1. Supraventricular tachycardia: Vagal maneuvers first, then intravenous adenosine,  Consider IV metoprolol. Electrical cardioversion is safe at any gestation. Place the pads sterno-apically and monitor the fetal heart rate. New atrial fibrillation is uncommon and warrants a structural workup.

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2. Acute aortic syndrome: Think about this in cases of connective tissues disorders (Marfan syndrome, Loeys-Dietz syndrome,  Ehlers-Danlos syndrome), Turner syndrome, bicuspid aortic valve. Risk generally rises with aortic diameter; above 50 mm in bicuspid disease, pregnancy is high risk. Imaging ie CT scan should not be delayed.

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3. Mechanical heart valves: This is a high group in pregnancy. Anticoagulation is not stopped — a documented plan should already be in place.  DOACs are not used. Consider valve thrombosis in new dyspnea or an embolic event.

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4. Pulmonary hypertension: Pregnancy carries very high maternal risk. The same applies to Eisenmenger syndrome, an ejection fraction below 30 percent. Consider it in unexplained dyspnea or hypoxia.

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5. Cardiac medications: ACE inhibitors, angiotensin receptor blockers, sacubitril/valsartan, mineralocorticoid receptor antagonists and SGLT2 inhibitors are not recommended in pregnancy. Statins maybe continued in established atherosclerotic disease.