Peripartum cardiomyopathy, an uncommon cause of chronic heart failure, may present during the third trimester of pregnancy, but most often develops within 2 months postpartum. The etiologies of heart failure during pregnancy and postpartum are numerous, however. The authors describe the case of a 25-year-old woman who developed severe, symptomatic heart failure following delivery and discuss their initial consideration of peripartum cardiomyopathy and the differential diagnostic features of this case. (c)2001 CHF, Inc.