Care Providers

Practical tools and trusted resources to help practitioners deliver consistent support. Designed with the realities of everyday practice in mind, these materials make it easier to navigate complex decisions and provide the best possible care.

Clinical Guidelines

Connecting global expertise to support better care across the region.

Canadian Guidelines

Canadian Cardiovascular Society: Clinical Practice Update on Cardiovascular Management of the Pregnant Patient

American Guidelines

Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement from the American Heart Association

European Guidelines

2025 ESC Guidelines for the management of cardiovascular disease and pregnancy: Developed by the task force on the management of cardiovascular disease and pregnancy of the European Society of Cardiology (ESC)

International Guidelines

North West Maternal Medicine Network: Cardiac Disease in Pregnancy Pathway

Risk & Care Strategies
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CARPREG II  Risk Calculator

Complete the Risk Calculator to gain personalized insights and guide next steps in care and prevention.

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mWHO  Classification

Determine the Modified WHO 2.0 Classification to better understand cardiovascular risk levels.

Care Plan Templates
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Care Algorithms

View Canadian Guidelines

*These care algorithms are intended for educational and clinical guidance purposes only. They are not a substitute for professional clinical judgment and should be applied in consideration of each patient's individual circumstances. Source: Windram et al., Canadian Cardiovascular Society: Clinical Practice Update on Cardiovascular Management of the Pregnant Patient. Canadian Journal of Cardiology, 2021; 37:1886–1901. Reprinted with permission from Elsevier.

Red Flags

Valvular Heart Disease

Preconception Red Flags

Mechanical valve
Bioprosthetic valve
Previous valve intervention
≥ Moderate native valve stenosis
Ventricular dysfunction
NYHA function class III/IV
History of arrhythmia
History of non-vagal syncope
Elevated BNP

Red Flags During Pregnancy

Worsening NYHA Class
New cardiac symptoms
Worsening ventricular function
Increasing pulmonary pressures
Increasing BNP
More than expected increase in valve gradient
Bew severe valve regurgitation
Symptoms of infective endocarditis
Thromboembolism
Lack of adequate therapeutic anticoagulation with mechanical valve

*This resource is intended for educational and clinical guidance purposes only. It is not an exhaustive list of warning signs and does not replace professional clinical judgment. Assessment and care should consider each patient's individual circumstances.

Cardiomyopathy

Preconception Red Flags

Aggressive disease trajectory/family history/genotype
Previous peripartum cardiomyopathy
Need for cardiac medication
NYHA III/IV functional class
Ventricular dysfunction
Reduced contractile reserve on stress echo
Significant functional mitral regurgitation
Increased pulmonary pressure
Impaired heart rate reserve or peak oxygen uptake on exercise testing
Elevated BNP

Red Flags During Pregnancy

Worsening NYHA functional
New cardiac symptoms
Worsening ventricular function
Increasing pulmonary pressure
Increasing BNP

Ischemic Heart Disease

Preconception Red Flags

Established vascular disease
Previous coronary event
Evidence of residual ischemia
Left ventricular dysfunction
Hypertension, Dyslipidemia,
Diabetes, Smoking
Family history of premature coronary artery disease

Red Flags During Pregnancy

Acute chest pain
Escalating exertional symptoms
Reduction in left ventricular ejection fraction
Elevated troponin
New ischemic electrocardiographic changes

Arrhythmias

Preconception Red Flags

Structural heart disease
Aggressive disease trajectory/family history/genotype
Repeated hospital admissions or ER visits for arrhythmia management
Ventricular arrhythmia
Arrhythmia on medical therapy
Arrhythmia refractory to medical therapy or poor compliance
Non-vagal syncope
History of cardiac arrest
Pacemaker/implantable defibrillator

Red Flags During Pregnancy

Worsening/sustained arrhythmia
Declining LV ejection fraction
Arrhythmia with hemodynamic compromise
Hospital admission or emergency room visits for arrhythmia management
Non-vagal syncope

Aortopathy

Preconception Red Flags

Any heritable aortopathy (Marfan Syndrome, Loeys Dietz, Vascular Ehlers-Danlos)
BAV approaching thresholds for aortic surgery – 50 mm
Turner syndrome with ASI ≥ 2.0 cm/m²
Turner syndrome with BAV, aortic coarctation or hypertension
Aortic dilation with no definitive diagnosis
Personal or family history of aortic dissection
Annual aortic dilation rate > 0.5 cm/year
Hypertension
Previous aortic root replacement

Red Flags During Pregnancy

Acute chest/back pain
Unexplained loss of consciousness
New neurologic event
Hypertensive disorder of pregnancy
Progressive aortic dilation

