Clenbuterol and the horse revisited

Clenbuterol is a beta(2)-agonist and potent selective bronchodilator that is used to treat bronchospasm in the horse. The drug is normally administered to horses orally as a syrup formulation. Once absorbed into the systemic circulation, clenbuterol has the potential to cause many side effects, including a repartitioning effect and major alterations in cardiac and skeletal muscle function. Recent studies have also reported that clenbuterol can affect bone and the immune, endocrine and reproductive systems. A great deal of information has been published on the beneficial effects of short term therapeutic doses of clenbuterol on the equine respiratory system, although there is limited information about chronic administration, particularly since this has been associated with adverse physiological effects on other systems. This review summarizes the relevant understanding of clenbuterol for clinicians and horse owners who may administer this drug to pleasure and performance horses.     

Advances in echocardiography

Before the development of echocardiography, cardiac disease in the horse was diagnosed if a loud heart murmur (grade III-IV/VI or louder) and clinical signs of congestive heart failure (coughing, edema, venous distention, jugular pulsations) were detected on physical examination. Arrhythmias that persisted during and after exercise also indicated cardiac disease, which could be characterized electrocardiographically. Electrocardiography, thoracic radiography, angiography, cardiac catheterization, and oximetry could add only small pieces of information about the heart. M-mode echocardiography provided the first "window" with which to evaluate the heart and its intracardiac structures, albeit an ice-pick one-dimensional view. With M-mode echocardiography, the diameter of the aorta at the valves, the left ventricle, right ventricle, and left atrial appendage, as well as the thickness of the interventricular septum and left ventricular free wall, could be measured. Motion and thickness of the tricuspid, mitral, and aortic valves could be assessed, but only in a one-dimensional plane. Two-dimensional echocardiography provided an added dimension, resulting in visualization of all the intracardiac structures, aorta, and pulmonary artery. Two-dimensional echocardiography became the diagnostic technique of choice for the evaluation and characterization of congenital cardiac disease in critically ill neonates, as well as in adult horses. Two-dimensional echocardiography also improved the ability to diagnose valvular regurgitations, characterize valvular lesions (bacterial endocarditis, ruptured chorda tendineae), myocardial function (segmental wall motion abnormalities), atrial size, mass lesions (endocarditis, neoplasia, and thrombi), and pericardial effusion. Information about blood flow was obtained using contrast echocardiography but was limited to certain cardiac abnormalities (congenital cardiac defects and tricuspid regurgitation). This information about blood flow was limited to the detection of positive or negative contrast jets. Comprehensive information about blood flow was lacking until the application of Doppler echocardiography to equine cardiology. Pulsed-wave and color flow Doppler echocardiography resulted in precise localization of the abnormal blood flow and semiquantitation of the shunt flow or regurgitant jet. Color flow Doppler echocardiography sped up the localization and semiquantitation of the jet in many instances and provided some information about blood flow velocity in the enhanced and variance modes. The peak velocity of jets can be determined using continuous-wave Doppler echocardiography. This value then can be used to estimate pressure difference between cardiac chambers or to calculate cardiac output noninvasively if angles parallel to flow can be obtained. Thus, information about cardiac size, function, and blood flow can be combined to diagnose cardiac disease in horses and to formulate a prognosis for life and performance.     

Development of an equine nuclear medicine facility for gamma camera imaging

A nuclear medicine facility constructed specifically for the application of a gamma camera system to the radioisotope imaging of bone, pulmonary circulation and ventilation in the horse is described. The gamma camera was previously used for human nuclear medicine, and a support for the gamma camera head was specifically designed for this work. Imaging protocols are suggested and the necessary materials for bone and lung studies are described. Images of bone and lung are shown and computer analysis of the data indicated. Imaging times are approximately 1 to 2 mins and typical bone and lung studies can be completed in 20 to 30 mins.     

