**5.2 Myocarditis**

First time Melvin et al. proposed myocarditis as a cause for PPCM. Myocarditis could be viral or autoimmune. With pregnancy there is increased in susceptibility to both. In another study, endomyocardial biopsies in five patients showed features of myocarditis. The reason for lesser positive biopsy report among the studies may be related to small sample size and timing of biopsy with relation to the onset of symptoms. The incidence of inflammation is greater in patients who are biopsied soon after presentation [13, 14]. The proinflammatory-inflammatory cytokines may play a role in the pathogenesis and progression of PPCM, as the cytokines that are elevated in PPCM compared with controls include tumor necrosis factor (TNF) alpha and interleukin-6 [15].
