Which cardiovascular change is physiological in last trimester of pregnancy?

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.