Cardiac Transplantation following Cobalt Cardiomyopathy from Bilateral Metal-on-Metal Hip Replacements

Table 1

Signs and symptoms of cobalt toxicity by organ systems.

Organ system
Constitutional	Cardiovascular	Endocrine	Neurological	Hepatic	Gastrointestinal	Immune
Signs and symptoms
	Lethargy	Pericardial effusion	Hypothyroidism	Peripheral neuropathy (tremor, sensory deficit)	Hepatomegaly	Reflux oesophagitis	Enlarged mediastinal lymph nodes and lymph nodes around joint replacements
	Anorexia	Dyspnoea on exertion	Goitre	Hearing loss
	Weight loss/difficulty gaining weight	Palpitations	Metabolic acidosis	Visual impairment
	Polycythemia	Sinus tachycardia		Parkinsonism
	Pyrexia of unknown origin	Hypotension		Cognitive decline
		Cyanosis
		Low voltage on ECG
		Reduced ejection fraction
		Elevated serum enzymes (raised troponin and BNP)
		Elevated myocardial cobalt levels
		Elevated serum cobalt levels
		Absence of ischemia and other common causes of cardiomyopathy

Adapted from [5, 8].