Cardio Flashcards

Question

Horses with AF can have : A. Increased frequency and severity of EIPH and low prevalence of clinically important tracheal mucus accumulation (TMA) B. Increased severity of EIPH and high prevalence of clinically important TMA C. Decreased severity of EIPH and high prevalence of clinically important TMA D. Decreased severity of EIPH and low prevalence of clinically important TMA

Answer 1

Horses with AF can have : **A. Increased frequency and severity of EIPH and low prevalence of clinically important tracheal mucus accumulation (TMA)** B. Increased severity of EIPH and high prevalence of clinically important TMA C. Decreased severity of EIPH and high prevalence of clinically important TMA D. Decreased severity of EIPH and low prevalence of clinically important TMA ## Footnote Associations between postrace atrial fibrillation and measures of performance, racing history and airway disease in horses | Nath, Laura C. Elliott, Adrian Gerche, Andre La Weir, Joe Forbes, Grace, | JOURNAL OF VETERINARY INTERNAL MEDICINE 2023

Answer 2

Based on a study examining atrial fibrillation (AF) in racehorses, which of the following statements is correct? A) Horses with AF had lower career earnings before the event compared to horses performing as expected (TE). B) The volume of exercise was a significant factor contributing to AF in racehorses. **C) Horses with AF were more likely to have a higher grade of exercise-induced pulmonary hemorrhage (EIPH) compared to horses with poor performance but without AF (PP).** D) Age was not a significant factor when comparing horses with AF to those performing to expectation (TE). ## Footnote Associations between postrace atrial fibrillation and measures of performance, racing history and airway disease in horses | Nath, Laura C. Elliott, Adrian Gerche, Andre La Weir, Joe Forbes, Grace, | JOURNAL OF VETERINARY INTERNAL MEDICINE 2023

Answer 3

B. Supraventricular premature depolarization and ventricular premature depolarisation ## Footnote Frequency of cardiac arrhythmias in horses during straight and untethered swimming Emma Santosuosso | Florent David | Shannon Massie | Silvio A. Filho |Persephone McCrae | Sarah Johnson | Renaud Leguillette, EQUINE VET EDUC, 2022

Answer 4

Answer 5

**B) Horses exhibited a complete collapse of the URT, including the external nares, nasopharynx, and rima glottidis, during apnoea while swimming.** ## Footnote Frequency of cardiac arrhythmias in horses during straight and untethered swimming Emma Santosuosso | Florent David | Shannon Massie | Silvio A. Filho |Persephone McCrae | Sarah Johnson | Renaud Leguillette, EQUINE VET EDUC, 2022

Answer 6

**B. Sodium and calcium channel blockers (lidocaine/lignocainehydrochloride) and magnesium sulphate.** ## Footnote Diagnosis and management of accelerated idioventricular rhythms in horses Elizabeth Williams Louie1 | Katharyn J. Mitchell, EquinE Veterinary Journal, 2023

Answer 7

In 8 out of 9 horses, AT originated from a localized macro-reentrant circuit (n= 5) or a focal source (n= 3) located at the transition between **the right atrium and the caudal vena cava.** The source of right atrial AT in horses was safely treated by **radiofrequency catheter ablation**. ## Footnote Detection of the origin of atrial tachycardia by 3D electro-anatomical mapping and treatment by radiofrequency catheter ablation in horses jvim 2022

Answer 8

Atrial remodelling → shortening of the **atrial effective refractory period** (aERP) and thus shortening of **atrial fibrillatory cycle length** (AFCL). Can be measured invasively with a catheter placed in the atrium. The **atrial fibrillatory rate** (AFR) measures the number of fibrillations (f waves) per minute (fpm) and is **inversely correlated with AFCL**. The AFR can be measured noninvasively from surface ECG recordings. ## Footnote Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion jvim 2022

Answer 9

High AFR is associated with **failure of quinidine cardioversion** and **AF recurrence after successful TVEC**. ## Footnote Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion jvim 2022

Answer 10

* Lower maximum velocity * Higher HR * More abnormal QRS complexes * **EIPH** (horses with AF had increased **frequency** and **severity** of EIPH) ## Footnote Atrial fibrillation as a risk factor for exercise-induced pulmonary haemorrhage following a standardised exercise test evj 2023 Associations between postrace atrial fibrillation and measures of performance, racing history and airway disease in horses jvim 2023

