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The spectrum of cardiovascular disease presenting during pregnancy is evolving and differs according to geographical conditions. Several risk scoring systems have been developed and represent easily identifiable hemodynamic predictors for maternal and/or fetal risk. If heart failure occurs, management should be as for non-pregnant patients, with prescription of diuretics to relieve congestion, and beta-blockers for afterload reduction and modulation of sympathomimetic tone. Mitral stenosis accounts for most of the morbidity and mortality of rheumatic disease during pregnancy and is mostly encountered in the developing world. There is a broad spectrum of congenital abnormalities and therefore a wide range of risk associated with pregnancy, from a risk similar to the normal population (e.g. mild pulmonary stenosis) up to very high-risk conditions such as the Eisenmenger syndrome. Acute coronary syndromes during pregnancy are rare events with an estimated prevalence of 3-6 per 100,000 deliveries.