This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': 'Which cardiovascular change is physiological in last trimester of pregnancy \nSelect and explain. \nA. Middiastolic murmur, B. Occasional atrial fibrillation, C. Shift of apical impulse laterally and upwards in left 4th intercostal space, D. Cardiomegaly', 'role': 'user'}, {'content': 'Answer: C \nExplanation: Clinical findings related to cardiovascular changes occuring during pregnancy:\n\nHeart rate (resting) increases by about 10 – 15 bpm.\nApex 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).\nSlightly enlarged cardiac silhouette.(marked enlarged cardiac silhoute is not normal in pregnancy)\nExaggerated splitting of the first heart sound (both components loud).\nSecond heart sound : Normal\nThird heart sound : Loud and easily auscultated.\nMurmurs :\n\n– 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.\n– Continuous hissing murmur\xa0audible over tricuspid area in left 2nd and 3rd intercoastal spaces known as Mammary murmur.\n\nECHO – Shows increased left atrial and ventricular diameters.\nECG – Shows left axis deviation.\nChest X-ray – Straightening of left heart border.\n\nNote :\nNone of the arrythmias are normal during pregnancy, rather their presence indicates heart disease during pregnancy.', 'role': 'assistant'}]