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Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)2025; doi: 10.1111/vec.70009

Retrospective Evaluation of Synchronous Diaphragmatic Flutter in Horses: 37 Cases (2004-2022).

Abstract: To describe the clinical presentation of horses with synchronous diaphragmatic flutter (SDF) and identify clinical and laboratory variables associated with survival. Methods: Retrospective study from January 2004 to September 2022. Methods: Five large animal referral hospitals in the United States. Methods: Thirty-seven horses of various breeds and ages presenting with clinical signs of SDF, excluding animals participating in an endurance competition. All horses were >1 year of age. Methods: None. Results: Variables recorded and analyzed included signalment, clinical and laboratory data, treatments, and outcome. SDF was seen with gastrointestinal disease in 35% (13/37) of horses. The survival for horses with SDF was 78.4% (29/37). Nonsurvivors had a higher heart rate (78 ± 15/min) than survivors (58 ± 17/min; p = 0.01). Nonsurviving horses were more likely than surviving horses to have had nasogastric reflux (odds ratio: 16.8; 95% confidence interval: 1.9-222.8). Compared with survivors, nonsurvivors had a lower sodium concentration (131 ± 7 mmol/L [131 ± 7 mEq/L]) and bicarbonate concentration (22.7 ± 2.8 mmol/L [22.7 ± 2.8 mEq/L]). Nonsurvivors had higher lactate concentration (7.1 ± 3.9 mmol/L [64 ± 35.1 mg/dL]), glucose concentration (20 [13.3-29] mmol/L; 378 [239-522] mg/dL), and gamma-glutamyltransferase activity (51 [27-687] U/L). In horses that had ionized calcium concentration measured, 13 of 18 (72%) had a concentration <1.3 mmol/L (5.2 mg/dL). Conclusions: SDF in horses is seen concurrently with gastrointestinal and other diseases, and not all horses present with hypocalcemia. The survival for nonendurance horses with SDF was 78%. Nonsurvival was associated with increased heart rate, the presence of nasogastric reflux, and a variety of laboratory abnormalities.
© 2025 Veterinary Emergency and Critical Care Society.
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Publication Date: 2025-08-10 PubMed ID: 40785156DOI: 10.1111/vec.70009Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study retrospectively examines 37 cases of horses with synchronous diaphragmatic flutter (SDF) to describe its clinical signs and identify factors that could affect survival. The research revealed that not all SDF horses present with hypocalcemia, but survival is linked to increased heart rate, nasogastric reflux, and a range of lab abnormalities.

Study Overview

  • The research is a retrospective study examining 37 documented cases of horses with synchronous diaphragmatic flutter (SDF) at five large animal referral hospitals in the United States. Synchronous diaphragmatic flutter, also known as ‘thumps’, is an involuntary jerking of the diaphragm in rhythm with the heart, which can result from electrolyte imbalances in the body.
  • The focus of the study is not only to understand the clinical presentation of SDF in horses but also to identify clinical and laboratory variables that might be predictive of survival outcomes for these animals.
  • The study period ranges from January 2004 to September 2022 and includes horses of varying breeds and ages (all more than a year old). Notably, the study deliberately excludes horses participating in endurance competitions.

Findings

  • The research found that 35% of the horses with SDF also had a concurrent gastrointestinal disease. Additionally, 72% demonstrated low ionized calcium concentration, which disputes the notion that all cases of SDF are accompanied by hypocalcaemia (low calcium levels in the blood).
  • In terms of survival, about 78.4% of the horses with SDF survived. A statistical analysis of various clinical and laboratory variables indicated that a higher heart rate, the presence of nasogastric reflux, and several laboratory abnormalities were associated with non-survival.
  • Non-survivors exhibited higher concentrations of lactate, glucose, and gamma-glutamyltransferase, and lower levels of sodium and bicarbonate. These abnormalities might be symptomatic of the body’s failed attempts to correct electrolyte balance, associated organ dysfunction, or increased metabolic activity.

Conclusions

  • The study concludes that SDF in horses often co-exists with other health conditions, particularly gastrointestinal diseases. However, low calcium levels in the blood isn’t a uniform finding in all SDF cases.
  • Survival in SDF cases is predominantly determined by the horse’s heart rate, presence of nasogastric reflux, and deviations in certain laboratory measures- particularly sodium, bicarbonate, lactate, glucose, and gamma-glutamyltransferase levels.
  • This new information may be valuable for timely diagnostics, potentially improving prognosis, and tailoring treatment approaches for horses affected by SDF.

Cite This Article

APA
Faircloth J, Fielding L, Epstein K, Crabtree N, Mochal C, Magdesian G, Major D. (2025). Retrospective Evaluation of Synchronous Diaphragmatic Flutter in Horses: 37 Cases (2004-2022). J Vet Emerg Crit Care (San Antonio). https://doi.org/10.1111/vec.70009

Publication

Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
ISSN: 1476-4431
NlmUniqueID: 101152804
Country: United States
Language: English

Researcher Affiliations

Faircloth, Joanna
  • Loomis Basin Equine Medical Center, Penryn, California, USA.
Fielding, Langdon
  • Loomis Basin Equine Medical Center, Penryn, California, USA.
Epstein, Kira
  • Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA.
Crabtree, Naomi
  • Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA.
Mochal, Cathleen
  • Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA.
Magdesian, Gary
  • Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA.
Major, Dustin
  • Department of Large Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine, College Station, Texas, USA.

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