Tachycardia in pregnancy is common, and distinguishing between physiological and pathological causes can be a challenge. Understanding the cardiovascular changes that take place in pregnancy can help to direct investigations. The finding of a persistent tachycardia, regardless of symptoms, should always prompt clinical review and consideration of investigations (such as blood tests, electrocardiography and echocardiography), where indicated. Treatment of tachyarrhythmias in pregnancy differs very little from a non-pregnant adult, and unstable arrhythmias should follow Resuscitation Council UK guidelines. Pregnant women with pathological arrhythmias need to be cared for under a multidisciplinary team, including obstetricians, obstetric anaesthetists, specialist midwives, cardiologists and obstetric physicians.

Key content The importance of effective contraception in women with cardiac disease is discussed. Circulatory changes in pregnancy can cause unmasking and decompensation of pre‐existing cardiac disease. Information is provided for obstetricians, cardiologists and other healthcare professionals that will enable them to counsel women with cardiac disease appropriately about contraceptive options. Learning objectives To appreciate the physiological changes that occur during pregnancy and why this can lead to decompensated heart disease. To gain an understanding of the most appropriate contraceptive methods for women with cardiac disease. To appreciate the cautions and contraindications for commonly used contraceptives in women with cardiac disease.

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The maternal population in the UK has become an increasingly challenging group of patients to manage. Women with pre-existing and often complex medical conditions are successfully conceiving. Most physicians will have had some involvement in the care of obstetric patients admitted with medical problems, and a lack of experience and fear of causing harm may result in essential investigations and treatment being withheld. The physiological changes in pregnancy can complicate the interpretation of observations and test results. This article discusses the presentation of commonly encountered medical problems in the obstetric population, including breathlessness, chest pain, palpitations, seizure and headache. It covers specific investigations and suggested treatment in this subset of patients. These women should receive the same level of care and attention as those who are not pregnant. Early diagnosis and effective management can help to reduce maternal morbidity and mortality caused by medical problems arising during pregnancy.