Title: HISTORY
1HISTORY
- 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.
2CLINICAL 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
3CLINICAL EXAMINATION ON ADMISSION
- Respiration rate 12/minute
- Breathing strategy normal
- No lameness
- Rest of physical and locomotor examinations is
unremarkable
4LABORATORY 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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7ECHOCARDIOGRAPHY 1
Right parasternal 2-dimensional long axis five
chamber view
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8ECHOCARDIOGRAPHY 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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9TASKS 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
10RESULTS OF TRACHEAL ASPIRATE
- Bacterial culture
- Streptococcus equine subspecies zooepidemicus at
less than103 colony forming units/ml)
11BRONCHO-ALVEOLAR LAVAGE
Wrights stain, x 400
12BRONCHO-ALVEOLAR LAVAGECytology
- Total cells 432 leukocytes/ml
- Macrophages 44
- Lymphocytes 36
- Neutrophils 17
- Eosinophils 0.4
- Mast cells 2.6
13TREADMILL 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
14TREADMILL EXERCISE TEST UP TO FATIGUE
PaO2 (mmHg) DURING EXERCISE
Control healthy horses
Present case
15STANDARDISED 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
16STANDARDISED TREADMILL TEST (up to 11m/sec)
Plasma lactate (mmol/l)
Heart rate (beats/min)
ECG during exercise No cardiac arrhythmia
Speed (m/sec)