		mWHO 2.0 I	mWHO 2.0 II	mWHO 2.0 II-III	mWHO 2.0 III	mWHO 2.0 IV
Diagnosis		Ventricular (dys)function + pulmonary hypertension
				Mild left ventricular impairment: EF >45%. Significantly impaired RV (subpulmonary) function.	Moderate left ventricular impairment: EF 30%–45%. Previous PPCM with not more than mild residual left ventricular impairment.	Severe left ventricular impairment: EF <30% or NYHA class III/IV. Previous PPCM with more than mild left ventricular impairment. PAH.
		Arrhythmias
		Atrial or ventricular ectopic beats, isolated.	Most supraventricular arrhythmias. Bradycardia requiring pacemaker.	Low-risk LQTS: no previous events + on full dose beta-blocker therapy. Low-risk CPVT: well controlled by medical therapy. BrS with no previous events.	Sustained ventricular tachycardia from any aetiology. LQT2 (post-partum). Symptomatic CPVT and LQTS not adequately controlled by therapy. BrS with previous events.
		Cardiomyopathy
		HCM: genotype-positive + phenotype-negative.		Low-risk ARVC: genotype-positive + no or mild phenotype. HCM without complications. DCM/NDLVC with normal or mild left ventricular impairment: EF >45%.	ARVC with moderate/severe disease. HCM with arrhythmic and/or moderate haemodynamic complications. DCM/NDLVC with moderate left ventricular impairment: EF 30%–45%.	DCM/NDLVC with severe left ventricular impairment: EF <30% or NYHA class III/IV. HCM with symptomatic severe outflow tract obstruction: ≥50 mmHg. HCM with severely symptomatic LV dysfunction (EF <50%).
		Congenital heart disease
		Successfully repaired simple lesions without significant residual (haemodynamic) complications (atrial or ventricular septal defect, patent ductus arteriosus, anomalous pulmonary venous drainage).	Unoperated uncomplicated atrial or ventricular septal defect. Repaired tetralogy of Fallot without significant residual haemodynamic/arrhythmic lesions. Transposition of the great arteries with arterial switch without significant residual lesions.	Repaired atrioventricular septal defect without significant residual lesions. Uncomplicated Ebstein anomaly: mild to moderate TR, no tricuspid stenosis, no accessory pathway.	Unrepaired cyanotic heart disease (not Eisenmenger). Systemic RV with good or mildly decreased ventricular function. Uncomplicated Fontan circulation: good ventricular function, no significant valve disease or arrhythmias, good exercise tolerance, and normal arterial saturations. Ebstein anomaly with any complication.	Systemic RV with moderate or severely decreased ventricular function. Fontan with any complication. Eisenmenger syndrome.
		Valvular heart disease
		Small or mild • pulmonary stenosis • mitral valve prolapse without significant regurgitation.		Native, homograft or tissue valve disease not considered mWHO 2.0 I or IV: mild mitral stenosis, moderate aortic stenosis. Moderate valvular regurgitation.	Uncomplicated mechanical valve with stable well controlled INRs. Moderate mitral stenosis. Severe asymptomatic aortic stenosis. Severe left-sided valvular regurgitation.	Severe mitral stenosis. Severe symptomatic aortic stenosis.
		Aortopathy
		Non-HTAD mild aortic dilatation (<40 mm).	Turner syndrome without cardiovascular features (BAV, coarctation, AHT, aortic dilatation).	Marfan or other HTAD syndrome without aortic dilatation. Aorta <45 mm in BAV pathology. Repaired coarctation.	Moderate aortic dilatation: 40–45 mm in Marfan syndrome or other HTAD; 45–50 mm in BAV, Turner syndrome ASI 20–25 mm/m2, other aortic dilatation <50 mm. Marfan with previous aortic root replacement. Previous aortic dissection with stable diameter.	Severe aortic dilatation: >45 mm in Marfan syndrome or other HTAD, >50 mm in BAV, ASI >25 mm/m2 in Turner syndrome, other aortic dilatation >50 mm. Vascular Ehlers–Danlos syndrome. Severe (re)coarctation. Previous aortic dissection with increasing diameter.
		Acquired + coronary heart disease + other
					Prior SCAD. Prior ischaemic cardiac event (STEMI/NSTE ACS). Prior adverse pregnancy outcome requiring hospitalization. Prior adverse cardiovascular effects of cancer treatment.
Risk		No detectable increased risk of maternal mortality and no/mild increased risk in morbidity.	Small increased risk of maternal mortality or moderate increase in morbidity.	Intermediate increased risk of maternal mortality or moderate to severe increase in morbidity.	Significantly increased risk of maternal mortality or severe morbidity.	Extremely high risk of maternal mortality or severe morbidity.
Average maternal cardiac event rates	Van Hagen et al. (2016)	9.9%	7.7%	17.7%	28.9%	50.3%
Average maternal cardiac event rates	Silversides et al. (2018)	3.1%	21.7%	12.8%	21.1%	35.6%
Individualize each maternal risk with the modifiers below (derived from CARPREG II)
CARPREG II score: 1 point • No prior cardiac intervention indicated • Late pregnancy assessment			CARPREG II score: 2 points • Ventricular dysfunction • High-risk left-sided valve disease or outflow tract obstruction • Pulmonary hypertension • Coronary artery disease • High-risk aortopathy		CARPREG II score: 3 points • Prior cardiac event or arrhythmias • Baseline NYHA III/IV or cyanosis • Mechanical valve

Care Providers

Clinical Guidelines

Canadian Guidelines

American Guidelines

European Guidelines

International Guidelines

Risk & Care Strategies Coming Soon

CARPREG II Risk Calculator

mWHO Classification

Care Plan Templates Coming Soon

Care Algorithms

Red Flags

Valvular Heart Disease

Preconception Red Flags

Red Flags During Pregnancy

Cardiomyopathy

Preconception Red Flags

Red Flags During Pregnancy

Ischemic Heart Disease

Preconception Red Flags

Red Flags During Pregnancy

Arrhythmias

Preconception Red Flags

Red Flags During Pregnancy

Aortopathy

Preconception Red Flags

Red Flags During Pregnancy

Care Providers

Patients

Risk & Care Strategies
Coming Soon

CARPREG II  Risk Calculator

mWHO  Classification

Care Plan Templates
Coming Soon