Cardiovascular disease (CVD) is the most common cause of non-obstetric complications of pregnancy. The number of pregnant women with CVD is steadily increasing, so heart failure (HF) rates may increase proportionally. HF may complicate pregnancy-specific CVD (peripartum cardiomyopathy, hypertensive disorders of pregnancy, and amniotic fluid embolism) and nonspecific ones (myocarditis, valvular heart disease, arrhythmias, congenital heart defects, coronary heart disease, various cardiomyopathies, etc.). Pregnant women with acute HF must be immediately referred to an intensive care unit in a tertiary care center, where hemodynamically unstable patients with severe HF must undergo an urgent cesarean section, irrespective of gestation time. Urgent delivery is also advocated if the fetus is unviable. If the fetus is viable and it is possible to stabilize the mother’s condition, delivery can be postponed. Assessment of cardiovascular risk is a cornerstone of HF prevention. Women with a history of CVD or preeclampsia need thorough counseling including symptom assessment, maternal/fetal risk evaluation, adjustment of medications, general health evaluation, and appropriate education. In general, HF in pregnancy is a life-threatening complication comprising a broad spectrum of medical conditions. Management of HF in pregnancy generally resembles management in nonpregnant patients, however, avoiding potentially teratogenic drugs must be kept in mind.