Severe Cardiomyopathy Due to Arthroprosthetic Cobaltism: Report of Two Cases with Different Outcomes

Cobalt-induced cardiomyopathy is a well-known but uncommon disease, and the physician must maintain a high index of suspicion in order to make a timely diagnosis. We report two patients with cobalt-induced cardiomyopathy. Both patients developed progressively worsening symptoms of cobalt toxicity fo...

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Bibliographic Details
Published in:Cardiovascular toxicology 2019-02, Vol.19 (1), p.82-89
Main Authors: Choi, Hyo-In, Hong, Jung Ae, Kim, Min-Seok, Lee, Sang Eun, Jung, Sung-Ho, Yoon, Pil Whan, Song, Joon Seon, Kim, Jae-Joong
Format: Article
Language:English
Subjects:
Biomedical and Life Sciences
Biomedical materials
Biomedicine
Cardiac patients
Cardiology
Cardiomyopathy
Cardiotoxicity
Care and treatment
Chelation
Cobalt
Diagnosis
Echocardiography
Effusion
Fractures
Health aspects
Heart
Heart diseases
Heart enlargement
Heart function
Heart transplantation
Hip
Hypertrophy
Intoxication
Patients
Pharmacology/Toxicology
Polyethylene
Polyethylenes
Surgery
Surgical implants
Total hip arthroplasty
Toxicity
Transplantation
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Summary:Cobalt-induced cardiomyopathy is a well-known but uncommon disease, and the physician must maintain a high index of suspicion in order to make a timely diagnosis. We report two patients with cobalt-induced cardiomyopathy. Both patients developed progressively worsening symptoms of cobalt toxicity following revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. In both patients, echocardiography showed LV hypertrophy, biventricular systolic dysfunction, and a large amount of pericardial effusion. Due to decompensated heart failure, both patients were initially considered candidates for heart transplantation. One patient was diagnosed with cobalt-induced cardiomyopathy before transplantation. He received cobalt chelation therapy and revision surgery, which led to complete recovery of heart function. In the other patient, the diagnosis was not made until the time of heart transplantation. The gross examination of the explanted heart revealed typical features of cobalt cardiotoxicity, which was then diagnosed as cobalt-induced cardiomyopathy. These cases emphasise the importance of early diagnosis and prompt treatment of cobalt intoxication.
ISSN:1530-7905
1559-0259
DOI:10.1007/s12012-018-9480-0