Heart Failure in a Case of Inverted Takotsubo Cardiomyopathy due to Cocaine and Methamphetamine Abuse Treated with Levosimendan

A variant of takotsubo cardiomyopathy is the inverted takotsubo type, where the wall motion abnormalities affect the basal and mid segments but spare the apex. We describe a case of this variant induced by cocaine and methamphetamine consumption. There are reported cases of transient apical ballooning associated with drug abuse, but none of them presented with the inverted variant and low cardiac output treated with levosimendan.