A normal, uncomplicated pregnancy causes many physiologic cardiovascular changes and symptoms. For example, maternal blood volume, heart rate, and cardiac output increase, and fatigue, orthopnea, and presyncope often occur. In general, these findings are innocuous. Physicians need to recognize those that are not typically associated with pregnancy, such as diastolic murmurs, paroxysmal nocturnal dyspnea, and syncope. Diagnostic evaluation of pregnant women must be approached cautiously to avoid risk to the fetus. Methods using ionizing radiation should be avoided whenever possible. Hypertension, one of the most common complications of pregnancy, may be transient and benign, or it may be chronic or gestational. Early recognition and intervention are beneficial to both the mother and the child.