Epistaxis in Horses

Question 1

what are the 2 key questions to ask about a horse with epistaxis?

Answer 1

1. does it happen during exercise or at rest?
2. is it unilateral or bilateral?

Question 2

if epistaxis occurs during exercise, it is almost always __________

Answer 2

EIPH: exercise induced pulmonary hemorrhage
occasionally pleuropneumonia, pulmonary abscess and others

Question 3

when does EIPH Occur?

Answer 3

after hard exercise: racing TB, barrel racers

Question 4

what is the mechanism of EIPH?

Answer 4

unknown, but thought to be stress failure of pulmonary capillaries and role of inflammatory airway disease

Question 5

T/F: epistaxis usually occurs in every case of EIPH

Answer 5

false. only occurs in 1-10% of cases, so often will miss

Question 6

clinical signs of EIPH

Answer 6

• epistaxis in 1-10%: bilateral usually. if a little will trickle out of 1
• cough
• poor performance

Question 7

how do you diagnose EIPH?

Answer 7

• endoscopy of trachea 60-90 mins after exercise
• BAL: RBCs and hemosiderophages: 150 days after last episode
• radiographic changes in 10%

Question 8

what is the best way to diagnose EIPH?

Answer 8

BAL! looking for RBCs. sometimes can be fresh if caught right after bleeding, but can pick these horses up even 6-8 weeks after an episode: because will find hemosiderin in the macrophages and there isn’t much else that will cause that

Question 9

how do you treat EIPH?

Answer 9

rest, NSAIDs, furosemide