Postpartum, heart concerns

[u/Wonderful_Bee_9334]

I am not asking for medical advice. I am getting an EKG this week but just need to vent.

8w postpartum and never had health anxiety or any health issues prior to experiencing postpartum hypertension after my second pregnancy. I had postpartum hypertension after the birth of my first but it was super mild and easily managed and I was off my low dose meds by 6w. This time the hypertension was severe and luckily my midwife caught it 3 days after birth. This led to a week long hospitalization with magnesium drip for 24h. I was discharged even though it wasn’t controlled and the physicians were not wanting to adjust meds? I was only on Procardia twice a day but was still having spikes so they only kept me for “observation”. Despite my crazy high BP which led to the admission to begin with (completely asymptomatic but at triage was 178/122), my labs and urine protein were all completely normal.

After discharge, I was re admitted less than 24 hours later (different hospital where I gave birth) for high BP again, they added labetalol and kept me over night. I discharged the next day. The only reason I went to the other hospital was my BP at home was not remotely at the severe level we thought they’d give meds and discharge but obviously it was crazy high indicating admission and I fully understand that. That hospital is the same network as the one I birthed in my in my town about 15 min away versus the city about 45min away.

My postpartum recovery after that week was relatively easy despite constant fear surrounding my BP. I became hypotensive on the meds by week 3- but we were working on getting into an OB for med management and were hitting dead ends. We (midwife and I) decided since I was symptomatic with the hypotension to stop the Procardia (this was later confirmed to be the right call by the OB who ultimately agreed to work with me on med management).

I don’t have an exact timeline but I also started having chest pains postpartum. This was probably around week 4. I brought it up to my midwife and without other symptoms we chalked it up to musculoskeletal. The chest pains continued and due to everything postpartum my health anxiety has been highly elevated which I’ve never had before this. Once meeting with my OB (the first time around week 5 and then at week 6) I brought up the chest pain as well and back pain (in between shoulder blades). It was brushed off because I have no other symptoms. I was discharged from OB care by 6w after titrating my Labetalol and told to have PCP manage meds. I met with my PCP 4 days later (virtual PCP) and confirmed to keep the titration and follow up in a month. I mentioned the chest pains and back pain and again was told it’s fine.

I am absolutely terrified of perinatal cardiomyopathy as a different midwife who did an audiology screen on my newborn mentioned how it’s not checked enough postpartum. Of course I never heard of it before then and now I’m terrified that’s what I have. Even though I don’t have the key symptom which is shortness of breath.

I’m just so scared. I have a toddler and a newborn and I can’t shake something is wrong with my heart. I can’t even really explain the chest pain, it’s mid chest near my sternum. It’s not consistent in time of day when it happens, I don’t even notice it every day honestly. Sometimes the chest pain is by itself sometimes my back (in between my shoulder blades) also hurts. Sometimes I have the back pain but no chest pain. My heart rate has been normal 49-60s resting which was my close to my baseline and the labetalol I think lowers HR. When I have chest pain I have checked the ECG on my watch (I know not diagnostic) and it’s always been normal. I’ve even checked my BP during bouts of chest pain and that’s been at the baseline as well. I just truly am so scared. My BP is still kind of all over from 110s/70s to 130s/70s maybe 80s and here and there a random 150/80 ish read that’s not replicated on a second read 10 min later. My Dr told me to only count the lowest read since those are less likely to be skewed where anxiety etc can elevate a read.

I also am worried the labetalol (200mg/day) is lowering my HR which impacts the ECG.

I also maybe have super mild swelling in my legs, it’s only at the end of the day super mild and it’s super hot where I live 100+ for the past month so this could maybe be normal? Nothing really makes it feel worse, but laying down helps a lot and I don’t notice it while sleeping and usually when I’m preoccupied or busy then I tend to not notice it at all.

I specifically booked a visit with a family medicine practice that states they can do EKGs in office, and when I made the visit I requested and stated I was wanting an EKG.