Method of selective and non-selective angiocardiography for the horse

A practical and safe method of angiocardiography for the horse is described. The technique involved the rapid injection of 50 to 150 ml contrast agent via catheters in the right and left heart, pulmonary artery and aorta. The examination was carried out with the horse in the standing position or under general anaesthesia. Angiocardiograms were performed on 10 normal horses and satisfactory pictures of the right and left ventricles, pulmonary arteries, aorta and coronary circulation were obtained. The technique was also used in a foal with severe congenital heart disease. The most practical methods of recording the images in the standing position were cinefilm or video taperecording. In the recumbent position both cinefilm and radiographs were taken. No damage to the heart was inflicted by the catheters and only a few ventricular premature contractions (less than five) were produced by the pressure of injection. No signs of toxicity were recorded using repeated injections of contrast material (ie, less than 600 ml).     

Concentration of cardiac troponin I in a horse with a ruptured aortic regurgitation jet lesion and ventricular tachycardia

An 18-year-old Thoroughbred gelding was evaluated because of sudden onset of ventricular tachycardia and signs of colic. Three years earlier, a diastolic decrescendo murmur, consistent with aortic regurgitation, had been detected, but the horse continued to perform well and compete successfully. Cardiac ultrasonographic examination revealed a defect in the interventricular septum below the aortic root, and serum concentrations of cardiac troponin I (cTnI) were higher than those measured in clinically normal horses. Repeated development of tachyarrhythmia during hospitalization prompted a decision to euthanatize the horse. A ruptured endocardial jet lesion below the aortic valve with formation of a cleft into the interventricular septum was found on necropsy. This report of increased serum cTnI concentrations in a horse with myocardial disease and our other findings suggest that assessment of cardiac troponin concentrations may be a useful tool in the evaluation of horses with suspected myocardial disease.     

Analysis of the right ventricular function in the exercising horse: use of the Fourier Transform

The objective of this study was to develop and test a technique to allow dynamic cardiac function to be studied during exercise in the horse. Blood pressure waveforms in the exercising horse are difficult to interpret because of the large influence of stride and respiration. A method has been devised to study dynamic right ventricular variables during high-speed exercise in the horse. A Fast Fourier Transform was performed on the digitised pressure waveforms and the frequency components associated with stride and respiration were removed. An inverse Fourier Transform was then performed to generate a time-domain pressure signal. Several dynamic right ventricular variables were calculated using the derived signal. Various parameters associated with removing frequencies from the frequency-domain pressure signal were changed to determine their influence on the variables. Most of the variables were not sensitive to these parameters. When compared during separate exercise bouts, some variables differed among runs, while others were not significantly different. Using the signal separation technique described here, right ventricular function of an exercising horse can be critically analysed.     

LEFT VENTRICULAR EJECTION FRACTION IN THE NORMAL HORSE DETERMINED BY FIRST-PASS NUCLEAR ANGIOCARDIOGRAPHY*

A method to perform first-pass nuclear angiocardiography (FPNA) in the conscious, standing horse is proposed. Technetium ?99m (0.75–1.0 mCi per 5 kg body weight) is injected as a bolus into the peripheral venous circulation. The passage of the radioactive bolus is recorded in listmode format using a dedicated nuclear medicine computer and a gamma camera. A semiautomatic equine cardiac computer program to calculate left ventricular ejection fraction (LVEF) is described. Effects of region-of-interest selection, background correction, portion of levophase analyzed, and sampling rate on ejection fraction values are discussed. Mean LVEF determined for a group of 13 normal horses using separate end-systolic and end-diastolic LV regions of interest for the middle three levophase beats and background correction was 71%±5%. Additional LV parameters recorded were LV ejection time, 429±78 milliseconds; LV ejection rate, ?1.9±.5 midsytolic volumes per second; LV filling time, 238±33 milliseconds; and LV filling rate, 2.4±0.5 midfast filling volumes per second. LVEF determinations were repeated three times in four horses to determine reproducibility of the method. Results were independently determined for three horses by four persons to assess interobserver error in processing data. Paired FPNA and electrical conductivity (EC) studies were performed on four horses to determine correlation of the two methods (FPNA=1.16 EC+9.16, R=0.75). FPNA is a safe and reproducible method to measure LVEF in the horse. Additional valuable information regarding cardiac function can be easily obtained using this technique.     

