From Hip to Heart: A Comprehensive Evaluation of an Infiltrative CardiomyopathyNovel Teaching Points
Manavotam Singh, MD,
Mrinalini Krishnan, MD,
Amre Ghazzal, MD,
Marc Halushka, MD,
James E. Tozzi, MD,
Robert D. Bunning, MD,
Maria E. Rodrigo, MD,
Samer S. Najjar, MD,
Ezequiel J. Molina, MD,
Farooq H. Sheikh, MD
Affiliations
Manavotam Singh, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA; Corresponding author: Dr Manavotam Singh, MedStar Heart and Vascular Institute, 110 Irving St NW, Washington, DC 20010, USA. Tel.: +1 202-877-5975; fax: 202-877-3339.
Mrinalini Krishnan, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
Amre Ghazzal, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
Marc Halushka, MD
Department of Pathology, John Hopkins University, Baltimore, Maryland, USA
James E. Tozzi, MD
Department of Orthopedic Surgery, Medstar Washington Hospital Center, Washington, DC, USA
Robert D. Bunning, MD
Department of Physical Medicine and Rehabilitation, MedStar National Rehabilitation Hospital, Washington, DC, USA
Maria E. Rodrigo, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
Samer S. Najjar, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
Ezequiel J. Molina, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA; Department of Pathology, John Hopkins University, Baltimore, Maryland, USA; Department of Orthopedic Surgery, Medstar Washington Hospital Center, Washington, DC, USA; Department of Physical Medicine and Rehabilitation, MedStar National Rehabilitation Hospital, Washington, DC, USA; Department of Cardiothoracic Surgery, MedStar Heart and Vascular Institute, Washington, DC, USA
Farooq H. Sheikh, MD
Advanced Heart Failure, MedStar Heart and Vascular Institute, Washington, DC, USA
Infiltrative cardiomyopathies are an increasingly recognized cause of heart failure warranting systematic evaluation. Given overlap of clinical and imaging findings among etiologies of infiltrative cardiomyopathies, comprehensive evaluation, including a history and physical examination, advanced cardiac imaging, and sometimes endomyocardial biopsy, is required for diagnosis. We report a case of infiltrative cardiomyopathy in which endomyocardial biopsy confirmed diagnosis of cobalt-induced cardiomyopathy. The novel teaching points highlighted by this case report include identification of heavy-metal toxicity as a cause of infiltrative cardiomyopathy, and the outline of a diagnostic approach and management for cobalt-induced cardiomyopathy. Résumé: Le fait que les cardiomyopathies infiltrantes sont de plus en plus reconnues comme la cause de l’insuffisance cardiaque justifie une évaluation systématique. Puisque les résultats cliniques et d’imagerie se recoupent entre les étiologies des cardiomyopathies infiltrantes, l’évaluation exhaustive, y compris les antécédents et l’examen physique, les techniques avancées en imagerie cardiaque et parfois la biopsie endomyocardique, est nécessaire au diagnostic. Nous présentons un cas de cardiomyopathie infiltrante pour lequel la biopsie endomyocardique a permis de confirmer le diagnostic d’une cardiomyopathie induite par le cobalt. Parmi les points à enseigner illustrés dans cette observation, on cite la reconnaissance de la toxicité des métaux lourds comme une cause de cardiomyopathie infiltrante, et la vue d’ensemble de l’approche diagnostique et de la prise en charge de la cardiomyopathie induite par le cobalt.
