A case report of cobalt cardiomyopathy leading to electric storm and cardiogenic shock: the importance of the orthopaedic background in patients with heart failure of unknown aetiology

Abstract

Background The first series of cobalt cardiomyopathy was described in the 60s in relation to the abuse of a cobalt containing beer. Since then, millions of metal hip arthroplasties have been performed and a small number of cobalt cardiomyopathies related to metal prosthesis have been reported. Case summary We report a case of a 48-year-old man who developed a severe non-dilated restrictive cardiomyopathy in the setting of a systemic metallosis following several hip arthroplasties. The diagnosis was suspected by exclusion of other more common causes for restrictive cardiomyopathies and confirmed by the levels of cobalt and chromium in the serum and the endomyocardial biopsy performance that showed metal deposits in myocardial tissue. Despite the removal of the metal prosthesis and a significant decrease in serum metal levels, he suffered cardiogenic shock (CS) and electric storm that required emergency mechanical circulatory support as a bridge to heart transplant. Discussion Cobalt cardiomyopathy is a rare condition that has been observed in patients who develop cobalt toxicity after metal hip arthroplasty. The condition may improve after diagnosis and removal of the prosthesis or get worse and progress to end-stage heart failure or CS. The concern about the metal toxicity associated with metal hip prosthesis has increased in the last few years. Orthopaedic surgeons and cardiologists should be aware of this severe complication that is probably under diagnosed.

Too young for an acquired cardiomyopathy? Cobalt metallosis as a cardiac amyloidosis mimicker

“…If exposure persists, the course of cobalt‐induced cardiomyopathy is progressive, towards severe systolic dysfunction and death. Extreme presentations, such as cardiogenic shock or electric storm, requiring advanced mechanical circulatory support and heart transplantation can occur in patients who either were not previously diagnosed or failed to show reversal of cardiac abnormalities 2–4,12 …”

“…Extreme presentations, such as cardiogenic shock or electric storm, requiring advanced mechanical circulatory support and heart transplantation can occur in patients who either were not previously diagnosed or failed to show reversal of cardiac abnormalities. 2 , 3 , 4 , 12 …”

“… 1 Extreme presentations have been described, including electrical storm or cardiogenic shock requiring ventricular assist devices and heart transplantation. 2 , 3 , 4 Due to the fact that it can imitate other acquired or hereditary cardiomyopathies, correct diagnosis and specific management are often delayed. 5 …”