Maternal heart disease complicates 0.2 to 3% of pregnancies and is responsible for 10% to 25% of maternal deaths. Many healthy women manifest subtle signs of cardiac failure during uncomplicated pregnancy and birth. Classic symptoms of heart disease mimic common symptoms of late pregnancy, such as palpitations, shortness of breath with exertion, and occasional chest pain. A complete cardiovascular examination assists the healthcare team to fully assess and evaluate the pregnant woman with known heart disease. Detailed assessment of the woman throughout pregnancy may lead to initial discovery of heart disease. Compilation of these objective data with subjective functional capacities allows for risk stratification and assignment to a New York Heart Association functional classification.