Which cardiovascular change is physiological in last trimester of pregnancy -

Ans. is 'c' i.e. shifting of apical impulse laterally and upwards left 4th intercostal space .Due to elevation of the of diaphragm consequent to the enlarged uterus the heart is pushed upwards and outwards with slight rotation to left.Before concluding the answer let's seeOther physiological C.V.S. findings in pregnancy.MurmursSystolic murmur intensified during inspiration/expiration (90%)Soft diastolic murmur (20% of cases)Continuous murmur * But nowhere middiastolic is given specifically as physiological.Cardiac output is increased by increased by inotropic effect and even heart rate is increased.S, SplittingThere is slight degree of pericardial effusion in some pregnant ladies which may increase cardiac silhouette on X-ray, but as cardiac function improves and systemic vascular resistance decrease cardiomegaly is not the physiological feature.