**8. Diagnosis**

As mentioned initially diagnosis of PPCM based on three clinical criteria, development of heart failure in last month of pregnancy or in the initial 5 months following delivery with the absence of another identifiable cause of HF and left ventricular (LV) systolic dysfunction with an left ventricular ejection fraction (LVEF) of < 45%. The last criteria will exclude patients with accelerated hypertension, diastolic dysfunction, systemic infection, pulmonary embolism, or preeclampsia or amniotic fluid embolus. Chest X-ray, electrocardiogram (ECG), and echocardiogram should be performed in patients who are clinically suspected of having PPCM.

Studies showed brain natriuretic peptide (BNP) levels, cardiac magnetic resonance (CMR) imaging, cardiac catheterization, and endomyocardial biopsy (EMB) will be helpful in these patients. Bacterial cultures and viral titers are usually not indicated, as these tests are nonspecific and without proven value in patients with myocarditis. The novel markers, plasma concentrations of proangiogenic and antiangiogenic factors, placenta growth factor, and fms-like tyrosine kinase 1 receptor, have been proposed to be used to distinguish patients with PPCM [22].
