Introduction Peripartum cardiomyopathy (PPCM) is a rare and potentially fatal disease. It is mostly of unknown etiology although idiopathic, viral and autoimmune factors contribute to it. Reported incidence is of 1 in 3000-4000 live births with high mortality rate of 20-30%.

Case report We present a rare case of PPCM in a 42-year-old G6P0+5 previously fit and well women at 36+3 weeks gestation. She was initially treated for an upper respiratory tract infection. Due to persistence and worsening of symptoms echocardiogram was performed which showed PPCM with left ventricular failure. Patient was managed with bed rest and diuretic therapy, however with worsening left ventricular function on echocardiogram and worsening of breathlessness at rest delivery was planned. She underwent a caesarean section with intensive cardiac support. She remained stable and recovered well in the immediate post operative period. In the postnatal period she was managed with beta blocker and ACE inhibitor. A repeat echocardiogram with cardiology review was organised at 8 weeks postnatal.

Conclusion Cardiac causes remain the most common cause for indirect maternal death in the United Kingdom. Higher index of suspicion is required in parturient with prolonged chest symptoms especially in older women. A multidisciplinary approach and increased clinician's awareness is needed. Management of these women with acute presentation may not be straightforward as PPCM is rare in occurrence and also has an increased fatality rate.