This chapter addresses the unique cardiovascular adaptations and challenges during pregnancy, focusing on evaluating and managing pregnant patients with preexisting or newly diagnosed heart disease. It reviews physiological changes, such as increased blood volume, cardiac output, and heart rate, and their implications for conditions like congenital heart disease, valvular disorders, cardiomyopathies, and arrhythmias. This chapter highlights risk stratification tools to predict maternal and fetal outcomes, discusses management of common complications including preeclampsia and peripartum cardiomyopathy, and outlines safe pharmacologic and procedural considerations during pregnancy. Emphasis is placed on multidisciplinary care involving obstetrics, cardiology, and anesthesia to optimize maternal-fetal health. This chapter equips hospitalists with essential knowledge to recognize, evaluate, and manage cardiovascular issues in pregnancy, ensuring timely intervention and improved outcomes for both mother and  baby.