A 36-year-old woman, gravida 2 para 1, at 30 weeks gestation comes to the office for a prenatal visit. The patient has noticed some ankle swelling at the end of the day that is relieved with elevating her legs, but she has no other concerns. The pregnancy has been uncomplicated, and her only medications are a prenatal vitamin and iron supplement. The patient has no chronic medical conditions. She does not use tobacco or alcohol. Blood pressure is 118/78 mm Hg and pulse is 72/min. BMI is 30 kg/m². Fetal heart tones are normal. There is trace bilateral pedal edema to the shins. Physical examination is otherwise unremarkable. Urinalysis shows no protein. Compared to a nonpregnant state, which of the following cardiac changes are most likely to be found in this patient?

Question

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Eductional Objective: During pregnancy, increased metabolic demands lead to multiple physiologic cardiovascular changes, including decreased systemic vascular resistance and increased blood volume.  These changes cause increased preload and decreased afterload, resulting in increased stroke volume and cardiac output.  Heart rate also gradually increases during pregnancy and is the major contributor to increased cardiac output in late pregnancy.

A 36-Year-Old Woman, Gravida 2 Para 1, at 30 Weeks