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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.
Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. VIII. Conclusions and implications.
Equine veterinary journal    September 1, 1987   Volume 19, Issue 5 428-434 doi: 10.1111/j.2042-3306.1987.tb02636.x
O'Callaghan MW, Pascoe JR, Tyler WS, Mason DK.This paper reviews a series of clinical, post mortem and imaging studies on exercise-induced pulmonary haemorrhage (EIPH) performed on 26 Thoroughbred racehorses. Post mortem techniques included routine gross, subgross and histological examination; coloured latex perfusions of pulmonary and bronchial circulations; and microradiography and computerised tomography scans of lungs with contrast injected vasculature. The major lesions were multiple, separate and coalescing foci of moderately proliferative small airway disease accompanied by intense neovascularisation of the bronchial circulation. A...
Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. VI. Radiological/pathological correlations.
Equine veterinary journal    September 1, 1987   Volume 19, Issue 5 419-422 doi: 10.1111/j.2042-3306.1987.tb02634.x
O'Callaghan MW, Pascoe JR, O'Brien TR, Hornof WJ, Mason DK.This study was initiated to determine if the extent and intensity of lung lesions associated with exercise-induced pulmonary haemorrhage (EIPH) in horses could be predicted from thoracic radiographs. Sets of thoracic radiographs from 24 horses with varied histories of EIPH were subjectively coded for radiographic quality, and perceived extent and intensity of diffuse interstitial opacity by three radiologists who had no knowledge of the corresponding autopsy results. Codes assigned from radiographs for the chosen parameters were compared with coded estimates of lung surface staining assigned a...
Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. III. Subgross findings in lungs subjected to latex perfusions of the bronchial and pulmonary arteries.
Equine veterinary journal    September 1, 1987   Volume 19, Issue 5 394-404 doi: 10.1111/j.2042-3306.1987.tb02629.x
O'Callaghan MW, Pascoe JR, Tyler WS, Mason DK.Latex was injected under pressure into bronchial and pulmonary arteries of the inflated lungs of Thoroughbreds and transverse sections taken to calculate the area of lesions resulting from exercise-induced pulmonary haemorrhage. Extensive areas of dense brown haemosiderin varying from 0 to 45 per cent of total lung volume were identified, predominantly in the dorsocaudal lungfields. Bronchial arterial proliferation appeared to have replaced the pulmonary supply in affected areas of the lung. Closely associated with the staining and bronchial arterialisation, there was widespread small airway d...
Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. I. Clinical profile of horses.
Equine veterinary journal    September 1, 1987   Volume 19, Issue 5 384-388 doi: 10.1111/j.2042-3306.1987.tb02626.x
O'Callaghan MW, Pascoe JR, Tyler WS, Mason DK.Detailed physical and clinical examinations were performed on 26 Thoroughbred racehorses which were used subsequently in a series of studies to investigate the contribution of the pulmonary and bronchial arterial circulations to the pathophysiology of exercise-induced pulmonary haemorrhage (EIPH). Twenty-five of the horses had been retired from race training in Hong Kong during the 1984-85 season, all but four raced that season; one horse had been retired the previous season. The average number of races for the group that season was 4.1 +/- 2 with an average distance of 1502 +/- 216 metres, me...
Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. II. Gross lung pathology.
Equine veterinary journal    September 1, 1987   Volume 19, Issue 5 389-393 doi: 10.1111/j.2042-3306.1987.tb02628.x
O'Callaghan MW, Pascoe JR, Tyler WS, Mason DK.Gross post mortem examinations were performed on the lungs of 26 Thoroughbred horses of known exercise-induced pulmonary haemorrhage (EIPH) status. The most consistent finding was a variable degree of bilaterally symmetrical, dark discolouration of the dorsocaudal regions of the caudal lung lobes. In more severely affected lungs, the stained areas extended cranially along the dorsal surfaces of the lungs, and in some cases affected approximately one third of the lung surface. Discoloured areas of lung were denser than normal, collapsed less readily, often contained trapped air and were slow to...
