Question

Which of the following is a normal finding in the third trimester of pregnancy?

• A. Apex beat shifted to the 4th intercostal space
• B. Cardiomegaly
• C. Diaphragm is pushed up
• D. Short mid diastolic murmur

Hint:

The gravid uterus pushes the diaphragm up, which displaces the heart so the apex beat shifts to the 4th intercostal space, a normal finding in late pregnancy.

Answer 1

The Correct Option is A

Step 1: Understanding the Question.
Pregnancy causes several changes in the heart and chest that examiners must know are normal, so as not to mistake them for disease. We need to pick the one finding that is a true, benign change of late pregnancy.

Step 2: Key Concept or Approach.
As the uterus enlarges in the third trimester, it pushes the diaphragm upward. This in turn rotates and displaces the heart upward and to the left. On clinical examination, this is best appreciated as the apex beat moving from its usual place in the fifth intercostal space up to the fourth intercostal space, along with a small outward shift. This shifted apex beat is the classic bedside finding taught as a normal change of pregnancy.

Step 3: Detailed Explanation.
Cardiomegaly, meaning true enlargement of the heart itself, is not a normal change, if it is found in pregnancy it should raise concern for a pathology such as peripartum cardiomyopathy or a pre-existing heart disease, and needs further work-up.
The diaphragm being pushed up is real and happens because of the growing uterus, but it is a mechanical, respiratory-system change rather than the specific cardiovascular examination sign this question is testing, and it is the cause behind the apex beat shift rather than the finding asked about here.
A short, soft systolic flow murmur is common in normal pregnancy because cardiac output rises, but a mid-diastolic murmur is not part of this benign picture, a diastolic murmur in pregnancy should prompt a search for structural disease such as mitral stenosis rather than being accepted as a normal variant.

Step 4: Final Answer.
The recognized normal cardiovascular examination finding of late pregnancy is the apex beat shifting up to the fourth intercostal space.
\[ \boxed{\text{Apex beat shifted to the 4th intercostal space}} \]