I purchased this card just under a month ago. I have been monitoring temperatures levels recently and noticed some issues. The card under 100% load was running at 100-105degrees C. and about 50degrees idle.
The case has great airflow, but sky high temperatures within 2 minutes of playing Battlefield 3 or even Eve Online which isn't that taxing. Have forced me to send this back for a replacement.
Make sure you install MSI's Afterburner software, and keep tabs on your temperatures.
Update: 2 days earlier than the estimated delivery date, my replacement card arrived.
Playing battlefield3, my temperatures dont go over 50degrees, the GPU usage no longer sticks to 100% usage on the most mundane of tasks, and my performance in Battlefield3 has doubled over the faulty card. Working properly, this card is great. I may get another to SLI them.
I can't fault Amazon on their support, and now i have a fully working card, it's great. I still won't give it 5 stars due to the issues with the original card i had. But if you get a good one first time, then pretend i gave it 5.