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HISTORY

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for 2 months has had poor exercise tolerance & delayed recovery of the ... no abnormal respiratory noise during exercise ... ENDOSCOPY DURING EXERCISE ... – PowerPoint PPT presentation

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Title: HISTORY


1
HISTORY
  • 3 year old standardbred gelding, racehorse, 455
    kg
  • previously good performer
  • for 2 months has had poor exercise tolerance
    delayed recovery of the respiratory rate after
    exercise
  • no abnormal respiratory noise during exercise
  • intermittent cough
  • no fever, depression or inappetance
  • stabled in a box with straw bedding
  • fed good quality hay and concentrates
  • regularly vaccinated against influenza and EHV-4.

2
CLINICAL EXAMINATION ON ADMISSION
  • Heart auscultation 35 beats/minute, regular
    rhythm, holosystolic murmur grade V/VI, audible
    bilaterally, with point of maximal intensity
    (PMI) as shown below

3
CLINICAL EXAMINATION ON ADMISSION
  • Respiration rate 12/minute
  • Breathing strategy normal
  • No lameness
  • Rest of physical and locomotor examinations is
    unremarkable

4
LABORATORY DATA
Haematology, Biochemistry and Arterial blood gas
analysis at rest were within the normal limits
5
  • ENDOSCOPIC VIEW OF UPPER AIRWAY AT REST

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6
  • ENDOSCOPIC VIEW OF LOWER AIRWAY AT REST

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7
ECHOCARDIOGRAPHY 1
Right parasternal 2-dimensional long axis five
chamber view
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8
ECHOCARDIOGRAPHY 2
Continuous Doppler on the right parasternal
2-dimensional long axis five chamber view
8.0 m/s
5.0 m/s
0.0 m/s
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9
TASKS FOR REVIEW PRIOR TO EXAM
  • When you enter the examination room, you will be
    asked to
  • summarise the clinical problem
  • list the differential diagnosis for each of the
    clinical signs presented by this horse
  • identify and interpret the results of ancillary
    tests
  • describe your further investigative plan
  • After you have outlined your plan, you will be
    given additional information to interpret
  • 6. Propose a diagnosis

10
RESULTS OF TRACHEAL ASPIRATE
  • Bacterial culture
  • Streptococcus equine subspecies zooepidemicus at
    less than103 colony forming units/ml)

11
BRONCHO-ALVEOLAR LAVAGE
Wrights stain, x 400
12
BRONCHO-ALVEOLAR LAVAGECytology
  • Total cells 432 leukocytes/ml
  • Macrophages 44
  • Lymphocytes 36
  • Neutrophils 17
  • Eosinophils 0.4
  • Mast cells 2.6

13
TREADMILL EXERCISE TEST UP TO FATIGUE
  • ENDOSCOPY DURING EXERCISE
  • Full abduction of the larynx was observed
    throughout the treadmill test up to fatigue
  • No dorsal displacement of the soft palate

14
TREADMILL EXERCISE TEST UP TO FATIGUE
PaO2 (mmHg) DURING EXERCISE
Control healthy horses
Present case
15
STANDARDISED EXERCISE TEST (up to 11m/sec)
Before Exercise 6 hours after Exercise CK
(iu/l) 167 289 LDH (iu/l) 432 540 AST
(iu/l) 246 260
16
STANDARDISED TREADMILL TEST (up to 11m/sec)
Plasma lactate (mmol/l)
Heart rate (beats/min)
ECG during exercise No cardiac arrhythmia
Speed (m/sec)
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