Around 0.2–4% of all pregnancies are complicated by cardiovascular disease (CVD) and these numbers have seen a rising trend because of the increase in prevalence of hypertension, diabetes, obesity and maternal age. Advances in treatment of coronary heart disease (CHD) have resulted in more number of CHD patients attaining the childbearing age and ultimately adding to the number of cases. This chapter covers the physiological changes in the cardiovascular system during pregnancy, assessment of risk in patients with cardiac disease, specific cardiac lesions, cardiomyopathy, effect of heart disease on pregnancy outcomes, diagnostic approach, and management principles.