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  • Author or Editor: Cristobal Navas de Solis x
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Abstract

OBJECTIVE To evaluate horses with atrial fibrillation for hypercoagulability; plasma D-dimer concentrations, as a marker of a procoagulant state; and a relationship between coagulation profile results and duration of atrial fibrillation or presence of structural heart disease.

DESIGN Case-control study.

ANIMALS Plasma samples from 42 horses (25 with atrial fibrillation and 17 without cardiovascular or systemic disease [control group]).

PROCEDURES Results of hematologic tests (ie, plasma fibrinogen and D-dimer concentrations, prothrombin and activated partial thromboplastin times, and antithrombin activity) in horses were recorded to assess coagulation and fibrinolysis. Historical and clinical variables, as associated with a hypercoagulable state in other species, were also recorded.

RESULTS Horses with atrial fibrillation and control horses lacked clinical signs of hypercoagulation or thromboembolism. Compared with control horses, horses with atrial fibrillation had significantly lower antithrombin activity. No significant differences in plasma fibrinogen and D-dimer concentrations and prothrombin and activated partial thromboplastin times existed between horse groups. In horses with atrial fibrillation versus control horses, a significantly larger proportion had an abnormal plasma D-dimer concentration (10/25 vs 2/17), test results indicative of subclinical activated coagulation (18/25 vs 6/17), or abnormal coagulation test results (25/121 vs 7/85), respectively.

CONCLUSIONS AND CLINICAL RELEVANCE Horses with atrial fibrillation did not have clinical evidence of a hypercoagulable state, but a higher proportion of horses with atrial fibrillation, compared with control horses, did have subclinical activated coagulation on the basis of standard coagulation test results.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To determine whether hypertension, high sympathetic tone, resting and exercising arrhythmias, and echocardiographic changes consistent with hypertensive cardiomyopathy were associated with equine metabolic syndrome (EMS) in ponies.

DESIGN Prospective case-control study.

ANIMALS 19 privately owned ponies with a diagnosis of EMS (history of laminitis, body condition score ≥ 7/9, cresty neck score ≥ 3/5, and abnormal oral sugar test result; cases) and 20 healthy control ponies.

PROCEDURES Heart rate (HR), noninvasively measured arterial blood pressure (BP), markers of autonomic tone (splenic volume and HR variability), 24-hour and exercising ECGs, and echocardiograms were compared between cases and controls.

RESULTS Compared with controls, cases had a higher mean ± SD HR (44.5 ± 7.5 beats/min vs 38.6 ± 6.8 beats/min) and median mean left ventricular wall thickness (2.0 cm vs 1.8 cm). No differences were identified between groups in BP, splenic volume, HR variability, and number of premature complexes in ECGs. Mean wall thickness was correlated with BP (r = 0.54), high-frequency power (r = −0.71), and ratio of low-to high-frequency power (φ = 0.66). Relative wall thickness was correlated with serum insulin concentration (r = 0.71).

CONCLUSIONS AND CLINICAL RELEVANCE Ponies with EMS had myocardial hypertrophy that was correlated with insulin response to an oral sugar test, sympathetic and parasympathetic tone, and BP. The heterogeneity and limited sample size of this preliminary study should be considered when drawing conclusions. Cardiovascular changes associated with this syndrome deserve further attention.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the prognosis and clinical, echocardiographic, and pathological features of hypertensive cardiomyopathy in horses.

Design—Retrospective case series.

Animals—5 horses with cardiac hypertrophy and systemic hypertension.

Procedures—Demographics, history, physical and cardiological examination findings, diagnosis, clinical progression, prognosis, and pathological findings were obtained from medical records.

Results—The primary diagnosis was chronic laminitis in 3 horses and chronic renal failure in 2. Persistent tachycardia, hypertension, chronic laminitis, or a combination of these prompted the cardiac evaluations. Blood pressure values (median [range]), measured noninvasively, were determined as 190 mm Hg (183 to 261 mm Hg) for systolic pressure, 126 mm Hg (100 to 190 mm Hg) for diastolic pressure, and 155 mm Hg (126 to 222 mm Hg) for mean pressure. No arrhythmias were reported. For the left ventricle, all horses had increased relative wall thickness, mean wall thickness, and ventricular mass. The interventricular septum was thickened at end diastole (n = 5) and in peak systole (4). The left ventricular internal diameter was small at end diastole (n = 4) and in peak systole (3). The left ventricular free wall was thickened at end diastole (n = 3) and in peak systole (4). No associations between blood pressure and variables consistent with hypertrophy were detected. All horses were euthanized because of the grave prognosis of the primary diseases. All 3 horses that underwent postmortem evaluation had cardiovascular abnormalities.

Conclusions and Clinical Relevance—Hypertensive cardiomyopathy should be considered as a comorbid diagnosis in horses with laminitis or chronic renal failure. Information about the development, progression, reversibility, importance of early detection, and long-term sequelae of this condition is needed.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To assess whether remote assistance is beneficial to the accuracy of point-of-care ultrasound (POCUS) examinations during equine emergency evaluations.

ANIMALS

Adult horses presenting to a tertiary care large animal emergency service for respiratory or gastrointestinal clinical signs.

PROCEDURES

Prospective, randomized, controlled, clinical study. Cases were assigned to receive POCUS with remote assistance (“POCUS-R” group) or POCUS with no assistance (“POCUS” group). Accuracy of diagnosis, duration of sonograms and survival to discharge were the objective outcomes compared between groups. Perceptions about the use of teleultrasound were gathered using a survey.

RESULTS

29 cases were enrolled in the study over an 18-month period. Based on Cox regression estimates, sonogram duration was likely to be longer in the POCUS-R group (n = 13) relative to the POCUS group (16) hazard ratio 0.43 (95% CI, 0.9 to 0.2; P = .03). Whether the final diagnosis was included in the differential diagnosis list, number of diagnoses in the differential list and survival were not different between groups. Educational benefits were the most frequently mentioned benefit by clinician users while logistical and technical problems related to the use of the equipment and inconvenience of enrollment in the study was the most common negative aspect.

CLINICAL RELEVANCE

Teleultrasound was generally not well adopted by users likely due to inconvenience and time constraints. Further work is indicated to assess differences in clinical outcomes in a setting that would allow a larger sample size to increase statistical power.

Restricted access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To determine the effectiveness of a digital interactive multimedia tutorial (DIMT) for preparing veterinary students to perform ultrasonography in horses.

SAMPLE

42 third-year veterinary students.

PROCEDURES

Students were randomly assigned to 3 instructional methods: independent study (ie, 45 minutes to read a highlighted textbook chapter), lecture (ie, 45-minute lecture by a faculty member), or digital interactive multimedia tutorial (DIMT; ie, 45-minute narrated, interactive module). Written and practical tests were administered after each instruction session. For the practical test, each student was required to obtain a series of ultrasound images of a live horse, and images were later scored for quality by an individual unaware of the instructional method used.

RESULTS

Higher-quality ultrasound images were obtained by veterinary students who had reviewed the DIMT rather than the analogous information in textbook chapters. No difference in scores was identified between students in the lecture group and those in the DIMT group. Students’ perceptions suggested that practical instruction facilitated by clinicians was a key component of learning how to perform ultrasonography in horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Results supported the use of DIMTs in preparing veterinary students to perform ultrasonography in horses.

Full access
in Journal of the American Veterinary Medical Association