In a pregnant woman presenting with a 2/6 ejection systolic murmur, when should concern arise?

The presence of a 2/6 ejection systolic murmur in a pregnant woman is often a benign finding due to the increased blood volume and hemodynamic changes that occur during pregnancy. However, concern should arise when symptoms of heart failure develop. Symptoms such as dyspnea, fatigue, palpitations, or edema may indicate that the heart is struggling to cope with the increased demands placed on it during pregnancy.

Monitoring the patient for these symptoms is crucial because the physiological changes of pregnancy can exacerbate any underlying cardiac conditions that may not have been apparent before. If heart failure symptoms develop, further evaluation is warranted to rule out significant structural heart issues or comorbidities that may need intervention.

The other scenarios, such as the murmur becoming diastolic or the presence of an S4 heart sound, while they could warrant further investigation, do not necessarily indicate immediate concern as they may not correlate directly with heart function in a pregnant individual. Hence, the development of heart failure symptoms serves as a critical indicator for further assessment and potential intervention.