Topic:Exercise-Induced Pulmonary Hemorrhage
Exercise-Induced Pulmonary Hemorrhage (EIPH) is a condition observed in horses, characterized by bleeding from the blood vessels within the lungs during or shortly after intense physical activity. This phenomenon is commonly identified in racing and performance horses. The condition is associated with the rupture of pulmonary capillaries, leading to the presence of blood in the airways. EIPH can affect a horse's respiratory efficiency and overall performance. Diagnosis is typically confirmed through endoscopic examination or detection of blood in the trachea post-exercise. This page compiles peer-reviewed research studies and scholarly articles that explore the pathophysiology, diagnosis, management, and implications of EIPH in equine athletes.
Effects of pentoxifylline on hemorheologic alterations induced by incremental treadmill exercise in thoroughbreds. To determine whether pentoxifylline treatment altered hematologic, rheologic, electrolyte, or blood gas test results of Thoroughbreds during submaximal treadmill exercise. Methods: 5 healthy Thoroughbreds that had raced within the past year and had no history of exercise-induced pulmonary hemorrhage. Methods: Mixed venous blood samples were obtained before exercise, at treadmill speeds of 9 and 13 m/s, and 20 minutes after exercise; hematologic, rheologic, electrolyte, and blood gas test results were determined. Results: Pentoxifylline treatment resulted in a 45% reduction in RBC filtration pr...
Effects of furosemide on hemorheologic alterations induced by incremental treadmill exercise in thoroughbreds. To determine whether furosemide treatment altered the blood flow properties and serum and RBC electrolyte concentrations of Thoroughbreds during submaximal treadmill exercise. Methods: Thoroughbreds were subjected to submaximal treadmill exercise with and without treatment with furosemide (1 mg/kg of body weight, IV). Methods: 5 healthy Throughbreds that had raced within the past year and had no history of exercise-induced pulmonary hemorrhage. Methods: Venous blood samples were obtained before exercise, at treadmill speeds of 9 and 13 m/s, and 10 minutes after exercise, and hemorheologic and ...
Effects of hematocrit and erythrocyte deformability on pulmonary vascular pressures in perfused pony lungs. To evaluate the contribution of hematocrit and RBC deformability to pulmonary vascular pressures of racehorses. Methods: Pony lungs were isolated and right and left lungs were perfused separately with blood. The effects of changing hematocrit and of pentoxifylline treatment were evaluated. Methods: 11 healthy mixed-breed ponies. Methods: Ponies were anesthesized, blood was collected, and lungs were removed and perfused with blood at constant flow rate. Results: Increasing the hematocrit from 35% to 65% resulted in increases in pulmonary arterial pressure (53%, 45%), capillary shear stress (45%...
Equine pulmonary disease: a case control study of 300 referred cases. Part 4: Treatments and re-examination findings. One-hundred and forty-seven of 270 (54.4%) horses suffering from pulmonary disorders were given at least one re-examination including, clinical, bronchoscopic, pulmonary function and cytological examinations after treatment and a further 83 of these horses (30.7%) had their clinical progress assessed by verbal or written reports. These examinations and progress reports showed high levels of partial or total recovery for most pulmonary disease categories, including chronic obstructive pulmonary disease, infectious, S. zooepidemicus and undifferentiated pulmonary disease and lungworm infection g...
Equine pulmonary disease: a case control study of 300 referred cases. Part 2: Details of animals and of historical and clinical findings. Examination of historical and clinical details of 270 adult horses suffering from a variety of mainly chronic pulmonary diseases showed that the chronic obstructive pulmonary disease (COPD) group (median age 9 years) were the oldest, and that the COPD, chronic idiopathic hypoxaemia and exercise induced pulmonary haemorrhage (EIPH) groups had the longest duration of disease (median durations 7, 12 and 9 months, respectively) with a median disease duration of 2 months for the remaining horses. A history of antecedent respiratory infection was present in 24.3% of all horses. Six out of 12 horses ...
