Wife's doctor denied a second opinion, baby was lost one week later
October 21, 2019 3:36 PM Subscribe
My wife has a history of first trimester miscarriages so we were both shocked and relieved when she made it to her second trimester. Around 17 weeks my wife started having heart palpitations and made an appointment with her doctor to discuss the symptoms and her family's history of cardiomyopathy. She had a clean EKG but the doctor said she needed to get an ECG and a heart monitor as soon as possible. She called cardiology to schedule the appointment and they said that in their opinion it was not urgent and could wait to a later time.
My wife called her primary doctor to say she wanted a referral to see a different cardiologist sooner and he said just to wait for the in house cardiologist. Well, at a follow up ob/gyn appoint at 20 weeks it was discovered that our baby no longer had a heartbeat. They estimated the baby died around 18 weeks, just one week after the heart palpitations. I was on deployment and according to my wife the tech who was assisting her left rushed out of the room with no explanation and made her wait alone for over 30 minutes until the doctor showed up.
1. We are on Tricare Prime, and on their website it says we are allowed to ask for second opinions. Is her doctor in the wrong for denying her the option to see a different cardiologist?
2. Even if she did see the cardiologist, is there any way they would have been able to see if the baby's heartbeat was declining or abnormal?
3. They estimated the baby died around 18 weeks, just one week after my wife reported the heart palpitations, so they may be connected. If a pregnant woman is having heart palpitations is a sonogram or ultrasound typically ordered?
My wife called her primary doctor to say she wanted a referral to see a different cardiologist sooner and he said just to wait for the in house cardiologist. Well, at a follow up ob/gyn appoint at 20 weeks it was discovered that our baby no longer had a heartbeat. They estimated the baby died around 18 weeks, just one week after the heart palpitations. I was on deployment and according to my wife the tech who was assisting her left rushed out of the room with no explanation and made her wait alone for over 30 minutes until the doctor showed up.
1. We are on Tricare Prime, and on their website it says we are allowed to ask for second opinions. Is her doctor in the wrong for denying her the option to see a different cardiologist?
2. Even if she did see the cardiologist, is there any way they would have been able to see if the baby's heartbeat was declining or abnormal?
3. They estimated the baby died around 18 weeks, just one week after my wife reported the heart palpitations, so they may be connected. If a pregnant woman is having heart palpitations is a sonogram or ultrasound typically ordered?
I'm so sorry about your loss.
I am an ob gyn. To answer your questions 2 and 3, your wife's symptoms are very unlikely to have anything to do with her pregnancy loss. I can think of no way that her palpitations would be a cause or result of a pregnancy loss. If a patient reported palpitations to me, I would order an EKG and make a referral to cardiology. The cardiologist would not make an evaluation of the fetus's heart. The symptoms would not be an indication for an ultrasound.
posted by i_am_a_fiesta at 5:17 PM on October 21, 2019 [5 favorites]
I am an ob gyn. To answer your questions 2 and 3, your wife's symptoms are very unlikely to have anything to do with her pregnancy loss. I can think of no way that her palpitations would be a cause or result of a pregnancy loss. If a patient reported palpitations to me, I would order an EKG and make a referral to cardiology. The cardiologist would not make an evaluation of the fetus's heart. The symptoms would not be an indication for an ultrasound.
posted by i_am_a_fiesta at 5:17 PM on October 21, 2019 [5 favorites]
Response by poster: @i_am_a_fiesta - One thing my wife's doctor has brought up is that the heart palpitations may have been caused by blood clots, so they are testing her for a clotting disorder. He did say a blood clot could potentially have caused the baby's death.
posted by ascetic at 5:36 PM on October 21, 2019
posted by ascetic at 5:36 PM on October 21, 2019
OK, a bunch of questions: Do you mean an echocardiogram? An EKG and ECG are one and the same. I'm not clear on who did the first test and ordered the second test, along with the monitor. Was this her PCP, an initial cardiologist or her OB? Was she seeing a high risk OB due to her history? Did she have a prior history of palpitations? Was she experiencing the palpitations during the EKG? Was it explained to your wife that it's not unusual to feel/hear your heartbeat upon exertion when you're pregnant because your blood volume increases by 50%?
Do you need a referral to see a cardiologist? Is that why she was unable to go see another? If it was her OB that was requesting the test, why did s/he not contact the PCP to expedite, if that was the case?
The only way you can tell if the fetal HR is declining or abnormal is by directly checking the fetus, not your wife. That can only be done at the OB or if you rented a fetal HR monitor. (It looks like a little doppler microphone attached to an old school walkman - you can rent them monthly.) It is highly unlikely that a cardiologist would have this at their office unless they specialized in pregnant women.
Sonograms/ultrasounds aren't generally ordered due to palpitations. Palpitations are different than arrhythmias. Palpitations are when you can feel your heart beating. Arrhythmias are when you don't have a typical rhythm - too slow, too fast, or you miss (or have too many) beats.