Predisposition for right lung involvement in equine exercise-induced pulmonary haemorrhage.
The British veterinary journal    May 1, 1986   Volume 142, Issue 3 287-288 doi: 10.1016/0007-1935(86)90073-4
Hillidge CJ.No abstract available
Sex variation in the prevalence of exercise-induced pulmonary haemorrhage in racing quarter horses.
Research in veterinary science    May 1, 1986   Volume 40, Issue 3 406-407 
Hillidge CJ, Whitlock TW.Post race endoscopy was carried out on 255 two-year-old quarter horses and exercise-induced pulmonary haemorrhage (EIPH) was diagnosed in 166 (65 per cent) of them. Visible epistaxis was seen in a higher proportion of geldings than in either mares or stallions. The prevalence of EIPH was similar in mares (73 per cent) and in geldings (74 per cent). A significantly lower prevalence (49 per cent) was noted in stallions (P less than 0.01). It was concluded that a sex variation in the prevalence of EIPH exists in two-year-old quarter horses.
Exercised-induced pulmonary hemorrhage in polo and racing horses.
Journal of the American Veterinary Medical Association    February 1, 1986   Volume 188, Issue 3 301-302 
Voynick BT, Sweeney CR.Philippine polo and racing horses were examined for exercise-induced pulmonary hemorrhage after their competitive exercise. Exercise-induced pulmonary hemorrhage occurred in 11.1% of the polo horses and 64% of the racing horses. None of the horses had blood at the nostrils.
Effects of strenuous exercise on myocardial blood flow.
Medicine and science in sports and exercise    October 1, 1985   Volume 17, Issue 5 517-521 
Bove AA.Myocardial blood flow is the major determinant of oxygen delivery to the myocardium, since oxygen extraction by the myocardium is near maximum in the resting state. Regulation of flow during exercise depends on local metabolic factors and, to a small extent, on autonomic tone. Maximum flow of 5-6 times resting has been measured in reactive hyperemia experiments. In strenuous exercise, myocardial oxygen delivery appears to be adequate and flow reserve seems capable of handling the increased oxygen demand. No evidence of myocardial failure in normal hearts due to excess exercise has been present...
Efficacy of furosemide in the treatment of exercise-induced pulmonary hemorrhage in Thoroughbred racehorses.
American journal of veterinary research    September 1, 1985   Volume 46, Issue 9 2000-2003 
Pascoe JR, McCabe AE, Franti CE, Arthur RM.The repeatability of endoscopic observations of exercise-induced pulmonary hemorrhage (EIPH) and the efficacy of furosemide as a prophylactic treatment of horses with EIPH were studied in Thoroughbred race horses after consecutive breezes (at or near maximum speed, approx 16 m/s). Of 56 horses examined greater than or equal to 2 times, 21 (38%) had identical EIPH scores, whereas 26 (46%) and 9 (16%) had scores that differed by greater than or equal to 1 grade. In 56 nontreated horses, there was good agreement between 2 consecutive observations (K = 0.59, Z = 4.54, P less than 0.001). Similar c...
Why does exercise induced pulmonary haemorrhage occur?
Equine veterinary journal    May 1, 1985   Volume 17, Issue 3 159-161 doi: 10.1111/j.2042-3306.1985.tb02455.x
Pascoe JR.No abstract available
Review of exercise induced pulmonary haemorrhage and its possible relationship with mechanical stress.
Equine veterinary journal    May 1, 1985   Volume 17, Issue 3 166-172 doi: 10.1111/j.2042-3306.1985.tb02460.x
Clarke AF.Exercise induced pulmonary haemorrhage (EIPH) is a condition of uncertain aetiology. This article reviews the evidence relating to its incidence, clinical findings, radiological observations, histopathology and certain aspects of respiratory physiology. It is proposed that EIPH is primarily caused by mechanical stress in the dorsocaudal region of the lung.