Equine pulmonary disease: a case control study of 300 referred cases. Part 1: Examination techniques, diagnostic criteria and diagnoses. Three-hundred adult horses, referred from 1990 to 1993 inclusively, for pulmonary examination were assessed using standardised history taking and clinical, intrapleural pressure, arterial blood gases and pH, bronchoscopic and tracheal and broncho-alveolar lavage fluid (BALF) cytological examinations. Two-hundred and thirty-five cases were referred with overt signs of pulmonary disease and the remaining 65 cases were referred for pulmonary examination because of reduced exercise (usually racing) performance or prolonged dyspnoea after racing. No pulmonary disease was detected in 30 cases. The 2...
Effects of glyceryl trinitrate (nitroglycerin) on pulmonary vascular pressures in standing thoroughbred horses. Strenuously exercising Thoroughbreds exhibit a dramatic increase in pulmonary capillary blood pressure, which contributes to stress failure of pulmonary capillaries resulting in exercise induced pulmonary haemorrhage (EIPH). One strategy to prevent EIPH is, therefore, to lower the pulmonary capillary blood pressure of exercising horses. Recent work in several species suggests that nitric oxide plays a significant role in maintaining low vascular resistance in the pulmonary circulation; however, the effects of nitrovasodilators (which work via the same mechanism as nitric oxide) on equine pulmo...
Stress failure of pulmonary capillaries as a limiting factor for maximal exercise. The pulmonary blood-gas barrier has a basic physiological dilemma. On the one hand it needs to be extremely thin for efficient gas exchange. On the other hand it also needs to be immensely strong because the stresses on the pulmonary capillary wall become extremely high when the capillary pressure rises on exercise. Maximal hydrostatic pressures in human pulmonary capillaries during exercise are not accurately known but must exceed 30 mmHg. In some animals, for example thoroughbred horses, the capillary pressure rises to about 100 mmHg. These pressures cause stresses in the capillary wall of 5...
Pleural effusion associated with acute and chronic pleuropneumonia and pleuritis secondary to thoracic wounds in horses: 43 cases (1982-1992). Case records of 43 horses with pleural effusion associated with acute pleuropneumonia, chronic pleuropneumonia, or pleuritis secondary to a penetrating thoracic wound were reviewed to determine the predisposing factors, diagnosis, and treatment of this condition. Acute pleuropneumonia was diagnosed in 36 horses, the majority of which were Thoroughbreds (89%). Of 22 (61%) horses that were in race training at the onset of illness, 11 (31%) had been recently transported a long distance and 4 (11%) had evidence of exercise-induced pulmonary hemorrhage. Physical examination findings and hematologic...
Stress failure of pulmonary capillaries as a mechanism for exercise induced pulmonary haemorrhage in the horse. Exercise induced pulmonary haemorrhage (EIPH) is a serious problem in the Thoroughbred industry. The condition apparently occurs essentially in all Thoroughbreds in training but the mechanism has proved elusive. There is now strong evidence that the condition is caused by mechanical failure of the walls of the pulmonary capillaries when the pressure inside them rises to very high levels. It is well known that pulmonary capillaries have extremely thin walls to allow rapid exchange of respiratory gases across them. Recently we have shown that the wall stresses are very large when the capillary t...
A survey of exercise-induced pulmonary haemorrhage in Quebec standardbred racehorses. Sixty Standardbred horses, aged 3 to 10 years, were examined endoscopically for exercise-induced pulmonary haemorrhage (EIPH) 1 h after racing, on at least 3 occasions. Racing time, finishing position and post exercise venous lactate concentrations were also recorded. Horses positive for tracheal blood on endoscopy were classified as having either grade 1 EIPH (one or a few spots of blood in the trachea), or grade 2 (stream of blood). Air temperature, relative humidity and air pollutant levels were recorded on each examination day. Of the 60 horses, 52 (87%) were EIPH-positive on at least one ...
Pulmonary vascular pressures of strenuously exercising thoroughbreds after administration of flunixin meglumine and furosemide. High-intensity exercise results in a dramatic increase in mean pulmonary capillary blood pressure of horses, and administration of furosemide 4 hours before exertion significantly attenuates this exercise-induced increment. To test whether this effect of furosemide is mediated via release of prostaglandins, right atrial and pulmonary vascular pressures were measured in 8 healthy, sound, exercise-trained Thoroughbreds at rest and during incremental-step exercise on a treadmill. Horses were studied on 3 separate occasions: after i.v. administration of saline (0.9% NaCl) solution, after administr...