I am a high risk antepartum RN and have an arrhythmia (my resting HR is about 140 without meds). I also experience palpitations. I've gone through two high risk pregnancies (deemed high risk because of the arrhythmia) and never was sent for ultrasounds for the palpitations. Since I was aware of my condition prior to the pregnancies, I did go to a cardiologist recommended by my OB/GYN. She did do a baseline EKG and echocardiogram at the beginning of my first pregnancy; it was also because I was a new patient. I had already been on beta blockers for about 12 years prior to this. During my pregnancies, we ended up playing with my meds, both the beta I was already on and adding a calcium channel blocker, to make sure my HR stayed in check.
I am very sorry about the loss of your baby (along with your previous losses). Late term losses are particularly heartbreaking, and it had to be horrible for your wife, given you were on deployment. The tech left the room to find the doctor because they aren't permitted to share medical information - especially not being able to find a heartbeat. During my first pregnancy, at our 18w ultrasound, we had the same experience with, "wait here, I'll be back", and the forever long wait. It turned out that my daughter's twin had a fatal brain abnormality.
Going forward, I would highly recommend that you fight for a high risk OB. From there, that OB can recommend other tests such as genetic testing, cardiology, etc. I hope I was able to answer some of your questions. Please Memail me if you can think of anything more. Again, I'm so sorry that you guys are going through this. Please consider looking into bereavement support groups. They may not have them on base, but call your local hospital and ask to speak to the social worker's office. They can hook you up. Big, big hugs.
posted by dancinglamb at 5:40 PM on October 21, 2019 [19 favorites]
Do you need a referral to see a cardiologist? Is that why she was unable to go see another? If it was her OB that was requesting the test, why did s/he not contact the PCP to expedite, if that was the case?
The only way you can tell if the fetal HR is declining or abnormal is by directly checking the fetus, not your wife. That can only be done at the OB or if you rented a fetal HR monitor. (It looks like a little doppler microphone attached to an old school walkman - you can rent them monthly.) It is highly unlikely that a cardiologist would have this at their office unless they specialized in pregnant women.
Sonograms/ultrasounds aren't generally ordered due to palpitations. Palpitations are different than arrhythmias. Palpitations are when you can feel your heart beating. Arrhythmias are when you don't have a typical rhythm - too slow, too fast, or you miss (or have too many) beats.
I am a high risk antepartum RN and have an arrhythmia (my resting HR is about 140 without meds). I also experience palpitations. I've gone through two high risk pregnancies (deemed high risk because of the arrhythmia) and never was sent for ultrasounds for the palpitations. Since I was aware of my condition prior to the pregnancies, I did go to a cardiologist recommended by my OB/GYN. She did do a baseline EKG and echocardiogram at the beginning of my first pregnancy; it was also because I was a new patient. I had already been on beta blockers for about 12 years prior to this. During my pregnancies, we ended up playing with my meds, both the beta I was already on and adding a calcium channel blocker, to make sure my HR stayed in check.
I am very sorry about the loss of your baby (along with your previous losses). Late term losses are particularly heartbreaking, and it had to be horrible for your wife, given you were on deployment. The tech left the room to find the doctor because they aren't permitted to share medical information - especially not being able to find a heartbeat. During my first pregnancy, at our 18w ultrasound, we had the same experience with, "wait here, I'll be back", and the forever long wait. It turned out that my daughter's twin had a fatal brain abnormality.
Going forward, I would highly recommend that you fight for a high risk OB. From there, that OB can recommend other tests such as genetic testing, cardiology, etc. I hope I was able to answer some of your questions. Please Memail me if you can think of anything more. Again, I'm so sorry that you guys are going through this. Please consider looking into bereavement support groups. They may not have them on base, but call your local hospital and ask to speak to the social worker's office. They can hook you up. Big, big hugs.
posted by dancinglamb at 5:40 PM on October 21, 2019 [19 favorites]
Response by poster: @dancinglamb - Sorry for the confusion, she did receive an ECG and when it was normal her OB/GYN was the one that she get an ultrasound of her heart as well as the heart monitor and he wanted her to get it sooner rather than later. Perhaps his perceived sense of urgency is what made my wife think it was an emergent issue. Also, any time I reference her doctor I am referring to her OB/GYN. Throughout this process she was only seeing her OB, not her PCP.
My wife is in a group called Mothers Experiencing Neonatal Death and one of the ladies in that group was the one who was saying that she should fight to no longer be seen at that hospital. If you are on the free military healthcare ("Prime") you can't just pick and choose where you want to be seen and by whom. You just get what they give you.
posted by ascetic at 6:51 PM on October 21, 2019
My wife is in a group called Mothers Experiencing Neonatal Death and one of the ladies in that group was the one who was saying that she should fight to no longer be seen at that hospital. If you are on the free military healthcare ("Prime") you can't just pick and choose where you want to be seen and by whom. You just get what they give you.
posted by ascetic at 6:51 PM on October 21, 2019
I think, if when your wife called the OB after she tried to make the appointment with the cardiologist the first time around, and she was told that the OB felt it was OK to wait, there was nothing indicating a problem.
