Case Report
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 | | | | | |
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