The purpose of this guideline is to develop a standardized evaluation and management approach for patients with cardiac symptoms (chest pain, palpitations, shortness of breath) during pregnancy.

Cardiovascular disease is a leading cause of severe maternal morbidity and mortality. Symptoms of cardiac disease overlap with symptoms of pregnancy, making differentiation of normal pregnancy symptoms from medical complications challenging. Shortness of breath can occur during normal pregnancy due to hormonal changes, anemia, pressure effect of the uterus on diaphragm and lungs, and an increase in minute ventilation. Chest pain in pregnancy can have both cardiac and non-cardiac etiologies and identifying pain that requires urgent or emergent intervention is critical. Evaluation and management of both shortness of breath and chest pain may be impacted by clinical history, acute vs chronic nature of complaint, risk factors, gestational age, or postpartum state. For example, shortness of breath in the postpartum period always warrants evaluation as dyspnea of pregnancy should not continue into the postpartum period. Importantly, there is an increased risk of acute coronary syndrome, cardiomyopathy, pulmonary embolism, and coronary or aortic dissection in pregnancy and up to 12 weeks postpartum, with the highest risk in the first week after delivery. It is important to note that cardiac complications can occur in patients without cardiovascular risk factors and without a prior diagnosis of cardiovascular disease.