Changes over time in echocardiographic measurements in young Standardbred racehorses undergoing training and racing and association with racing performance

OBJECTIVE: To evaluate changes over time in echocardiographic measurements in young Standardbred racehorses undergoing training and racing and determine whether there was any relationship between cardiac dimensions and racing performance. DESIGN: Longitudinal observational study. ANIMALS: 103 horses. PROCEDURE: 2-dimensional and M-mode echocardiography was performed 4 times at 6-month intervals. RESULTS: Significant cardiac enlargement took place during the study period as indicated by increases in left ventricular internal diameter in diastole (LVIDd), estimated left ventricular muscle mass (LV mass), and mean wall thickness attributable to eccentric left ventricular hypertrophy. Estimated body weight was positively correlated with left ventricular size, and males had significantly larger LVIDd and LV mass than did females. Horses that were racing regularly had larger LVIDd and LV mass than did unraced horses. A significant relationship between left ventricular size and racing performance was observed. The relationship was strongest at the time of the fourth examination. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that age must be taken into account when interpreting results of echocardiography in young Standardbred racehorses because significant cardiac enlargement takes place with age and training. A larger heart was found in horses that were racing, and size of the heart was correlated with athletic performance of the horse.     

Mitral valve and tricuspid valve dysplasia in a 9‐week‐old Standardbred colt

A 9‐week‐old Standardbred colt was presented for investigation of dull demeanour, exercise intolerance and heart murmurs. Cardiac auscultation revealed a grade 5/6 holosystolic murmur and a grade 5/6 pansystolic murmur over the left and right cardiac apex respectively, and an irregularly irregular cardiac rhythm. Electrocardiographic examination findings were consistent with atrial fibrillation and tachycardia. Echocardiographic examination identified marked atrioventricular regurgitation and atrial dilation bilaterally, thickening of the mitral and tricuspid valves and dilation of the pulmonary artery consistent with pulmonary hypertension. No ventricular or atrial septal defect was present. Cardiomegaly and diffuse pulmonary oedema were evident on examination of lateral thoracic radiographs. Dysplasia of the mitral and tricuspid valves, eccentric cardiomegaly and pulmonary oedema were confirmed by post mortem examination. Dysplasia of the atrioventricular valves represents a rare cause of biventricular failure in the horse.     

Equine heart disease. An overview

The clinician must appreciate unique aspects of equine cardiovascular physiology in order to distinguish normal variation from a pathophysiologic state. Cardiovascular problems in the horse include auscultation of cardiac murmurs, identification of cardiac arrhythmias, and recognition of congestive heart failure. A cardiac data base including history, general and cardiovascular examination, and resting and postexercise electrocardiogram are necessary to evaluate most horses for significant heart disease. Additional studies, such as echocardiography and cardiac catheterization, are useful in selected cases. Because some types of heart disease are amendable by therapy, an accurate diagnosis is needed to direct treatment and offer a realistic prognosis.     

EQUINE ARTHROGRAPHY

To obtain detailed radiographic information about the joint capsule, joint cavity, or articular cartilage, negative (air), positive, or double contrast arthrography is required. Negative and positive contrast arthrograms are easily obtained in a standing horse. Aseptic technique must be utilized. Aspiration of synovial fluid is followed by injection of contrast medium. For double contrast arthrography the horse must be anesthetized. After removal of some synovial fluid and the injection of air and positive contrast medium with the horse in lateral recumbency, the position of the horse is altered. Use of double contrast arthrography is limited to larger joints. In small joints distribution of air and positive contrast medium will be unequal, resulting in false-positive or false-negative findings. The diagnostic value of negative contrast arthrograms is relatively poor. Such arthrograms are useful only for the visualization of radiolucent joint mice or for the differentiation of intraarticular and extraarticular bone fragments. Positive contrast arthrograms are useful for the detection of larger synovial abnormalities, e.g., villonodular synovitis, herniation, or rupture of the joint capsule, or for the visualization of communication between the joint cavity and cystic bone lesions or cystic periarticular soft tissue masses. Double contrast arthrograms provide more detailed information than negative or positive arthrograms. Minor abnormalities of the articular cartilage or the synovial membrane can be visualized.     

