This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Physiological Changes of Pregnancy, Subject name: Gynaecology & Obstetrics
Which cardiovascular change is physiological in last trimester of pregnancy: 
Select and explain. 
A. Middiastolic murmur, B. Occasional atrial fibrillation, C. Shift of apical impulse laterally and upwards in left 4th intercostal space, D. Cardiomegaly
C: Shift of apical impulse laterally and upwards in left 4th intercostal space
Answer: C: Shift of apical impulse laterally and upwards in left 4th intercostal space 
Explanation: There is diaphragmatic elevation in pregnancy with the growing uterine size which pushes the hea upwards and outwards thus leading to Shift of apical impulse laterally and upwards in left 4th intercostal space. This change is more Prominent in last trimester of pregnancy Mid diastolic murmur, atrial fibrillation and cardiomegaly are all abnormal findings in pregnancy that require fuher evaluation