Answer 11

The presence of **arrhythmia increased HRV** in **submaximal and strenous exercise, and recovery** (RMSSD and SDRR). Lameness decreased HRV during submaximal exercise. ## Footnote Heart rate variability during high-speed treadmill exercise and recovery in Thoroughbred racehorses presented for poor performance evj 2023

Answer 12

**None**. The total number of arrhythmias was **repeatable** between training and racing, but the **reliability of arrhythmia type** was poor to moderate. Race-simulated training elicits the same physiological response as competition in Chuckwagon horses. ## Footnote Training vs. racing: A comparison of arrhythmias and the repeatability of findings in Thoroughbred Chuckwagon racehorses Vet J 2023

Answer 13

**Conductive tissue** with gap junctions and adrenergic and non-adrenergic nerve fibres is present within the entire **myocardial sleeve** in all **pulmonary vein ostia**. ## Footnote Morphological and histological investigation of the conduction system in the equine atrial muscle sleeve of pulmonary veins evj 2024

Answer 14

C- The amount of time the HR > 199 bpm and upper levels of eventing ## Footnote Premature depolarisations in horses competing in United States Eventing Association and Fédération Equestre Internationale-sanctioned 3-day events evj 2024

Answer 15

**Caudal vena cava** and **pulmonary veins** Isolation of these myocardial sleeves by radiofrequency catheter ablation may be an effective treatment for these arrhythmias. ## Footnote Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro-anatomical mapping and a contact force-guided ablation system evj 2024

Answer 16

* **Sotalol** : prolonged QT interval, which entails potential risks combined with anesthesic drugs. No longer used in Ghent. * **Amiodarone** : should only be used before or during TVEC in case of unsuccessful cardioversion or high risk of recurrence, and preferably in the absence of sotalol co-treatment. Hypotension. ## Footnote Anti-arrhythmic drugs before, during and after transvenous electrical cardioversion of atrial fibrillation in horses: Weighing the benefits and risks (Clinical commentary) eve 2024

Answer 17

* Sotalol * Amiodarone * Propafenone * Phenytoin ## Footnote Anti-arrhythmic drugs before, during and after transvenous electrical cardioversion of atrial fibrillation in horses: Weighing the benefits and risks (Clinical commentary) eve 2024

Answer 18

Correct Answer: C) Three-dimensional electro-anatomical mapping (3D EAM) Justification: The correct answer is C) Three-dimensional electro-anatomical mapping (3D EAM), as it was the primary tool that enabled precise localization of the AP by identifying the earliest site of ventricular activation, which is essential for targeting the correct location during ablation. The text states, "3-dimensional electro-anatomical mapping (3D EAM) and RFCA, using the CARTO 3 System...were used to identify and treat the AP" and "This procedure identified an AP at the right cranial free wall between the right atrium and right ventricle" ## Footnote Three-dimensional electro-anatomical mappingand radiofrequency ablation as a novel treatment foratrioventricular accessory pathway in a horse: A case report 2022

Answer 19

Correct Answer: B. A 10-pole catheter in the caudal vena cava Justification: Option A is incorrect: The study focused on mapping the right atrium, not the left atrium. Option B is correct: A 10-pole catheter was placed in the caudal vena cava to serve as a positional reference during the mapping procedure. Option C is incorrect: The P-wave on the surface ECG was used as a timing reference, not a positional reference. Option D is incorrect: The sinoatrial node was one of the areas mapped, but it was not used as a positional reference. ## Footnote First catheter-based high-density endocardial 3D electroanatomical mapping of the right atrium in standing horses 2020

Answer 20

Correct Answer: B. Left atrium Justification: Option A is incorrect: There was no mention of the right atrium requiring additional tools for mapping. Option B is correct: The study noted that the left atrium was the most challenging chamber to map, requiring the use of a deflectable sheath. Option C is incorrect: The right ventricle did not require additional tools according to the study. Option D is incorrect: The left ventricle was mapped successfully, but there was no mention of extra tools needed for it. More info :Mild elevations in cardiac troponin I were observed post-procedure, indicating some myocardial stress. ## Footnote Three dimensional ultra-high-density electro-anatomical cardiac mapping in horses: methodology 2020

