Presentation of peripartum cardiomyopathy (PPCM) is typically with signs and symptoms of acute cardiac failure towards the end of pregnancy or postpartum. When treating hemorrhage caused by atony in a patient with PPCM, the obstetrician may proceed sooner to mechanical methods such as uterine balloon or hemostatic suturing, simply because the options for medical therapy are limited. Cardiac anesthesiologists should be consulted and pediatricians made aware of opioid administration. The inotrope levosimendan sensitizes cardiac myofilaments to intracellular calcium, and additionally mediates vascular smooth muscle dilatation through opening of ATP-sensitive potassium channels. Immunosuppressive therapy may be advocated if no improvement occurs in symptoms after standard medical therapy. Cardiac transplantation is an important therapy for a small number of patients for whom maximal medical management has failed and who remain in refractory symptomatic heart failure with poor systolic ventricular function. Patients with persistent left ventricular dysfunction are usually advised against subsequent pregnancies.