**Core Concept**
Cardiac disease in pregnancy is a significant concern, and identifying its presence is crucial for timely management. The physiological changes during pregnancy can mask or mimic symptoms of cardiac disease, making it essential to understand the normal changes and those that indicate underlying cardiac pathology.

**Why the Correct Answer is Right**
The presence of heart disease in pregnancy is often indicated by abnormal changes in maternal cardiac function, such as an increase in pulmonary vascular resistance, which can lead to a decrease in cardiac output. This can be reflected in the development of symptoms such as dyspnea, orthopnea, and chest pain. In normal pregnancy, the cardiac output increases by approximately 30-50% due to the increased blood volume and heart rate. However, in the presence of heart disease, this increase in cardiac demand can be compromised, leading to symptoms that are not typically seen in normal pregnancy.

**Why Each Wrong Option is Incorrect**
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**Clinical Pearl / High-Yield Fact**
A key point to remember is that in normal pregnancy, the cardiac output increases, and the heart rate increases by approximately 15-20 beats per minute. In contrast, in the presence of heart disease, the cardiac output may actually decrease due to increased pulmonary vascular resistance and decreased left ventricular function.

**Correct Answer:**