Answer 21

CHF = vasocontriction '+ renal sodium retention '+ abnormal tissue growth (hypertrophy and fibrosis) **CHF** is a **clinical syndrome**, not a specific disease. It is the **consequence of cardiac dysfunction** and compensations chronically activated to maintain **systemic BP**. ## Footnote VetClinics Cardio 2019

Answer 22

**Synovial distention** is common and often of minimal significance in older horses, but in tandem with **intermittent pyrexia** of unknown origin and the **sudden appearance of a cardiac murmur**, this finding may be consistent with the **synovitis** frequently noted in **endocarditis** cases. ## Footnote VetClinics Cardio 2019

Answer 23

**LV volume** at peak-systole (LVIVs), LV volume at end-diastole (LVIVd) **Ejection fraction** (EF) → %EF = [LVIVd - LVIVs] / LVIVd x 100 **Stroke volume** (SV) → SV = LVIVd - LVIVs **Cardiac output** (CO) → CO = SV x HR LV internal diameter (LVID) **Fractional shortening** (FS) → %FS = [LVIDd - LVIDs] / LVIDd x 100 ## Footnote VetClinics Cardio 2019

Answer 24

**ANP**, **BNP**, and **endothelin-1** According to the study results, it can be assumed that the **measurement of these cardiac biomarkers** can be helpful in the diagnosis of the jumping horse with cardiac valvular disorders (especially **pulmonic valve regurgitation**) and **changes in the dimensions of the heart ventricle**. ## Footnote Measurement of ANP, BNP and endothelin-1 concentrations in jumping horses with heart valvular regurgitation and their correlation with the dimensions of heart structures eve 23

Answer 25

**Friesians** are predisposed to **aortic rupture** near the **ligamentum arteriosum** (the remnant of the ductus arteriosus) in conjunction with **aortopulmonary fistulation**. The condition can occur as an acute event of **sudden death**, or can be more chronic with **aneurysm**, with less specific clinical signs, making the diagnosis challenging. Presenting signs are **recurrent colic**, increased rectal temperature, **tachycardia**, and **respiratory signs**. ## Footnote Reference values for 2-dimensional and M-mode echocardiography in Friesian and Warmblood horses jvim 20

Answer 26

- Friesians have **higher systemic blood pressure** and **higher arterial wall stiffness** than WB. - Several **left ventricular measurements** were **significantly smaller** in Friesians compared to Warmbloods. Also the **right ventricular** end-diastolic and peak-systolic internal diameter were **smaller** in Friesians. - **Fractional shortening** and **ejection fraction** were **significantly larger**. In general, the **left ventricular dimensions** in **Friesians** were significantly **smaller** compared to Warmbloods, emphasizing the need for breed-specific reference intervals. ## Footnote Reference values for 2-dimensional and M-mode echocardiography in Friesian and Warmblood horses jvim 20

Answer 27

Physiological stress at **mildly increased heart rates** (40-45 bpm) significantly **enhanced atrial pump function**. **Larger heart rate** and **blood pressure** increases during pharmacological challenge resulted in **altered cardiac dimensions** (decreased LA, LV, and increased Ao, PA). This should be taken into account when evaluating echocardiographic measurements at increased heart rates. ## Footnote Effect of physiological and pharmacological stress on heart rate, blood pressure, and echocardiographic measurements in healthy WB horses jvim 24

Answer 28

**Sinus pause**, **sinus arrhythmia**, **first-** and **second-degree atrioventricular [AV] blocks** ## Footnote Consensus Cardio

Answer 29

**Phase 0** : depolarization, Na+ in **Phase 1** : rapid repolarization, K+ out **Phase 2** : plateau, Ca2+ in **Phase 3** : repolarization, K+ out **Phase 4** : resting potential, K+ out (Na+/K+ -ATPase pump) ## Footnote VetClinics Cardio 2019

Answer 30

**Quinidine sulfate** toxicity (class Ia) → **sodium bicarbonate** (QRS prolongation > 25%) and **propanolol** (β-blocker, due to vagolytic effect of QS) **Digoxin** toxicity → **diltiazem** (class IV) and **phenytoin** (class Ib) ## Footnote VetClinics Cardio 2019