Hypoplastic left ventricular syndrome in a foal

A necropsy diagnosis of hypoplastic left ventricular syndrome was made in a day-old foal. The cardiac abnormalities included mitral and aortic valve atresia, patent ductus arteriosus, and a secundum atrial septal defect. The left ventricle was hypoplastic and nonfunctional. The brief survival of the foal was a consequence of left-to-right shunting through the atrial septal defect and right-to-left shunting through the patent ductus. The information is presented to demonstrate the existence of the syndrome as a congenital defect in the horse and to clarify the necropsy findings for the practitioner to diagnose if seen.     

Fatal acute lung injury after balloon valvuloplasty in a dog with pulmonary stenosis

A one-year-old French Bulldog was referred for the management of a severe form of pulmonary valve stenosis (PS) complicated by right-sided congestive heart failure.Echocardiography showed severe valvular PS with right ventricular concentric hypertrophy, dilatation and severe right atrial enlargement. A pulmonary balloon valvuloplasty (PBV) was performed with a balloon-to-pulmonary annulus ratio of 1.36. Echocardiography immediately after PBV showed a significant reduction in right atrial and ventricular size, improved opening and mobility of the pulmonary valve leaflets, and a 75% reduction in the pulmonary pressure gradient from 158 mmHg pre-operative to 40 mmHg post-operative. The dog recovered well from anesthesia, but 2 h later, it suddenly showed severe respiratory distress. Focus cardiac ultrasound showed increased left cardiac size with echocardiographic signs of high left ventricular filling pressure. Bedside lung ultrasound showed diffuse numerous-to-confluent B lines, compatible with a severe alveolar-interstitial syndrome. The dog was treated with furosemide, helmet continuous positive airway pressure, and then mechanical ventilation but without success.At post-mortem evaluation, histological examination of the lung showed diffuse, severe broncho-alveolar edema with mixed leukocyte, fibrin, and red blood cell infiltrate. Moreover, severe congestion and multifocal alveolar hemorrhages were evident. All findings were compatible with fatal acute lung injury after PBV secondary to pulmonary reperfusion-ischemia injury and increased pulmonary capillary hydrostatic pressure. Based on the present case, acute lung injury should be considered as a rare but serious complication of PBV.     

Congenital cardiac disease in dogs

Thoracic conformation, age, amount of body fat, and stage of respiration and cardiac contraction affect the cardiac silhouette. Deep-chested dogs have an upright, narrow cardiac silhouette about 2 1/2 intercostal spaces wide, while barrel-chested dogs have a round, wide silhouette about 3 1/2 intercostal spaces wide. On LAT films the vessels to a lung lobe should be of equal size and 0.25-1.2 times the diameter of the upper third of the 4th rib at the 4th intercostal space. On DV projections, vessels to the caudal lung lobe should be no larger than the diameter of the 9th rib. Signs of right ventricular enlargement include loss of the cranial waist, increased width of the cardiac silhouette, increased sternal contact of the heart, and an elevated cardiac apex. Signs of left ventricular enlargement include an elevated carina, loss of the caudal waist, and a more perpendicular caudal cardiac border. Signs of left atrial enlargement include separation of mainstem bronchi, compression of the bronchus to the left caudal lung lobe, and an increased distance from the carina to the dorsal border of the caudal vena cava. Enlargement of the aorta and main pulmonary artery segment on a LAT view appears as a soft tissue density obscuring the cranial waist. Pulmonary vascular fields are usually hypervascular in patent ductus arteriosus and interventricular septal defects, normal in uncomplicated aortic or pulmonic stenosis, and hypovascular in tetralogy of Fallot.     

TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION IN A FOAL

An 8-day-old Arabian-Morgan cross colt underwent cardiac evaluation. The foal was tachycardic, tachypneic, exercise intolerant and had a loud right-sided heart murmur and cyanotic mucous membranes. Total anomalous pulmonary venous connection was diagnosed with echocardiography and confirmed at postmortem examination. Total anomalous pulmonary venous connection is a very rare congenital cardiac abnormality that has not been reported before in the horse.     

