Family Nurse Practitioner Exam

Which of the following cardiac changes is not associated with normal pregnancy in the third trimester?

1. Systolic ejection murmur

2. Displaced apical impulse

3. Louder S1 and S2

4. Diastolic murmur

The correct answer is: Diastolic murmur

During normal pregnancy, particularly in the third trimester, the body undergoes significant physiological changes, particularly in the cardiovascular system. **Diastolic murmurs are not typically associated with normal pregnancy changes.** In pregnant women, there are common adaptations such as increased blood volume and changes in heart position, leading to enhanced blood flow across the valves. Systolic ejection murmurs, for instance, can occur due to increased blood flow across the aortic and pulmonary valves and are considered normal findings during pregnancy. Similarly, a displaced apical impulse is often noted as the growing uterus pushes the diaphragm upwards, resulting in a shift in heart position, which is another expected adaptation. In addition, the increased blood volume and the heightened cardiac output may cause the first and second heart sounds to become louder than normal, reflecting enhanced hemodynamics. Diastolic murmurs, however, might suggest underlying pathologies or abnormal hemodynamics, which is why they are not classified as typical physiological changes during a normal pregnancy. Their presence could indicate concerns like valvular heart disease or heart failure, which are not expected outcomes in a healthy pregnant individual. Therefore, the assertion that diastolic murmurs are not associated with normal pregnancy aligns with the understanding of typical