Answer 31

Rate control : - **Digoxin, esmolol** - Refractory cases : **diltiazem, propanolol** Rythm control : - **Procainamide** (class Ia) - **Sotalol** (β-blocker), **QS** (class Ia) Treat cases when **HR > 100 bpm** or evidence of poor perfusion using rate control ## Footnote VetClinics Cardio 2019

Answer 32

First line TT : **lidocaine** (class Ib), **magnesium sulfate** +/- procainamide (class Ia) Refractory cases : **phenytoin** (class Ib, in case of digoxin toxicity), **propanolol** (class II, in case of QS toxicity), **sotalol, propafenone** (class Ic) Treat if evidence of poor perfusion or malignant arrhythmias ## Footnote VetClinics Cardio 2019

Answer 33

First line TT : **QS, TVEC** (subacute / chronic) Refractory cases : **amiodarone** (class III), **procainamide** (class Ia) Treat if causing clinical signs of poor performance / epistaxis, or associated with tachyarrhythmias or ventricular complexes. ## Footnote VetClinics Cardio 2019

Answer 34

Not amenable for pharmacologic manipulation ## Footnote VetClinics Cardio 2019

Answer 35

Consider primary cause (**electrolytes, myocardial disease, toxins, SIRS**) First line TT : rarely indicated If persistent : **sotalol** ## Footnote VetClinics Cardio 2019

Answer 36

Consider and address primary cause (**electrolytes, myocardial disease, toxins, SIRS**) before TT First line TT : **sotalol** (class II) Refractory cases : **Phenytoin** (class Ib) ## Footnote VetClinics Cardio 2019

Answer 37

Stroke volume = cardiac contractility x preload x afterload First line TT : **ACEi (benazepril)** (↘︎ afterload and ⊖RAAS) Second line : **spironolactone** (↘︎ preload and ⊖ RAAS → ⊖ aldosterone) Third line : **inodilator (pimobendan)** and **β-blockers** (↗︎ cardiac contractility) ## Footnote VetClinics Cardio 2019

Answer 38

Stroke volume = cardiac contractility x preload x afterload First line TT : **diuretics (furosemide)** (↘︎ preload) Second line : **ACEi (benazepril)** (↘︎ afterload and ⊖RAAS) .+ **inotrope (digoxin** or **pimobendan)** . + **vasodilator (ACP** or **hydralazine** (arteriodilator)) Third line : **spironolactone** or **β-blockers** ## Footnote VetClinics Cardio 2019

Answer 39

Unfavorable prognosis if : **VSD > 2.5 cm** in a 500 kg horse or **VSD > 40% of aortic annular diameter** or **Doppler velocity < 4.5 m/s** The **grade of heart murmur** is not discriminatory as small defects may result in loud murmurs and concurrent congenital HD may accentuate abnormal auscultatory findings. **Small VSD** may be tolerable even in performance horses and spontaneous closure is possible. Reexamine **annually** ## Footnote VetClinics Cardio 2019

Answer 40

**Male sex** and **increasing age**. Typical condition of the older horse. **Small ponies** are less likely to have AR compared with other horse types. ## Footnote VetClinics Cardio 2019 Consensus Cardio

Answer 41

Horses **older than 15 years** were more likely to suffer from **MR** in a survey of a general horse population in United Kingdom. **MR** is the most common form of **valvular disease** associated with **congestive heart failure**. ## Footnote Consensus Cardio

Answer 42

Clinical characteristics that have been shown to be associated with the **onset of exercise intolerance** or **death within 2 years** of identification of **AR** included: - **diastolic murmur ≧ 4/6** - **abnormal pulse quality** (hyperkinetic), - **pulse pressure > 60 mm Hg** measured at the coccygeal artery, - **VPC** or **APC > 1 per hour** ## Footnote Consensus Cardio

Answer 43

1- Subjective assessment of the **regurgitant jet** : **mild** (< 1/3 of LV outflow tract in diastole), **moderate** (< 2/3 of LVOT), **severe** (> 2/3 LVOT) 2- Subjective assessment of **left ventricular size** in the four-chamber view (1-5 points) 3- **M mode** measurement of **left ventricular internal diameter** in diastole Combined score → **mild, moderate, severe AR** Reexamine **twice yearly** when moderate to severe, **annually** if stable or mild. ## Footnote Consensus Cardio

