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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.
Blood viscosity and its role in the haemodynamic responses to intense exertion.
Equine veterinary journal    February 12, 1998   Volume 30, Issue 1 3 doi: 10.1111/j.2042-3306.1998.tb04079.x
McKeever KH.No abstract available
Effects of airway obstruction on transmural pulmonary artery pressure in exercising horses.
American journal of veterinary research    August 1, 1997   Volume 58, Issue 8 897-903 
Jackson JA, Ducharme NG, Hackett RP, Rehder RS, Ainsworth DM, Shannon KJ, Erickson BK, Erb HN, Jansson N, Soderholm LV, Thorson LM.To determine whether laryngeal hemiplegia would increase transmural pulmonary artery pressure (TPAP). Methods: 6 horses. Methods: Horses were studied under 5 conditions: control conditions, after induction of left laryngeal hemiplegia, during obstruction of the left nostril, after placement of an instrumented tracheostomy, and after placement of an open tracheostomy. Horses were evaluated after being given saline solution and after being given furosemide. Methods: Horses were exercised on a high speed treadmill, using a maximum speed of 13 m/s. During each exercise, airway pressures, airflow, ...
Pulmonary vascular pressures of strenuously exercising Thoroughbreds after administration of varying doses of frusemide.
Equine veterinary journal    July 1, 1997   Volume 29, Issue 4 298-304 doi: 10.1111/j.2042-3306.1997.tb03127.x
Manohar M, Goetz TE, Sullivan E, Griffin R.The frusemide dose-response for attenuation of exercise-induced pulmonary capillary hypertension was studied in 7 healthy, exercise-conditioned Thoroughbred horses using previously described haemodynamic procedures. Four different doses of frusemide were tested: 250 mg regardless of bodyweight (amounting to 0.56 +/- 0.03 mg/kg bwt), 1.0 mg/kg bwt, 1.5 mg/kg bwt and 2.0 mg/kg bwt. Frusemide was administered i.v., 4 h before exercise. Haemodynamic data were obtained at rest and during treadmill exercise performed at 14.2 m/s on a 3.5% uphill grade; this workload elicited maximal heart rate of ho...
Very high pressures are required to cause stress failure of pulmonary capillaries in thoroughbred racehorses.
Journal of applied physiology (Bethesda, Md. : 1985)    May 1, 1997   Volume 82, Issue 5 1584-1592 doi: 10.1152/jappl.1997.82.5.1584
Birks EK, Mathieu-Costello O, Fu Z, Tyler WS, West JB.Thoroughbred horses develop extremely high pulmonary vascular pressures during galloping, all horses in training develop exercise-induced pulmonary hemorrhage, and we have shown that this is caused by stress failure of pulmonary capillaries. It is known that the capillary transmural pressure (Ptm) necessary for stress failure is higher in dogs than in rabbits. The present study was designed to determine this value in horses. The lungs from 15 Thoroughbred horses were perfused with autologous blood at Ptm values (midlung) of 25, 50, 75, 100 and 150 mmHg, and then perfusion fixed, and samples (d...
Invited editorial on “Nitric oxide and thermoregulation during exercise in the horse”.
Journal of applied physiology (Bethesda, Md. : 1985)    April 1, 1997   Volume 82, Issue 4 1033-1034 doi: 10.1152/jappl.1997.82.4.1033
Joyner MJ.No abstract available
Oxidant injury and nitric oxide: a role in exercise-induced pulmonary haemorrhage?
Veterinary journal (London, England : 1997)    March 1, 1997   Volume 153, Issue 2 119-121 doi: 10.1016/s1090-0233(97)80032-9
Derksen FJ.No abstract available
Oxidant injury, nitric oxide and pulmonary vascular function: implications for the exercising horse.
Veterinary journal (London, England : 1997)    March 1, 1997   Volume 153, Issue 2 125-148 doi: 10.1016/s1090-0233(97)80034-2
Mills PC, Higgins AJ.The athletic ability of the horse is facilitated by vital physiological adaptations to high-intensity exercise, including a thin (but strong) pulmonary blood-gas barrier, a large pulmonary functional reserve capacity and a consequent maximum oxygen uptake (VO2max) far higher than in other species. A high pulmonary artery pressure also serves to enhance pulmonary function, although stress failure of lung capillaries at high pulmonary transmural pressures, and the contribution of other factors which act in the exercising horse to increase pulmonary vascular tone, may lead to pathological or path...
Exercise-induced changes in the lung of Shetland ponies: ultrastructure and morphometry.
Journal of submicroscopic cytology and pathology    January 1, 1997   Volume 29, Issue 1 65-72 
Erickson HH, McAvoy JL, Westfall JA.The ultrastructural changes in pulmonary alveoli produced by running two ponies on a high speed treadmill at 7.6 m/sec, 3-degree incline, for 2 min support the hypothesis of pulmonary capillary stress failure as an explanation for exercise-induced pulmonary hemorrhage (EIPH). Light microscopy combined with scanning and transmission electron microscopy confirmed the presence of red blood cells and proteinaceous material in the alveolar lumina and interstitial swelling in approximately one third of the pulmonary alveoli examined. Morphometric analysis revealed that the blood-gas barrier was 30-7...
Pulmonary vascular pressures of exercising thoroughbred horses with and without endoscopic evidence of EIPH.