Effects of furosemide on the racing times of horses with exercise-induced pulmonary hemorrhage.
American journal of veterinary research    April 1, 1985   Volume 46, Issue 4 763-768 
Soma LR, Laster L, Oppenlander F, Barr-Alderfer V.In 3 groups of horses with exercise-induced pulmonary hemorrhage (EIPH), comparisons of racing times and finishing positions were made between the 5 races before the horses were given furosemide and 5 races after furosemide administration. The horses were grouped according to 3 methods used to diagnose EIPH: group 1, observation of hemorrhage at the nostrils within 1 hour after a workout or race; group 2, observation of pulmonary hemorrhage only by endoscopic examination after a race or workout; and group 3, observation of hemorrhage at the nostrils during a race or immediately after a race. G...
Endoscopic and virological observations on respiratory disease in a group of young Thoroughbred horses in training.
Equine veterinary journal    March 1, 1985   Volume 17, Issue 2 99-103 doi: 10.1111/j.2042-3306.1985.tb02059.x
Burrell MH.A group of racehorses in training was examined on several occasions with a fibreoptic endoscope and monitored for viral infection. Only equine herpes virus-2 (EHV-2) infection was detected. Pharyngeal lymphoid hyperplasia (PLH) was present in all horses and decreased in severity with age. There was no association between PLH severity and antibody titres to EHV-1, or with the isolation of EHV-2. Finishing position in races was not affected by PLH severity. Exercise induced pulmonary haemorrhage (EIPH) was evident on 23 out of 49 (47 per cent) examinations after maximal speed training exercise. ...
Effect of bedding on the incidence of exercise induced pulmonary haemorrhage in racehorses in Hong Kong.
The Veterinary record    September 15, 1984   Volume 115, Issue 11 268-269 doi: 10.1136/vr.115.11.268
Mason DK, Collins EA, Watkins KL.An investigation into the incidence of exercise induced pulmonary haemorrhage (EIPH) in thoroughbreds in Hong Kong was carried out between the 1981 and 1983 racing seasons. A total of 1039 post race endoscopic examinations were performed in 1982-1983 and the results indicated that 46.8 per cent of runners had EIPH. This was not statistically different from the percentage of horses showing EIPH during 1981-82 (46.9 per cent). As it had been postulated that dust, especially from straw, could be implicated in lung haemorrhage a proportion of horses were bedded on paper in the 1982-83 season. No s...
Exercise-induced pulmonary hemorrhage in thoroughbred horses: response to furosemide or hesperidin-citrus bioflavinoids.
Journal of the American Veterinary Medical Association    July 15, 1984   Volume 185, Issue 2 195-197 
Sweeney CR, Soma LR.Of 61 horses with a history of exercise-induced pulmonary hemorrhage and treated with furosemide 4 hours prior to racing, 34 (55.7%) continued to bleed. Of 24 horses with exercise-induced pulmonary hemorrhage that were not treated with furosemide prior to racing, 17 (70.8%) still bled. There was no statistically significant difference between the treated and the nontreated groups. Of 45 horses given hesperidin-citrus bioflavinoids, 38 (84.4%) bled when exercised 90 days later. There was no statistically significant difference between the results for hesperidin-citrus bioflavinoid-treated horse...
Exercise-induced pulmonary hemorrhage in exercising Thoroughbreds: preliminary results with pre-exercise medication.
The Cornell veterinarian    July 1, 1984   Volume 74, Issue 3 263-268 
Sweeney CR, Soma LR, Bucan CA, Ray SG.Thoroughbreds with a confirmed history of exercise-induced pulmonary hemorrhage (EIPH) were treated pre-exercise with atropine sulfate, cromolyn, ipratropium or furosemide. Atropine prevented EIPH in 3 of 3 trials in 1 horse, while having no significant effect on bleeding status in the other 2 horses. Pre-exercise treatment with cromolyn had no significant effects in the 3 horses. Pre-exercise treatment of ipratropium was apparently responsible for preventing EIPH in 17 out of 18 trials in 2 horses. The pharmacologic properties of ipratropium in the horse have not been studied, but based on hu...
