Unusual Case of Congestive Heart Failure Cardiac Magnetic Resonance Imaging and Histopathologic Findings in Cobalt Cardiomyopathy

A 69-year-old woman presented with symptoms and examination findings consistent with congestive heart failure. She had history of hypertension, mild renal insufficiency, and bilateral hip replacements. Transthoracic echocardiogram showed left ventricular ejection fraction of 25% to 30%, normal left ventricular size and left ventricular wall thickness, and moderate pericardial effusion (Figures 1 and 2; Movie I in the Data Supplement). Pericardiocentesis removed 650 mL of straw-colored fluid, which was negative for infection or malignant cells. Coronary angiogram showed normal coronary arteries. Figure 1. Echocardiographic image showing restriction by mitral inflow. Figure 2. Echocardiographic images showing tissue Doppler imaging. She was discharged on low-dose beta blocker, angiotensin-converting enzyme inhibitor, and diuretics. Over the next 4 months, her biventricular function declined significantly, leading to multiple hospitalizations for congestive heart failure or symptomatic hypotension. Cardiac MRI revealed normal left ventricular size and wall thickness with severely reduced left ventricular ejection fraction of 14%. Right ventricle was normal in size with …