Which cardiovascular change is physiological in last trimester of pregnancy

Clinical findings related to cardiovascular changes occuring during pregnancy: Heart rate (resting) increases by about 10 – 15 bpm. Apex 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). Slightly enlarged cardiac silhouette.(marked enlarged cardiac silhoute is not normal in pregnancy) Exaggerated splitting of the first heart sound (both components loud). Second heart sound : Normal Third heart sound : Loud and easily auscultated. Murmurs : – 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 begining of post partum period. – Continuous hissing murmur audible over tricuspid area in left 2nd and 3rd intercoastal spaces known as Mammary murmur. ECHO – Shows increased left atrial and ventricular diameters. ECG – Shows left axis deviation. Chest X-ray – Straightening of left heart border. Note : None of the arrythmias are normal during pregnancy, rather their presence indicates heart disease during pregnancy.