Pulmonary arterial haemodynamics and blood gas values of Thoroughbred racehorses with a history of epistaxis during a race.
Veterinary research communications    February 1, 1984   Volume 8, Issue 1 41-45 doi: 10.1007/BF02214693
Littlejohn A, Howell W, Killeen V.In ten Thoroughbred racehorses which suffered epistaxis during a race, the mean pulmonary arterial diastolic pressure (PADP) was significantly higher, and the mean pulmonary arterial oxygen tension (PaO2) was significantly lower, than the corresponding mean values of a sample of fourteen clinically normal Thoroughbreds in training. The authors conclude that in horses with epistaxis during a race, pulmonary dysfunction may persist for up to two months after the episode, and that the results indicate a need for pulmonary function studies before and after racing, in order to resolve problems conc...
Endoscopic findings in the upper respiratory tract of 479 horses.
Journal of the American Veterinary Medical Association    September 1, 1982   Volume 181, Issue 5 470-473 
Raphel CF.A flexible fiberoptic endoscope was used to examine the upper respiratory tract of 479 horses and 41 (8.6%) had abnormalities. Pharyngeal lymphoid hyperplasia (PLH) was found in 141 horses (29.5%). Statistical analysis showed a relationship between the age of the horse and the prevalence of PLH. Sixteen (3.3%), 10 (2.1%), and 6 (1.3%), of the horses had laryngeal hemiplegia, epiglottic entrapment, and dorsal displacement of the soft palate, respectively. There was no association between the age of the horse and the prevalence of any of these abnormalities; nor was there a positive correlation ...
Radiographic changes in the lungs of horses with exercise-induced epistaxis.
New Zealand veterinary journal    August 1, 1982   Volume 30, Issue 8 117-118 doi: 10.1080/00480169.1982.34905
O'Callaghan MW, Goulden BE.This paper describes the distinctive radiographic changes detected in the dorso-caudal lungfields of four racing thoroughbreds recently affected by exercise-induced epistaxis. A diffuse but localized increase in density was seen in all four cases, which demonstrated a variation from a predominantly alveolar density to an interstitial pattern and finally to increased bronchial markings. Evolution of the radiographic pattern of the pulmonary densities appeared to be related to the time that had elapsed since the bleeding incident. The implications of the changing pattern and site of the densitie...
Pulmonary haemorrhage in standardbred horses after racing.
Australian veterinary journal    August 1, 1982   Volume 59, Issue 2 38-40 doi: 10.1111/j.1751-0813.1982.tb02712.x
Speirs VC, van Veenendaal JC, Harrison IW, Smyth GB, Anderson GA, Wilson DV, Gilbo B.Endoscopic examinations of the upper respiratory tract were done on 92 of 314 Standardbred horses that raced one or more times at 4 consecutive, weekly race meetings. Although participation was voluntary, the characteristics of the population of horses examined were not statistically different from those of all horses that raced. No horse showed epistaxis, but 34 (32.4%) examinations of the trachea revealed blood that ranged from a trace in the tracheal mucus to large amounts scattered over the tracheal walls. Forty-four horses exhibited minor degrees of pharyngeal lymphoid hyperplasia, 2 had ...
Exercise-induced pulmonary hemorrhage in Thoroughbreds after racing and breezing.
