Inverted Takotsubo cardiomyopathy

“Inverted Takotsubo” cardiomyopathy is a variant of Tako-tsubo cardiomyopathy in which there is hyperkinesis of apex with mid ventricular ballooning, unlike the reverse pattern seen in classical Takotsubo cardiomyopathy. Instead of the precordial ST segment elevation, inferior ST segment elevation has been reported in these cases. The presentation and clinical features of “Inverted Tako-tsubo” cardiomyopathy are similar to those of typical Takotsubo cardiomyopathy. The difference in pattern of involvement has been attributed to the variation in sympathetic and parasympathetic innervation of the heart. A pattern similar to this has also been reported in sub arachnoid hemorrhage. A guideline published from Japan in 2007 mentions that “Inverted Takotsubo” cardiomyopathy should not be included in the diagnosis of Takotsubo cardiomyopathy. Takotsubo cardiomyopathy is also known as ampulla cardiomyopathy, stress cardiomyopathy and broken heart syndrome.