Scorpion stings and broken hearts: an underdiagnosed etiology of inverted Takotsubo cardiomyopathy

INTRODUCTION: Severe cases of scorpion envenomation are commonly characterized by pulmonary oedema and heart failure. One mechanism of this acute heart failure is Takotsubo cardiomyopathy. The inverted type is reported less, and its management remains controversial. CASE REPORTS: We present six patients diagnosed with inverted Takotsubo cardiomyopathy following scorpion envenomation. They were aged 5-55 years and presented with clinical signs of acute heart failure. Echocardiography revealed apical hyperkinesia and basal hypokinesis, consistent with inverted Takotsubo cardiomyopathy. Management included supportive care and dobutamine infusion. All patients demonstrated significant improvement within one week. DISCUSSION: We report six cases of inverted Takotsubo cardiomyopathy in scorpion envenomation, a pattern commonly underdiagnosed. Clinical presentation mimics acute coronary syndromes, with chest pain, dyspnea, and pulmonary edema. Echocardiography remains the gold standard. The management is controversial, as catecholamine infusion may exacerbate heart ballooning, and the use of beta-blockers or non-catecholamine alternatives, used by some experts, is unsafe in patients with a very low ventricular ejection fraction. CONCLUSION: Inverted Takotsubo cardiomyopathy is a rare but reversible cardiac complication of scorpion envenomation. The management protocol requires further investigation.