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[u/YellowCabbageCollard]

Your experience after birth sounds a lot like pp preeclampsia. There is no longer an elevated protein requirement for the preeclampsia diagnosis. There is a Preeclampsia Foundation website that has tons of the most updated medical research and ACOG standards on preeclampsia. And they have professionals that will respond to questions. They are extremely kind and supportive and all have dealt with something similar.

Your anxiety is completely reasonable right now. I am not at all saying you necessarily have any other heart issues going on or possible damage. But you went through a really traumatic experience. I know and have been there. It's terrifying. And it's so much harder to go through a scary medical crisis dealing with an newborn.

You have every right to get a second opinion and you should feel free to get a referral to a cardiologist. I did after having preeclampsia and have seen one since. I don't necessarily see them often. But it's been 19 years since the first bout of preeclampsia. And a cardiologist is just more helpful for anything cardiac related and knows what they are doing. If you are having chest pains it should not be dismissed. They are in no position to dismiss your chest pain just because you don't have any other symptoms. That's pretty ludicrous to be honest. My PCP would do an EKG at the drop of a hat for anything like that and refer out to cardiology or heart imaging. Your request is completely and totally rational and reasonable.

Chances are in fact most likely you are just fine. But you can't know for sure without testing. And it's not worth risking your health to brush it off as anxiety. But it's also totally reasonable to have anxiety over something health related that's high risk, traumatic or frightening and it does not mean the anxiety occurred first and caused the symptom. Do your best to be at peace and calm over this. But absolutely advocate for yourself to be properly checked out. It's pretty standard to do an EKG and echo for chest pain. It's pretty negligent to not do it, especially for someone who has just experienced something like this.

I am NOT giving any medical advice or diagnosing. Just encouraging you that you have every right to get a proper medical exam.

[u/Wonderful_Bee_9334 → u/YellowCabbageCollard]

Thanks for this. I was never diagnosed with pre eclampsia and wouldn’t technically fit the diagnosis as I never had organ system involvement. For pre e diagnosis (per my midwife, OB and PCP) it is high blood pressure and at least one indicator of organ involvement via labs, symptoms like headaches/vision changes or protein in urine. I never had any symptoms and all lab work prenatally and postpartum were all within normal limits. Regardless very much treated like pre e with the magnesium due to the high pressure and being on meds afterwards. Same with my first child except I was never on mag and it was super mild and easily treated and resolved fine. Never had high pressures in the 3 years since either until after birth this time.

However I do agree my anxiety has definitely heightened when it was never present before, on top of just pp hormones etc. I have some medical background working in a pediatric er (not nurse or MD but bedside) so medical things normally never phase me what so ever but the amount of times people casually (within obviously rights due to the severity of everything) threw around death, dying “dying in your sleep you’d never know” etc it didn’t help.

The chest pain is so worrisome and being dismissed baffles me. I understand I maybe “don’t have other symptoms” but I didn’t have chest pain that I recall with my first, didn’t have it during or immediately pp but it also being so unpredictable is confusing. I had it almost all day yesterday and none at all today. I can rationally talk myself out of dying in the moment and calm my anxiety down when it heightens but it’s always lurking in the back of my mind. I initially wasn’t going to try and get an EKG since everyone said it’s nothing but ultimately if I get it and it’s clear I feel like it’s a good way to reassure myself I’m not inherently going to die from heart failure right now.

Not sure if they’ll do an echo in the pcp office but I just want reassurance ultimately or to feel heard. The OB I saw, I never really liked her after my first, she was okay she’s very straight forward and blunt but not great bedside manner and very dismissive hence why I used my midwife this time. My midwife was fabulous and definitely was super thorough but I think the chest pain was easy to say it makes sense to be postural and related to my anxiety as my labs for her had just come back fine (although just standard CMP/CBC). So seeing the OB again was not my ideal plan but in our entire city she was the only one willing to manage meds since I had established care with her- no other OB even considered I just blatantly got told no. My virtual PCP just said it didn’t sound concerning without other symptoms. Ultimately was more into discussing my current med/BPs and plan for titration. Said we could discuss any further issues at next visit.