Comparative aspects of the strength of pulmonary capillaries in rabbit, dog, and horse. In previous studies of rabbit and dog lung, we demonstrated stress failure of pulmonary capillaries at high transmural pressures (Ptm). The Ptm necessary to elicit stress failure was 40 cmH2O higher in dog than rabbit, and the total blood-gas barrier (BGB) thickness was greater in dog than rabbit. This suggests that stress failure may be related to BGB thickness, and is consistent with the Laplace relationship which states that wall stress is proportional to capillary radius but inversely proportional to wall thickness. In the present studies, we compared BGB thickness and an index of capillar...
Evaluation of a technique for detection of pulmonary hemorrhage in horses, using carbon monoxide uptake. The diffusing capacity for carbon monoxide (DLCO) and the functional residual capacity (FRC) of the lung were measured in 5 healthy Thoroughbreds before and after instillation of autologous blood into their lungs, in an attempt to develop a method to quantitate extravascular blood in the lungs of horses with exercise-induced pulmonary hemorrhage. Mean (+/- SD) baseline values of DLCO and FRC were 333.8 +/- 61.9 ml/min/mm of Hg and 21.464 +/- 4.156 L, respectively. Blood instillation resulted in decreases in DLCO and FRC. The paradoxic decrease in DLCO (we were expecting to find an increase owi...
Monitoring furosemide in racehorses participating in an EIPH program. Analytical procedures were developed to monitor furosemide concentrations in post-race serum and urine samples obtained from horses participating in an exercise-induced pulmonary haemorrhage (EIPH) program. High performance liquid chromatography with ultraviolet light detection proved a reliable, sensitive method for measuring urinary furosemide concentrations up to 12 h after administration of either 150 or 250 mg of the drug to race horses. However, this method was unreliable for determination of serum furosemide concentration. High performance liquid chromatography with fluorescence detecti...
Mechanisms of exercise-induced pulmonary hemorrhage in the equine athlete. This article discusses exercise-induced pulmonary hemorrhage (EIPH), a pathophysiological syndrome which occurs worldwide in the equine athlete. It reviews the history of EIPH, the incidence in performance horses, the etiology, studies performed on the treadmill to determine the mechanisms of EIPH, and the most likely causes of stress failure of the pulmonary capillaries.
Frusemide attenuates the exercise-induced rise in pulmonary capillary blood pressure in horses. Catheter mounted micro-tip-manometers (the signals from which were matched with fluid-filled pressure signals from same cardiovascular sites and zeroed at the point of the shoulder), were used to study pulmonary haemodynamics in 8 healthy sound horses at rest and during exercise performed at 8, 10, 12 and 14 m/s on a treadmill. Measurements were made without frusemide (control) and 4 h after iv administration of 250 mg frusemide. Post-frusemide data were also obtained on a separate day, and these observations were not significantly different from those made on the same day as controls. Pre-fru...
Furosemide, bumetanide, and ethacrynic acid. Furosemide and, less commonly, bumetanide and ethacrynic acid are potent diuretics administered to horses for a variety of reasons, including prophylaxis of exercise-induced pulmonary hemorrhage. These drugs affect urine volume and composition, and furosemide has marked effects on plasma volume and composition and on systemic hemodynamics at rest and during exercise.
Rheological characteristics of horse blood: significance during exercise. When horses maximally exercise, splenic contraction and fluid movement out of the vascular compartment greatly increase the hematocrit (up to 0.70). We studied the in vitro rheological characteristics of blood from Thoroughbreds and Quarter Horses to determine the interaction of hematocrit and shear rate on apparent viscosity. We also compared the rheological characteristics of the blood before and after horses received furosemide, a drug commonly used to prevent exercise-induced pulmonary hemorrhage. Although the apparent viscosity of blood with a high hematocrit was high at low shear rates, ...
