<prompt> Which cardiovascular change is physiological in last trimester of pregnancy -Middiastolic murmurOccasional atrial fibrillationShift of apical impulse laterally and upwards in left 4th intercostal spaceCardiomegaly  <response>: 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 lets seeOther physiological C.V.S. findings in pregnancy.MurmursSystolic murmur intensified during inspirationexpiration 90Soft diastolic murmur 20 of casesContinuous 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. 