Which cardiovascular change is physiological in last trimester of pregnancy?
Mid-diastolic murmur
Occasional atrial fibrillation
Shift of apical impulse laterally and upwards in left 4th intercostal space
Cardiomegaly
Ans. is c, i.e. Shift of apical impulse laterally and upwards in the left 4th intercostal spaceRef. Dutta Obs. 7/e, p 52; Williams Obs. 25/e, p 60-62, 119, 960Clinical findings related to cardiovascular changes occuring during pregnancy:Heart rate (resting) increases by about 10-15 bpm. QApex beat shifts to the 4th intercoastal space, 2.5 cm outside the mid clavicular line (as heart is pushed upwards, outward, with slight rotation to left). QSlightly enlarged cardiac silhouette. Q (marked enlarged cardiac silhouette is not normal in pregnancy)Exaggerated splitting of the first heart sound (both components loud). QSecond heart sound : Normal QThird heart sound : Loud and easily auscultated. QMurmurs: - Grade II systolic ejection murmur is audible in aortic or pulmonary area at about 10-12 weeks due to expanded intravenous volume. It diappears in the beginning of postpartum period.- Continuous hissing murmur Q audible over tricuspid area in left 2nd and 3rd intercoastal spaces known as Mammary murmur.ECHO - Shows increased left atrial and ventricular diameters. QECG - Shows left axis deviation QChest X-ray - Straightening of left heart border.Note: None of the arrhythmia are normal during pregnancy, rather their presence indicates heart disease during pregnancy.
Physiological changes during Pregnancy