Clotting issues are indeed a cause of miscarriage and there are ways to deal with that. But unless your wife was experiencing atrial fibrillation -- and that would most definitely show on an ECG, not to mention present very apparent signs, like shortness of breath, chest pain, dizziness, lightheadedness -- I'm not sure what the correlation with palpitations is. If your wife *was* exhibiting those symptoms and the cardiologist (not to mention her OB) blew her off, well, that's a whole different situation.
Regardless, I hope you figure out what's going on. I'm glad to hear that your wife has a support group already in place. Hopefully, you have someplace to go talk about this, as well. Just because she was the one carrying the baby, it doesn't mean you're necessarily affected less.
posted by dancinglamb at 7:14 PM on October 21, 2019 [2 favorites]
Clotting issues are indeed a cause of miscarriage and there are ways to deal with that. But unless your wife was experiencing atrial fibrillation -- and that would most definitely show on an ECG, not to mention present very apparent signs, like shortness of breath, chest pain, dizziness, lightheadedness -- I'm not sure what the correlation with palpitations is. If your wife *was* exhibiting those symptoms and the cardiologist (not to mention her OB) blew her off, well, that's a whole different situation.
Regardless, I hope you figure out what's going on. I'm glad to hear that your wife has a support group already in place. Hopefully, you have someplace to go talk about this, as well. Just because she was the one carrying the baby, it doesn't mean you're necessarily affected less.
posted by dancinglamb at 7:14 PM on October 21, 2019 [2 favorites]
I am so sorry for your loss, and hope you and your wife are hanging in there. I am not a doctor and have both a family history of heart disease and I had preeclampsia, so when I started experiencing heart palpitations while pregnant, I felt concerned. I mentioned it to my doctor and she said that heart palpitations, in the absence of other symptoms of heart issues, are not unusual during pregnancy. Blood volume increases by about 50% during pregnancy so a pregnant person’s heart is just working harder. My doctor said to follow up if I started experiencing heart palpitations *and* other symptoms like chest pain. She added that when she has referred pregnant patients with heart palpitations to a cardiologist, 90% of the time, they didn’t find anything.
If/when your wife becomes pregnant again, it might be worthwhile to talk to the doctor about taking a baby aspirin or two during her pregnancy. I wouldn’t do it without talking to a doctor but it’s a blood thinner and may reduce the likelihood of heart issues and/or blood clots.
I hope that’s helpful and wish you and your wife the best.
posted by kat518 at 7:26 PM on October 21, 2019 [1 favorite]
If/when your wife becomes pregnant again, it might be worthwhile to talk to the doctor about taking a baby aspirin or two during her pregnancy. I wouldn’t do it without talking to a doctor but it’s a blood thinner and may reduce the likelihood of heart issues and/or blood clots.
I hope that’s helpful and wish you and your wife the best.
posted by kat518 at 7:26 PM on October 21, 2019 [1 favorite]
I recommend you research and ask for advice on handling TriCare on the r/infertility forum. You’ll hear from people who have walked similar paths with Tricare there.
posted by samthemander at 9:18 PM on October 21, 2019 [3 favorites]
posted by samthemander at 9:18 PM on October 21, 2019 [3 favorites]
At the very least, please have your wife search out a Cardiovascular Genetics clinic/genetic counselor. If there is a strong family of non-idiopathic cardiomyopathy, there is some very good genetic testing available to affected family members to see if this is an inherited condition.
posted by kuanes at 3:58 AM on October 22, 2019 [1 favorite]
posted by kuanes at 3:58 AM on October 22, 2019 [1 favorite]
I am really really sorry. FWIW I don’t think it’s worth pursuing the insurance company because I don’t think the timeline of care was inappropriate. But I want to validate that your wife should not have been made to wait alone in a room for 30 min to find out if her child died. Miscarriage is handled terribly by medical professionals. Also, your wife didn’t do anything wrong to cause the loss of her child.
posted by pintapicasso at 5:41 AM on October 22, 2019 [5 favorites]
posted by pintapicasso at 5:41 AM on October 22, 2019 [5 favorites]
But unless your wife was experiencing atrial fibrillation -- and that would most definitely show on an ECG, not to mention present very apparent signs, like shortness of breath, chest pain, dizziness, lightheadedness
Not necessarily. I was in my cardiologist's office having a clean ECG at 4 PM, and in the ER being diagnosed with Afib five hours later. (I was having chest pain though, for sure.)
posted by DarlingBri at 7:25 AM on October 22, 2019
Not necessarily. I was in my cardiologist's office having a clean ECG at 4 PM, and in the ER being diagnosed with Afib five hours later. (I was having chest pain though, for sure.)
posted by DarlingBri at 7:25 AM on October 22, 2019
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posted by ascetic at 3:39 PM on October 21, 2019 [2 favorites]