A multidisciplinary, high-risk team should evaluate all pregnant women presenting with an acute cardiac event. Such events are potentially devastating if not recognised early and treated by experienced specialists. Management decisions are determined by the severity of the maternal condition and fetal viability. The management of most cardiac complications is similar in pregnant and non-pregnant women. There are no large studies investigating the management of cardiac emergencies in pregnant women, hence, therapeutic strategies are mainly based on expert opinion and small observational studies. Risks and benefits for both mother and child need to be balanced, with the over-riding aim to achieve and maintain maternal haemodynamic stability.