Which of the following changes in pregnancy needs fuher evaluation ?

Atrial and ventricular premature contractions ,15deg Left Axis Detion and mild ST changes in inferior leads are considered normal during pregnancy. Criteria for diagnosing Hea Disease in Pregnancy (Finding Suggestive of Hea Disease in Pregnancy). Symptoms: Progressive dyspnea or ohopnea. Nocturnal cough Hemoptysis Syncope Chest pain Clinical Findings: Cyanosis Clubbing of fingers Persistent neck vein distention Systolic murmur grade 3/6 or greater Diastolic murmur Cardiomegaly Persistant tachycardia nd/ or arrythmiaa Persistant split S2 Presence of S4 Findings suggestive of Pulmonary hypeension