Which of the following features indicates the presence of heart disease in pregnancy and which is not seen in normal pregnancy?

Ans. is b, i.e. Distended neck veinsRef. Williams Obs. 22/e, p 1019, 23/e, p 960, Dutta Obs. 7/e, p 275Many of the physiological adaptations of normal pregnancy and physical findings resemble heart disease symptoms and signs, making the diagnosis of heart disease more difficult.For example, in normal pregnancy, functional systolic heart murmurs are quite common; respiratory efforts is accentuated, at times suggesting dyspnea and edema in the lower extremities usually develops after midpregnancy.It is important not to diagnose heart disease during pregnancy when none exists, and at the same time not to fail to detect and appropriately treat heart disease when it dose exist.Clinical indicators of Heart disease during Pregnancy: Metcalfes criteria for Heart disease in pregnancySymptomsClinical findings* Progressive dyspnea or orthopnea* Nocturnal cough* Hemoptysis* Syncope with exertion* Chest pain related to effort or emotion* Symptoms of pulmonary hypertension* Cyanosis* Clubbing of fingers* Persistent neck vein distension* Systolic murmur greater than grade 3* Diastolic murmur* Cardiomegaly* Persistent arrhythmia* Persistently split second sound* Criteria for pulmonary hypertensionNote: In question 3 - exertional dyspnea, and pedal edema are seen normally during pregnancy and do not indicate heart disease. During pregnancy due to relaxation of the smooth muscles of the arteries by the progesterone, blood pressure decreases (Ref. Dutta 7/e, p 53) i.e. systemic hypotension normally occurs during pregnancy.Distended neck veins are suggestive of heart disease in pregnancy and are not a normal physiological condition.