A 28-year-old woman was admitted for heart failure with severe dyspnoea, 15 days after her first normal delivery with a normal last trimester of pregnancy. She had no personal history, familial cardiac disease or cardiovascular risk, and her electrocardiogram was normal, but transthoracic echocardiography showed left ventricular (LV) dysfunction (LV ejection fraction [LVEF] 20%) despite normal findings on coronary angiography. C-reactive protein and N-terminal pro-brain natriuretic peptide concentrations were 46 mg/L and 2015 ng/L, respectively. Rapidly, she presented cardiogenic shock that needed mechanical support (extracorporeal life support). After a transient improvement, allowing weaning of mechanical support, cardiac magnetic resonance imaging (MRI) was performed. Cine sequences showed global hypokinesia, with LVEF 23%, LV end-diastolic volume 153 mL, and LV end-systolic volume 119 mL. LV short-axis views with T2-weighted sequences showed high signal intensity circumferential ( Fig. 1 , Panel A, arrow) evidence of inflammation or oedematous tissue. MRI performed 10 minutes after a bolus of gadolinium for delayed enhancement imaging showed circumferential areas of myocardial delayed enhancement (MDE) ( Fig. 1 , Panel B, arrow). Endomyocardial biopsy showed no evidence of acute viral myocarditis. One month later, the patient underwent heart transplant, with an uneventful postoperative course.