Answer 44

Clinical signs associated with **severe MR** include: - **murmurs of grade ≧ 3/6**, - **loud S3**, - exercise intolerance or respiratory signs, - **congestive heart failure** - +/- ventricular arrhythmias ## Footnote Consensus Cardio

Answer 45

**Mild** : when there is no LA enlargement, and CFM demonstrates 1 or 2 **thin regurgitant jets**, whose height is subjectively < 1/3 of the height of the LA. **Moderate** : ↗︎ in **pulmonary wedge pressure** at **exercise**, which may be associated with **exercise intolerance**. **Severe MR** : leads to **LA, LV**, and **pulmonary artery dilation**, which can lead to **PA rupture**, and affected horses will often show signs of **congestive heart failure** at rest. Compare Ao vs PA. Reexamine at least **annually** or **every other year** if mild. ## Footnote Consensus Cardio

Answer 46

**Physiologic valvular regurgitation** is extremely common in equine athletes. In a large echocardiography study including 526 British racehorses, **TR** was reported in **80% to 90%** of mature Thoroughbred racehorses and **MR** has a prevalence of **40% to 60%** in mature Thoroughbred racehorses. Furthermore, physiologic regurgitation in the athlete increases with **cardiac adaptation to exercise**.

Answer 47

**TR** are common in equine athletes, increasing with **age** and **training** ## Footnote Consensus Cardio

Answer 48

**Severe TR** if **grade murmur ≧ 4/6** with **poor performance** **TR > 3.5 m/s** → suspicion of **pulmonary hypertension** with **left-sided heart disease** or severe pulmonary disease. Reexamine **annualy** if moderate to severe. ## Footnote Consensus Cardio

Answer 49

The most common site of infection is the **mitral valve**, closely followed by the **aortic valve**. The **tricuspid valve** most frequently occurs in horses with septic jugular vein **thrombophlebitis**. Horses of all ages can be affected, but the condition is more common in **younger animals** and has been reported in **males** more than females. **Pasteurella / Actinobacillus**, **Pseudomonas**, **Rhodococcus equi** Bacteremia is common with equine dental procedures. ## Footnote Consensus Cardio

Answer 50

Presenting signs frequently include **fever**, **shifting leg lameness**, and **synovial distension**, with valvular regurgitation +/- rupture of associated **chordae tendineae**. There may also be concurrent myocarditis with arrhythmias. Ideally, **3 serial blood cultures** at **1-hour intervals** should be obtained before treatment with antimicrobials. Assay of **cardiac troponin I** can be helpful to identify myocardial involvement. Typically, there is **neutrophilic leukocytosis** with **hyperfibrinogenemia**, **hyperglobulinemia**, and **anemia** of chronic disease. Azotemia may be detected in horses with renal emboli or may be prerenal in horses with low cardiac output.

Answer 51

Cases with involvement of the **mitral valve** have a particularly **grave prognosis**. Even when bacteriologic cure is achieved, **severe valvular regurgitation** can ultimately lead to **heart failure**. Selection of **antimicrobials** should be **broad-spectrum** or whenever possible based on culture and sensitivity results. Antibiotics with **good tissue penetration** should be chosen. This is a **life-threatening** condition and therefore, despite concerns regarding antimicrobial resistance, treatment with the critically important antimicrobials, **fluoroquinolones**, **macrolides**, or **cephalosporins** (bof) is often warranted. Equine Cardiology said : **TMPS, macrolides, tetracyclines, fluoroquinolones** Nonsteroidal antiinflammatory drugs are also indicated.

Answer 52

**Rupture** of one or more **chordae tendineae** can occur **spontaneously** or be associated with preexisting **degenerative disease** or **infective endocarditis**. The **mitral valve** is the most common site. Because of the rapid change in hemodynamics, horses with ruptured chordae tendineae will often develop signs of **acute left-sided heart failure**, including coughing, foamy nasal discharge, and moist crackles on auscultation of the lung fields. **Sudden death** is also possible.

