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Challenges in Clinical Electrocardiography
July 5, 2022

Physiological Murmur in a Pregnant Woman: A Catch in the Notch

Author Affiliations
  • 1Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal
  • 2Department of Cardiology, National Cardiac Centre, Kathmandu, Nepal
JAMA Intern Med. 2022;182(8):876-877. doi:10.1001/jamainternmed.2022.2512

A 29-year-old primigravida woman presented to the outpatient obstetric clinic for a routine antenatal checkup. Cardiovascular system examination revealed a systolic murmur in the left upper parasternal region, which was initially thought to be a physiological murmur of pregnancy. There was no history of dyspnea, chest pain, palpitation, or lower limb swelling. Her vital parameters were within normal limits. The 12-lead electrocardiogram (ECG) is presented in the Figure.

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