Review of two viral agents of economic importance to the equine industry (equine herpesvirus-1, and equine arteritis virus)

Equine herpesvirus type-1 (EHV-1) and equine arteritis virus (EAV) are infectious agents that cause serious health risks to horse populations and are disbursed worldwide, which can lead to significant financial losses. In addition to being responsible for abortion and neonatal death, these viruses are associated with respiratory illness. Although previous research and reviews have been written on these viruses, both viruses still affect horse populations around the world and the vaccines currently available are not completely protective, especially against EHV-1 and equine herpes myeloencephalopathy (EHM). Moreover, EAV is considered a threat to the $102 billion equine industry in the United States. As a result, these viruses represent a huge threat to the horse industry and efforts geared towards preventing the outbreak of the disease are strongly encouraged. For this reason, updates about these viruses are necessary and require more and more discussion on the nature and characteristics of these viruses to know how to overcome them. Prevention and control of abortion and neonatal foal death caused by each of the two viruses depend on appropriate management strategies coupled with prophylactic vaccination. This review presents the latest detailed information on EHV-1 and EAV from several aspects such as transmission, clinical signs, pathogenesis, latest developments on the treatment of the diseases, vaccination, and finally challenges and future perspectives. The information presented herein will be useful in understanding EHV-1 and EAV and formulating policies that can help to limit the spread of these viruses within horse populations.     

Anaesthesia and analgesia of the donkey and the mule

The number of donkeys and mules throughout the world is stable, and awareness of their use and concern for welfare, pain recognition and treatment are receiving increasing veterinary interest. Therefore, accurate information about anaesthesia and analgesia in donkeys and mules is important to ever more equine practitioners. Since donkeys are physiologically and pharmacologically different from horses, knowledge on species specific aspects of anaesthesia and analgesia are very important. Mules combine elements from both donkey and horse backgrounds, leading to great diversity in size, temperament and body type. Physiologically, they seem to resemble horses more than donkeys. This review highlights the current knowledge on various anaesthetic and analgesic approaches in donkeys and mules. There is still much information that is not available about donkeys; in many circumstances, the clinician must use available equine information to treat the patient, while monitoring carefully to observe for differences in response to therapy compared to the horse.     

Postsurgical ventricular tachycardia in a horse.

A 2-year-old Thoroughbred racehorse developed ventricular tachycardia after elective laryngoplasty and ventriculectomy were performed while anesthesia was maintained with halothane. During surgery, the horse became febrile and developed transient mild hypercarbia. The horse was treated with an IV infusion of quinidine gluconate. Continuous electrocardiographic monitoring was used to evaluate cardiac rhythm during treatment, and conversion was achieved after 12 hours of IV infusion. The inciting cause for the arrhythmia was not determined.     

Thoracoscopic pericardiectomy: A feasibility study and impact on cardiac volumetry in healthy horses

This study was conceived to evaluate the feasibility of a thoracoscopic technique intended for partial pericardiectomy in horses and how cardiac volumes are influenced by such procedure in an immediate and mid-term perspective. Thoracoscopic pericardiectomy, which is known as a minimally invasive technique, was performed in six healthy horses. Echocardiographic evaluation was performed in every horse at different times, before and after the procedure. According to the area-length method, the following parameters were evaluated: maximum left atrial volume, minimum left atrial volume, left ventricular volume in systole and left ventricular volume in diastole. These variables were used to calculate the ejection fraction of the left atrium and left ventricle. After 28 days, repeated thoracoscopy was performed to inspect the thoracic cavity. Pericardiectomy was successfully performed in all horses, with post-operative complication documented in only one animal. After 28 days, adhesion was observed in two animals, located between the epicardium and the thoracic wall, without however impairing cardiac function. Pericardial window was broad and well delimited in all horses, without impairing cardiac function. The thoracoscopic pericardiectomy was feasible in all horses. Although a mild reduction in cardiac volumes was documented in the first 72 h after surgery, the procedure did not impair cardiac filling and emptying in the mid-term perspective. Future studies are warranted to investigate how this technique performs in horses with pericardial diseases.