Inverted (reverse) Takotsubo cardiomyopathy (iTCM) is a rare variant of stress cardiomyopathy characterized by basal and mid-ventricular left ventricular (LV) hypokinesis with apical hyperkinesis. Methomyl is a reversible acetylcholinesterase-inhibiting carbamate insecticide responsible for severe cholinergic toxidrome. The occurrence of iTCM as a complication of methomyl carbamate poisoning remains exceptionally rare and has not been comprehensively described in the literature. We describe a 45-year-old woman admitted to intensive care following intentional ingestion of methomyl, a carbamate insecticide. She presented comatose with cholinergic syndrome and respiratory failure requiring intubation. Initial investigations revealed profound cholinesterase inhibition, sinus bradycardia, and non-specific ECG changes. During ICU monitoring, dynamic T-wave abnormalities and a marked rise in cardiac biomarkers were observed. Transthoracic echocardiography demonstrated basal and mid-ventricular hypokinesia with apical hyperkinesis, consistent with inverted Takotsubo cardiomyopathy, confirmed by International Takotsubo (InterTAK) criteria. Supportive management included mechanical ventilation, continuous atropine infusion, and close hemodynamic monitoring. The patient recovered fully, with normalization of cardiac biomarkers and ventricular function, and was discharged on day 4. This case highlights inverted Takotsubo cardiomyopathy as a rare but important complication of carbamate poisoning. Recognition of toxin-induced TTC is crucial, as it mimics acute coronary syndrome yet requires tailored supportive management. Early echocardiographic evaluation and vigilant ICU care are essential for favorable outcomes.