Table 1.

Quick reference for cardiac emergencies in pregnancy.

Cardiac Condition	ED Presentation	ED Management
Gestational Hypertension, Pre-eclampsia, and Eclampsia	Hypertension, proteinuria, swelling, headache, visual disturbances, abdominal pain, seizures (in eclampsia)	Blood pressure control (IV labetalol or hydralazine preferred); magnesium for seizures.
Peripartum and Postpartum Cardiomyopathy	Shortness of breath, edema, fatigue, decreased exercise tolerance	Diuresis with furosemide; vasodilators such as hydralazine and nitrates. Avoid ACE inhibitors or ARBs. Ionotropes if needed.
Arrhythmias	Palpitations, dizziness, syncope	Arrhythmia-specific medications, cardiovert if unstable. Avoid amiodarone. Low molecular weight heparin preferred for anticoagulation; avoid warfarin in the first trimester.
Valvular Disease	Shortness of breath, fatigue, edema; can develop heart failure symptoms or arrhythmias	Management of concurrent heart failure or arrhythmias as above; anticoagulation with heparin if needed.
Aortopathies	Sudden severe chest and back pain, pulse deficits, may progress to tamponade	Blood pressure control (esmolol, labetalol), surgical consultation.
Congenital Heart Disease and Pulmonary Hypertension	Shortness of breath, fatigue, edema; heart failure symptoms	Oxygen, phenylephrine for hypotension, and cautious diuresis with furosemide. Avoid vasodilators. Inhaled nitric oxide and prostacyclins for pulmonary hypertension crises.
Coronary Artery Concerns	Chest pain, shortness of breath, diaphoresis, nausea	Aspirin, heparin, percutaenous coronary intervention.
Anticoagulation Issues and Bleeding	Swelling, pain, or redness in legs (for deep vein thrombosis). Chest pain, shortness of breath, and hemoptysis (for pulmonary embolism) Bleeding, bruising, or petechiae (for thrombocytopenia)	For deep vein thrombosis or pulmonary embolism, low-molecular-weight heparin is preferred over unfractionated heparin. Hemorrhage management requires a multidisciplinary approach, which may include transfusion, uterotonics (e.g., oxytocin), tranexamic acid, and mechanical interventions like uterine tamponade or artery ligation.