Equine bronchoalveolar lavage cytology: survey of thoroughbred racehorses in training. Sixty-two Thoroughbred horses aged between 1 and 7 years in training in Sydney had bronchoalveolar lavage (BAL) samples collected for cytological examination. All horses, except the yearlings and those with a cough, had raced at the time of the examination and the trainers reported satisfactory performance. Free erythrocytes were found in 73% of samples and haemosiderophages in 90% of the samples, indicating immediate or past occurrences of exercise-induced pulmonary haemorrhage (EIPH). Bronchoalveolar fluid from the yearlings contained significantly less (P < 0.05) erythrocytes and haemosi...
Stress failure of pulmonary capillaries in racehorses with exercise-induced pulmonary hemorrhage. Bleeding into the lungs in thoroughbreds is extremely common; there is evidence that it occurs in essentially all horses in training. However, the mechanism is unknown. We tested the hypothesis that exercise-induced pulmonary hemorrhage (EIPH) is caused by stress failure of pulmonary capillaries. Three thoroughbreds with known EIPH were galloped on a treadmill, and after the horses were killed with intravenous barbiturate the lungs were removed, inflated, and fixed for electron microscopy. Ultrastructural studies showed evidence of stress failure of pulmonary capillaries, including disruptions...
Effect of furosemide and weight carriage on energetic responses of horses to incremental exertion. The effect of furosemide-induced weight loss on the energetic responses of horses to running was examined in a 3-way crossover study. Eight 2- to 3-year-old Standardbred mares received, in random order, 10 ml of saline solution 4 hours before running on a treadmill (control trial, C); or, during 2 trials, 1 mg of furosemide/kg of body weight, i.v., 4 hours before running. During one of the trials when the horses received furosemide, they carried weight equal to that lost over the 3.75 hours after furosemide administration while running (furosemide-loaded, FL), and during the other trial they d...
Pulmonary haemodynamics in the exercising horse and their relationship to exercise-induced pulmonary haemorrhage. Exercise-induced pulmonary haemorrhage (EIPH) is a common occurrence in race horses. Although blood in cases of EIPH has been suspected to originate from the bronchial circulation, which receives approximately 1% of the left ventricular output, physiological evidence has recently emerged to indicate that the pulmonary circulation, which receives the entire output of the right ventricle, is a more likely source. High transmural pulmonary capillary pressures have been shown to cause breaks in the capillary endothelium, basement membrane as well as in the alveolar epithelium. Blood constituents e...
Influence of cyclooxygenase inhibitors on furosemide-induced hemodynamic effects during exercise in horses. Furosemide, which commonly is used as a prophylactic treatment for exercise-induced pulmonary hemorrhage in horses, may mediate hemodynamic changes during exercise by altering prostaglandin metabolism. To determine if furosemide's hemodynamic effects during exercise in horses could be reversed, cyclooxygenase inhibitors were administered with furosemide. Four treatments were administered 4 hours prior to treadmill exercise at 9 and 13 m/s. They included a control treatment (10 ml of 0.9% NaCl solution, IV), furosemide (1 mg/kg of body weight, IV) administered alone, and furosemide in combinati...
Evaluation of hemorheologic variables as implications for exercise-induced pulmonary hemorrhage in racing thoroughbreds. Hematologic and rheologic changes were examined in 49 Thoroughbreds before and after competitive racing. Mean postrace values for RBC count, hemoglobin concentration, and PCV increased by 58 to 61%, whereas blood viscosity increased 2 to 3 times. Postrace echinocyte numbers were 162% greater than prerace values. Smaller, but statistically significant, changes were found for mean corpuscular hemoglobin concentration, red cell distribution width, plasma total protein concentration, total WBC count, neutrophil count, and lymphocyte count. Variables measured did not predict whether a horse was a b...
Plasma concentration of furosemide versus specific gravity of urine in predicting dose of administration in race horses. This study was undertaken to determine the applicability of plasma concentration of furosemide and specific gravity (SG) of urine in regulating the use of furosemide administered 4 hours prior to race time in Exercise-Induced Pulmonary Hemorrhage (EIPH) race horses. Nonbleeders (CTL) and certified bleeders (FUR) actively racing in Illinois (IL) and Pennsylvania (PA) were used in the study. Various doses (less than 250, 250, 300, 350, 400 and 500 mg) were administered either as a single intravenous (IV) dose or as a combination (IV-IM) of IV and intramuscular (IM) administrations 4 hours before...