumonia. He adds that the number of deaths from heart disease in the registration area of the United States doubled during the eight year period from 1917 to 1925, while the population increased by only one-third.
Many deaths from heart disease are due primarily to valvular disease resulting for the most part from activity of the virus of rheumatic fever. In other cases, death results from vascular syphilis or is the end result of arterial hypertension. A very large proportion of the deaths from heart disease result, however, from chronic changes in the myocardium which we group under the term chronic myocarditis, or chronic myocardial degeneration, often ascribed to senescent changes. Impairment of the blood supply secondary to coronary artery disease is an important factor in the development of the myocardial changes. Often, however, the cause is not apparent. I wish to emphasize one possible factor, namely, chronic focal infection, which is often overlooked or its importance underestimated.
Rheumatic infections of the heart valves and heart muscle are focal in origin in the sense that they usually metastasize from infection in the nasopharynx. These infections occur. . .