Cardiovascular disease (>25%) is the leading cause of death among pregnant women in the United States. This chapter covers risk stratification, pathophysiology, and anesthetic management of women with specific cardiac diseases. In the last decade, advances in treatment and management of cardiac disease in the pregnant patient have led to improvements in survival of obstetric patients with known cardiac disease. Key to the improvements in care is the creation of Pregnancy Heart Teams, multidisciplinary teams with knowledge and experience caring for the obstetric patient with cardiovascular disease. Cardiovascular disease encompasses a heterogeneous group of lesions with differing hemodynamic goals, management and risks during pregnancy, delivery, and postpartum. The anesthesiologist is best able to care for these women by understanding the specific cardiovascular lesion, a woman’s current status, the obstetric and fetal considerations and the impact of anesthetic techniques.

During your call duty, a 38-year-old G5P4 with a spontaneous dichorionic pregnancy presents to the obstetric emergency assessment unit of your tertiary center at 37+5 weeks’ gestation with dyspnea and noticeable bilateral leg edema. She has no obstetric complaints. Your colleague follows her prenatal care. Routine prenatal laboratory investigations, aneuploidy screening, fetal morphology surveys, and serial sonograms have all been unremarkable. She had four uncomplicated pregnancies and term vaginal deliveries in your hospital center.