Answer 53

Recommendations for both **MR** and **AR** include regular monitoring of **heart rate and rhythm**. **MR** : **annual** cardiological reassessment (or if mild, every other year). **AR** : **biannual** reassessment until it is established the condition is stable. **Exercising ECG** with **moderate or severe MR** and **AR**, rapidly progressive regurgitation, and in cases in which atrial fibrillation, ventricular ectopy, or other arrhythmias are suspected. TR is common in athletes. **Annual reassessment** of **moderate and severe TR**. ## Footnote ACVIM Consensus

Answer 54

- **Ionophores** (monensin, lasalocid, salinomycin) - Plants containing **cardiac glycosides** (Digitalis spp...) - **Atypical myopathy** (hypoglycin-A)

Answer 55

**Aortic root rupture** with or without **aneurysmal dilation** is commonly reported in **older horses** of all breeds, predominantly **stallions**. Presenting signs in horses with **aortocardiac fistulas** are **acute-onset poor performance**, exercise intolerance, sustained tachycardia, and pain or distress that often resembles **colic**. **Continuous murmur** loudest on right side with bounding arterial pulse. ## Footnote VetClinics Cardio Consensus Cardio

Answer 56

Echocardiography is indicated when: 1- Previously diagnosed **functional murmurs** that are **louder** on serial exam 2- **Grade ≧ 3/6 left-sided murmurs** compatible with **MR** and **AR** 3- **Grade ≧ 4/6 right-sided murmurs** compatible with **TR** 4- Suspected **VSD** or other congenital heart lesion 5- **Continuous** or combined **systolic-diastolic** murmurs 6- Murmurs associated with **poor performance** 7- Clinically important **arrhythmias** 8- Suspected **myocardial** injury 9- Suspected **CHF** ## Footnote Consensus cardio 2014

Answer 57

**TDI** : detection of LV **diastolic** dysfunction **2D-ST** : detection of LA stunning after TT of **AF** and LV **systolic** dysfunction in horses with **myocardial** disease

Answer 58

**⍺2-agonist** : ↗︎ afterload and **myocardial depression** → ↘︎ LV systolic performance and **worsen regurgitation** **ACP** : ↘︎ afterload → may **improve** LV systolic performance and **↘︎ regurgitation**

Answer 59

It is important to obtain SpECG tracings from **both sides of the thorax** in horses. Significantly more **P waves** were of diagnostic quality from the **right side** and significantly more **QRS and QT intervals** were of diagnostic quality from the **left side**. The SpECG is a **useful stall-side arrhythmia-screening tool** for some common arrhythmias in horses. ## Footnote Stall-side screening potential of a smartphone electrocardiogram recorded over both sides of the thorax in horses jvim 20

Answer 60

We identified **decreased HR** at rest and **increased frequency of 2AVB** in trained horses vs untrained horses. ## Footnote Electrocardiographic characteristics of trained and untrained standardbred racehorses jvim 22

Answer 61

Systolic, diastolic, and mean **arterial blood pressure** and **pulse pressure** were **significantly higher in Friesians** compared to Warmbloods. Friesians seem to have a **stiffer aorta** (plus rigide), but not cranial and caudal common carotid artery and external iliac artery, which might be related to the higher incidence of **aortic rupture in Friesians**. ## Footnote Differences in ultrasound-derived arterial wall stiffness parameters and noninvasive blood pressure between Friesian horses and Warmblood horses jvim 20

Answer 62

In horses, **arteries stiffen with age** (se rigidifient), in combination with **luminal enlargement** and **arterial wall thickening**. This might, at least partially, explain the increased incidence of **arterial rupture in older horses**. ## Footnote Age-related differences in blood pressure, ultrasound-derived arterial diameters and arterial wall stiffness parameters in horses evj 20

Answer 63

Horses experience a **postexercise increase in cTnI** and **cTnT** with peaks occurring **2 to 6 hours postexercise** and values returning to normal at 24 hours. Racing speed and placings had no effect on serum cTnT concentrations post-race. ## Footnote Pre- and post-race serum cardiac troponin T concentrations in Standardbred racehorses Vet J 20 VetClinics 19

Answer 64

Correct Answer: **A)** Increased systolic, diastolic, and mean arterial blood pressure, along with left-sided cardiac hypertrophy. Ingesting a High-Energy diet first induced minor changes in **Blood Pressure** (first year), and progressed to **left-sided cardiac hypertrophy** (increased mean **left ventricular wall thickness**) (second year) in Shetland pony mares. These findings are of interest given the increasing incidence of obesity in horses. ## Footnote Effect of a long-term high-energy diet on cardiovascular parameters in Shetland pony mares jvim 21

Cardio Flashcards

(88 cards)