Journal of applied physiology (Bethesda, Md. : 1985)    October 1, 1996   Volume 81, Issue 4 1589-1593 doi: 10.1152/jappl.1996.81.4.1589
Manohar M, Goetz TE.Exercise-induced pulmonary hemorrhage (EIPH) is a common occurrence in racehorses. The objective of this study was to compare pulmonary vascular pressures of healthy Thoroughbred horses with and without postexertion endoscopically detectable fresh blood in the trachea. The nasopharynx, larynx, and trachea (down to the carina) of horses were examined weekly with an endoscope 55-60 min postexertion, and the diagnosis of EIPH was confirmed by the presence of fresh blood in the trachea. Measurements of heart rate and right atrial, pulmonary arterial, and pulmonary arterial wedge pressures were mad...
Pulmonary vascular pressures of strenuously exercising thoroughbreds after administration of phenylbutazone.
American journal of veterinary research    September 1, 1996   Volume 57, Issue 9 1354-1358 
Manohar M, Goetz TE, Griffin R, Sullivan E.To determine the effects of phenylbutazone administration on heart rate and right atrial and pulmonary vascular pressures in Thoroughbreds during rest and during exercise performed at maximal heart rate. Methods: 7 healthy, exercise-conditioned Thoroughbreds. Methods: Horses were studied on 3 occasions: without medication [control], after i.v. administration of phenylbutazone (4.4 mg/kg of body weight) at 12-hour intervals for 2 days and a final dose given 1 hour before exercise, and after i.v. administration of phenylbutazone for 2 days in the same manner, but with the final dose given 24 hou...
Effects of pentoxifylline on hemorheologic alterations induced by incremental treadmill exercise in thoroughbreds.
American journal of veterinary research    September 1, 1996   Volume 57, Issue 9 1364-1368 
Weiss DJ, Geor RJ, Burger K.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.
American journal of veterinary research    June 1, 1996   Volume 57, Issue 6 891-895 
Weiss DJ, Geor RJ, Burger K.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.
American journal of veterinary research    March 1, 1996   Volume 57, Issue 3 346-350 
Weiss DJ, Richwagen K, Evanson OA.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.
Equine veterinary journal    November 1, 1995   Volume 27, Issue 6 436-439 doi: 10.1111/j.2042-3306.1995.tb04424.x
Dixon PM, Railton DI, McGorum BC, Tothill S.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.
Equine veterinary journal    November 1, 1995   Volume 27, Issue 6 422-427 doi: 10.1111/j.2042-3306.1995.tb04422.x
Dixon PM, Railton DI, McGorum BC.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.
Equine veterinary journal    November 1, 1995   Volume 27, Issue 6 416-421 doi: 10.1111/j.2042-3306.1995.tb04421.x
Dixon PM, Railton DI, McGorum BC.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...
Racing horses, nitroglycerin and exercise induced pulmonary haemorrhage (EIPH).
Equine veterinary journal    July 1, 1995   Volume 27, Issue 4 240-241 doi: 10.1111/j.2042-3306.1995.tb03069.x
Harkins JD, Tobin T.No abstract available
Effects of glyceryl trinitrate (nitroglycerin) on pulmonary vascular pressures in standing thoroughbred horses.
Equine veterinary journal    July 1, 1995   Volume 27, Issue 4 275-280 doi: 10.1111/j.2042-3306.1995.tb03076.x
Manohar M.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.
European journal of applied physiology and occupational physiology    January 1, 1995   Volume 70, Issue 2 99-108 doi: 10.1007/BF00361536
West JB, Mathieu-Costello O.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).
Journal of the American Veterinary Medical Association    December 15, 1994   Volume 205, Issue 12 1753-1758 
Collins MB, Hodgson DR, Hutchins DR.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...
EIPH: the case for capillary stress failure.
Equine veterinary journal    November 1, 1994   Volume 26, Issue 6 429-431 doi: 10.1111/j.2042-3306.1994.tb04043.x
Pascoe JR, Jones JH.No abstract available
Stress failure of pulmonary capillaries as a mechanism for exercise induced pulmonary haemorrhage in the horse.
Equine veterinary journal    November 1, 1994   Volume 26, Issue 6 441-447 doi: 10.1111/j.2042-3306.1994.tb04047.x
West JB, Mathieu-Costello O.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.
Equine veterinary journal    November 1, 1994   Volume 26, Issue 6 482-485 doi: 10.1111/j.2042-3306.1994.tb04054.x
Lapointe JM, Vrins A, McCarvill E.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.
American journal of veterinary research    September 1, 1994   Volume 55, Issue 9 1308-1312 
Manohar M.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.
Respiration physiology    July 1, 1994   Volume 97, Issue 2 235-246 doi: 10.1016/0034-5687(94)90029-9
Birks EK, Mathieu-Costello O, Fu Z, Tyler WS, West JB.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.
American journal of veterinary research    July 1, 1994   Volume 55, Issue 7 1032-1036 
Aguilera-Tejero E, Pascoe JR, Smith BL, Tyler WS, Woliner MJ.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.
Journal of veterinary pharmacology and therapeutics    June 1, 1994   Volume 17, Issue 3 163-168 doi: 10.1111/j.1365-2885.1994.tb00229.x
Stevenson AJ, Weber MP, Trudel R, Leavitt R, Woodard D, Todi F, Mendonca M, Robillo V, Young L, Kacew S.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.
Biomedical sciences instrumentation    January 1, 1994   Volume 30 33-38 
Erickson HH, Lowe BS.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.
Equine veterinary journal    January 1, 1994   Volume 26, Issue 1 51-54 doi: 10.1111/j.2042-3306.1994.tb04331.x
Manohar M, Hutchens E, Coney E.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.
The Veterinary clinics of North America. Equine practice    December 1, 1993   Volume 9, Issue 3 511-522 doi: 10.1016/s0749-0739(17)30383-8
Hinchcliff KW, Mitten LA.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.