Makindo Medical Notes

Related Subjects: |Dilated Cardiomyopathy |Hypertrophic cardiomyopathy (HCM - HOCM) |Peripartum cardiomyopathy |Restrictive Cardiomyopathy |Takotsubo Cardiomyopathy

💙 Cobalt Cardiomyopathy is a distinctive, rapidly progressive, and often reversible cause of heart failure linked to cobalt exposure. Historically called Beer-Drinker’s Cardiomyopathy.

🔎 About

• Subacute, potentially reversible form of heart failure.
• Can mimic hypertrophic or restrictive cardiomyopathy.
• First described in heavy beer drinkers due to cobalt additives.

🧬 Aetiology

• Cobalt is an essential trace element (needed for cobalamin/B12 synthesis).
• Excess leads to apoptosis, necrosis, and oxidative DNA damage.

⚠️ Risk Factors

• 🍺 Alcoholism / heavy beer drinking (cobalt used to stabilise beer foam).
• 🍽️ Low-protein diet.
• 🌡️ Hypothyroidism.
• 🦴 Cobalt-alloy hip prosthesis (prosthetic wear releasing cobalt).
• 🏋️‍♂️ Cobalt misuse by athletes.
• Vitamin B1 (thiamine) deficiency.

🩺 Clinical Features

• Lethargy, anorexia, weight loss (weeks-months before onset).
• Subacute severe heart failure → dyspnoea, oedema.
• Hypotension, cyanosis, pericardial effusion.
• Tender hepatomegaly, possible goitre.
• Sensorineural hearing loss (extra-cardiac clue).

🧪 Investigations

• 📉 FBC: polycythaemia.
• 📉 ECG: low voltage complexes.
• 🧪 VBG: lactic acidosis.
• 🧪 TFTs: hypothyroidism.
• 🫀 Echo: LV dysfunction, possible restrictive pattern.
• 🧲 Cardiac MRI: myocardial oedema, wall thickening, reduced LV function.
• 🥼 Serum cobalt: may support diagnosis but levels do not always correlate with severity.

🔀 Differentials

• Wet Beri-Beri (thiamine deficiency).
• Sarcoidosis.
• Amyloidosis.
• Haemochromatosis.
• Mitochondrial syndromes.
• Fabry disease.

💊 Management

• 🩹 Standard heart failure care (ABC, oxygen, diuretics, vasodilators).
• ❌ Stop cobalt exposure (remove source: prosthesis, supplements, alcohol).
• ❓ Chelation therapy: role uncertain.
• 🔧 If hip prosthesis: removal essential; beware risk of acute deterioration post-op → may need mechanical support as bridge to transplant.
• 📈 Prognosis: Many survivors show rapid and complete recovery once exposure stops.

📚 References

• Review article – AHA
• Case study – cobalt from hip prosthesis