Although cardiac lesions in pregnancy are often well tolerated, those that are not warrant a cardiac evaluation as well as careful management in the antepartum and peripartum periods. Congenital heart disease cases comprise the majority of pregnant cardiac patients, and the lesions can require careful monitoring. Women who have valvular disease often tolerate pregnancy well, but there are specific lesions that require close monitoring throughout the pregnancy. Finally, peripartum cardiomyopathy, although rare, is of great concern and must be managed quickly and appropriately. We will review concerns and treatment for pregnant women who have congenital heart disease, valvular lesions, and peripartum cardiomyopathy, as well as provide guidance for drug therapy in the pregnant patient who has cardiac disease.