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Doctors Treat Rare Heart Disorder in Unborn Baby

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Baby Emery, with her mom, Hayley and father, Justin Couglin

Emery Coughlin had a team of doctors at St. Luke’s caring for her before she was even born. When her mother, Hayley Coughlin was 30 weeks pregnant (40 weeks is full-term) she went to see her obstetrician for a regular check-up. However, her appointment was far from routine.

null“The doctor was listening to Emery’s heart and she heard an arrhythmia (irregular heartbeat),” recalls Hayley. “I was referred to Dr. Bhurtel, a pediatric cardiologist. During the initial visit with Dr. Bhurtel, Emery’s heart rate skyrocketed twice to 250 beats per minute (160 is typical). I remember he told me I was going to need to be admitted to the hospital right away. I was shocked.”

;A heart arrhythmia or irregular heart beat is not uncommon during pregnancy, but most of the time it is a few random beats here and there,” explains Dilli Bhurtel, MD, UnityPoint Clinic Pediatric Cardiology. “In those instances, we periodically monitor the baby and the extra beats resolve. In Emery’s case her irregular heart beat was extremely high, which warranted further monitoring. During an ultrasound, Emery went in to an SVT (supraventricular tachycardia) episode with heart rates reaching 254 beats per minute.”

What is SVT?

SVT is an abnormally fast heart beat that originates above the ventricles (bottom chambers of the heart). Dr. Bhurtel explained to Hayley and her husband Justin, that he wanted to see how often Emery’s heart was going into SVT and how long each episode lasted. It would help him determine if Emery needed treatment before birth. The only way they could accomplish this was to continuously monitor Emery in a hospital setting. During Hayley’s hospitalization one of Emery’s SVT episodes lasted two hours.


“Emery’s case is very rare,” explains Dr. Bhurtel. “Of the one to three percent of babies in utero with irregular heartbeats, very few have SVT. Emery’s SVT was likely in the beginning stages; otherwise she would have had other symptoms like decreased heart function and fluid around her heart and lungs. We were fortunate to catch this early, as leaving SVT untreated can have dire consequences for the mother and baby. Fetal SVT is different and unique because you must give the mother medication to treat the baby in the womb.

Treatment Plan

“Once it was determined they needed to treat Emery for SVT, they transferred me to the cardiac unit at St. Luke’s,” shares Hayley. “Dr. Bhurtel explained they wanted to give me medicine to help regulate Emery’s heart. In order for Emery to receive this medicine, I had to take a higher dose than they would normally give to an adult with this condition and they wanted to monitor both of us. The first medicine didn’t fully control Emery’s SVT, so I started taking a second medicine.”

“Dr. Bhurtel and the nurses at St. Luke’s were really great and took such good care of Hayley,” remembers Justin. “I remember Dr. Bhurtel explaining if the second medicine didn’t work and control Emery’s SVT they would need to deliver early to prevent damage to her heart. It was scary.” 

“The medicines we give to control the fast heart rate can create heart issues in the mother, so we had to make sure Hayley was tolerating the medicines,” explains Dr. Bhurtel. “That’s why we needed her to stay in the hospital for nearly a week. Once we determined she was doing fine on both medications, Hayley was able to go home. After that we continued to monitor her as an outpatient every one to two weeks.”

“Everything seemed to settle down until I hit 36 weeks in my pregnancy,” shares Hayley. “At that point I developed preeclampsia (high blood pressure). This was a totally separate issue. Doctors put me on bed rest but a week later they decided to induce me at 37 weeks.” 

Emery arrived Nov. 2, 2018. She weighed five pounds, two ounces and was 19 1/4 inches long. 

Surrounded with Care

“Right away they moved her to St. Luke’s NICU,” shares Justin. “We knew this would be the plan before she was born. The doctors were able to monitor her and get her started on SVT medicine right way. Dr. Bhurtel and the whole St. Luke’s team worked well together. Emery was in good hands and was in the NICU for a week.”

“It was a great team effort,” shares Dr. Bhurtel. “Besides myself, we had a UnityPoint Health cardiologist, St. Luke’s neonatologists and the obstetrician caring for Hayley and Emery. We were pleased to keep her close to her home in Cedar Rapids. It was also exciting as this was the first known case of fetal SVT at St. Luke’s.” 

Emery’s future looks bright. She remains on medication for SVT, but babies usually grow out of it within their first year. In some cases, babies may stay on the medication until they are a little older and have a procedure to correct the issue. For now, Emery sees Dr. Bhurtel every six weeks for continued monitoring.

“At the end of our journey I wondered, ‘why me?,’” shares Hayley. “Up to 30 weeks I had a fantastic pregnancy but then everything started happening so unexpectedly. I’m just glad I found Dr. Bhurtel and was able to receive this great care close to home. Dr. Bhurtel is passionate about what he does, and we love him. He and all of the nurses at St. Luke’s that took care of us were fantastic.” 

To speak with Dr. Bhurtel at UnityPoint Clinic Pediatric Cardiology, call 
(319) 558-4951.

When to see a pediatric cardiologist 

If your child's pediatrician or healthcare provider suspects a heart defect or problem, they will refer you to a pediatric cardiologist. Some heart defects may be evident at birth and will require immediate care  and evaluation, while others may be detected later in the child's life.

Contact your doctor if these signs are present in your baby or child: 

  • Bluish tinge or color to the lips, tongue and/or nail beds
  • Difficulty breathing or an increased rate of breathing 
  • Small appetite or trouble feeding 
  • Weight loss or failure to gain weight 
  • Chest pains, heart murmurs or palpitations 
  • Dizziness or sweating 
  • Reduced strength of a baby's pulse 

Watch this video about pediatric cardiology