American journal of veterinary research    July 1, 1982   Volume 43, Issue 7 1123-1127 
Raphel CF, Soma LR.Thoroughbred horses (n = 191) were examined with a flexible fiberoptic endoscope within 2 hours of racing on a dirt track; 147 (75.4%) had evidence of exercise-induced pulmonary hemorrhage (EIPH), and 13 (9.0%) had blood at the nostrils. Of 107 Thoroughbreds examined within the same period after breezing, 41 (38.3%) had evidence of EIPH. One horse (2.4%) of this group had blood at the nostrils. Statistical analysis of frequency data showed that a relationship existed between EIPH and the horse's age or distance raced or breezed. Relationship did not exist between EIPH and sex or finishing posi...
Epistaxis in race horses.
Modern veterinary practice    May 1, 1982   Volume 63, Issue 5 395-397 
Ferraro GL.No abstract available
Exercise-induced pulmonary hemorrhage in racing thoroughbreds: a preliminary study.
American journal of veterinary research    May 1, 1981   Volume 42, Issue 5 703-707 
Pascoe JR, Ferraro GL, Cannon JH, Arthur RM, Wheat JD.Of 235 Thoroughbred racehorses examined with a flexible fiberoptic endoscope within 2 hours of racing to determine the frequency of exercise-induced pulmonary hemorrhage (EIPH), 103 (43.8%) had various degrees of hemorrhage in the tracheal lumen. Two of these horses (0.8%) subsequently had blood flow from the nostrils. Blood seemed to originate from the lung. Statistical analysis of frequency data for 191 horses which finished in 1st, 2nd, and 3rd places did not show any relationship between EIPH and horse's age, sex, or finishing position. However, a trend toward an increased frequency of EIP...
Pathophysiology of airway obstruction in horses: a review.
Journal of the American Veterinary Medical Association    February 1, 1978   Volume 172, Issue 3 299-303 
Robinson NE, Sorenson PR.Obstruction of the upper and lower airways is common in horses. In the upper airway, paresis of abductor muscles of the nares and larynx allows inspiratory collapse of soft tissues, which is accentuated by factors increasing upper airway resistance and by high inspiratory flow rates. Intrapulmonary airway obstruction occurs due to accumulation of secretions, release of chemical mediators in response to a variety of stimuli, and parasympathetic stimulation of airways. Obstruction of large airways increases the work of breathing, whereas obstruction of small airways may cause no measurable incre...
Racing problems in the U.S.A.
British journal of sports medicine    October 1, 1976   Volume 10, Issue 3 159-162 doi: 10.1136/bjsm.10.3.159
Jaggard G.The major problems of racing in the United States at the present time are caused by too much racing. This has led to too few horses and small fields. Consequently many owners and trainers are trying to enter their horses too frequently and to race them when they are not really fit to run. The desire to race horses as frequently as possible has led to constant pressure from horsemen through their organizations for so called "permissive medication". Started in the state of Colorado approximately ten years ago this has grown until finally there are only a few states, notably New York and New Jers...
The incidence of epistaxis in racehorses in South Africa.
Journal of the South African Veterinary Association    September 1, 1976   Volume 47, Issue 3 215-218 
Pfaff G.In South Africa 2,41% of horses bleed in a race. If all raced until they were 7 years old probably another 2,12% would bleed. Many others bleed after the race or during exercise or at rest. The incidence of epistaxis is significantly greater in geldings than in females and uncastrated males (P less than 0,001). There is an age distribution of bleeding which is highest at 4 years and lowest at 2 years of age (P less than 0,001).
Epistaxis in the racehorse.
Equine veterinary journal    April 1, 1974   Volume 6, Issue 2 45-58 doi: 10.1111/j.2042-3306.1974.tb03930.x
Cook WR.No abstract available
[Fibrinogen in galloping and trotting horses subject to epistaxis].
Archiv fur experimentelle Veterinarmedizin    January 1, 1970   Volume 24, Issue 4 903-911 
Stolpe J, Wiesner E.No abstract available
Furosemide in equine practice.
Veterinary medicine, small animal clinician : VM, SAC    September 1, 1967   Volume 62, Issue 9 881-884 
Vail CD, Beeman GM, Johnson HW.No abstract available