CEDAR RAPIDS — Emery Coughlin’s parents describe her as a happy six-month-old — and a healthy one, thanks to what one UnityPoint Health-St. Luke Hospital’s doctor described as an evolved approach to patient care.
Her mother, Cedar Rapids resident Hayley Coughlin, now 27, went to her doctor’s office for a regular checkup when she was 30 weeks pregnant. There, the baby’s heart went into supraventricular tachycardia, or SVT.
That’s is a type of heart arrhythmia that refers to an abnormally fast heartbeat that originates from the bottom chambers of the heart.
The doctor caught the irregular heart beat on the monitor almost by chance, which kicked off a multidisciplinary care effort for the unborn child, led by Dr. Dilli Bhurtel, a pediatric cardiologist at UnityPoint Health-St. Luke’s.
“I wasn’t really an (obstetrics) patient and I wasn’t really a cardiologist patient, I was kind of a mix of both,” Hayley recalled.
Bhurtel said SVT is rare for an irregular heartbeat to occur during pregnancy — only in about two percent to three percent of pregnancies, he said.
The condition can start at any age. However, heart arrhythmia often is very difficult to diagnose in young children and babies because they can’t tell their parents something isn’t right, said Bhurtel.
And diagnosing SVT in a fetus is extremely rare, Bhurtel said.
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Bhurtel, who joined St. Luke’s in 2017, was able to diagnose Emery with SVT using a fetal echocardiogram, a test similar to an ultrasound that diagnoses heart conditions in patients still in the uterus.
The Coughlin baby was Bhurtel’s first case of fetal SVT in Cedar Rapids.
“With Hayley’s baby during pregnancy, the biggest challenge we had was that baby was still inside mama,” he said. “That’s why this case was unique and challenging in regards to management.”
To treat Emery before she was born, Bhurtel, along with others in St. Luke’s cardiology department, partnered with a team from obstetrics to come up with a plan of action.
To treat Emery, Hayley Coughlin had to take medication used to regular heart beats — but at three to four times the normal dose a nonpregnant individual would take, so the baby would benefit from the medication.
“It was kind of uncharted territory with monitoring (Hayley’s) heart and (Emery’s) heart,” said Emery’s father, 29-year-old Justin Coughlin. “They had never really done that before.”
Bhurtel “did a really good job explaining what was going on in a way we could understand. He always had a plan from the beginning that he outlined and explained. That was really reassuring,” Justin added.
There were concerns the medication could have a negative effect on Hayley, who does not have a heart condition. She was monitored closely in the hospital and at home, she said, and had no negative outcomes from the medicine.
Emery was born seven weeks after that 30-week visit, on Nov. 2, 2018.
Emery still takes the medication to regulate her heartbeat, but doctors tell her parents she likely will no longer need it by the time she reaches her first birthday.
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Bhurtel said he sees “a lot of potential to grow” fetal cardiology, which he described as an important service that can help providers prepare to care for young heart patients.
For example, he said if there’s an indication that an unborn baby may need heart surgery, the care team could plan to deliver the baby in a center that has the capacity to perform an operation.
“We don’t want the baby flown or on road to go to that center right after birth,” Bhurtel said. “We want these mothers to deliver in those centers, and create a plan way in advance so know doctors what to expect.”
This procedure also is offered at Mercy Medical Center in Cedar Rapids, by Dr. Mark Zittergruen.
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