Medical therapy is eff ective in the majority of patients; treatment is commenced with a loop diuretic, and if the patient is postpartum, an angiotensin-converting enzyme inhibitor or antiotensin receptor blocker is added. In severe cases, placement of an intra-aortic balloon counter pulsation device or extracorporeal membrane oxygenation [23] may be necessary. Th ere is a very high incidence of thromboembolic disease associated with peripartum cardiomyopathy, and anticoagulation is essential. Early experience with prolactin inhibitors, such as bromocriptine, appears to be positive, and this may become the mainstay of treatment in the future [24] .